The Truth About Estrogen: What the Women's Health Initiative Got Wrong with Dr. Avrum Bluming & Dr. Carol Tavris

What if the biggest health study in history got it wrong and millions of women paid the price? In this premiere episode of “unPAUSED," Dr. Mary Claire Haver sits down with Dr. Avrum Bluming, medical oncologist and former senior investigator at the National Cancer Institute, and Dr. Carol Tavris, social psychologist and co-authors of the life-changing book: Estrogen Matters. In this conversation, they dismantle the 2002 Women's Health Initiative study that terrified an entire generation of women away from hormone therapy and reveal why the fear was based on misinterpreted data, flawed conclusions, and a refusal to correct the record. You'll learn why estrogen actually decreases breast cancer risk, how heart disease kills seven times more women than breast cancer, and why the "lowest dose of estrogen for the shortest time" advice has no scientific backing. This conversation will inform you and empower you to demand better from your own healthcare provider. If you've ever been told hormone therapy is too dangerous, that your symptoms are "just aging," or that you need to accept suffering in silence, this episode of “unPAUSED” is for you. Dr. Haver, Dr. Bluming, and Dr. Tavris give you the science, the tools, and the truth you need to hear including a free informed consent form and quality of life questionnaire you can bring to your doctor's office today. Guest links: Estrogen Matters https://estrogenmatters.com/ Estrogen Matters https://www.instagram.com/estrogen_matters/?hl=en (Instagram) Articles Long-Term (≥5-Year) Remission and Survival After Treatment With Ciltacabtagene Autoleucel in CARTITUDE-1 Patients With Relapsed/Refractory Multiple Myeloma https://ascopubs.org/doi/10.1200/JCO-25-00760? (Journal of Clinical Oncology) Early Exposure to Medicine Inspired Committed Careers in Cancer Care https://medicine.yale.edu/news-article/yale-cancer-center-faculty-lead-major-national-cancer-organizations/ (Yale School of Medicine) Estrogen and cognitive functioning in women: lessons we have learned https://pubmed.ncbi.nlm.nih.gov/22004260/ (Behavioral Neuroscience) Uncertainty about Postmenopausal Estrogen — Time for Action, Not Debate https://www.nejm.org/doi/abs/10.1056/NEJM199109123251108 (New England Journal of Medicine) Estrogens for Prevention of Coronary Heart Disease: Putting the Brakes on the Bandwagon https://www.ahajournals.org/doi/10.1161/01. CIR.94.11.2982 (Circulation) Effects of estrogen plus progestin on health-related quality of life https://pubmed.ncbi.nlm.nih.gov/12642637/ (New England Journal of Medicine) Menopausal Hormone Therapy and Breast Cancer: What is the Evidence from Randomized Trials? https://pmc.ncbi.nlm.nih.gov/articles/PMC6386596/? (Climacteric) Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer. Collaborative Group on Hormonal Factors in Breast Cancer https://pubmed.ncbi.nlm.nih.gov/10213546/ (Lancet) Lung Cancer Mortality Higher in Women Who Used Combination Hormone Therapy https://jamanetwork.com/journals/jama/article-abstract/184379 (JAMA) Depot Medroxyprogesterone Acetate and Risk of Meningioma in the US https://jamanetwork.com/journals/jamaneurology/article-abstract/2838202 (JAMA Neurolog ...

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Dr. Mary Claire Haver?

  When my patients come to me in clinic, it's number one to put out the fire, get them to a functional status again. Then the conversation about the next 30 years begins.

• 0:08Speaker 01

  When a woman either with a history of breast cancer or with no history of breast cancer asks for estrogen, she is often told, "I don't want to talk about it. That's not open for discussion. And if you insist, you'll have to find a different doctor." To refuse to discuss it in today's world is no longer acceptable.

• 0:30Dr. Mary Claire Haver?

  Men on social media squawking about how they want to live to 120, no woman I know wants to live that long. She just wants to stay out of a nursing home and to maintain her independence.

• 0:49Dr. Mary Claire Haver?

  The views and opinions expressed on UnPaused are those of the talent and guests alone and are provided for informational and entertainment purposes. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment.

• 1:07Dr. Mary Claire Haver?

  I'll never forget the first time I heard Dr. Avrum Bluming and Dr. Carol Taver speak. It was at my very first menopause conference in Santa Monica. I'd been invited to speak about nutrition and menopause based on my work with the Galveston Diet. They were being interviewed by Dr. Sharon Malone, a nationally recognized OB-GYN and menopause expert. And as I sat in the audience, I listened to them dismantle the Women's Health Initiative. They exposed the flaws in its design, the way the findings were misrepresented, and the truth. Estrogen was not the villain I had been taught it was. I felt tears streaming down my face. It was a lightning bolt moment. I was shocked, ashamed, furious.

• 1:52Dr. Mary Claire Haver?

  Not because I had missed something, but because this information had never been given to me. Even as a board-certified OB-GYN, through my years of recertification, this information was nowhere to be found. And that realization cut me to the core. If this could blindside me as a trained OB-GYN, imagine what it had done to millions of women. My field is supposed to be the gatekeeper of women's health. Yet somehow, menopause, something that affects more than half the population, had been pushed to the margins and treated like a side note instead of central to our specialty. That was a turning point for me. Sitting in that room, hearing Dr. Blooming and Dr.

• 2:34Dr. Mary Claire Haver?

  Tavris tell the truth, I couldn't stay quiet. I had to use whatever platform I had to make sure that women knew the truth that had been hidden from me as a doctor and from them as patients. Because here's the reality. The Women's Health Initiative study did a number on us. It created fear and confusion around hormone therapy and set back menopause care 20 years. Women suffered because of it. I've spent my career since then helping women untangle those myths and get the information they deserve to make informed choices about their health. And now, with this podcast, we're going even further, setting the record straight,

• 3:14Dr. Mary Claire Haver?

  cutting through the fear, and giving women science-backed, practical advice in conversations with experts and others they can trust. Midlife isn't easy. Your body changes, relationships shift, careers take turns, and you're left asking, what's next? UnPaused is here to provide a place for conversations with honesty. No fluff, no judgment, just real talk and actionable advice. And I can't think of a better way to begin than with the two people who lit this fire in me, Dr. Avrum Blooming and Dr. Carol Tavris. I'm Dr. Mary Claire Haver, a board-certified obstetrician, gynecologist, and certified menopause practitioner.

• 3:58Dr. Mary Claire Haver?

  I'm also an adjunct professor of obstetrics and gynecology at the University of Texas Medical Branch. Welcome to UnPaused, the podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life. Dr. Blooming is a medical oncologist, emeritus clinical professor at USC, and a former senior investigator at the National Cancer Institute, and a master of the American College of Physicians. He spent more than 30 years studying the benefits and risks of hormone therapy, including in women with a history of breast cancer. Dr. Carol Tavris is a social psychologist, writer, and lecturer, best known for her books, Mistakes Were Made, But Not By Me,

• 4:41Dr. Mary Claire Haver?

  and Estrogen Matters, which she co-authored with Dr. Blooming. She's a fellow of the Association for Psychological Science and has dedicated her career to showing how science and psychology shape our beliefs and why myths are so hard to shake.

• 4:57Dr. Mary Claire Haver?

  Welcome. So glad you're here. How did your paths cross? And what made you decide to write this book together?

• 5:04Speaker 02

  Oh, it's a long path, but a very windy and fun one. I learned about Avrum because he saved my sister-in-law's life. That was the first time I'd heard about him.

• 5:12Dr. Mary Claire Haver?

  I don't know this story.

• 5:12Speaker 02

  Oh, well, no. I mean, so he was a big name in my family. She'd had a terrible reaction to a medication that nearly killed her. And Avrum, a hematologist, saved her life. So I knew all about Avrum Blooming. And then mutual friends invited us both to dinner, thinking we might enjoy meeting each other. And I walk in, and there is Avrum Blooming. That was a very long time ago. And we discovered that we shared, in our professional and intellectual lives, a passion for bringing the best science and the best information to public attention and clinical practice, even when people may not want to hear that information. That was the challenge.

• 5:49Dr. Mary Claire Haver?

  And then what made you decide to write the book together?

• 5:51Speaker 01

  Well, I was writing a book about the different experiences I've had as an oncologist. And one of the chapters in the book dealt with estrogen and breast cancer. And Carol said, "That should be its own book."

• 6:07Dr. Mary Claire Haver?

  Did you agree at the time?

• 6:08Speaker 01

  I don't remember if I agreed, but Carol is very persuasive, and it just grew.

