“I feel like I’m being brainwashed,” a menopausal woman shared with me recently.
She wanted to come off HRT but kept hearing (not from her doctor, but from the media) that if she did, she’d pay a price down the line.
The woman is from the UK, where promoting prescription-only medicine (such as HRT) to consumers is supposed to be prohibited.
In recent years, menopause influencers can take to social media, jump on a podcast, get on TV, write an article for an established news outlet and say practically anything about HRT, without any consequences from regulators who are supposed to protect consumers.
So much of what women hear about menopause and HRT is based on weak science. Yet in the age of fast media, it’s easy for weak science to become the narrative du jour.
Private doctors are conducting surveys online among their (favourable) followers and promoting it as scientific research.
Poorly designed observational studies are elevated and said to offer breakthrough findings.
All the while, large randomized controlled trials, still the gold standard in medicine, are completely ignored if their conclusions contradict the narrative that influencers are committed to promote.
It’s a brilliant business plan to have celebs help brand HRT as a panacea. Who needs the scientific method when you have a familiar face?
How many viewers of an Instagram post are going to discern if the latest supposed benefit of HRT has been verified by a large randomized controlled trial carried out over a decade, or cherry picked from a survey, which collected answers on X over three days?
An example of fast media, weak menopause science crossed my radar recently.
In March 2024, New Scientist published this article:
Some menopause influencers promoted the article on social media to advance the unproven theory that HRT can help you live longer.
Was this a responsible position to take?
The original piece of research that led to the New Scientist article is an observational study, which stated from the outset:
“This article is a preprint and has not been peer-reviewed…It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.”
The research cannot be considered to provide evidence that HRT, or any of the other medicines mentioned, prolong life. So why even discuss it outside academia unless, despite the scientific uncertainty, you would like to slowly solidify the idea that HRT prolongs life.
Drip, drip, drip, one weak study here, another one there…until the public believes it.
Professor Richard Faragher from the University of Brighton suggested in the New Scientist article that HRT’s supposed lifespan benefit could be because “HRT improves bone strength.”
While the oestrogen component of HRT can increase bone density (which is not necessarily equal to bone strength), the impact on bone density is only seen while a woman takes oestrogen and is rapidly reversed once she stops (see the Osteoporosis section here).
Since prolonged use of any HRT is not recommended due to an increased risk of numerous serious conditions (see Explaining Hormone Therapy Risk – Safety here), most women won’t take HRT decades past menopause, when they're more at risk of the type of hip fractures that can lead to fatal complications.
Suggesting that HRT could prolong your life due to a possible change in bone density during the years that a woman may take HRT (most likely in her 40s or 50s) only bolsters another unproven menopause theory.
Additional questions that must be asked about the research revolve around the type of HRT used. The HRT mentioned in the research refers to oestrogen-only products. Were these products given without progesterone, as is the case for women who’ve had a hysterectomy? Are researchers, the media and menopause influencers once again ignoring the increased risks that arise from hysterectomies, and blurring the very different needs of women in natural menopause?
Why wouldn’t we rely on the most robust piece of research available on HRT and all-cause mortality?
Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality, was published in The Journal of the American Medical Association (JAMA) in 2017, following an 18-year clinical trial. The authors of the research concluded, that they “would not support use of hormone therapy for reducing chronic disease or mortality.” This research was adopted by most national menopause societies to provide scientific backing for hormone policies.
To serve women in perimenopause and menopause, we need to focus on the most robust science available. Promoting supposed benefits of HRT that are scientifically unproven is irresponsible and exposes women to unnecessary risks.
Always consult with your doctor regarding the benefits and risks of any medicine.
