How Did Doctors Not Know About the Risks of Hormone Therapy?

Image Credit: Michal Jarmoluk / Pixabay. This image has been modified.

Why Did Doctors Keep Prescribing Cancer?

We’ve known about the role of estrogen in breast cancer going back to the 1800s, when surgical removal of the ovaries seemed to help in some cases. Ovaries were said to send out “mysterious” influences to the rest of the body, which were identified as estrogen in 1923. The medical profession jumped on this discovery and started injecting menopausal women by the thousands, and it was said that “[t]he ‘shot’ gives a ‘respectable’ hook on which to hang the visit to the doctor…” Soon, there were pills and patches, and medical journals like the Journal of the American Medical Association regaled doctors with ads I feature in my video How Did Doctors Not Know About the Risks of Hormone Therapy? on how they can “help the women to happiness by simply prescribing estrogen” and, “[w]hen women outlive their ovaries…,” there is Premarin.

As far back as the 1940s, concerns were raised that this practice might cause breast cancer, noting it would have been nice to figure this out before we started dosing women en masse. But breast cancer risk didn’t seem to matter as much, because heart disease was the number-one killer of women, reviews concluded, and because women taking hormones appeared to have lower heart attack rates, which would outweigh any additional breast cancer. However, women taking estrogen tended to be of a higher socioeconomic class, exercised more, and engaged in other healthy lifestyle changes like consuming more dietary fiber and getting their cholesterol checked. So, maybe that’s why women taking estrogen appeared to be protected from heart disease. Perhaps it had nothing to do with the drugs themselves. Despite the medical profession’s “enthusiasm for estrogen replacement therapy,” only a randomized clinical trial could really resolve this question. We would need to divide women into two groups, with half getting the hormones and half getting a placebo, and follow them out for a few years. There was no such study…until the 1990s, when the Women’s Health Initiative study was designed.

Wait a second. Why did it take the bulk of a century to decide to definitively study the safety of something prescribed to millions of women? Perhaps because there had never been a female director of the National Institutes of Health until then. “Just three weeks after being named NIH Director in 1991, [Bernadine Healy] went before Congress to announce, ‘We need a moon walk for women.’ That ‘moon walk’ took the form of the Women’s Health Initiative, the most definitive, far-reaching clinical trial of women’s health ever undertaken in the United States.”

The bombshell landed in summer 2002. There was so much more invasive breast cancer in the hormone users that they were forced to stop the study prematurely. What about heart disease? Wasn’t that supposed to balance things out? The women didn’t just have more breast cancer—they had more heart attacks, more strokes, and more blood clots to their lungs.

The news that women treated with hormone replacement therapy “experienced higher rates of breast cancer, cardiovascular disease, and overall harm has rocked women and physicians across the country.” Estrogen started out as the most prescribed drug in America before the study, but, after, the number of prescriptions dropped immediately and, within a year, so did the incidence of breast cancer in the United States.

The most important question about this story is why were we all so surprised? There had been “decades of repeated warnings” about the risks of cancer. In fact, the reason breast cancer patients had so much trouble suing the pharmaceutical company was that “the drugs have contained warning labels for decades.” And, with that disclosure, surely any reasonable physician would have included it in their risk and benefit discussions with their patients, right? It’s like the warning labels on packs of cigarettes. If you get lung cancer now, you should have known better. And, so, if you were on hormone replacement therapy and got breast cancer, don’t blame the drug company. They warned you about the risks, right there in the fine print.

Why didn’t more doctors warn their patients? Even after the study came out, millions of prescriptions continued to be dispensed. That’s a lot of cancer in our patients we caused, wrote one doctor. “How long will it take us to discard the financial gains, to admit that we are harming many of our patients, and to start changing our prescription habits?”

“Why did this practice continue in the face of mounting evidence of harm?” Well, it is a multibillion-dollar industry. “Despite an overwhelming amount of evidence to the contrary, many physicians still believe that estrogenic hormones have overall health benefits,” a “non-evidence-based perception [that] may be the result of decades of carefully orchestrated corporate influence on medical literature.” Indeed, “[d]ozens of ghostwritten reviews and commentaries published in medical journals and supplements were used to promote unproven benefits and downplay harms of menopausal hormone therapy…” PR companies were paid to write the articles that were then passed off as having been written by some expert.

What now? “Gynecologists must switch allegiance from eminence-based to evidence-based medicine.” In other words, they must consider what the science says and not just what some so-called expert says. It’s been said that the “current culture of gynecology encourages the dissemination of health advice based on advertising rather than science.”

“Women were placed in the way of harm by their physicians, who acted as unsuspecting patsies for the pharmaceutical companies.” If we really wanted to prevent heart attacks in women, simple lifestyle behaviors can eliminate more than 90 percent of heart attack risk. So, instead of being Big Pharma’s pawns, “recommending a healthful diet, increased exercise, and smoking cessation would truly benefit women’s health.”

The whole Premarin debacle speaks to the importance of putting purported therapies to the test (see, for example, Do Vitamin D Supplements Help with Diabetes, Weight Loss, and Blood Pressure?), as well as to the power of Big Pharma (Eliminating Conflicts of Interest in Medical Research), medical community collusion (American Medical Association Complicity with Big Tobacco), and my most recent series on mammograms.

What about Plant-Based Bioidentical Hormones and Soy Phytoestrogens for Menopause Hot Flashes? Check out the videos to find out.

In general, patients (and doctors) tend to wildly overestimate the efficacy of pills and procedures. See Why Prevention Is Worth a Ton of Cure and The Actual Benefit of Diet vs. Drugs.

Medical care, in general, may be the third leading cause of death in the United States. See How Doctors Responded to Being Named a Leading Killer.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

129 responses to “Why Did Doctors Keep Prescribing Cancer?

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    1. Whoa, what a shotgun blast to the faces of Big Pharm. CEOs and execs Dr Greger! If you lived in a more violence prone country you might fear for your safety – BP could have bigger guns than misinformation – although I don’t think real guns could have done more harm to these women.

    2. Awesome blog!! Thanks for all you do! BTW: on a “nearly plant based diet,” (still doing a little dairy and fish), for just 6 months, my cholesterol dropped from 305 to 260, and lost 10 pounds without really trying! Brain fog has lifted and energy is a lot better! Obviously not done yet, but still working on getting closer to completely Whole Foods/Plant Based! ❤️

    3. OMG! I am shocked at this finding. I’ve been taking bio identical hormones for 15 years. I was told they didn’t cause cancer by my Beverly Hills doctor. My mother died from breast cancer after a very lengthy fight, chemo, radiation, & experimental drugs. Lately, I’ve been trying to ween myself off of them. I’m sure the only thing that has kept me disease free is my strict, WFPB diet and daily exercise for the last 5 yrs or so. I’m tossing the tubes today. Wow, thanks for bring this information to the public.

    4. Many years ago I took Premarin for about a week. Then I read the possible side effects – and I had most of them. I stopped taking it immediately, despite the angry request from my husband to continue. Years later he totally understands why I made that choice. We have enough dangers coming from our food, our environment and our emotions, so we do not need to add toxic hormones to the mix.

  1. Although in some cases, the medical professions have swung a little too heavily into evidence-based medicine. What I mean by that is that I’ve met doctors and nurses from Johns Hopkins and other medical campuses who completely disregard any research that isn’t double-blind placebo controlled trials. If those studies aren’t available then apparently there isn’t any research on the subject.

    These trials are the highest value of research as long as the experiments are properly setup and analyzed but if this type of evidence doesn’t exist, you have to start looking at longitudinal, cross-sectional, and other methods of research.

  2. Wow.

    I love this one!

    I love the topic so much!

    I love the history lesson!

    I love the writing!

