Perimenopause, Post Menopause
For decades, women’s health has been underserved, underfunded, and misunderstood. Yet two of the most influential studies in the field — the Million Women Study (MWS) in the UK and the Women’s Health Initiative (WHI) in the US were hailed as landmark contributions to science. They involved hundreds of thousands of women and were designed to clarify risks around hormone replacement therapy (HRT), particularly in postmenopausal women.
But what if I told you these very studies, despite their size and scale, may have unintentionally held back progress in women’s health?
As a menopause specialist, I believe we must acknowledge not only what these studies taught us but what they cost us.
A Quick Recap: The Studies That Shaped Menopause Care
The Million Women Study (UK)
Recruited: 1.3 million women aged 50–64 (1996–2001)
Focus: The effects of HRT, lifestyle, and reproductive history on cancer risk
Key finding: Combined HRT use was associated with an increased risk of breast cancer, ovarian cancer, and endometrial cancer
Outcome: A wave of caution across UK medical practice; many women were stopped or denied HRT, sometimes overnight
The Women’s Health Initiative (US)
Recruited: Over 160,000 postmenopausal women (1991–1998)
Focus: Risks and benefits of HRT, dietary change, and supplements on chronic disease
Key finding: Combined oestrogen-progestogen therapy increased the risk of breast cancer, stroke, and cardiovascular disease
Outcome: A highly publicised 2002 announcement led to a global drop in HRT prescribing and lasting fear among women and clinicians
Where It Went Wrong
1. Generalising the Risks — Without Context
Both studies included mostly older postmenopausal women (average age 63 in the WHI), yet their findings were applied across the board even to younger women in their 40s and early 50s, the very group most likely to experience significant menopause symptoms and consider HRT.
We now understand that age and timing matter greatly. Starting HRT near the onset of menopause carries different risks (and often benefits) compared to starting it a decade later. But this important nuance was lost in the headlines.
2. Risk-Focused, Not Quality-of-Life Focused
Both the WHI and MWS prioritised disease risk: heart attacks, cancer, stroke.
What they didn’t measure meaningfully was quality of life: sleep, energy, mood, mental clarity, libido, joint pain the very symptoms women seek relief from during menopause.
This helped entrench a medical culture where symptom relief was viewed as optional or cosmetic, not worthy of risk.
3. Media Panic and Clinical Paralysis
The WHI’s 2002 press release “risks outweigh the benefits "caused global panic. HRT prescriptions plummeted. Women were told to stop treatment. Doctors became fearful of prescribing.
This fear endured for years. Research funding dried up. Pharmaceutical development in women’s hormones stagnated. It became easier to do nothing than to offer personalised care.
4. One-Size-Fits-All Conclusions
The studies treated HRT as a single, uniform treatment. But we now know:
Route matters: Transdermal oestrogen carries lower clot risk than oral forms.
Type matters: Body-identical hormones may carry different risk profiles from synthetic versions.
Dose matters: Lower doses may offer symptom relief with fewer side effects.
These nuances weren’t explored.
The result? An entire generation of women missed out on personalised, evidence-based care.
What We’ve Learned and What We Must Do
Today, slowly, the narrative is shifting. Updated guidelines from the British Menopause Society (BMS), International Menopause Society (IMS), and NICE now support:
Individualised risk assessment
Starting HRT around the time of menopause, not years later
Recognising the role of HRT in improving quality of life
Addressing the risks of not treating menopause symptoms (e.g. sleep disruption, bone loss, cardiovascular decline)
But there is still much to rebuild.
We lost years of progress to fear. We under-researched the complexity of hormone therapy. We left millions of women without support — not because the science told us to, but because it was misunderstood, misapplied, and overgeneralised.
As Menopause specialists, Our Responsibility Is Clear
We must:
Demand better-designed studies that reflect the real-life diversity of women’s experiences.
Push for funding in women's midlife health, not just reproductive or cancer care.
Include quality of life as a meaningful, measurable health outcome.
Stop treating women's symptoms as something to “put up with” and instead ask how we can treat them safely, effectively, and compassionately.
Moving Forward
The Million Women Study and WHI taught us a lot. But they also silenced important conversations, stifled innovation, and delayed progress in menopause care.
Now is the time to reframe the conversation with better data, more respect for complexity, and a commitment to centring women in research that is for them, not just about them.