The Vilification of Hormones

How the Women’s Health Initiative Changed the Narrative on Hormone Replacement Therapy — and Why That Reputation Still Lingers

In July 2002, the Women’s Health Initiative (WHI) — one of the largest studies ever done on postmenopausal women’s health — released early results showing that a common form of combined hormone replacement therapy (conjugated equine estrogen plus progestin) was associated with an increased risk of breast cancer, cardiovascular disease, stroke, and blood clots. The study arm testing this therapy was stopped early for safety concerns, and the media headlines were stark: hormones were dangerous. 

From Standard Practice to Sudden Fear

Before the WHI, hormone replacement therapy was widely prescribed to relieve menopausal symptoms (like hot flashes and night sweats) and was even believed to protect women’s hearts and bones. Its use had soared through the 1980s and 1990s, with millions of women on HRT by the turn of the millennium.

But the initial WHI results did not simply add nuance to the conversation — they ignited public fear. Many women and doctors interpreted the early media reports as declaring hormone therapy unsafe for all women, in all circumstances. Prescription rates plunged globally, in some places by as much as 40–80%, almost overnight.

Media and Messaging: Amplifying Fear?

Part of the vilification can be traced to how the study results were communicated. The dramatic warnings and early termination of the combined hormone arm lent themselves to sensational headlines, and the media ran with it. Subsequent analyses and trial revisions — such as findings showing no increased risk and lower all-cause mortality in certain age groups when started before, or near to, the onset of menopause — were less prominently covered by the press. 

There’s evidence that media coverage significantly shaped women’s attitudes toward HRT, even affecting trust in healthcare providers. Many women reported altering or stopping their therapy after hearing about the WHI results, sometimes regardless of their individual risk profiles. 

Nuance Lost: A ‘One-Size-Fits-All’ Narrative

In reality, the WHI findings applied to synthetic hormones and a population of older women — average age 63 — many of whom were more than a decade past menopause. Later research suggests that for younger or recently menopausal women, HRT can have different risk/benefit profiles, and may even protect against heart disease, osteoporosis, and overall mortality. 

Despite this evolving research, the fear caused by the WHI remains embedded in public consciousness. Many clinicians trained during the post-WHI era became cautious about prescribing HRT, and a generation of women grew up hearing that hormone therapy was dangerous. This has contributed to ongoing reluctance, confusion, and under-treatment of menopause-related symptoms.

Long-Term Consequences of the Backlash

The reputation of HRT as something to avoid has had real effects. Millions of women found themselves managing menopausal symptoms without the most effective therapy. Can you imagine the negative impact on cardiovascular and bone health alone? We may never know the true cost to the medical system. . 

More recently, regulatory bodies have begun to revise their guidance. In 2025, the U.S. FDA initiated the removal of “black box” warnings on many HRT products, acknowledging that the earlier approach may have been overly broad and unduly fear-based. Current evidence supports a personalized approach to hormone therapy, particularly for women within 10 years of menopause onset or under age 60.

Looking Back and Moving Forward

The story of hormone replacement therapy after the WHI is a powerful example of how research, media, and public perception can interact to shape health behavior — for better and worse. It reminds us that:

• Clinical studies must be interpreted and communicated with nuance.

• Media headlines rarely capture clinical complexity.

• Healthcare decisions are individual and blanket treatment guidelines should be avoided.

As research continues and messages evolve, there’s hope that a more balanced and evidence-based understanding of HRT will take hold — one that recognizes where therapy can be safe, effective, and life-enhancing for the right person.