    “Ovaries were said to send out “mysterious” influences to the rest of the body…”
    “eminence-based to evidence-based”
    and the mysterious visually-silent “d” in [d]ozens of ghostwritten reviews

    I’ve outlived my ovaries and I don’t know what to do.

    It also helps me understand the topic better. I have read the pro-hormonal replacement studies and had wondered about whether it was not getting hormone replacement, which caused the vegan women Adventists to die slightly younger than the fish-eaters.

    I love how much this helps me unravel the mysteries I am already looking at.

    Thank you so much, Dr. Greger!

    1. I remember being told by the doctor, “I would give it to my mother.”
      Might pay to check the Mother’s will. Maybe the doctor was her only beneficiary. ‘-)

      (Apoligies to any doctor who is not a cold blooded money hungry killer. ‘-)

  3. The issue is not health benefits however but the often greatly debilitating symptoms of menopause (particularly early ovarian failure-I had this and could not work as I was so unwell-imagine having up to 50 hot flashes per day let alone waking up soaked with sweat at night.
    I was desperate and no-one could give me a solution beyond HRT. Dietary factors, controlled breathing etc does not work (and I’m speaking as a nurse consultant in liver disease and a clinical hypnotherapist) hypno helps a little only. Any other ideas?

      1. I wish. Unfortunately, going vegan is not the answer. I’m vegan. I’m healthy as a result, however hot flashes and night sweats have not improved at all.

        1. A few of us here felt that our Menopause went so well because we ate a lot of soy and I looked it up and that can help.

          So can nuts, flaxseed and Omega 3’s.

          Are you supplementing Omega 3?

          A study of 483 menopausal women said that omega-3 supplements decreased the frequency of hot flashes and the severity of night sweats.

          Getting enough Vitamin D can help

          Staying low in alcohol and caffeine and sugar can help.

          Staying away from spicy foods can help (and don’t worry, you can have them back when it is over.)

          1. Yes! Low carbs, high amounts of Omega 3 and D along with other lifestyle choices. No alcohol. Smoking. Lost 5 pounds the years I went through menopause. Only 2 issues…vaginal dryness and cholesterol went from.
            Normal range to 100 points over. Three calcium scores have shown zero blockage. I am 62.

            1. You are doing great!

              I will say that part of the reason Estrogen replacement can help some things is that Estrogen (and other things) can affect Homocysteine and Omega 3 levels.

              That is why going off animal products and getting lowering Methionine and adding in plant foods and using turmeric and eating blueberries and supplementing B-12 and Omega 3’s can be a different way to handle things.

              For Alzheimer’s risk hormone replacement increased the risk of it was after women’s brains had adapted. It was okay if the hormones were at the beginning of the process, but eating soy and taking B12 and eating food sources of folate and food sources of lutein things like kale and blueberries and turmeric and broccoli sprouts really helped without the risks.

            2. Nancy Gwin

              Why low carb? I know that it is fashionable and heavily promoted on the internet but low carb eating will probably significantly up your mortality risk especially if it is based on animal foods.

              A low-carbohydrate diet based on animal sources was associated with higher all-cause mortality in both men and women, whereas a vegetable-based low-carbohydrate diet was associated with lower all-cause and cardiovascular disease mortality rates.’

              Certainly, your cholesterol and hence your risk of CVD appears to have been increased by your low carb diet and this increases your risk of atherosclerotic cardiovascular disease (ASCVD) – no matter what some people on the internet/YouTube may claim

              ‘We assessed whether the association between LDL and ASCVD fulfils the criteria for causality by evaluating the totality of evidence from genetic studies, prospective epidemiologic cohort studies, Mendelian randomization studies, and randomized trials of LDL-lowering therapies. In clinical studies, plasma LDL burden is usually estimated by determination of plasma LDL cholesterol level (LDL-C). Rare genetic mutations that cause reduced LDL receptor function lead to markedly higher LDL-C and a dose-dependent increase in the risk of ASCVD, whereas rare variants leading to lower LDL-C are associated with a correspondingly lower risk of ASCVD. Separate meta-analyses of over 200 prospective cohort studies, Mendelian randomization studies, and randomized trials including more than 2 million participants with over 20 million person-years of follow-up and over 150 000 cardiovascular events demonstrate a remarkably consistent dose-dependent log-linear association between the absolute magnitude of exposure of the vasculature to LDL-C and the risk of ASCVD; and this effect appears to increase with increasing duration of exposure to LDL-C. Both the naturally randomized genetic studies and the randomized intervention trials consistently demonstrate that any mechanism of lowering plasma LDL particle concentration should reduce the risk of ASCVD events proportional to the absolute reduction in LDL-C and the cumulative duration of exposure to lower LDL-C, provided that the achieved reduction in LDL-C is concordant with the reduction in LDL particle number and that there are no competing deleterious off-target effects.

              Consistent evidence from numerous and multiple different types of clinical and genetic studies unequivocally establishes that LDL causes ASCVD.’

          2. Here, I will try to bring some of the links.

            Soy helps


            Soy and sea vegetables are what they have looked at to explain why only 7 percent of menopausal Japanese women suffer from hot flashes, as compared to 55 percent of women living in the United States.

            Avoid sugar and avoid high fat (bad fat) and eat your fruit and veggies


            Women involved in a dietary modification trial which encouraged them to decrease fat and increase fruit, vegetable, and whole grains were significantly more likely to eliminate hot flashes. (As part of that, losing weight also helped. You are vegan and might not need to lose weight, but I am mentioning it because they mentioned it.)


            Cut back on caffeine for a while. You can have your coffee back later, too.


            Don’t supplement calcium, but eat your broccoli


            Soy, nuts, and pineapple also affect serotonin and Dr. Greger has a video on eating to improve serotonin levels and serotonin is involved in hot flashes.


            Glycine and Vitamin E from leafy greens can help menopause symptoms.

            Glycine is in things like seaweed, watercress, spinach.

            I recently started eating watercress in my salads. It tasted peppery at first, but my no-oil dressing really helps.

            If you don’t eat soy, there are other foods, which can help

            Phytoestrogens are in things such as plum, pear, apple grape berries, beans, sprouts, cabbage, spinach, grains, hops, garlic, onion, wine, and tea.

            Drinking enough water helps Dehydration triggers hot flushes and sweating increases dehydration, so it is a loop.

            1. Hi Deb, Has anyone addressed whether or not tests are done on E1,E2, E3 or E4 as well as phytoestrogens? I am concerned that everyone is lumping estrogen into one big package which includes Premarin. Some estrogens are beneficial whereas others when left out of balance can lead to disease. Then we have all those who are on hormone blockers. That it me is the most serious of mistakes. Hormones rule our bodies. I like that you included all the phytoestrogens. Everyone singles out soy. Not sure why.

              1. Dale,

                They single out the soy because that is what has studies and that is why they believe the Japanese don’t have problems with menopause.

                And because organic soy is a protective food against things like Breast Cancer – as long as you keep the servings to fewer than 5 per day. Over that, you can raise IGF-1.

                The problem is that people are afraid of soy because they believe that it is all GMO, which is not true at all. It is easy to find organic soy. Miso gets to have health claims about Breast Cancer on its package.

                People are confused about it though.

                1. I agree about soy. I have been reading studies for years, since the mid 1990’s, about the benefits. My concern was that soy is most often singled out as dangerous while it is instead protective. I find it terribly misrepresented by mainstream.

              2. Estradiol, and estrone are ones they believe linked to the increase the risk of developing breast cancer.

                Here is what I just read about the historical trend for women to handle things with diet:

                . Concurrently, Adlercreutz reported in the early 2000s that phytoestrogens had a preventive effect against various cancers and breast cancer specifically. This suggested a dietary link to increase health, in general, and potential prevention of age-related diseases, [80, 81] which supported early reports on this topic [6, 55–59].