• 6:14Speaker 02

  Well, as I'm fond of saying, what I know about medicine is what Avrum knows about book publishing. So we were the perfect collaboration in that sense. But no, over the years, as when the Women's Health Initiative first came out, and Avrum called me up practically at dawn, saying, "Have you heard this horrible, horrible press conference and the mistake in the information they're providing?" We shared a passionate disagreement with what we were being told at that time. And so we had many years run up, collecting all of the information about the Women's Health Initiative to write this book.

• 6:47Speaker 01

  Actually, as a test, we collaborated on an article talking about hormone replacement therapy, real concerns and false alarms. And I sent the article to a physician, an oncologist I respected, for his comments. The oncologist is Vince DeVita. Vince was the head of the National Cancer Institute. He was the director of oncology at Sloan-Kettering. He's been the director of oncology at Yale. And he called me the next morning, and instead of giving me comments, he said, you know, I'm also the editor in chief of The Cancer Journal, and with your permission, I'd like to publish it.

• 7:27Dr. Mary Claire Haver?

  Wow.

• 7:27Speaker 01

  That was Christmas morning, December 25th, and the first call I got was from Vince. And the reason it surprised me is Carol says things in medical articles that we usually don't say. Like, what were they thinking? It's in the article. And it caused me to change my style, make it a little less dry and a little more Carol-like. And that's what we've been doing.

• 7:56Dr. Mary Claire Haver?

  So you decide to make this book. And in publishing, I've authored a couple of books now, you have to basically sell your idea to a publisher. What was that like? How hard was this? Or was it like, yes, we want this book? Or did you have to convince them?

• 8:11Speaker 02

  Well, no, I was sitting with my former editor from Harvard, actually. And we were having lunch, and I was telling her about what we'd been writing about and thinking about. And she said, oh, my God, this is a book. Who killed HRT? Who killed HRT? I'm connecting you with my agent right now. And she did. And the next day, we had an excited agent, we wrote a proposal quickly, and within a few weeks...

• 8:36Speaker 01

  In two weeks, she said, I have five people from major publishing firms who want to speak to you. And within two weeks, we...

• 8:44Dr. Mary Claire Haver?

  You had a contract.

• 8:45Speaker 02

  Yes. Now, what's really interesting is that at that time, and when the first edition of this book came out, we were expecting a kind of blockbuster reaction. It was too soon. The world was not ready for the many women who began... Became the menopause who were picking up the challenge and the criticisms of the Women's Health Initiative. But now that that's happened, our book has really taken off.

• 9:05Dr. Mary Claire Haver?

  Yeah.

• 9:05Speaker 02

  As you know, and as yours have.

• 9:06Dr. Mary Claire Haver?

  I mean, the book changed my life very much for the better. And I think because your work has changed my life, you've then changed the life of millions of my followers and all of my patients.

• 9:17Speaker 02

  Thank you.

• 9:17Dr. Mary Claire Haver?

  Thank you for that. So, Dr. Bluming, you've spent decades in the oncology space treating breast cancer. I know you've shared your wife's story of her breast cancer and kind of you rethinking her experience and her life. Walk me through your patients' experiences, your wife's experiences, and how that kind of helped you shape the thought process in the book.

• 9:38Speaker 01

  For several decades, about 60% of my practice was breast cancer. And I've watched breast cancer prognosis improve over those decades.

• 9:49Dr. Mary Claire Haver?

  So, let's talk to our audience a little bit. What does that look like now? If I get diagnosed with breast cancer tomorrow, what is my risk of death?

• 9:57Speaker 01

  The current cure rate, cure defined as the cancer goes away and you live a normal lifespan. The current cure rate for newly diagnosed breast cancer, certainly in Western countries, is over 90%. It's approaching 95%.

• 10:15Dr. Mary Claire Haver?

  Okay.

• 10:15Speaker 01

  Which doesn't mean to belittle cancer.

• 10:18Dr. Mary Claire Haver?

  No, absolutely.

• 10:19Speaker 01

  It's a frightening word. I wish it on nobody. We have a healthy respect for that. But that shouldn't overshadow all other considerations.

• 10:29Dr. Mary Claire Haver?

  Okay. So, let's, let's go back to the thought process, you know, these decades of how the thought process changed as the prognosis improved.

• 10:37Speaker 01

  What's happening in cancer generally now is patients are being allowed into the decision process. That's happening in many conditions. To give one example, there's a blood condition called multiple myeloma, which used to be almost uniformly fatal. Multiple myeloma now has a very significant cure rate.

• 11:03Speaker 01

  And patients are being allowed to decide what treatments they will take. And there are patient groups that are being formed, sitting in with doctors, making this decision with individual physicians. Eric Weiner, and I've mentioned Eric Weiner several times. Eric Weiner is a very interesting oncologist. Eric was born with hemophilia. And when he was a very young boy, he got factor VIII, which can help save the lives of hemophiliacs, which also caused him to get an HIV infection. And so he's been treated for that. Eric went on to graduate medical school.

• 11:48Speaker 01

  He became the director of breast cancer research at the Dana Farber Cancer Institute. He became the president of the American Society of Clinical Oncology, which is the largest group of organized oncologists in the world. And he's now the director of oncology at Yale. And Eric, in his presidential address to ASCO, titled the address, "Partnering with Patients: The Cornerstone for Cancer Care and Research."

• 12:18Dr. Mary Claire Haver?

  And this was revolutionary.

• 12:19Speaker 01

  This was 2023, and it shouldn't have been revolutionary, but it clearly is and was. And what he's saying is patients should be allowed into the discussion. As you know, you and I and many members of the menopause are contacted by women all over the world.

• 12:39Dr. Mary Claire Haver?

  All over the world.

• 12:40Speaker 01

  They often tell us stories about how they interact with physicians. And one of the most common interactions, when a woman, either with a history of breast cancer or with no history of breast cancer, asks for estrogen, she is often told, "I don't want to talk about it. That's not open for discussion. And if you insist, you'll have to find a different doctor." That is a totally unacceptable response. A doctor can have strong feelings about it, feelings that are backed up by data. But to refuse to discuss it in today's world is no longer acceptable.

• 13:18Dr. Mary Claire Haver?

  I think this is going to come as a surprise to a lot of our listeners, is that they are under the assumption, they go in and they're told what to do. And that this is a little bit of a radical concept, that especially in cancer care, that you should be allowed to have this conversation of risks, benefits, alternatives across the spectrum. Dr. Tavris, what made you want to step into the medical side of this debate?

• 13:44Speaker 02

  I've been in it since I was a baby, probably. No, well, this is a debate in which feminist issues of what is best and healthiest for women have often obscured women's decision making. Because over many years, women have thought, well, are hormones, is that an unfeminist thing to do?

• 14:02Dr. Mary Claire Haver?

  Right.

• 14:03Speaker 02

  Is it unnatural? Is it going to hurt me?

• 14:05Dr. Mary Claire Haver?

  I see that a lot on social media, like this debate over age naturally and...

• 14:10Speaker 02

  No, exactly right. Well, as Barbara Sherwin, who studied the benefits of estrogen on cognition going forward, she said, what's not natural is living 30 years after menopause.

• 14:18Dr. Mary Claire Haver?

  Yeah.

• 14:18Speaker 02

  Let's just get what the natural part out of the way. And I think that's why estrogen has been the Jekyll and Hyde of treatments for women. For me, the question is, what is healthiest and best for women? Regardless of what the so-called feminist position is one way or another. That is, when I was starting out, feminism, that is emphasizing and identifying the bias against women in medicine, that balance between the feminist question of what is best and healthiest for women, against what does the science say, what does the research say, is where I land in between.

• 14:49Dr. Mary Claire Haver?

  And what do you take away from this? You know, was this the worst of bias in medicine? You know, this whole estrogen debate and women not being allowed to have a voice in their own health care and weighing risk and benefits, and then we create a boogeyman of estrogen through the WHO, basically. Do you think that this really represents the worst of this bias?

• 15:08Speaker 02

  Not the worst. The bias against women, against listening to women, against studying women who are not differently shaped men.

• 15:16Dr. Mary Claire Haver?

  Right.

• 15:17Speaker 02

  The medical biases against women. I mean, for example, in how we diagnose heart attack and heart disease in women. There's so many ways in which... Women's bodies are misdiagnosed, if you will, against the male norm in medicine. So it's part of a longstanding medical tradition, starting with the questions we ask about women's health, what we do for women's health, and whether we even listen to women in our offices and take their complaints seriously, or ignore them.

• 15:42Dr. Mary Claire Haver?

  In my training, I only took care of women. Like, the only penises I saw were baby boys at birth, you know, and then I handed them back to their mothers. And talk to me a little bit about the bias you see. Like, if you had a male patient come in with, you know, X, Y, and Z, how the system kind of taught you, now you've practiced for decades now, but, you know, how we address female versus male concerns. So, for example, in urology, they have people coming in with the same list of complaints, low libido, or fatigue, energy, and like, immediately, the men, you check a testosterone level, you think of these things, and in women, it's a psychiatric referral. Did you see that in your training and your interactions, you know, through the years?

