unPAUSED with Dr. Mary Claire Haver

Episode: The Truth About Estrogen: What the Women's Health Initiative Got Wrong

Guests: Dr. Avrum Bluming & Dr. Carol Tavris
Released: October 21, 2025

Overview

This episode dives deep into the legacy of the Women's Health Initiative (WHI) and unpacks its flawed impact on women's health, particularly regarding hormone therapy (HT) and menopause management. Host Dr. Mary Claire Haver is joined by Dr. Avrum Bluming, an oncologist, and Dr. Carol Tavris, a social psychologist. Together, they discuss decades of scientific research, persistent medical bias, the myths surrounding estrogen, and what women—and clinicians—need to know to reclaim their health and autonomy in midlife.

Key Discussion Points & Insights

1. Personal Motivation & Collaboration Origins

• Dr. Haver shares her "lightning bolt" moment on hearing Bluming & Tavris critique the WHI, confessing to feeling "shocked, ashamed, furious" (02:00) that crucial data was hidden from her even as a board-certified OB GYN.
• Dr. Tavris describes their partnership:

  “We discovered that we shared 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.” (05:47)

• They co-authored "Estrogen Matters" to challenge entrenched narratives and help women make informed choices.

2. Context: Breast Cancer, Prognosis, and Patient Agency

• Dr. Bluming: Over 90% cure rate for breast cancer in Western countries today (10:29), a dramatic improvement over prior decades.
• A revolution in cancer care:

  “Patients are being allowed into the decision process... patients should be allowed into the discussion.” (12:50)

• Doctors, Bluming notes, too often shut down the conversation about estrogen—even for women desperate for relief or with valid questions.

  “To refuse to discuss it in today's world is no longer acceptable.” (13:47)

3. Medical & Social Bias Against Women

• Dr. Tavris: Medical bias has led to misdiagnoses and neglect of women’s unique health needs:

  “Women have thought, well, are hormones...unfeminist? Is it unnatural? Is it going to hurt me?...For me, the question is what is healthiest and best for women regardless of the so-called feminist position.” (14:16)

• The system inherently favors male norms:

  “So many ways in which women's bodies are misdiagnosed... against the male norm in medicine.” (15:40)

• In practice, similar symptoms often lead to testosterone checks for men but psychiatric referrals for women. (19:41)

4. Clinical History: How Women Were Treated

• Past breast cancer treatment was drastic and often without basis:

  “Women were abused medically with very little benefit. We don’t do that anymore. But somehow we could do that to women. There isn’t a chance you would be allowed...to do that to men.” (20:04)

5. Deep Dive: The Women’s Health Initiative’s Legacy

• WHI’s design flaws:
  • Median participant age: 63 (not typical menopausal start at 50–51)
  • High rates of obesity, smoking, other co-morbidities in study group
  • Exclusion of symptomatic women (less hot flashes) from study
  • Press release before peer-reviewed publication (26:07)
  • Led by investigator previously calling to "halt the HRT bandwagon" (25:10)
• WHI’s misrepresentation:
  • Claimed HT increased heart disease, stroke, and breast cancer risk—but the breast cancer results were “not statistically significant” (29:19)

  "The mathematical test for the increase... didn't hit the rim." (29:19–29:21, Bluming)

• Subsequent walk-backs:
  • Now, even WHI says HT “decreases the risk of heart disease, when started within 10 years [of menopause]... actually prolongs life” and “estrogen... decreases the risk of breast cancer development by 23%... decreases the risk of death from breast cancer by 40%.” (30:25)
  • Yet, public and clinical guidelines lag behind—stuck in fear-mongering.

Notable Quote:

“The symptoms that these women didn’t have were not affected when they got hormones.” (32:14, Bluming, on quality of life data).

6. The Persistence of Bad Science & Guidelines

• Lowest dose, shortest time advice still dominates, despite lack of evidence (35:59).
• Dr. Tavris ridicules half-measures:

  “The shortest dose for the smallest amount of time represents a foolish compromise.” (36:08)

• Real risk, even using WHI’s numbers: only 1 additional non-fatal breast cancer per 1,000 women—statistically negligible (37:00+).
• Placebo group contamination in WHI: Prior HT use among placebo participants likely skewed results (39:45).

7. Role of Fear & Media

• Bad news dominates, and major journals (JAMA, Lancet, NEJM) shy away from pro-hormone therapy findings (47:37).
• “Fear sells” and liability fears keep clinicians cautious, even against the best evidence.
• Risk aversion dominates the psychology of decision making, even when the benefits far outweigh the risks:

  "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." (43:06, Tavris)

8. The Fallout: Real-World Harm

• Huge drop in HT prescriptions after WHI press conference—70%+ decrease (49:49).
• Estimated 50,000–90,000 additional deaths over a decade due to loss of estrogen protection (49:49).
• Losses in bone health (osteoporosis) and increased heart disease risk, which is the leading cause of death for women in every decade (51:08).