                …. 30 to 50% of women used a “natural” remedy during the postmenopausal interval to address their physical condition in an attempt to improve reproductive-endocrine function while at the same time avoiding the potential adverse effects associated with traditional HRT [76, 79, 82, 83]. Consequently, more women (and men) have turned to natural health remedies such as phytoestrogens (with their polyphenolic chemical structures made in plants) which has become one of the most researched topics in the last decade.

                  1. They said a sentence in the study evaluating weight loss versus changing the diet

                    “Nevertheless, although small weight or dietary changes may make little measurable difference in severity of symptoms, larger changes may bring substantial relief.”

                    They felt that overweight women with severe symptoms may need to lose 17 pounds.

                    They also said that either way – losing weight or changing the diet – worked at relieving symptoms within a year. The more changes people made to their diet, the bigger the results.

            2. Flaxseed is another source of phytoestrogens and it is good for helping with the ALA / Omega 3 ratio, which is critically important as a woman enters menopause.

              I feel like the mechanisms are important to understand.

              Estrogen and things like having your period for a long time and being pregnant are protective for things like Alzheimer’s because Estrogen keeps your Omega 3’s high and keeps your Homocysteine lower. So, once you reach menopause, you have to supplement B12 and eat plant foods and take Omega 3’s to make up for those changes.

              Science is still confused to some degree with whether giving Estrogen replacement is helpful. Finland tried it and the rate of Alzheimer’s increased, not decreased. The thing is, they believe that maybe if it was given right away, it might have been more effective, but giving it after the women’s brains adapt to menopause, it becomes a risk factor.

              But you still do have to try to keep your Homocysteine low and Methionine is one of the things, which increases Homocysteine. Methionine is from animal products and lowering those help in more than one way.

              But you HAVE TO eat your vegetables and supplement B12.

              The other thing to do is lower your saturated fats and sugars and refined carbohydrates and I mean refined as in white floured bread, white floured pasta.

              The reason that is important is part of menopause is losing vasculature and lowering saturated fats improves your blood flow.

              Doing things to improve blood flow to the brain is essential for women who are post-menopausal.

              Also, you need an anti-inflammatory diet and you want to eat foods which are good antioxidants. That is where the superfoods come in.

        2. That scares me that you’re suffering. I’m turning 51 in a month. I’m vegan, and I don’t seem to have hot flashes or the other symptoms. And I know what hot flashes are since I had them at age 29 when i went through temporary menopause for the year that I took tamoxifen after breast cancer.

          1. Suzanna,

            A lot of us had ZERO menopause symptoms.

            I just posted a lot of studies of things which can help.

            I had such bad periods my whole life doubled over in pain and suicidal PMS and such bloating and other things and ZERO menopause.

            I thought it was because I had started eating a lot of soy and I think Liisa said the same thing.

            1. I confirm this, Deb. I had horrible pain with menses when younger. Once I doubled over on a public bus. I knew I would be okay, but the bus driver, (a man,) was so worried that he offered to call a cab. Menopause? Well, I was eating “vegetarian” by then and eating soy products…. No problems. I didn’t understand these “night sweats,” etc.. that I heard about from others.

        3. Shari

          Many so-called vegan diets are unhealthy. So your exoerience isn’t particularly surprising.or unusual.

          This site promotes whole food plant-based diets which may or may not contain small amounts of animal foods.

      1. Speaking from much experience It improves ones condition and reduces symptoms greatly. But, my experience was after many years on WFPB. I had no peri menopausal or menopausal symptoms. Haha. At least I didn’t think so! My husband has a different version – ex. Emotionally.
        However, after 17 years WFPB, then repeat endometrial cancer, I have been on BRT. NOT HRT. And, my husband is happy, I’m happy. And 10 years cancer free. Still going WFPB STRONG.
        Many of the educated comments in support of BHT are spot on and appreciated.

    1. I highly recommend the ‘Period Repair Manual’, as well as the author’s blog posts – just ignore her misinformation regarding plant-based diets.

    2. Have you tried herbal medicine? I mean working with a herbalist prescribing personalised formulas, not over the counter herbs of course. Myself, and many of my colleagues would have had great success in situations like these. Worth giving it a go, if you haven’t yet. Best of luck.

    3. Doing Qigong regularly is awesome. If you look into it, you will find a lot of relief in learning how to regulate your own energy with your mind. Tai Chi is related to Qigong, and both have relation to Acupuncture and Traditional Chinese medicine.

    4. I agree. I had so many symptoms, joint pain, hot flushes, terrible skin irritation, hardly any sleep, panic attacks, aural halkucinations, no spatial awareness, cdnt drive anymore as hardly knew which side of road to be on, loss of muscle, hair loss, cdnt hold a conversation and on. I was prepared to kill myself until i took hrt and got my identity and life back. I dont believ the study mentioned is now considered reliable. Many of the women had previous conditions and were overweight. From what i have read hrt is sage if u follow guidelines. Keep alcohol to a minimum, keep a healthy weight, exercise and eat well. The small additional risks i am prepared to take to be able to live a normal life, as life wasnt worth living without it. And dont give me any rubbish about herbs and cotton nightdresses. None of it is any relief.

      1. I went through a lot of those symptoms, a while back, but mine was more related to things like Homocysteine and Aluminum in my brain and RoundUp and blood sugar being off and too much saturated fat. I know that because each thing improved my condition markedly.

        I went off of dairy to get rid of the saturated fat and cholesterol and those helped. I know that a lot of it is bloodflow to the brain. I drank Fiji Water for 12 weeks to get the aluminum out of my brain (silica water) and that got rid of hallucinations and night terrors and I started supplementing B12 and eating vegetables for Folate to lower Homocysteine.

        I haven’t had hallucinations since the Fiji Water. Nope, I had them start again before I dealt with B12 deficiency, but they went away when I dealt with things. Removing the saturated fats and cholesterol took away Diabetes symptoms, which I was ignoring. Six months after changing my diet, my horizontal nail ridges grew out and a lump on my breast shrunk and eczema on a nipple on the same side went away. My eyes couldn’t focus pre Whole Food Plant Based, but I have gotten rid of just about everything with diet – going off oil and dairy and increasing my fruits, like blueberries, and vegetables, particularly leafy greens and broccoli sprouts and spices, like turmeric. Lots of beans and soy.

        Anyway, I have reversed so many symptoms that I can’t even keep track and it has entirely been with diet. Mostly, using Dr. Greger’s videos.

        1. It is genuinely uncanny how similar our brain part of our lists are.

          I didn’t have hot flushes and I didn’t have a lot of the traditional menopause symptoms, but I had all of the brain ones, which I believe was from out of control Homocysteine and Diabetes. Estrogen does keep Homocysteine in check, so it makes sense that using it could reverse things.

          I did it by diet.

          I had hallucinations and I had no spatial awareness, and shouldn’t have been driving anymore as hardly knew which side of road to be on, because the visual field was disappearing and my eyes were not able to focus. I had to close my eyes so often. I also went functionally mute and could not process information. My calendar was a year and a quarter off. But none of those are the embarrassing brain ones.

          I have more cognitive brain ones than you have and none of the other ones.

          I believe that Homocysteine and out of control blood sugar and aluminum toxicity from sliced cheese and baked goods were giving me early-onset Alzheimer’s, but most of the symptoms are gone now.

      2. Stephanie,

        I think the point is that changing diet alone can bring the symptoms of Menopause down to a 7% risk.

        I really did have all of the things you had, but those things were not timed perfectly with my going Post-menopause though I do know that Estrogen can lower Homocysteine and does affect Omega 3’s and blood flow to the brain, but all of those can be corrected with diet without the risks or cost.

        I have gotten rid of the same things as you have doing it Dr. Greger’s way.

        You have such a close list to mine that I know that it has to be a mechanism like Homocysteine, which Estrogen does affect.