• 16:20Speaker 01

  It's been subtle, but to compare prostate cancer with breast cancer, approximately as many men die of prostate cancer as women die of breast cancer in the United States.

• 16:34Dr. Mary Claire Haver?

  Okay.

• 16:35Speaker 01

  And prostate cancer was treated with a prostatectomy, which can often cause...

• 16:40Dr. Mary Claire Haver?

  So that's surgical removal of the prostate, for those who are listening?

• 16:43Speaker 01

  Right. And impotence, meaning an inability to get an erection, is a common side effect of that, and we've now reached a point where we can treat with less surgery. But once prostate cancer spread, there was very little we could do, except give men estrogen, which helped some, not very much. Women with breast cancer had their breasts taken off. The radical mastectomy took off the breast and all of the tissue up until the chest wall, so that you could see the ribs underneath the skin.

• 17:19Dr. Mary Claire Haver?

  Yeah.

• 17:20Speaker 01

  And they had many, many lymph nodes taken out from under their arm, and we've backed away from that surgery, so that now lumpectomy with radiotherapy is often, more often, used than mastectomy. But when a woman had metastatic cancer... We were so sure that it was caused by estrogen that we took out the women's ovaries as treatment. And when the cancer progressed, we took out their adrenal glands because estrogen can come from the adrenal gland as well. And when it progressed, we took out their pituitary glands. So that women were abused medically with very little benefit. We don't do that anymore.

• 18:04Speaker 01

  But somehow, we could do that to women. There isn't a chance we would be allowed or taught to do that to men, and we never have.

• 18:14Dr. Mary Claire Haver?

  Let's talk about the Women's Health Initiative. For our listeners who may not have heard of it, what was that study?

• 18:20Speaker 01

  The Women's Health Initiative was set up by Bernadine Healy. Bernadine Healy was a cardiologist, who was the first female director of the National Institutes of Health. And what she said echoes what Carol said, that women have been treated largely as almost men. And most of the medical studies were done on men, not on women.

• 18:41Dr. Mary Claire Haver?

  Right.

• 18:41Speaker 01

  And the rationale was, women have a tendency to get pregnant, and they may not know that they're pregnant, and if we were doing a study on them, we could be subjecting the fetus to something in our ignorance. So that's the rationale. But not only are studies done largely on men, animal studies are done on male animals.

• 19:02Dr. Mary Claire Haver?

  Yeah.

• 19:02Speaker 01

  Laboratory studies are done on male cells. And the results are extrapolated to women, and we're learning that women aren't almost men. They're their own...

• 19:14Dr. Mary Claire Haver?

  They're women.

• 19:15Speaker 01

  They're women. Bernadine Healy said, "It's time we did studies on women that we could learn from and would help us treat women." And so she set up what was to become the Women's Health Initiative. In 1992, they pulled together 44 highly respected academicians and practitioners to study heart disease in women. Heart disease is the leading... Killer of women in Western countries. Seven times as many women die of heart disease as die of breast cancer.

• 19:52Dr. Mary Claire Haver?

  I want to make sure everyone understands this. The number one killer by far in the United States of women is not breast cancer. Not even close. It is heart disease.

• 20:02Speaker 02

  More breast cancer survivors will die of heart disease than of breast cancer.

• 20:07Dr. Mary Claire Haver?

  So you're after your breast cancer diagnosis, you're still more likely to die of heart attack.

• 20:11Speaker 01

  The leading cause of death among breast cancer patients is heart disease.

• 20:15Dr. Mary Claire Haver?

  This is an important study. I remember being excited about it before 2002.

• 20:19Speaker 01

  This study was intended to do a prospective, meaning patients are admitted to the study before you decide how they're going to be treated. Double blind, which means neither the physician nor the patient knows whether they're getting the test treatment or a placebo. Randomized trial so that the doctor and the patient don't pick the treatment. It is randomized.

• 20:42Dr. Mary Claire Haver?

  Right.

• 20:43Speaker 01

  And that is the purest form of unbiased study.

• 20:47Dr. Mary Claire Haver?

  So for our audience, we knew from observational studies for decades before that women who were on hormone therapy tended to have less heart attacks. This was the proof, you know?

• 20:57Speaker 01

  This was intended to be the proof. And in fact, it's worth pointing out historically that in 1991, the lead editorial in the New England Journal of Medicine, written by doctors Lee Goldman and Anna Toesterson, lead editorial, New England Journal of Medicine, was titled, "Postmenopausal Estrogen: Time for Action, Not Debate." That was 34 years ago. And Bernadine Healy said, okay, it's time we tested that. And she raised a half a billion dollars. That's $500 million. To date, that study has cost us $1,000 million or a billion dollars.

• 21:41Dr. Mary Claire Haver?

  And it is the most expensive study the NIH has ever.

• 21:44Speaker 01

  It's the most expensive study ever done anywhere, as far as I'm aware, in medicine.

• 21:49Speaker 02

  And I have to interject that the man, the leading investigator of this bazillion teen dollar project. Jacques Rousseau had published an article in the 1990s calling for a halt to the HRT bandwagon. This was the impartial person put in charge of this study.

• 22:08Dr. Mary Claire Haver?

  Turns out, that doesn't sound impartial.

• 22:10Speaker 02

  That doesn't sound impartial. It's time to call a halt to this bandwagon, all these women taking HRT. Let's get, let's stop the bandwagon.

• 22:16Speaker 01

  And so the study was initiated. And then in 2000, and there were two major arms to the study. One arm was estrogen alone was randomized against a placebo for women who no longer had a uterus, since estrogen does increase the risk of uterine cancer. And it was felt that if a woman is still in possession of her uterus, she should get progesterone as well as estrogen, since that eliminates the increased risk.

• 22:47Dr. Mary Claire Haver?

  We can negate that risk.

• 22:48Speaker 01

  Right. And so women who still had a uterus were randomized to either the combination of estrogen and progesterone, or women without a uterus were randomized to estrogen versus placebo. And in 2002, there was a press conference. Now, usually, and Carol will interrupt and say, "Press conference? I thought the first thing you do is you write and publish the article so that the doctors can learn the data on which the results are based."

• 23:18Dr. Mary Claire Haver?

  So I was sitting in M and M, which in, in the hospital setting is morbidity and mortality conference, basically a once a week meeting from, from our Department of Obstetrics and Gynecology, where we go through cases that week and, you know, our hits and misses and wins and, and some lectures and learning things. When that press conference broke. And all the whispers, you know, going, this is before the internet, before cell phones, and everyone was so upset and, and it was just like, I remember that lightning bolt moment.

• 23:47Speaker 01

  And the press conference said...

• 23:50Speaker 01

  Estrogen increases the risk of heart disease, of death, of stroke, and of breast cancer. And the headline was, in the New York Times, "Estrogen Increases the Risk of Breast Cancer." Breast cancer is the red flag here.

• 24:06Dr. Mary Claire Haver?

  Yeah.

• 24:06Speaker 01

  Well, actually, that's not what their data said.

• 24:10Dr. Mary Claire Haver?

  So you've once said, in the book, "Once they misinterpreted their own data, now you say they're misrepresenting it."

• 24:18Speaker 01

  That's correct. We have to talk about each one of these. Let me just dispense quickly with heart disease. They said it increased the risk of breast cancer. Actually, the median age of patients, the average age, was 63, not between 45 and 51, when most women reach menopause. Half of the women were smokers. Many of them had hypercholesterolemia. Many were overweight, and 25% were obese. This wasn't the representative population, although at the time of the press conference, they said, "These data can be extrapolated to the general female population." But on breast cancer, what they said is it increases the risk of breast cancer. Actually, there are laws

• 25:03Speaker 01

  that allow us to determine the significance or validity of a result.

• 25:08Dr. Mary Claire Haver?

  So we're talking about statistics?

• 25:09Speaker 01

  We're talking about statistics. And the laws are kind of like basketball. In basketball, if you sink the ball through the basket, you get two points. If the ball bounces off the rim, you get zero points. Now, I don't have to argue the validity of that, but those are the rules. In statistics, in order for something to be called statistically significant, it has to have a likelihood of developing of less than 1 in 20.

• 25:39Dr. Mary Claire Haver?

  Right.

• 25:40Speaker 01

  Okay. And there are mathematical tests that determine that. The mathematical test for the increase that they saw in breast cancer, and this was only among the women who got the estrogen and progesterone, not the women who got estrogen alone. The mathematical test didn't add up.

• 25:58Dr. Mary Claire Haver?

  At the rim.

• 26:00Speaker 02

  Hit the rim.

