The Question
Welcome to “Ask Barbie,” where I answer all your burning questions about menopause. This question: “Why did the Women’s Health Initiative (WHI) lie about HRT for menopause?” is hot enough to burn the whole house down.
So why oh why did the WHI lie?
The answer will shock you. Hopefully, it will anger you.
History of Menopause
Let me explain the sequence of events by going back to how we did things before the WHI.
Back in the good old days, we doctors relied on basic science for most medical care. And basic science is a great thing because it usually leads you in the right direction.
So, hormone replacement for menopause began with good ole’ basic science way back in the good ole’ days.
As I’ve told you before, human females didn’t start living long enough to routinely experience menopause until the early 1900s. Before then, women died at about age 47. So nobody knew that menopause existed. The few women who lived long enough to experience menopause ended up in asylums because everybody thought they were going crazy.
Menopause as a Hormone Deficiency
Well, when women started living long enough to routinely experience menopause, good ole’ basic science made it recognizable as a hormone deficiency. Women were, quite literally, outliving their ovaries. So the ovaries died and stopped producing estrogen, but we women went on living without our estrogen.
Well, good ole’ basic science about any other hormone deficiency told us that hormone loss requires hormone replacement. So, just as we would replace insulin for insulin deficiency of diabetes, or thyroid hormone for thyroid hormone deficiency of hypothyroidism … we thought it reasonable to give women estrogen placement for estrogen deficiency at menopause.
All hormone deficiencies cause a long list of symptoms that are due to the hormone deficiency. Why would estrogen deficiency be any different? That’s the voice of good ole’ basic science.
Hormone Replacement
So, in the early 1900s, researchers started looking at options to provide estrogen replacement for menopause because it constituted good ole’ basic science.
The very first estrogen replacement option was a product called Premarin. Pre-mar-in is pregnant mare urine. And pregnant mares have a lot of estrogen in their urine. So it seemed to be a great source of estrogen.
Because Premarin was the only estrogen replacement product available, all women took Premarin as estrogen replacement when they became peri- or post-menopausal between 1941 and 2002. That was more than 50 years. It served to prevent all the symptoms of estrogen deficiency.
As the average female lifespan lengthened, women took hormone replacement for menopause for longer and longer periods of time. And this set the stage for the discovery that estrogen replacement for menopause prevented the three fatal diseases of estrogen deficiency, which are heart attack, osteoporosis, and Alzheimer’s.
While Premarin stood the test of time, with time, other estrogen replacement products became available.
The fact that estrogen prevented these diseases was so certain that hormone replacement products stated on their packages that estrogen replacement would help prevent a heart attack, osteoporosis, and Alzheimer’s.
But one of the problems with good ole’ basic science is that it can threaten poor ole’ human egos.
The Start of the Lie
Just a few years before the start of the WHI study, a cardiologist by the name of Jacques Rossouw became very upset about the fact that estrogen replacement hormone products stated on their packages that estrogen replacement could prevent heart attacks. He wrote and said, “It’s time to put the brakes on that bandwagon.”
Jacques Rossouw was the lead researcher of the WHI study.
Now remember: Heart attacks are the bread and butter for a cardiologist. The last thing a cardiologist wants is for women to know that all they have to do in order to avoid a heart attack is take hormone replacement for menopause.
So the motive of this cardiologist was to take hormone replacement away from women so that they didn’t have a way of easily preventing a heart attack.
The Women’s Health Initiative
The WHI study began in the year 1993. It was supposed to run for over eight years. And the goal of the study was to answer the question: Does HRT for menopause prevent heart attacks and other diseases of estrogen deficiency?
One of the most basic things in scientific research is the study design.
Study design refers to how the researchers conduct the study in order to answer the question that forms the basis for doing the study.
And study design dictates everything.
One of the most important rules of study design is that your study design must be consistent with the question at hand.
In other words, if the purpose of the study is to address diseases, then the study design must focus on diseases. And if the purpose of the study is to address prevention of diseases, then the study design must focus on prevention of diseases.
Again, this is just good ole’ basic science.
It is absolutely contrary to all scientific principles to switch gears during the study.