        I did it with diet.

    5. There are many herbal therapies. Sadly, many of the studies on these are in Chinese or Japanese and no corporation is willing to finance a study that will result in people using less of their pharmaceutical products. My wife finds that soy milk helps a lot.

      John S

    6. If you find something that works please tell me too! I don’t have the same debilitating symptoms you have, but the one that’s not polite to talk about. Vaginal pain making intercourse impossible. So since I’m happily married and still want a physical relationship with my husband, I use one of the vaginal rings that’s impregnated with estrogen. Doesn’t make me happy to do this but literally nothing else has worked.

      P.S. to those who think they’ve got the easy solution, I’ve probably already tried it …. body weight isn’t the problem, WFPB (since the 1990’s) isn’t the problem, omega 3’s aren’t the problem, lack of soy isn’t either, and I’ve tried herbs.

  4. Loved this post Dr. Greguer! Thank you so much for all the women out there!

    I was wondering, what do we know about the health effects of estrogen-based contraceptive pills?

    Many thanks from France,

    1. Unfortunately, estrogen isn’t the only harmful thing in birth control pills – the progestin drospirenone is the worst thing you can find in those.

    2. Hello, Olga,

      It is always fun to see greetings from France!

      There are risks.

      If a woman smokes and takes the pill, she has about the same risk of dying from that as from dying in a car accident is the analogy they used. Even if that woman is a smoker older than 35 years of age, she has a risk of death from the pill of 1 in 5200.

      I say that because you are in France and, from what I remember, it is hard to get away from smokers and I am not sure if constant exposure to second-hand smoke might be a risk factor or not.

      Increased risk of venous thrombosis, which is closer to 1 in 10,000 and certain cancers.

      It is linked to cervical, breast, and liver cancers, but is protective against other types of cancers.

  5. I unapologetically take hormone replacement and I am thrilled with it. If you are interested in evidence-based medicine on this topic, you should read _Estrogen Matters_ by Bluming and Tavris. They scour the medical evidence on hormone replacement (not just relying on the highly flawed WHI), and show convincingly that it may be worth an increased risk for a few problems to decrease your risk for many more common (and deadly) problems by using HRT, not to mention to avoid the symptoms of perimenopause and menopause. They have no connections to pharmaceutical companies. Every person has to decide for themselves, but I highly recommend the book if you are considering HRT at all. (I really like Dr. Greger and the information he provides, but to blame all differences of medical opinion on Big Pharma smacks of paranoia.)

    1. I have read this book and unequivocally agree with everything you have said Jennifer. It made me change my mind about taking HRT. Wondering if Dr Gregors team could have another look into this topic? Oestrogen is a vital hormone in the female body for more than just reproduction, and its demise has repercussions that are equivalent to if a body stops producing insulin or thyroxine. Am pretty sure most people would not expect hypothyroidism not to be treated. Up until the last 150yrs not many women lived past 55 – 60 was considered old. The WHI has since been refuted by a few of its own authors as being inaccurate in many ways and the legacy of biased data mining. Seriously Dr Gregor, please rethink your advice on this or give the evidence that backs up the WHI report as this book gives very strong evidence to the contrary and the authors are very well respected in their fields.

    2. Not everybody agrees with Bluming and Tavris’ arguments or the assertions they make.

      Also, books are a favourite way of presenting skewed arguments that would never pass peer review in a credible journal (and making a few bucks).

  6. I’m wondering what all those hormones do to men who take them for strength and endurance in sports and in other areas of their lives. The body is an incredible bio-machine. I’ve learned from Dr. Greger and others to interfere with it as little as possible.

  7. I had awful hot flashes, insomnia and memory loss because of menopause along with vaginal dryness. I was put on the lowest dose of estrogen…it has improved all of my symptoms. Is there something else I could be taking?

    1. Gina,

      Soy is pretty effective without the risks.

      Changing the diet away from animal fat and sugar and caffeine and refined flour and toward soy and flax and other food sources makes the same changes with fewer risks.

      Are you planning on staying on it for the rest of your life?

      Or are you planning on weaning off of it at a certain age?

    2. Gina,

      For things like hot flashes, food sources of phytoestrogens work.

      For the memory loss, make sure you take Omega 3 and B12 if you are vegan and possibly even if you aren’t. 60% of people are low in B12.

      Also eat foods rich in folate – meaning plant foods.

      I say those things because Homocysteine can go up and Omega 3 can go down in Menopause. Also blood flow to the brain can decrease so stay low in saturated fats and oils and high in antioxidants.

      You want to keep the arteries to the brain unblocked.

  8. It is important to to note that the study referred to looking at thousands of nurses on “estrogen” and “progesterone” were actually taking Premarin and progestins-horse derived and synthetic hormones that were and are foreign to the human female. It should be no surprise that these would have side effects! In addition, the Premarin was given orally and therefore subjected to the first pass effect so that the hormones the women were exposing their bodies to were the metabolites of Premarin. If one is going to prescribe a natural form of estrogen, it should not be prescribed orally, only transcutaneously which more accurately reflects the natural state by avoiding the first pass effect.
    Additionally, if one is to prescribe estrogen, it is imperative that a natural form of progesterone also be prescribed to keep the hormones in balance. Natural progesterone has been shown to activate the p53 gene which encourages apoptosis of cancer cells.
    Having said that, I do agree nutrition is essential for optimal health of both women and men.

    1. Interesting. Dr Greger was quoting a 2002 study for this blogpost. Really hoping he can address your points with more up to date research if it exists. In fact a whole series on peri and menopause would be brilliant!

      1. Darren,

        I think the fact that women went off hormone replacement therapy and did better with phytoestrogens from plants and those plants prevented cancer without the risks and that was so effective that breast cancer decreased is the part that needs an arrow pointing at it.

  9. This is most helpful, what about treatment for those who have an oophorectomy (Removal of ovaries) before menopause? Is a low does of any HRT that is subdermal beneficial? Or still the same level of risk?

  10. It’s important to note the difference between bioidentical estrogen and progesterone, and the estrogen and progestins in hormonal birth control and HRT. Our female hormones are SO important for our health. I highly recommend the book ‘Taking Charge of Your Fertility’ and the ‘Period Repair Manual’ to learn about the benefits of our hormones, and the website ‘Natural Womanhood’ to learn about the harms of hormonal birth control and HRT.

  11. I went through menopause 14 years ago and had no symptoms at all except for vaginal dryness. Do you believe it’s safe to use estradiol and suppository form? I’ve had one abnormal pap smear 8 years ago and had a colposcopy done.

    1. I am 71 and had breast cancer last year , luckily it was caught early with a mammogram ,it required surgery and radiation … my last checkup with my gp was very good … i Have been wondering all along what did I do that could cause this hormonal cancer? everyone kept telling me I did not do anything to cause it , but I had a nagging doubt …I had been using estradiol as a vaginal cream after menopause, even though it did warn of breast cancer risk …recommended by dr and gynaecologist … there was no history of cancer in my family , I am very happy all went well , timing , surgery and treatments, but what If I hadn’t used that cream ? there are other ways to ease vaginal dryness , it is called Replens an all natural lubricant ..

      1. Dear fullheart, Please accept my sincere sadness for what you have been through. There are so many factors that can also be contributors. Sometimes it is just that we started on a WFPB diet later in life. There are no guarantees. We just do our best. Many of us started too late on WFPB. I was in my 30’s, did water only fasting under supervision and after 17 years of all that, I got repeat endometrial cancer. All in all, myself and my oncologist feel I survived these past 10 years and got the cancer later in life instead of earlier because of being WFPB. Some cancers take many years to manifest and we can slow down the process by lifestyle. Same happened with Bill Gates. So, hang in there. Never give up. Never surrender.