• 26:00Speaker 01

  That's right. It hit the rim and bounced off. And in that article said, "The increased risk of breast cancer almost approached nominal statistical significance." I have never seen that statement before or since in any published medical article on any topic.

• 26:20Dr. Mary Claire Haver?

  Let me review this. So, the average age of women in the study was 63. Very different than the average age of women who would typically start hormone therapy at 50 or 51, when they hit full menopause. This group of women were 70% overweight and then like 30 something percent obese.

• 26:37Speaker 01

  Yes.

• 26:38Dr. Mary Claire Haver?

  40% were smokers. They had several risk factors for cardiovascular disease being elevated, much higher than ladies who would have been early in menopause, taking the medications. And the outcome was cardiovascular disease. You know, that was the primary outcome was, is she going to have a heart attack or not starting this medication? There's also problems, as you've talked about before, with the control group.

• 27:04Speaker 01

  It's worth saying, so that we don't confuse people listening. What they said about heart disease, they have walked back. So that now what they say is actually estrogen or the combination decreases the risk of of heart disease when started within 10 years of a woman's last menstrual period.

• 27:25Dr. Mary Claire Haver?

  Right.

• 27:25Speaker 01

  The stroke, they've also now no longer stated. They said it increases the risk of death, again, starting, they say, within 10 years of the last menstrual period. It actually prolongs life. It doesn't decrease lifespan. Estrogen, they now say, based on 20 years of follow-up, estrogen actually decreases the risk of breast cancer development among women who never had breast cancer by 23%. And that is a significant reduction. And, and here's a very important point, decreases the risk of death from breast cancer by 40%. Also statistically significant.

• 28:05Dr. Mary Claire Haver?

  Stunning.

• 28:05Speaker 01

  The one other thing they said, they said this the following year, they wrote it up, that estrogen has no effect on quality of life. Well, I'm sitting here with two women, of course, you're smart. But the question was, well, How is that possible? And if you read the article on quality of life that was published in 2003, they said, "We knew that women who were symptomatic, who were randomized to placebo, would know within weeks

• 28:34Dr. Mary Claire Haver?

  Yeah.

• 28:34Speaker 01

  that they were getting a placebo, not the hormones, and they would drop out of the study, which we didn't want. So we intentionally did not select symptomatic women to join the study.

• 28:47Dr. Mary Claire Haver?

  So symptomatic, meaning severe hot flashes?

• 28:49Speaker 02

  Yeah.

• 28:50Speaker 01

  Exactly.

• 28:50Dr. Mary Claire Haver?

  So women with severe hot flashes were largely excluded

• 28:53Speaker 01

  Correct.

• 28:53Dr. Mary Claire Haver?

  from the study.

• 28:54Speaker 01

  Correct. And so what they say in the article, but most people don't read the fine print, they said, "The symptoms that these women didn't have were not affected when they got hormones."

• 29:07Speaker 02

  You can't make this up, you know?

• 29:09Speaker 01

  That's right.

• 29:09Speaker 02

  But they did.

• 29:10Dr. Mary Claire Haver?

  And all of this has been walked back.

• 29:12Speaker 01

  So now they say that hormones are actually the best choice for symptomatic treatment. But following up on the question of breast cancer, the one thing they still hold on to, and this is now 23 years after that famous press conference, they say that the combination, estrogen alone, I said, decreases the risk of breast cancer, death from breast cancer. But they say the combination increases the risk of breast cancer development, but doesn't increase the risk of death from breast cancer. And they still say that. And Carol and I said, "Well, they misunderstood their own data." Well, now, having spoken with them, having written with them,

• 29:54Speaker 01

  having debated them, having debated them in the medical literature, everything I'm about to say, they know. And what I am saying is their first conclusion wasn't statistically significant. In 2006, they published an article saying, "You know, we hear that we've been challenged because, as you mentioned, the study was directed at heart disease, not at breast cancer. And in order to have a fair study, what we have to do is balance risk. And the risks for heart disease The rest smoking, high fat diet, of high cholesterol levels are different than the risk

• 30:37Speaker 01

  for breast cancer development, family history of breast cancer, number of children. And so, since our population was not selected on the basis of breast cancer risk, people have said that the increase we reported is not meaningful.

• 30:53Dr. Mary Claire Haver?

  Right.

• 30:54Speaker 01

  And so Garnet Anderson, the chief biostatistician for the Women's Health Initiative, published an article in 2006 that said, okay, what I've done is I have retrospectively balanced for breast cancer risk, and I reanalyzed the data, looking only at breast cancer risk factors for women. And she said it makes no difference, meaning I still see an increased risk. That's a lie. It makes a huge difference, because we spoke about the basketball rules or the statistical rules.

• 31:30Dr. Mary Claire Haver?

  Yeah.

• 31:30Speaker 01

  It went from being borderline statistically significant to statistically not significant. This is a biostatistician, and she said it made no difference. It made a huge difference.

• 31:44Dr. Mary Claire Haver?

  So, why do you think that me, board certified, OBGYN, on the front lines, counseling women day after day in menopause about the risk and benefits of hormone therapy, did not know any of this information? This all didn't come out in the last three years since I heard you guys speak or since I read the book. This has been coming out for, since the study was published, right? Trickling out over time. I do my recertification every year. I have articles put in front of me that are the latest, greatest updates, you know, new guidelines, and none of this, until recently, was put in front of me. I was out there counseling patients based on 2002. Erroneous data. I mean, why do you think that is?

• 32:28Speaker 01

  Well, first, it's still being reported in 2025. They are still reporting an increased risk associated with the combination hormones and

• 32:38Dr. Mary Claire Haver?

  The guidelines today from ACOG, American College of OB-GYN, are lowest dose, shortest amount of time.

• 32:45Speaker 02

  Still.

• 32:45Dr. Mary Claire Haver?

  Still.

• 32:46Speaker 01

  For which there is no data.

• 32:47Dr. Mary Claire Haver?

  Yeah.

• 32:48Speaker 02

  See, that's the deadly compromise, which is we actually know that hormones are beneficial and helpful, but wait, the WHO says that they're dangerous. So what's the compromise that will allow us to use a little, shortest time? Which is like, okay, smoking could kill you, so only smoke one pack instead of three packs, you know, and only for a year instead of for 10 years. That would be stupid advice. Either it's not a risk, in which case, take the drug, or it is a risk, in which case, don't. But the shortest dose for the smallest amount of time represents a foolish compromise, I think.

• 33:21Speaker 01

  Let's take two steps back.

• 33:23Dr. Mary Claire Haver?

  Okay.

• 33:23Speaker 01

  What is the risk? It's not a risk of death, it's a risk of breast cancer development. Even if they're right, and they're not, what is the risk? The risk is one extra case of breast cancer, non-fatal breast cancer.

• 33:37Dr. Mary Claire Haver?

  Non-fatal.

• 33:38Speaker 01

  Per thousand women taking hormones.

• 33:41Dr. Mary Claire Haver?

  If their data is correct.

• 33:42Speaker 01

  The data is not correct, but even if their data were correct.

• 33:45Dr. Mary Claire Haver?

  If we believe it.

• 33:46Speaker 01

  That's right. One per thousand. Well, you can't know that. In human beings, a one in a thousand increased risk is nothing. It's nothing. Human beings aren't genetically identical mice.

• 34:01Dr. Mary Claire Haver?

  Right.

• 34:02Speaker 01

  There are differences among us, even in the best controlled studies. And there is no other study where this kind of a libel against the drug would stand for 30-plus years based on one extra non-fatal case of breast cancer per thousand. But even that one extra case is wrong. It's important to know, I said that there were four different groups in this. The combination women against placebo and The estrogen alone women against placebo. And if you look at the combination against placebo, it does look on the graph as if there is a difference.

• 34:44Speaker 01

  In fact, the combination does have a higher risk of breast cancer than the placebo. But it's not because there's an increased risk among the women who got the combination. In fact, that risk is identical to the risk among the women who got estrogen alone.

• 35:03Dr. Mary Claire Haver?

  Right.

• 35:04Speaker 01

  And I said that that showed a decreased risk. It's the placebo group against which the combination is measured that has a lower than expected risk. And that's been ignored, except for an article in 2004 that was ignored. An article in 2018 by Howard Hodis from USC and Phil Sorrell from Yale, saying the placebo group is the problem. It isn't that there's an increased risk among the women getting the combination. And so one has to ask the question, why would the placebo group have a lower than expected risk? And the first answer is, I don't know. And the second answer is, a significant number, 23%

• 35:49Speaker 01

  of women who were randomized to placebo had taken hormones before they were randomized to the placebo group. And if the hormones decreased the risk of breast cancer and they were taking them, well, what would happen if we eliminated women who had taken hormones before they joined the study, both from the test group and the placebo group? And no surprise, the placebo group risk goes up. And the graph for both the combination and the placebo group are now the same.