9. Navigating Solutions: Risk, Quality of Life, and Advocacy

• There are almost no absolute contraindications to hormone therapy, just individual risk/benefit decisions (52:13).
• Estrogen prevents ovarian and uterine cancer in some cases; only unopposed estrogen increases uterine cancer risk, remediable by adding progesterone (52:58).
• Benefits extend far beyond symptom control: heart health, bone health (hip fracture risk = breast cancer risk), brain health (memory/dementia) (58:05).
• The cascade that women experience (insomnia > anxiety > polypharmacy) is often avoidable.
• New tools:
  • Informed Consent Form (61:21): for patient-doctor dialogue, to help overcome medico-legal barriers.
  • Quality of Life Questionnaire (61:33): records “tolerable, unbearable, or not at all” symptoms and their functional impact, facilitating informed, shared decision-making.

10. Why Change Is So Slow

• Medical establishment slow to change: “Turning a battleship around in a tiny river.” (65:20, Tavris)
• Stubbornness, fear of admitting mistakes, and bias impede rapid guideline shifts.
• “From new research to clinical guidelines to practice change: 17 years.” (65:44, Haver)
• The importance of women advocating—with resources and data—for themselves as "CEO" of their healthcare (65:52).

11. Three Keys for Future Training

• Bluming’s Top Three for Physicians:
  1. Listen to the patient—she is the core of the care team.
  2. Stay up to date with literature—medicine constantly evolves.
  3. Remain open: criteria and data change; humility is necessary. (68:31)
• Tavris: Warns against patronizing, gender-biased interventions (“Just quit your job... Get you an antidepressant...”) and advocates for addressing root medical causes. (69:08)

Notable Quotes & Moments

• Dr. Haver on awakening to the WHI’s myths:

  “If this could blindside me as a trained obgyn. Imagine what it had done to millions of women... menopause... had been pushed to the margins.” (02:00)

• Dr. Bluming on risk:

  “Even if they’re right and they’re not... one extra case of breast cancer—non fatal—per thousand women taking hormones... In human beings, a one in a thousand increased risk is nothing.” (37:00)

• Dr. Tavris on risk aversion:

  "Most people don't think in terms of what they can gain. They worry more about what the risk is." (43:06)

• On gender bias:

  “We don’t see this demonization or this otherness... when we talk about testosterone for men.” (47:12)

• On moving forward:

  “Enough outsiders becomes a movement. And that’s exactly what’s being created here.” (72:28)

• Advice to women told hormones aren’t safe:

  “Learn, read, share. Become angry...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.” (73:49, Tavris)

Timestamps for Key Segments

• Personal journey & genesis of "Estrogen Matters" – 02:00–09:16
• Breast cancer prognosis and patient agency – 10:11–13:51
• Medical bias and women's unique needs – 14:16–16:15
• History: Gender disparity in cancer treatment – 19:41–21:35
• WHI origins, design, and flaws – 21:40–26:07
• Press conference & media impact – 26:39–27:07
• Risk factors, statistical manipulation, and fallout – 27:38–39:45
• The risk of bias, and the power of anecdote and media – 43:06–47:12
• Decline in hormone therapy use and societal impact – 49:49–51:19
• Current clinical barriers, tools, and patient advocacy – 61:21–64:50
• Why medical practice is slow to change – 64:50–65:52
• Advice for clinicians & curriculum priorities – 68:18–70:42
• Closing thoughts: legacy, passion, and the women’s movement – 71:50–74:33

Action Steps & Resources

• Women seeking hormone therapy or more information:
  • Visit estrogenmatters.com, thepauzelife.com for informed consent and quality of life tools.
  • Download the informed consent form and Quality of Life Questionnaire for appointments (see show notes).
  • Be prepared to actively advocate for your own care—bring data and questions into the clinic.
• Clinicians: Stay abreast of the evolving evidence, and engage in shared, open discussions with patients.
• Community: Spread awareness—empower other women with facts, not fear.

Final Thoughts

"Estrogen was not the villain." This episode aimed to arm women and clinicians alike with the truth hidden in plain sight: the WHI’s enduring shadow does not reflect the current scientific evidence on hormones and women's health. The call is clear—demand open conversations, individualized care, and the right to thrive in midlife and beyond.

“Enough outsiders becomes a movement. And that’s exactly what’s being created here.” – Dr. Tavris (72:28)