      2. Highly unlikely the estrogen cream had any bearing. Such a tiny amount is absorbed into the circulation, it effects local tissue. It doesn’t even cause the endometrial proliferation that creates the need to take progesterone with it. Yes, the warning it included but that’s probably just legal terms. So don’t blame yourself for using it. Breast cancer is a complex issue and all the causes are not know. My mother and aunt developed it and neither used any hormones. Diet and environmental issues may have an impact. The full cause is not yet known.

  12. I agree with this article but you might ask why people have cosmetic surgery when it might kill them. To many, a far off risk is worth a clear cut immediate need.

  13. Typically I am a grateful fan of Dr. Greger’s work, but I am sorely disappointed in this post. His recounting of the Women’s Health Initiative (WHI), including the back history, has a number of errors and omissions. I will address just a few.

    First and foremost, there are two main categories of hormone replacement therapy– estrogen alone versus a combination of estrogen plus progesterone. The risks of hormone replacement therapy (HRT) vary significantly based on which type a woman uses. Estrogen-alone replacement therapy, referred to by its trade name Premarin in this post, indisputably increases the risk of uterine cancer if used in women who have not undergone hysterectomy. In the WHI study, estrogen-only therapy showed a trend toward LOWER breast cancer risk (on the magnitude of 7 fewer cases per year per 10,000 women taking estrogen replacement therapy). The combination estrogen plus progesterone is where the breast cancer scare came into play, with an increased risk for breast cancer on the magnitude of 9 additional cases per year per 10,000 women taking estrogen plus progesterone. Dr. Greger’s statement, “There was so much more invasive breast cancer in the hormone users that they were forced to stop the study prematurely” is only half true; only the arm of the study involving women receiving estrogen plus progesterone was terminated early. The estrogen-only (Premarin) arm continued.

    Since the initial release of WHI data around 2002, researchers continued to follow the study participants for an additional 10 years, providing invaluable data on the risks and benefits of HRT that included risks during treatment and any risk that persisted after treatment. This cumulative follow-up data was published in JAMA Oct 2013 and should be referenced.

    Another very important factor in HRT risk not addressed in this post is age. The risk for coronary heart disease, for example, is vastly different in the 50-59 age group versus the 70-79 age group. In the 50-59 age group, women taking combined estrogen plus progesterone showed a small trend toward higher coronary heart disease on the magnitude of 5 additional cases per year per 10,000 women taking HRT; in the 70-79 age group that increased risk jumped to 14 additional cases. In the estrogen-only study arm, however, women in the 50-59 age group had a DECREASED risk of coronary heart disease on the magnitude of 11 fewer cases per year per 10,000 women taking estrogen-only replacement therapy. The protective effect was lost in the 70-79 age group, with no increased or decreased risk of coronary heart disease in women taking estrogen-only therapy.

    Reading this, I’m sure many people wonder why anyone would take estrogen plus progesterone as opposed to estrogen alone. The primary determining factor is whether a woman has undergone hysterectomy or not. (There are other caveats to determining which type of hormone is appropriate, such as whether administration is systemic versus low-dose vaginal, but that is getting beyond the scope and point of this comment.)

    Discussing the pros and cons of FDA-regulated hormone replacement therapy with patients is a very nuanced conversation. Overall risks and benefits vary hugely by type of hormone used (estrogen alone versus estrogen plus progesterone), duration of use, AGE, family history, past medical history, route of hormone administration, etc. If a boon to quality of life is significant enough to warrant assuming the real but (in most cases) small risk, then hormone replacement therapy is a very viable option as women’s bodies transition to the new normal.

    I am a women’s health physician, and I frequently recommend Dr. Greger’s book to my patients. I have no ties to “pharma” or “the industry”. My ties are to my patients.

    1. Thank God you replied to this hysteria regarding HRT. People use HRT in the WS study and interchange it with use of the E1, E2, and E3 alone. They do not realize the term HRT means a combo or Provera a Progestin and Premarin. Provera has been a known carcinogen for before that study even started yet they still gave it women. Premarin although made from horse urine is a very strong Estrogen, if my memory serves me right when given alone it did not show an increase in breast cancer compared to individuals who had cancer but never took hormones. Today most most women use Bi-Est or TriEst with or without natural Progesterone. I am in the camp of replacing a reasonable blood level of Estradiol in menopause and definitely so after Hysterectomy. From the actual research I have seen the levels of breast cancer are NOT increased when compared to a non hormonal population. Notice I said Estrogen and note Progestin is Provera a known carcinogen Progesterone refers to a natural product.

  14. I had endometrial cancer after being on a bioidentical hormone low dose patch for 8 years. I read the fine print and discovered that the risk of this type of cancer rises considerably after 6 years. My dr kept reminding me how well I was doing on it when I’d ask if I should go off it. At least I caught it early surgery was my cure—no radiation or chemo. Also, I was always active and ate well, mostly plant-based (I’m a nutritionist) but did go through a time of enormous high stress which I believe contributed to raising my cancer risk. I was never on the pill, and seldom took over the counter drugs.

  15. My mother’s doctor prescribed hormone replacement for her beginning at menopause when she was 52 and insisted she continue taking it until she developed breast cancer at 83. Much earlier in her life, when she was pregnant with me, the doctor ordered a drug to prevent miscarriage (she’d had two) known as diethylstilbestrol. I remember the day she called me after hearing that taking this drug had resulted in a rare form of cancer in daughters–and she was so horrified–wanted me to be tested–fortunately, negative for me. These and other experiences with pharmaceuticals resulted in an active decision at 20 to choose to take no meds whenever possible–and is part of choosing to eat a carb restricted, organic, vegan diet for many years now. I have zero diagnoses… Have 100% control over what I choose to eat!!! Tx Doc!

  16. Thank you Dr. Greger. What are your thoughts about the Mirena IUD? I got it at age 43 because my periods started to get very heavy and painful. 6 years later I still have the IUD, and I just had a FSH test and the results were 37 (post menopausal), even though I am still spotting often. I’m not sure whether the Mirena is considered dangerous or not. If not, will it help with menopausal symptoms enough to leave it in?

  17. Diagnosed with metastatic breast cancer causing tumor to attach to retina of right eye. After radiation last year can see but in middle of eye blurry. Since then tumor shows it is dead, only scar tissue and sd not come back. Placed on Ibrance and hormone blocker. Last two PET scans were clear, so I decided to discontinue Ibrance. However still on hormone blocker. Hv been eating plant based for about a year. Question is: should I discontinue hormone blocker and if not, is there something natural I can take instead?

  18. As much as a surprise as estrogen was and keeping in mind that ALL doctors were prescribing it with no prior testing from 1923 to 2002 and beyond depending on when the doctors were updated, it’s laughable now to read about John Hopkins doctors not believing anything but double blind, placebo controlled studies.

    In my view the doctor’s prescriptions overrode the fine print supplied by the drug companies. The doctors were presumably educated by Big Pharma reps before prescribing anything. Patients take their doctor’s advice regardless of fine print right up to the cliff edge and into the cold blue sea.

    The scientific method is an inflexible process that doesn’t allow for testing sequential and ganged effects where multiple substances all have to be tested at once to produce the desired effects. I guess those Hopkins doctors will be committing medical sins for years to come until new methodology is developed to allow science to test for real world causes and effects. Sort of like the knee jerk treatment for ingrown toenails where the nail bed is routinely surgically removed in a process that should land those doctors still performing that surgery in jail for assault.

    The other thing is of course that estrogen is only one thing among hundreds if not thousands of substances that cause nutritional harm. We can all agree the estrogen bombshell wouldn’t have been a bombshell if the there had been testing or if there had been honest testing. Lots of dishonest testing is done for other substances so we can expect many more of those bombshells because in Asia and Eastern Europe, economics don’t play the significant role in lab research that it does in the Western World.