• 36:24Dr. Mary Claire Haver?

  Yeah, proving in both groups that estrogen plus or minus a progestogen would be protective against breast cancer.

• 36:30Speaker 01

  Best we could tell.

• 36:31Dr. Mary Claire Haver?

  Yeah.

• 36:31Speaker 02

  Yeah.

• 36:32Speaker 01

  It's so easy to accept data, especially now with media, trumpeting results because bad news sells. And again, the investigators here are respectable people. I have respect for them, even though I disagree with what they're writing. The first is the collaborative reanalysis. In 1997, there are a group of physicians from England put together.

• 37:02Speaker 01

  I think fifty-one different studies and analyzed the studies to see if hormones increased the risk of breast cancer. And what they reported is that they had no data on women who had taken hormones and stopped. They didn't see any increased risk among that group. But women who had taken hormones and continued to take them, and this is true for estrogen and the combination, have an increased risk of breast cancer. Really, how much of an increase? Well, it's about six per thousand women taking it for over ten years.

• 37:41Speaker 01

  That is absurd, but that's what they reported, and because they're respected physicians, it's been published and it's still quoted. Interestingly, eighty percent of the women in that study were on estrogen alone. The Women's Health Initiative cites the collaborative reanalysis as confirming what they said. Well, no. What the Women's Health Initiative said is that estrogen alone decreases the risk of breast cancer. Well, they sort of glide over that. They really can't explain that, but they use the collaborative reanalysis to support what they're saying. The second study, also out of England, is called the Million Women Study. Million Women Study is a very big name.

• 38:26Speaker 01

  Actually, a million women did get mail sent to them, and they were drawn from a list of women who got mammograms. Well, first, the list, women who got mammograms, may have had a reason for getting the mammogram, so it may not be an unselected population. They're not all screening mammograms. That's right. But they sent a million, about four hundred thousand answered the two mailings. The mailings were separated by three years. Okay. And they reported an increased risk of breast cancer among women who took hormones, estrogen alone or estrogen and progesterone. First of all, they said, women who had taken hormones in the past, even for more than

• 39:10Speaker 01

  fifteen years, had no increased risk of breast cancer. Well, wait, wait, wait. Really? How do you explain that? No explanation. Second, the increase that they saw went from one in a hundred women to 1.4 in a hundred women. Yes, I mean, that's, that's a 50% increase, but it's one to 1.4. Come on, somebody.

• 39:37Speaker 02

  From crossing the speed to having an aspirin has a risk. We hear women say things like, okay, so the risk is only one in a thousand, but I don't want to be that one.

• 39:45Dr. Mary Claire Haver?

  I hear that all the time. What if I'm the one?

• 39:48Speaker 02

  The one, exactly. So this in psychology is called risk aversion. If I'm thinking in terms of my risk of getting something, I, you know, I don't want it. If I think in terms of my benefits of getting something, that's a different calculation. It's okay, one in a thousand of getting breast cancer, but how about 500 in a thousand of avoiding heart disease? Or I'm going to make up numbers here, but okay, so you have this one risk, but what if your benefits are greatly enhanced by your taking the drug? Most people don't think in terms of what they can gain. They worry more about what the risk is. That's a natural part of human thinking, I suppose, from our prehistoric tendency. We better look for that one tiger that might bite us, you know? But now the concern really is how

• 40:32Speaker 02

  to assess the overall risk versus benefits. And overwhelmingly, the benefits for women, how many things can we take in our lives that prolong our lives by three or four years?

• 40:44Dr. Mary Claire Haver?

  Right.

• 40:45Speaker 02

  What do studies show? If you, if you use this thing, you know, you'll live three months longer? You know, really? But years?

• 40:50Dr. Mary Claire Haver?

  I don't know of a single drug that will improve the quality of life of women over a certain age in, on multiple levels than

• 40:57Speaker 01

  Mm-hmm.

• 40:58Dr. Mary Claire Haver?

  Hormones, estrogen.

• 41:00Speaker 02

  Than estrogen, exactly.

• 41:01Dr. Mary Claire Haver?

  But that's left out of the conversation. It's only, how do we get to the point where the worst thing in the world is developing breast cancer?

• 41:07Speaker 02

  Fear of cells.

• 41:08Dr. Mary Claire Haver?

  I fear breast cancer. Trust me, I have a healthy respect for breast cancer.

• 41:11Speaker 02

  Exactly.

• 41:12Dr. Mary Claire Haver?

  But not to the exclusion of osteoporosis and heart disease.

• 41:17Speaker 02

  Exactly. But breast cancer does get the attention. Every celebrity woman who gets breast cancer immediately makes a public announcement about it and then gets prayers and wishes from everybody that she doesn't die, even though, as Avrum said, she has an extremely high likelihood of surviving. But it immediately gets sympathy and attention and publicity. And of course, it's our breasts. We worry about them. We love them. We want them. So of course, women are going to be distressed by this particular form of breast cancer. But it is unrelated to both probabilities of survival and the greater risks of what are the greater harms, right?

• 41:53Speaker 01

  And it's not just breast cancer.

• 41:55Dr. Mary Claire Haver?

  Okay.

• 41:56Speaker 01

  It's against hormones.

• 41:57Dr. Mary Claire Haver?

  Yeah.

• 41:58Speaker 01

  The Women's Health Initiative, now, they studied heart disease. They extrapolated to breast cancer. In 2009, they said hormones increase the risk of ovarian cancer. Around that same time, they said hormones increase the risk of lung cancer death. Not increase the risk of lung cancer, but increase the risk of lung cancer death. There are now studies showing that's not true, that if anything, it may actually decrease the risk of lung cancer death, but it certainly doesn't increase it. They never retracted that. The ovarian cancer, Wolf Udean, who was the head of the North American Menopause Society,

• 42:40Speaker 01

  challenged the WHO authors in 2009 and said, wait, what you said about ovarian cancer is not statistically significant. They backed off. But there was no retraction in public media. It's an attempt to frighten people away from hormones.

• 42:58Dr. Mary Claire Haver?

  Yeah.

• 42:59Speaker 01

  We came across an article that was published in JAMA Neurology last week that said that progesterone contraceptives increase the risk of brain tumors.

• 43:10Speaker 01

  Oh my God, brain tumors. That's terrible. So you read the article. It was published in JAMA Neurology. It's from the Cleveland Clinic. Again, respected people. And the increase, it doubles the risk of meningioma. That's the one

• 43:25Dr. Mary Claire Haver?

  Yeah.

• 43:26Speaker 01

  brain tumor they looked at. The increase went from 3.5 to 7 per thousand women taking it for several years. Those are nothing numbers. Those aren't numbers that I would accept as an editor for a publication. I'd be ashamed to write an article with that conclusion, but it's there.

• 43:52Dr. Mary Claire Haver?

  We don't see that for when we talk about testosterone for men, you know, and hormone therapy for men. We don't see this demonization or this otherness or this somehow it's bad for you. So let's talk about the cost of fear.

• 44:04Speaker 02

  The cost of fear. I want to say, by the way, about publication. As we know, in science, well, throughout the sciences, it's far easier to get a publication when you have a finding of alarm than when you have no results.

• 44:16Speaker 01

  And if you want to say something positive about hormones, forget JAMA, forget Lancet, forget the New England Journal of Medicine.

• 44:24Dr. Mary Claire Haver?

  So for our listeners, these are the major, most well-respected publications in the world.

• 44:29Speaker 01

  They don't accept articles that are in favor of hormones. When I suggest to co-authors that I write a paper with, why don't we try sending it to, they laugh and say, good luck. Menopause, which is a very good journal, Climacteric, which is a very good journal, there are three menopause-like journals, and they publish the favorable articles.

• 44:51Dr. Mary Claire Haver?

  Yes.

• 44:52Speaker 01

  That's an imbalance that reverberates through social media and mainstream media that pick up the lead articles

• 45:01Dr. Mary Claire Haver?

  Yeah.

• 45:01Speaker 01

  from the most reputable medical journals. I don't know why that is, but it is clearly a practice that's been going on for a long time.

• 45:10Speaker 02

  They will not dispute the Women's Health Initiative. They just will not permit anything that disagrees with them. And what's interesting is, I mean, it may be that their view is the Women's Health Initiative was so big So powerful, such a governmentally supported project that it has to be.

• 45:25Dr. Mary Claire Haver?

  It's too big to fail.

• 45:26Speaker 02

  It's too big to fail. And in the absence of the Women's Health Initiative, doing the right thing and calling another press conference. Here's where we are today in 2025. Isn't it important that we sort of review everything and reassure women? That hormones are really safe, effective and healthy and prolong life? Let's do that. And by the way, along the way, correct what we've been saying about breast cancer. But they haven't done that.