In other words, you cannot set out to study diseases … but then focus on symptoms. Likewise, you cannot set out to study prevention of diseases … and then focus on the cause of diseases.
But alas, that’s exactly what the WHI did. It broke every rule of scientific research by switching gears midstream.
The WHI purported to be a study on prevention of diseases. However, all of the findings and media reports focused on the cause of diseases.
The problem with the WHI is that it studied women whose average age was 63. And these were women who had never taken hormone replacement therapy for menopause.
The average age of menopause is 51. And because these 63-year-old women had not taken hormone replacement therapy for 12 years, they were already on the road to developing the three diseases of estrogen deficiency, which are heart attack, osteoporosis, and Alzheimer’s.
It is impossible to study prevention if your study group already has the beginnings of the diseases that you were seeking to prevent. But that’s exactly what the WHI did.
So instead of sticking to the study design and focusing on the question at hand, the WHI switched from studying prevention of diseases to claiming cause of diseases. And they did so by using women who already had the beginning of the diseases.
The end result is that the WHI was a great big lie. It was such a big lie that I have renamed it “The Women’s HELL Ini-shit-ive.” (I never use cuss words, but in this instance, I’m making an exception because I’m that angry.)
The media reports of the WHI came out in 2002. They were delivered as an early cessation of the study due to HRT causing diseases. And when the media reported the incorrect and distorted findings of the WHI study, they terrified women everywhere. Most women immediately flushed their hormone replacement therapy down the toilet. It was flush heard round the world.
And all good ole’ basic science got flushed with it.
Fear
Now, going back to our question of, “Why did the Women’s Health Initiative lie about HRT for Menopause?” The answer is really simple.
Fear is the most powerful emotion on earth. If you ever want to get someone to do something or refrain from something, scare them.
Well, the WHI used breast cancer to scare women away from HRT.
Think about this.
The WHI set out to see if HRT for menopause could prevent heart attack, osteoporosis, and Alzheimer’s. So how in the world did they end up scaring women by saying it causes breast cancer?
It was not designed to study the cause of anything. It was not designed to address breast cancer at all.
So how in the world did they shift gears from preventing heart attacks, osteoporosis, and Alzheimer’s … to causing breast cancer?
See what I mean?
Well, fear sells.
And this cardiologist knew that breast cancer would scare women away from HRT better than heart attacks. This is because most women don’t realize that heart attacks are the number one killer of menopausal women. Most women are, mistakenly, more afraid of breast cancer than they are of heart attacks. So this cardiologist went for the fear that sells best: Breast cancer.
The problem with good ole’ basic science is that it’s not very common.
And the problem with fear is that it is very difficult to reverse or erase.
Statins
There’s another interesting parallel here.
If you look at the timeline on all of these events, HRT for menopause went out of vogue at exactly the same time that statins for high cholesterol came into vogue.
And what do you know? Nowadays, statins are the number one selling class of drugs worldwide. Do you think that was coincidental? I don’t.
So, fear sells, and money talks.
Hell
The WHI really was a great big lie. It was “The Women’s HELL Ini-shit-ive.”
Ever since the WHI became known to the public, it has governed everything about hormone replacement therapy for menopause. In so doing, it has ruined millions of women’s lives.
For over two decades, women have been afraid to take HRT for their estrogen deficiency at the time of menopause. Never before has anyone feared any kind of hormone replacement.
No diabetic fears taking insulin replacement. No hypothyroid person fears taking thyroid hormone replacement. There has never been a hormone replacement that causes fear.
And yet the WHI demonized women’s estrogen. And that fear has outlasted all good ole’ basic science and all facts to the contrary.
Why oh why did the WHI lie? And why oh why don’t people wake up to the fact that it was just a great big lie?
Anger
I know that the answer to this question just makes you angry. And that’s actually a good thing. Anger is contagious. If more women get this education and more women become angry, we can change things.
But as long as women are in denial and have no education about menopause or the WHI, the fear will continue to govern the system. Menopause affects half of the world’s population for half of their lives. Menopausal women are the largest group on earth. We deserve to know the whole truth and the whole story. And all women deserve to manage their menopause their way … with facts rather than fear.