    There, unlike here, they have no problem slamming grain and dairy products as they so richly deserve. So eventually, people will catch on and look to the east for direction. But no, I’m not naive. I know that crooked science is global. So even that will help lay a few land mines in our paths.

    1. Yeah Asians slam grain products – that must be why they don’t eat rice then?

      And why Asian Americans review the scientific evidence and conclude (WG = whole grain)

      ‘Our meta-analysis demonstrated inverse associations of WG intake with total and cause-specific mortality, and findings were particularly strong and robust for CVD mortality. These findings further support current Dietary Guidelines for Americans, which recommends at least 3 servings/day of WG intake.’

      And why another Asian team also concluded

      Our study shows that whole grain intake was inversely associated with risk of total, CVD and cancer mortality. Our results support current dietary guidelines to increase the intake of whole grains. Government officials, scientists and medical staff should take actions to promote whole grains intake.’

      1. I get all that. On the other hand health restoration processes don’t work if you are still eating grain.

        There are lots of benefits undoubtedly, but lots of downsides too. Chief among them is constipation. Whole grains are better for that for many people. But for many more people they are a cause that that cannot be overcome while continuing to consume the trigger food.

        I’ve been grain free for a long time now and my health has improved in many ways. No identifiable downside. I’m as physically active as I was in my 40s.

        Grains, no matter what type are inflammatory. If you are a person who has inflammatory issues, eating grain of any description is not going to help. But grain consumption can certainly make things far worse in a hurry.

        I enjoy grain based foods as much as anyone but I’ve learned through countless experiments on myself that there are many symptoms that don’t appear to have anything to do with toast and jam or any other grain based snack/meal.

        Yet these symptoms are treated as though they were actual diseases that manifest like magic.

        At some point you either respect the reality of the elephant the room or you suffer the debilitating consequences.

        There are countless studies telling us about the benefits of whole grain consumption. Never do those studies deal wth the percentages of test subjects who didn’t benefit and those subjects outnumber those who benefitted.

        Telling me that whole grain consumption is 23% better than refined flour consumption does not convince me that the other 77% were benefitting. It leaves me wondering what happened to most of the participants whose negative impacts were glossed over.

        But those people weren’t who the studies were about.

        Study results that describe unknown benefits in percentages of study groups whose population amount to an unknown number don’t impress me either. Since I’m not a scientist and most people aren’t we don’t often get access to the full studies. So we’re left with partial synopses frequently. However even from those you can frequently tell that the people doing the interpretation are constipated themselves and don’t even realize it.

        If you’ve grown up being shot in the ass with a pellet gun as have your friends, that’s your normal. So we have scientists who have no clue what real, natural bowel function is telling us that bowel function hampered by grain consumption is normal. In the 21st century it certainly is but natural it is not for too many people.

  19. As a nurse practitioner who prescribed a lot of HRT I can tell you it had nothing to do with greed. It had to do with hot flashes. Many women are crippled by them. Nothing controls them like HRT. So of course they will continue to be prescribed like other medications who have potential long term effects. I say potential because 100% of women did not develop illness in the study…it was 12%. Also, the women’s health study showed the main problem was women who took both estrogen and progesterone. The estrogen only group had illness similar to those taking placebo. Some had fewer illness. So shouldn’t you be writing about progesterone? Starting HRT at an advanced age or taking it for a long time was also a negative factor for the estrogen. The study was needed but it doesn’t mean no women should ever take HRT. It concluded only when required and for short term. I enjoy your information Dr Gregor but this one is incomplete.

    1. Cynthia, that’s a pretty important chunk of related core information that probably statistically no one saw from the patient’s chair. My wife had breast cancer twice and she won’t touch anything with estrogen in it now. But I’m sure nothing was said to her about progesterone. I think that would have stuck in my mind. Thank you.

      As for greed, not all doctors are personally motivated by greed. Maybe not even most. But the profession as a whole is seen that way for good reasons and I doubt there’s anything anyone can say now that will change that opinion anytime soon.

      1. As for greed, not all doctors are personally motivated by greed. Maybe not even most.
        I think you are right.

        I also think that many doctors are just overwhelmed either by the amount of information out there or even by their case load.

        I suspect most of them are relying on old information because they just don’t have the time to bone up on new research. Many of them probably practice medicine by rote. It’s just easier.

        This is one reason Artificial Intelligence will someday make medicine efficacy up-to-the-minute… as the doctor’s office will be connected with unlimited data.

      2. John your wife is certainly correct not to use any estrogen product after having breast cancer. That is the recommendation. And I’m not just speaking as an NP in this discussion, both my mother and her sister died from breast cancer. Neither took hormones. Breast cancer is a complex issue, as are most cancers.

        Most doctors do not prescribe medicines for greed. I’ve been there working side by side for years. They do it because they believe it will help. When a petient takes the time to come to you for a solution to a problem and they are staring you in the face hoping for answers, you do the best you know with the tools you have to diagnose and treat. I haven’t eaten animal products for 45 years but few people will listen when I tell them to improve their diet. A few might. People like the taste of food and the desire to change habits has to come from somewhere inside. Reading a book does more to change habits than a doctor visit IMHO.

        1. Agreed Cynthia. So I’m writing a book people will read about constipation. Very comprehensive. It’s amazing the stuff people have no idea about on this subject.

          As for the greed, that is the profession itself often. But believe me I have witnessed plenty of naked greed in the medical profession. I nearly beat the shit out of my own surgeon over it.

          The greed doesn’t generally occur though directly between doctor and patient. It’s way more subtle than that.

          It’s when doctors opt for financial gain of one method vs another where there is little to no financial gain. The ingrown toe nail example I used earlier is a perfect example. No one even bothered to comment on it. But using old school invasive surgery in that case leaves patients maimed for life for no good reason. The alternative is easier, harmless, faster, pain-free and works every time and there is no cost involved.

          So don’t assume that greed is at all rare.

          ENTs in my opinion are so bad I consider them predators.

          And THAT speaks loudly to my stance where whole grains are concerned when I bash that sacred cow. Of course dairy gets it too. I’m an equal opportunity kind of guy.

  20. I’m confused because doctors are now saying there is a safe window when you can take HRT without increased risk, depending on when you experienced menopause. They say if you are within 10 years of menopause and under age 60 it is safe to take. They are even saying it’s detrimental not to take HRT if you experience early menopause (under age 45). These include doctors at harvard who say this is according to studies.

    There are very compelling reasons to take HRT! “According to the United States Census Bureau, approximately 43 million U.S. women are of menopausal age (45–64 years). For more than one third of their lives, they will have symptoms such as hot flashes, sleep and mood disturbances, and genitourinary problems. Eighty percent of women experience hot flashes, which are often incapacitating and continue for years after menopause.”

    1. Hello Kristen, and thank you for your question,
      I am a family doctor with a private practice in lifestyle medicine and also a volunteer for Dr. Greger on this website. This issue of the risks and benefits of HRT has very personal importance to me.

      When I was in residency training in the mid-1980’s, I advised my mother to take HRT, mainly because she had a strong family history of osteoporosis. She started taking a combined estrogen/progesterone pill, and after about six years or so, she developed breast cancer.

      [The rest of her story is also sad. Although she recovered, with a mastectomy and chemotherapy, she died at age 79 as an indirect result of osteoporosis, because she had very painful vertebral fractures which laid her up in bed, and she died from a massive pulmonary embolism in 2007(most likely due to her inactivity and to the reluctance of her “pain specialist” to adequately treat her pain)].

      In my former family medicine practice, I prescribed “bio-identical HRT” for a few years in the early 2000’s. After publication of the results of the Women’s Health Initiative, I switched to using only phyto-estrogens, e.g. black cohosh formulations.

      Interestingly, when I Google “benefits and risks of hormone replacement therapy”, I get very different answers from a popular source of medical advice in the US — the Mayo Clinic, vs. “Health-Canada.” Here is the Mayo Clinic:

      And here is advice from Health-Canada:

      It is remarkable to me how different these recommendations are. The Mayo Clinic article (written in May of 2018) gives various circumstances for which “the benefits of hormone therapy may outweigh the risks.” Contrast this with Health-Canada’s summary statement:

      “HRT (Estrogen with or without Progestin) is effective for the control of hot flashes, night sweats and vaginal dryness. However, even short-term use is associated with an increased risk of blood clots, stroke and coronary heart disease. HRT should only be used if your symptoms are severe and if you have been fully informed of the risks. HRT requires regular medical evaluation.”

      So, yes, I agree with your statement that there are “compelling reasons” to consider HRT, given the high prevalence of peri- and post-menopausal symptoms. But on the whole, I agree with Dr. Greger’s assertion that doctors in the US have WAY over-prescribed HRT, both before and after the publication of the results of the Women’s Health Initiative.

      I think there are various reasonable alternatives to HRT for treating menopausal symptoms, including phyto-estrogens. See this video by Dr. G:
      (Of course, I realize that, not being a woman, that’s easy for me to say!!).

      I hope this helps.
      Dr. Jon
      Health Support Volunteer for

      1. Hi Dr. Jon,

        Thank you for your response, and for the additional information. As a consumer I have done very extensive research on HRT, and I came to the conclusion that it’s controversial. As you said, there doesn’t seem to be agreement anywhere. Some, like Dr. Greger, say it’s like prescribing cancer, and other reputable sources say it’s safe when taken under certain circumstances.

        My doctor gave me information that states HRT is safe for me to take for 5 years without an increased risk of breast cancer, and that over 5 years will give me a bit of an increased risk. The medical community has swung back and forth on this, but that seems to be where they are for now at least. I will not be surprised if it swings back once more data comes to light.

        I have decided that, regardless, it’s worth the risk for me. My hot flashes were waking me up 8 times per night, and the lack of sleep affected every area of my life not the least my health. We all now know how important quality sleep is. I am not happy to be on HRT, and my functional medicine doctor is not happy I am on it either. But we think the alternative (chronic lack of sleep for years on end) is worse for my health. I am on a few supplements to help manage cortisol and the detoxing of estrogen that haven’t helped me yet.

        I take bioidentical hormones – the patch for estrogen and the pill for progesterone (no compounding). If I do get breast cancer I will have no way of knowing why, and I will not regret taking the HRT because at this point I have no other alternative. I have been WFPB with an excellent diet and lifestyle for two years, and I have tried many supplements and herbs over the years to treat the hot flashes, including soy and black cohosh. They have not made a difference at all.

        There are many other health issues where people have to weigh the benefits vs the risks. As long as people are fully informed I think we need to support their individual decisions. I hope Dr. Greger does, because I found his video headline alarming. I do read his work often and I have great respect for his opinion.

        I’m very sorry about your mother. Breast cancer is devastating and that must have been very difficult for you both to go through. I hope in most circumstances women won’t need to take HRT, and I hope I can get off it soon.

        Thank you again for your response and for sharing.


    2. Kristen,

      Those are not the global stastics.

      Honestly, if American women are up to 80% having symptoms, when Asian woman barely have any risk, because they eat soy, that says something about the American diet.

      When American women change their diet, their symptoms go away.

      The studies where women either just lost weight or changed their diet all the symptoms were gone within a year and the more they changed their diet, the more radically their symptoms improved and the faster they improve.

      That was what was discovered in the time period after moving away from

      1. If women aren’t willing to eat soy and increase their fruit and vegetables and move away from meat and sugar, then, maybe HRT becomes what they might need.

        BUT, then they have the increased risk of Breast Cancer from the hormone AND they ALSO still have the increased risk of cancer from the animal products, etc.

        Switching their diet, they don’t need the HRT, but not switching the diet, the diet is probably a lot bigger risk than the HRT itself.

        1. Deb I have done all those things you recommend and still have 30 or more hot flushes per day. So unfortunately it doesn’t work for everyone. I won’t use HRT mainly because of the cruel practices involved in making it but also because of cancer risk

  21. I started menopause at 41. Was having hot flashes and my gynecologist put me on Prempro. I took that pill every night for 22 years. In 2018 I was diagnosed with breast cancer. No one in my family had any type of cancer ever
    Now I am taking Letrazole and it is destroying my joints and causing pain in my neck knees and hands
    Just had a surgery on my left thumb 3 days ago and scheduled one in September for my right thumb
    They cannot recommend any medication that does not have severe side effects. Tried them all.
    I dropped meat and I am trying to do weight bearing exercises but still in pain. The hormone therapy was the biggest mistake of my life

    1. it is destroying my joints and causing pain in my neck knees and hands…
      A conversation I had with a friend just yesterday at coffee told of his problems with joints etc.

      He told me not to think he was crazy but someone told him to take CoQ10 for relief. He told of two of his other friends whom he has coffee with said they had found relief from taking that.

      I told him I had been taking CoQ10 for years and had no idea that taking that could be the reason I am pretty much pain free in my joints. I’ve read that our bodies make CoQ10 when we are young but as we age, that no longer is the case.

      As a sidenote, he also said he learned that taking Olive Leaf Extract would cure toe nail fungus. He has been trying that and he says he is seeing the new nail growth coming in pink while the old nail is still black.

      I’ve also been taking Olive Leaf Extract since hearing from Deb that it is perhaps better than olive oil for its health benefits. My toenails seem fine, although I had no idea that was a benefit. ‘-)

  22. This is a resource not referenced in this thread. WHI has been reviewed and results refined since its release. Did Dr. Greger take into consideration the current evaluations of the WHI as his impression seemed to align with the initial knee jerk reaction at its release.

    North American Menopause Association 2017 position statement on HRT

    1. It is still part of the culture where even though the problem is dietary, we give pills instead of fixing diets.

      My friend’s husband’s doctor was giving recommendations to her husband which would keep him doing fine on 3 Diabetes meds, costing him $1000 per month.

      She tried to ask if he could eat in ways to come off of one of the meds and the doctor said, “No, he is doing fine.”

  23. It used to be 55% of women who had problems and now, dietarily, we are up to 80% of women having problems, and that is a dietary problem so big that women need a dietary movement.

    You see, no matter whether they take the estrogen or not, the risk factors from the diet are so bad that the estrogen is just a band-aid.

  24. I am going to say that again.

    It seems maybe that the need for HRT comes from the SAD, as evidenced by cultures who don’t need it, including Asian women and the Adventist vegans.

    By focusing on the band-aid, rather than correcting diet, women end up delaying fixing the real problem of their diets.

  25. If I had fixed the Diabetes symptoms with meds and the Homocysteine symptoms with Estrogen, I never would have started eating fruits and vegetables and legumes and I would never know the power of food to heal.

  26. It feels like Whole Food Plant-Based is a “Road Less Traveled” experience.

    The people around me who go medical model and take pills don’t seem to have the resolve to do the dietary changes.

    Their numbers get better on blood pressure meds and Diabetes meds and statins, etc, and those improved numbers are what they are focused on.

    Those of us who are stubbornly trying to get out of taking meds are highly motivated to change our diets.