• 45:45Dr. Mary Claire Haver?

  So let's take it back to 2002. Press conference happens before the article's even published and we can read it. They're making all these claims. What happened on our end on the front line is we were getting calls because it was viral before there was the internet. Right? It was the newspapers, magazines, Good Morning America. It was the number one medical news story of 2002. I want to make sure everybody realizes this. And women, by and large, threw their hormones in the trash and said, this will give me cancer. I can't do this. That this is going to hurt me somehow. Doctors' offices were getting called. So here we have this, you know, 77% of prescriptions are no longer being filled. What do you think this meant in real life? Do we see more broken bones? Do we see more heart disease? Are we seeing more dementia?

• 46:28Speaker 01

  Phil Sorrell, who we already mentioned, who's on OB-GYN at Yale, who educates OB-GYN physicians about hormones, who runs an organization called Improving Health After Hysterectomy, wrote an article in 2012 saying the best data they could get suggested that there were somewhere between 50,000 and 90,000 extra deaths in the United States from people who had been taking estrogen and weren't taking it. Now, in fairness, having said that, the numbers weren't statistically significant. Have to be fair on both sides.

• 47:04Dr. Mary Claire Haver?

  Right.

• 47:04Speaker 01

  I've spoken to Phil numerous times. He believes the numbers are even better now, but there hasn't been a follow-up article on that. But there are unquestionably going to be more broken bones. We mentioned heart disease being the seven times as common as breast cancer as a cause of death. And I ought to mention, when I say that, women respond by saying, well, old women die of heart disease and young women die of breast cancer. And I'd rather die when I'm old than die when I'm young. And in point of fact, in every decade of a woman's life, a risk of dying of heart disease is greater than her risk of dying of breast cancer. And that difference increases with every successive decade.

• 47:48Speaker 02

  One answer to your question comes from the Women's Health Initiative itself, which has concluded that estrogen is the best and safest thing to prevent osteoporosis.

• 47:55Dr. Mary Claire Haver?

  Yeah, it's FDA approved.

• 47:56Speaker 02

  Absolutely.

• 47:57Dr. Mary Claire Haver?

  For the prevention.

• 47:58Speaker 02

  For the prevention.

• 47:59Dr. Mary Claire Haver?

  Of osteoporosis.

• 48:00Speaker 02

  For the prevention. So in that statement is, the women who were not taking it in the 20 years that we told them it was not good for them, did not get its protective benefits. So that is, in a way, one answer I have.

• 48:11Dr. Mary Claire Haver?

  So the boomers are really mad. The boomers that follow me, that generation who weren't given the option, told it was too dangerous, and then given sleeping pills, anxiety medications, they ended up on polypharmacy to treat all of their symptoms, are now really upset that they've been left out of the conversation.

• 48:31Speaker 02

  Good. Let's get mobilized then.

• 48:33Dr. Mary Claire Haver?

  Yeah. GenX isn't standing for it. They're not going to sit around and wait, you know, for the guidelines to all agree and catch up with each other.

• 48:39Speaker 01

  Which is why it is so important to have a doctor willing to sit down with you, educate himself or herself, and discuss with you what the risks for you are.

• 48:52Dr. Mary Claire Haver?

  Let's talk about who shouldn't take these hormones. Let's lay it out for the audience. What are the absolute contraindications?

• 48:58Speaker 01

  We started this whole discussion by talking about an open decision with your physician. In that open decision, there are no absolute contraindications. This isn't cyanide.

• 49:09Dr. Mary Claire Haver?

  That's a great way to put it. This isn't cyanide.

• 49:13Speaker 01

  This is a medicine that's got pros and cons, and in your individual situation, you must weigh the pros against the cons, and together with your physician, decide whether it's worth it to you.

• 49:27Dr. Mary Claire Haver?

  Gynecologic cancer survivors, specifically breast, ovarian, even uterine, are being told by oncologists, "You cannot have this medication. You will die."

• 49:38Speaker 01

  You know what? The only prophylactic medicine we know of that helps prevent ovarian cancer is estrogen. Estrogen...

• 49:50Speaker 01

  Taken as contraceptive estrogen, which there now seems to be some movement against, but estrogen will decrease the risk of ovarian cancer by somewhere between four and 10% for each decade that a woman takes it. Nothing else does that.

• 50:05Dr. Mary Claire Haver?

  Yeah.

• 50:06Speaker 01

  And the data do not support that estrogen increases the risk of ovarian cancer. They do support that it increases the risk of uterine cancer, an increase that's eliminated by the use of progesterone.

• 50:18Dr. Mary Claire Haver?

  Added antileptosis.

• 50:19Speaker 01

  That's correct.

• 50:19Speaker 02

  I would add one other element because I had, I was one of the 37 women in America who had no symptoms at all in menopause. Neither did my mother, for that matter. And a woman asked me after a lecture, she said, "Well, I'm 50 and I have no symptoms. Should I take HRT?"

• 50:35Dr. Mary Claire Haver?

  I get this question.

• 50:36Speaker 02

  Yeah.

• 50:36Dr. Mary Claire Haver?

  My patients ask this all the time.

• 50:38Speaker 02

  It's a great question. So I said, "You know what? When you're my age, you'll have a different answer than the answer that you have right then," you know? And because the answer has to, again, involve in conversation with your doctor, what are your risk factors going forward? My father and three of his brothers died of sudden heart disease when they were 50. What about osteoporosis? What about dementia? What about other risk factors in your family that you might like not to have when you are in your 70s and 80s? And of course, when you're 50, you're not thinking about when you're 80. You're thinking about, what is my health benefits right now for this decade?

• 51:08Dr. Mary Claire Haver?

  When my patients come to me in clinic, it's number one to put out the fire, like get them to a functional status again. Usually, they're coming in very symptomatic. They've been to several different clinicians before they end up with me and they saw something I said on social media and it drives them to my office. So we get them back their functionality, usually some combination of hormone therapy. Then the conversation about the next 30 years begins and the prevention. And we talk about, how's your mom? How's your grandmother? How are your aunts? How are the women in your family aging? And of course, it's a package. It's not just hormone therapy. And we talk about, you know, what the data is showing for cardiovascular protection, definitely for her bones, possibly for dementia prevention, but also the lifestyle factors that are going to play into that as well because...

• 51:53Dr. Mary Claire Haver?

  With all the bro science, forgive me, Dr. Blimby, you know, all the, the, the men on social media squawking about how they want to live to 120, no woman I know wants to live that long. She just wants to stay out of a nursing home and to maintain her independence and functional life and her brain power for as long as she possibly can, so that she doesn't burden her children or her husband, you know? She kind of is like buying into she's going to be his caretaker, but like, who's going to take care of her?

• 52:21Speaker 02

  Exactly right, exactly right.

• 52:22Dr. Mary Claire Haver?

  Okay, let's break down risk communication. In estrogen matters, you both say, statistics can terrify or clarify, depending on how they are used. Let's put that in plain English for me, for our listeners.

• 52:34Speaker 02

  Well, it's really what we were talking about before, about whether you want to see yourself as the one person in 10,000 who's at risk of something, or if you want to see yourself as part of the 500 who will benefit. The communications researcher George Gerberner once said, "Human beings are the only species to distinguish us from all of this species. We are the only species that tells stories." And then he added, "And lives by the stories we tell." And that is why the power of one anecdote, one story. My mother had a really bad time on estrogen when she was taking birth control pills. I'm never going to do it myself. Or my beloved, fill in the blank person, got breast cancer because she had been taking hormones. One compelling story often drives the narrative, drives the fear or the optimism, you know?

• 53:19Dr. Mary Claire Haver?

  Yeah.

• 53:19Speaker 02

  My friend is drinking kumquat juice every morning and swears that it's, you know, made her skin better, whatever it might be. And the reason this matters, a friend of mine told me that she had been at her oncologist and the women were there, were all dealing with breast cancer in one way or the other. And she said, "Some of us had been on HRT and we were sure that hormones had caused our breast cancer." And then she paused and said, "All of us had had coffee that morning, too."

• 53:41Dr. Mary Claire Haver?

  Yeah.

• 53:42Speaker 02

  If you're looking for a cause, as we all do, when something...

• 53:47Dr. Mary Claire Haver?

  We are really seeing this amplified on social media right now.

• 53:49Speaker 02

  Oh, yeah. Oh, yeah, yeah. It's this looking backward fallacy. If A comes before B, A must have caused B. There are a lot of things can cause B, and we might want to select one, but it behooves us to think further and see if it's really a logical cause or not. You know, one of the things I think that women don't understand about estrogen... Is that it is a hormone that affects every damn part of our bodies. I didn't realize this. I thought, when I went into menopause, I thought estrogen declined gently, the way it declines gently in men. No, it's a plummet. It's a damn plummet off a cliff, down to, you know, 1% of what it had been. And since every organ in our bodies is affected by estrogen, what are we depleting our bodies of?

