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The 20th Anniversary of the Women's Health Initiative

By: Holly L. Thacker, MD • Posted on July 01, 2022

The 20th Anniversary of the Women's Health Initiative

The Impact of the WHI Study

It was just over two decades ago that I opened the Center for Specialized Women’s Health at Cleveland Clinic. This was right before the results of the WHI (Women’s Health Initiative) were released on July 10, 2002. Everyone who was involved with women’s health and midlife medicine knew exactly what they were doing when the WHI news broke. I was on vacation for my husband’s birthday and my pager was going off like crazy. I read the JAMA published article, and the reported relative risk of breast cancer diagnosis was 1.24 compared to 1.35 already in the package insert. The study included women well over 10 years since the average age of menopause. I thought the reaction was overblown, and it certainly was.

Issues with the study

This was the first time that a large medical study was turned into a sound bite - a scary sound bite that reverberated around the world. A very scientific study, unscientifically communicated in a hyped and fearful way. And when the mass media communicates excessive, inflated health risks, it causes a pandemic of anxiety amongst the general population.

More than 1 billion women worldwide will be in menopause by 2025. Today, there are 55 million women in the United States in menopause, nearly 75 percent of whom report not receiving any support or hormonal or non-hormonal options for its side effects. The most debilitating menopause symptoms include:

It was several years before the WHI investigators published the age stratified data that showed women who were within 10 years of menopause who took hormone therapy had DECREASED DEATH RATES. By then the damage had been done. Millions of women threw away their hormone therapy. Many experienced debilitating symptoms and turned to unregulated compounded hormones.

Clarifying the Misconceptions

  • Oral hormone therapy was demonized and confused with needed hormone replacement therapy for women with premature or surgical menopause.
  • Estrogen/Progestin therapy (PRO-gesterone or PRO-gestins needed to PRO-tect the endometrium/uterus) was confused with estrogen alone in women with a hysterectomy.
  • Prevention (which requires a high bar for no side effects or risks) to therapy (which doesn’t require a higher bar than other medical therapies employed for common medical problems) were confused.
  • An entire generation of women experienced disruption and many turned to those promising individualized, compounded, unregulated and expensive therapies.
  • When prescribed by a knowledgeable clinician, hormone therapy (especially estrogen alone therapy in women with a hysterectomy) is safe, effective and associated with a reduction not only of bothersome to disruptive symptoms but INCREASED longevity.

Many physicians do not specialize in menopause or menopausal hormones because there is so much anxiety and misinformation surrounding the topic and because other areas of medicine and surgery are more remunerative. And many physicians simply have no training in menopause.

As a physician who does specialize in menopause and menopausal hormones, I feel it's important that women get the truth. I established a two-year fellowship in Specialized Women’s Health 25 years ago to train physicians in the field of midlife women's health so they can continue to provide women with the proper treatment for their menopause symptoms. And I direct this non-profit, Speaking of Women’s Health, to empower all women to “Be Strong. Be Healthy. And Be in Charge!”

-Holly L Thacker MD

    About Holly L. Thacker, MD, FACP

    Holly L. Thacker, MD, FACP is nationally known for her leadership in women’s health. She is the founder of the Cleveland Clinic Specialized Women’s Health Fellowship and is currently the Professor and Director of the Center for Specialized Women’s Health at Cleveland Clinic and Lerner College of Medicine at Case Western Reserve University. Dr. Thacker is also the Executive Director of Speaking of Women’s Health and the author of The Cleveland Clinic Guide to Menopause. Her special interests and areas of research including menopause and related medical problems including osteoporosis, hormone therapy, breast cancer risk assessment, menstrual disorders, female sexual dysfunction and interdisciplinary women’s health.



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