  27. I’m a Board Certified ObGyn and I don’t always agree with everything my professional organization (ACOG) puts out, but they have published guidelines for use of HRT based on evidence from the WHI study. I was wondering if you might do a video or short series of videos on the findings of that important study, because there may be some details that are important for folks to understand. For example, the purpose of the study was to see if HRT was of value for primary prevention of heart disease, dementia and osteoporosis; And we learned that it should not be used for this purpose. However, the mean age of participants was 63.3 (not 50, when most women complain of miserable vasomotor symptoms and desire some help). There was a small increased risk of breast cancer in the Prempro (estrogen with progestin) arm, but only after 5 years of HRT, and there was no increased risk of breast cancer in the Premarin (estrogen) only arm of the study, which was stopped for the increased stroke risk (it’s no panacea, I know). There was a decreased risk of colorectal cancer seen in both groups and a decrease in hip fractures, insulin resistance and cataracts. Estrogen alone was even protective against CHD and invasive breast cancer. Women who get breast cancer while on estrogen seem to have more well differentiated cancers, I believe. I read that all cause mortality was decreased in both groups when compared to controls; Is this an inaccurate analysis? We are being advised by ACOG that if women are in the first few years after menopause, and are at low or moderate risk of cardiovascular disease, that they can be on HRT for severe vasomotor symptoms of menopause. And if they have a hysterectomy, ERT would be even safer. Of course there are alternatives, like Paxil and Clonidine (ACOG doesn’t think that soy phytoestrogens have any significant effect…but that’s another struggle), but we are not being told that the WHI study (or any other) proved that ERT causes breast cancer.
    I would so appreciate your expert opinion on the results of the WHI study (at least the randomized controlled parts of it, E+P and E alone). My first obligation is to do no harm, but vasomotor instability is so unbearable for many women. I recommend your site to every single one of my patients in their “After Visit Summary.” I just want to give consistent and accurate information, based on the available evidence. I honestly don’t think we (you) can say that estrogen replacement causes breast cancer, based on the results of the estrogen alone arm of the WHI.
    Thank you so much for your expert advice,

    Debra Shapiro, MD FACOG
    A New View of Food

    1. Thank you Dr.! I just posted the question about Estrogen alone not being considered in the equation in the article. I worked at a Blood Bank and one of the Nurse’s daughters was a Research Scientist at Berkley who said, at the time of the study, that the study was flawed.

      1. Cathy,

        First the biggest take away from this study should be the researchers use of the conjugated estrogens from mare’s urine and the use of progestins an artificial form of progesterone. Neither of these is “bio-identical” to any women. We still seem to have all estrogens/progesterone’s lumped into the same category, a decade plus latter.

        Second since the groundbreaking studies results, which indeed were long overdue and clearly showed how medicine chose to completely turn a blind eye to patient first care vs dollars, with obvious adverse health results. And as pointed out the drums are still beating for the synthetics, but at a lessened level now that we have bio-identical prescription FDA approved options. Sad how dollars consistently trump healthy alternatives.

        For some thoughts on the Women’s Health Initiative studies weaknesses please see this brief interpretation:, from 2003. And yes, at that time there were many more limits on our current set of knowledge regarding herbal, food, BHT options with published studies.

        Then we have a completely different take on risk by using the Bio-identical hormones. This is a landmine of both controversies based on dollars and science. You might find it interesting that the tides are turning with the recent ( 2018) FDA approved bioidentical hormone combination,

        The two camps are very much still in the throes of distinctly different directions. After treating women for 30+ years I’ve found that those who indeed have significant, life impacting symptoms from menopausal endocrine decline and who have not been responsive to diet/lifestyle interventions, many benefit significantly from BHT. The use of hormones should be based on an informed discussion regarding the known and unknown risks between the patient and their provider.

        Dr. Alan Kadish moderator for Dr. Greger

  28. Dear Doctor, I am not new to your bogs and videos but new to ‘commenting’. I actually have an unrelated query but hope you can help. My daughter has recently diagnosed breast cancer and is treating it naturally. She is wanting to fast on juices for a moderate length of time, perhaps two weeks. How do I access your recent talk on various ways of fasting?
    Her other question at this stage is, “Am I able to continue taking natural supplements while I am fasting?”
    I wold appreciate if you could point me in the right direction to find this information please.
    Thank you so much.
    Kindest regards

    1. Hi, Delphine. I am a healthcare professional, plant based and all. My close friend recently got ill with breast cancer. I thought traditional treatment was her best bet for longer survival, but the surgery and chemo was supported by good nutrition, rest and exercise (as much as she could do). I highly recommend the same for your daughter. If your natural way of approaching her breast cancer doesn’t work, what then? If you loose her, how will you feel? Dr Greger is not recommending treating cancer naturally.

      1. I agree with Pip. My wife had breast cancer due to stress. Even though I’ve done extensive research on natural healing we opted for the traditional approach right away without losing a second. She recovered. Also using nutritional therapy after surgery. My wife only needed radiation, not chemo because she caught it early. Every second of delay is a opportunity wasted with breast cancer.

        My view is that so far I’m not seeing or hearing about any natural healing happening that can be relied upon. I’m not seeing evidence of clinical trials. You hear of rumours but you don’t get names of survivors who you can talk to so you can be sure what you heard about is real. What I have heard is people trying natural means dying one after the other from delaying treatment.

        Yes, people can heal naturally but they continue to be the exception rather than the rule.

        My wife is important to me. Her breast was important to both of us but not enough that we would gamble with her life.

        Trying to heal cancer naturally at this stage when the medical profession cannot even treat constipation properly is nothing less than foolish.

        I compare cancer to mould on an orange. I know cancer is not mould but the process is similar. Mould on an orange cannot be halted. It can only be slowed down. The mouldy portion never recovers. It can’t because it’s dead and an orange is no longer part of the tree. So no new life flows into it. We are not that much more powerful than an orange when it comes to fighting off certain invasives.

        All you can do with an orange is cut off the mouldy parts and hope the rest has not been affected. However, if the mould is more than vestigial, the orange is too far gone for us to enjoy the taste. With a human, the cancer has to be physically prevented from spreading and the only way to do that is by cutting out the offending tissues and again, hoping you get all of it.

        Natural techniques using nutrition as medicine are not natural for this type of aggressive assault.

  29. I thought that the risk was for women who started to take estrogen & progesterone years after starting menopause? What about women who took just estrogen? I was working at a Blood Bank at the time of this report and one of the Nurses daughters worked at Berkley as a Researcher and said the study was flawed. Any thoughts about this?

    1. Hi Cathy, I see you already pointed out that the study was flawed because the risk was for women who had started estrogens years after menopause. See my post just below.

  30. I’m afraid that Dr Gregor got this one wrong. The study he refers to showed just eight more cases of cancer per ten thousand patients (less than one in a thousand), but the people running the study panicked and stopped the study in spite of the OVERALL death rate being lower in the women receiving estrogens (probably due to fewer hip fractures, etc).

    Later the study was analyzed and it was discovered that the extra breast cancer cases were not in women who stayed on estrogen but in women who had been off for ten years or more and then restarted (for the study?), but it was too late. Everyone was scared.

    Women’s ovaries produce estrogen for what the normal life expectancy was. Now women live 30 years or more past menopause. Because of that flawed study, 999 women out of 1000 when going through menopause are deprived of the chance to keep their bodies young by continuing the same estrogens their bodies produced before menopause.

    Granted it’s a small sample, but all the female GYNECOLOGISTS I know either have stayed on estrogen replacement post menopause, or plan to when they get there.

  31. When I shared your video on Facebook, someone commented that the study was overstated and they included this link: (Landmark trial overstated HRT risk for younger women / CMAJ News).

    I was under the impression that a study doesn’t make it into your archives unless it passes all of the guidelines for ethics, sample size, significance level, and so on. (CMAJ seems to be by doctors for doctors and so I consider the organization highly susceptible to conflict of interest.)

  32. Apparently there is a youtube phenomenon Menopause Barbie (dr. Barbara Taylor) who (I have been told, cant stand to check) promotes HRT. People really will hear whatever they want to hear. At any cost.

  33. What about birth control containing estrogen? It seems like this would be just as harmful but still readily being prescribed. Any evidence against using this?

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