• 54:31Speaker 02

  If you have a thyroid removed and you'd need Synthroid to stay alive, no one thinks that's somehow unfeminist, or inappropriate, or unmedically sound. It's replacing what you lack.

• 54:45Dr. Mary Claire Haver?

  Protecting us from male levels of heart disease was estrogen.

• 54:48Speaker 01

  And talking about prevention, it's worth noting that estrogen's benefits, especially in areas that we can measure easily, last as long as you take it. And they stop when you stop. So that a woman who takes estrogen will decrease her risk of an osteoporotic hip fracture, around which about as many women die each year as die of breast cancer.

• 55:12Dr. Mary Claire Haver?

  Say that again, because I don't think people realize that.

• 55:14Speaker 01

  Osteoporotic hip fracture is associated with the same number of deaths in this country, close to the same number, as breast cancer. And that can be prevented in half

• 55:26Dr. Mary Claire Haver?

  Half.

• 55:27Speaker 01

  by women who take estrogen, but

• 55:29Dr. Mary Claire Haver?

  As long as she takes it.

• 55:31Speaker 01

  If you stop taking the estrogen within six or seven years, measuring your risk of osteoporotic hip fracture reaches a point where your bones will look as if you had never taken it.

• 55:43Dr. Mary Claire Haver?

  So, you've both been really clear, it's not enough just to critique the Women's Health Initiative, that, you know, I've heard the critiques, millions of women have heard the critiques, physicians are starting to hear the critiques, but we're not really shifting practice patterns. What do you think it's going to take to make that happen?

• 56:00Speaker 01

  I'm so glad. I mean, Carol and I, for the last eight years, have been talking to women all over the world, really. And it's easy to get them riled up.

• 56:14Dr. Mary Claire Haver?

  Yeah.

• 56:15Speaker 01

  Hey, sister, let's fight this. You're not changing much. How can we change?

• 56:19Dr. Mary Claire Haver?

  She walks into her doctor's office locked and loaded, ready for this discussion and is met with 94% of the time, a brick wall.

• 56:26Speaker 01

  That's right. I don't want to talk about it. So first, I don't want to talk about it. Doctor, that is not an acceptable response. I am your patient. If you don't want me to be your patient, I understand. But as long as I am here as your patient, I need a discussion. By the way, I came armed with information and I don't accept everything I read, even by these two people as gospel, but I need feedback from you. And the doctor must respond in an open way.

• 56:57Dr. Mary Claire Haver?

  Yeah.

• 56:58Speaker 01

  But we need more than that. And in discussions that we've had many, many times, we decided there are two main reasons why doctors aren't keeping up with women's desire for estrogen by giving estrogen. One is the fear of legal culpability.

• 57:17Dr. Mary Claire Haver?

  Yeah.

• 57:18Speaker 01

  Some women who take hormones that doctor you may prescribe will come down with breast cancer and who wants to be sued. And we live in a litigious society. What we've decided is let's put together an informed consent form. Doctor, I understand your concern about legal culpability. I want to spare you that aggravation. And so this informed consent form goes over the benefits referenced and the risks, including the risk of breast cancer development. And I will sign consent saying, I won't hold you legally liable should I come down with breast cancer. I think that's a wonderful first step.

• 58:01Dr. Mary Claire Haver?

  It's a fantastic tool. And for our listeners, we're going to have this on our website at thepauselife.com, click a button, easy to download that you can take to clinic and it'll be linked in the show notes as well.

• 58:12Speaker 01

  That's great. Okay. The second thing that we put together is a quality of life questionnaire. Most people aren't aware that There are many symptoms associated with menopause, not just hot flushes and night sweats. There are palpitations, there are joint aches, there are frozen shoulder.

• 58:30Dr. Mary Claire Haver?

  Bloating, fatigue, problems concentrating or remembering, I'm reading right off the list. Mood swings, head exploding, swelling of hands or feet, muscle or joint pains, breast tenderness, palpitations, chest pain with exertion or with the exercise. These are the ones that stop me in my tracks. Fear of heart disease, fear of osteoporosis, fear of breast cancer recurrence.

• 58:51Speaker 01

  Right. And what we suggest is that you download this Quality of Life questionnaire. And each one of these complaints is in a column where you can grade the symptom as either.

• 59:06Dr. Mary Claire Haver?

  Tolerable, unbearable, or not at all.

• 59:09Speaker 01

  Right. And on the second column, how much it interferes with the quality of your life. And you fill that out before you start the hormone therapy. And fill it out once a month or twice a month until you get tired of it and share it with the doctor treating you. I remember when we were talking about lumpectomy as a possible alternative to the radical mastectomy. And surgeons refused, they said it would be malpractice not to do the radical mastectomy. And I remember the first time a doctor in our community in Los Angeles did a lumpectomy. And he walked to the patient's bedside after the surgery.

• 59:48Speaker 01

  And after the conversation, he said to me, he was so overwhelmed by the patient's gratitude. He said, I'll never do another mastectomy. And it has spread.

• 1:00:00Dr. Mary Claire Haver?

  Right, it's standard of care now that the slumpectomy radiation is an accept, you know, is now the standard of care.

• 1:00:07Speaker 01

  It's certainly as good as, and it's much less toxic than the mastectomy, even the modified radical mastectomy.

• 1:00:14Speaker 02

  I want to add to the Quality of Life questionnaire. It's a fabulous document to bring to the doctor, even on your first visit. And the reason is that we all know the experience of, I have all these symptoms I want to discuss with the doctor. And then seven of them go out of your mind when you actually arrive. Like you forget to mention the heart palpitations, which are driving you crazy. So by filling out this list of symptoms associated with menopause and seeing where you are on them and how you are responding to them, it's a great document for the doctor to have as well.

• 1:00:40Dr. Mary Claire Haver?

  And let me add what you can't see, you know, our listeners can't see is on the informed consent form, there is about two full pages of medical references of journal articles that is attached to this in case the doctor has any questions or wants to read up on their own. So you and other members in our menopausey have published criticisms in peer reviewed journals and spoken at leading institutions, myself included, I spoke at ACOG, yet prescribing practices are resistant. As a matter of fact, the, the most up to date guidelines are the menopause society guidelines and they were changed in 2022, like stepping away from the smallest dose for the shortest time possible. Yet, you know, the American College of OB GYN still hasn't updated their guidelines in I think

• 1:01:24Dr. Mary Claire Haver?

  14 years at last count. You know, why do you think change is so slow here?

• 1:01:29Speaker 02

  You have to admit you were wrong. That's just a starter.

• 1:01:32Speaker 01

  Mistakes were made, but not by me.

• 1:01:34Speaker 02

  Not by them.

• 1:01:35Dr. Mary Claire Haver?

  So that's your, another book.

• 1:01:36Speaker 02

  Well, that's another book. Exactly. No, why, why no change? Well, who are, who are we to criticize the women's health initiative? But once a practice is established, I mean, look how long the radical mastectomy existed, many medical practices sort of get into the system and it, changing them is like, I'm fond of saying, it's like turning a battleship around in a tiny river. You need a lot of tugboats, I guess.

• 1:01:59Dr. Mary Claire Haver?

  Yeah.

• 1:01:59Speaker 02

  And even then, it's not going to be an easy process because the, the new guidelines become so entrenched that turning them around, it requires people to change their minds, change their practices. They have to actually read and learn why the original assumptions were wrong.

• 1:02:15Dr. Mary Claire Haver?

  I read a study that said specifically on the subject of from new research to clinical guidelines being updated to clinical practice change.

• 1:02:25Speaker 02

  212 years.

• 1:02:26Dr. Mary Claire Haver?

  17.

• 1:02:27Speaker 02

  Yeah.

• 1:02:27Dr. Mary Claire Haver?

  So that's about as long as the WHOI has been.

• 1:02:30Speaker 02

  Oh, good. It's only 17?

• 1:02:31Dr. Mary Claire Haver?

  So we're going to skip a whole generation of women. But what I love about social media and podcasts now is we are out there. I think the tide has turned. And women are realizing that they have power here and that they need to be the CEO of their own healthcare and that they can go in with these tools that we're arming them with to speed this process up because I think by and large clinicians are good people. They want to do well. They care deeply, but we're busy, especially in menopause care. I mean, as a former program director in obstetrics and gynecology, we had six hours of menopause built in hours in a four-year curriculum. So if you want to do up-to-date menopause care, you have to go seek outside training because they're not giving it to you in your CMA. This is something you have

• 1:03:15Dr. Mary Claire Haver?

  to like really want to do. So I want women to realize you really right now cannot expect to walk into your regular doctor's office. You might get lucky, but more than likely, they're not prepared to help you here. But like I graduated from my training the year the study hit and I was terrified of it. You know, I was sitting in your lecture three years ago reluctantly myself on hormone therapy because I thought, well, if I get breast cancer, at least I'll have a better quality of life, knowing my chances of surviving breast cancer were good, but I couldn't live like that. So realizing that I wasn't hurting myself and I had left a lot of patients bereft because I didn't know. And that's what we have to change.

• 1:03:52Speaker 02

  Well, and we have to understand too, the dilemmas for so many women going to see a doctor who has a tiny amount of time to devote to them.

• 1:03:58Dr. Mary Claire Haver?

  Yeah, 15 minutes at best.

• 1:03:59Speaker 02

  The 15 minutes, exactly. So to have this complicated conversation in 15 minutes is right away daunting for women. And because of the sad, long history of women not being listened to by their doctors when they do come in, the concern I would raise for women, women have always been good at getting information from other women, but your best friend and your mother may not have the best answers for you. And that's really something to keep in mind because the whole, this whole movement about this isn't natural and this isn't, it's unhealthy for you and so forth, that comes from the women's

• 1:04:32Dr. Mary Claire Haver?

  That's not what I did.

• 1:04:33Speaker 02

  No, yeah, it's not what I did. You don't really need this. It's adding something to your body that isn't natural and so forth. That is all from the Women's Whisper Network of bias, some superstition, some anti-medication, anti-medicalizing of menopause, anti-pathologizing of menopause. It's not pathologizing menopause to say you will benefit by restoring the you that was. That's the difference.

• 1:04:57Dr. Mary Claire Haver?

  If you were going to design, I have very strong thoughts here, a menopause curriculum from both from the psychological standpoint and from the medical standpoint. What are the top three things you would want your trainees to walk away with?

• 1:05:11Speaker 01

  Trainees, physicians.

• 1:05:12Dr. Mary Claire Haver?

  Physicians, yeah.

• 1:05:13Speaker 01

  Well, first, listen to the patient. The patient is an important part of the care team, probably the most important part. Second, you must keep up with the literature. What we're talking about now is what we understand today. One of the exciting, but sometimes frightening things is we never know enough. We are learning all the time. So keep an open mind. Data accumulates and criteria change and stay abreast of that.

• 1:05:47Speaker 02

  Yes, yes. I would say this, it's kind of interesting to me that for a very long time, when women say to their doctors, you know, all of the symptoms of menopause, and they say, well, but you know, midlife is a very difficult time for women. Women are, you know, anxious because I'm not, I don't look the way I did at 25, and because I'm taking care of my parents who are in trouble. I'm taking care of my teenagers who are in trouble. I have so many social, economic, and personal concerns. My husband and I are quarreling all the time. There are so many midlife emotional and psychological concerns for women about their changing bodies, about work, about family. So for a very long time, the intervention was, well, let's just solve those problems, dear. Let's get you an antidepressant for your unhappiness.

• 1:06:30Dr. Mary Claire Haver?

  Ambien for your sleep.

• 1:06:32Speaker 02

  A little cosmetic surgery. All of which might be appropriate or timely in certain circumstances. But the number one line of issue for the, for the doctor is, how are you medically? How is your estrogen? That is, I mean, in so many of the cases in our book that we describe, where women are told, well, you better quit your job. It's obviously too stressful for you. And, you know, how can you manage such a high, high, powerful job, you know, with all of these symptoms? You better cut back. You better get out of the workforce. Well, no. How about helping me do my job better?

• 1:07:04Dr. Mary Claire Haver?

  Right.

• 1:07:04Speaker 02

  And so on. So I think it would be useful in my menopause class for physicians to understand that these patronizing views of just quit working, you know, spend more time baking.

• 1:07:17Dr. Mary Claire Haver?

  Drink more wine.

• 1:07:18Speaker 02

  They're not what we're talking about as the first line of issue for women in menopause.

• 1:07:22Dr. Mary Claire Haver?

  So my mother is 88 and is in a memory care facility with Alzheimer's. And on January 1st, she thought she heard my father, she was hallucinating. And she got out of bed in the middle of the night without her walker and she fell and broke her hip. And so she survived, she was well enough to have the hip replacement and survived the surgery. And is just now, eight months later, walking with her walker again, some. It's been a lot. I want a different legacy. And my grandmother had a very similar course. And, and she's incontinent. She's in a diaper. And so her quality of life is terrible. It's as good as it can be, given the situation. I'm refusing for that to be my inevitable.

• 1:08:03Dr. Mary Claire Haver?

  And I think estrogen matters and is going to have a huge part, along with lifestyle and all the things that we're working towards. Dr. Blooming, you've said, "My patients are my teachers." After decades in oncology and women's health, I mean, I'm assuming, I don't know how old you are, I'm assuming you could retire. You know, I know you've retired from, from clinical practice, but you are always working. You are always lecturing, you are always teaching. What keeps you going here?

• 1:08:29Speaker 01

  First, passion. And second, I, I love what I do. There are very few ways to spend your life where you can go to bed every night and think how you made a difference. Now, you want that difference to be for good, but physicians are blessed with that as a built-in part of their job.

• 1:08:57Dr. Mary Claire Haver?

  And what about you?

• 1:08:58Speaker 02

  What keeps me going?

• 1:08:59Dr. Mary Claire Haver?

  What keeps you going? I'm assuming you could retire and just read and knit or do what we expect women in certain nations to be doing. But you are always working. Well, teaching, giving back.

• 1:09:09Speaker 02

  That's what keeps me going. A mentor of mine said to me years ago, I said, "Don't you feel sometimes, certainly for the movement for women's equality and rights, we're citizens, you know, we're just, how do you keep going, pushing that rock up the hill, up the hill, up the hill?" And he said, Think how much further down the hill it would be if we did not keep going. And you know, I mean, the path toward education and change is slow. The forces of reaction will always stand in your path. The people who don't want to change will stand in your path. They will call you cranks, outsiders. But you know, enough outsiders becomes a movement. And that's exactly what's being created here.

• 1:09:51Speaker 02

  And it is exhilarating and motivating to be a part of it.

• 1:09:56Dr. Mary Claire Haver?

  For both of you, for the women listening right now, who have been told by their doctors usually that hormones aren't safe. What do you want her to know?

• 1:10:05Speaker 01

  There is a place where she can get information that is sitting right in front of us. The reason we wrote the book is I can't say it in a sentence. There are no absolute answers, but the balance has to be correct. And this book gives you the information to help achieve that balance in your own situation.

• 1:10:29Speaker 02

  What would I say to such a woman? Learn, read, share, become angry, as the first reaction often is. You know, I've been lied to. I've been lied to by a massive enterprise that has not given me the full truth. And then, once you get through being really angry, do something with it. Tell your sisters, tell everyone you can, that they have been misled and there is a better path.

• 1:10:57Dr. Mary Claire Haver?

  Well, I want to thank you both for writing this incredible book, for joining me today, for changing my life and the lives of my followers and of course, my patients. And for all of you listening, welcome to UnPaused. We are just getting started.

• 1:11:13Speaker 02

  We want to thank you for your wonderful support, your enthusiasm, your efforts, not just for our book, but for the cause for women and for the work you do. It's been just magnificent.

• 1:11:23Dr. Mary Claire Haver?

  Thank you.

• 1:11:24Speaker 02

  So, thank you.

• 1:11:25Dr. Mary Claire Haver?

  Thank you.

• 1:11:25Speaker 01

  Your opinion obviously matters because it's informed, because you're open to learning new things and you're honest in the way you evaluate the new things. And we are very grateful for that. Very glad.

• 1:11:40Dr. Mary Claire Haver?

  Thank you.

• 1:11:44Dr. Mary Claire Haver?

  I'd love to hear from you about this topic and anything else that's on your mind. You can find me on Instagram at DrMaryClaire and get honest and accurate information on health, fitness, and navigating midlife at thepauselife.com. If you're loving this podcast, be sure to click Follow on your favorite podcast app so you never miss an episode. While you're there, leave us a review and be sure to share the show with the women you love. We would be so grateful. You can also find full episodes on YouTube at DrMaryClaire. As a reminder to our audience, you can follow Dr. Tavris and Dr. Blooming on Instagram at estrogen matters.

• 1:12:23Dr. Mary Claire Haver?

  For more information or to contact Avrum O'Carroll, go to their website at www'estrogenmatters.com. UnPaused is presented by Odyssey in conjunction with Pod People. I'm your host, Dr. Mary Claire Haver. The views and opinions expressed on UnPaused are those of the talent and guests alone and are provided for informational and entertainment purposes. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment.