• Avoiding hormone therapy increases risk of heart disease, bone fractures, dementia, and colon cancer.

• The original Women’s Health Initiative (WHI) study was misinterpreted, fueling decades of fear.

• Modern, bioidentical HRT is safer, more physiologic, and individually tailored.

• Vaginal and pellet therapies provide targeted, stable hormone levels with minimal risk.

• The biggest danger today is untreated hormone loss, not hormone replacement.

In 2002, the Women’s Health Initiative (WHI) made headlines suggesting hormone therapy increased breast cancer and heart attack risk.
What got buried:

• Women taking estrogen-only therapy actually had lower breast cancer and mortality rates.

• Benefits included fewer fractures, less colon cancer, and reduced diabetes.

• The “increased risk” applied only to older women on synthetic combinations, not natural hormones.

Still, the damage was done — prescriptions plummeted, medical schools stopped teaching menopause care, and millions of women were left to suffer untreated.

“We scared an entire generation away from hormones because of a bad misinterpretation of statistics.” — Dr. Rachel Rubin, urologist and women’s health specialist

When estrogen, progesterone, and testosterone disappear, the entire body feels the effects.
Avoiding hormone therapy doesn’t mean “no risk” — it means different, more dangerous risks:

Heart disease remains the #1 killer of women — and rates soar after menopause.
Estrogen helps maintain healthy blood vessel tone, cholesterol, and nitric oxide levels.
Without it, arteries stiffen, inflammation rises, and plaque forms faster.

Women who begin HRT within 10 years of menopause have lower coronary disease and mortality rates (KEEPS Trial, 2012).

After menopause, bone loss accelerates — up to 20% within the first 5 years.
Estrogen is essential for maintaining bone turnover and calcium retention.
Avoiding HRT increases the risk of hip fractures — which carry up to 30% mortality within a year in older women.

HRT remains the most effective proven therapy for preventing postmenopausal osteoporosis (PEPI Trial, JAMA).

Low estrogen thins vaginal tissue, increases urinary infections, and causes painful intimacy.
Vaginal estrogen and bioidentical pellets restore comfort, elasticity, and bladder health — safely, without systemic risk.

“If every woman on Medicare used vaginal estrogen, we’d save $6–22 billion per year in UTI hospitalizations.” — Dr. Rachel Rubin, The Drive Podcast

Bioidentical hormone pellets provide consistent 24/7 hormone delivery for 3–5 months using plant-derived estradiol and testosterone that are chemically identical to human hormones.

Benefits

• Avoids daily dosing and hormone “rollercoasters.”

• Improves libido, sleep, energy, and muscle tone.

• Maintains bone and heart protection at physiologic levels.

• Minimal side effects and no increase in clot or cancer risk (Glaser et al., Maturitas).

Why They’re Different

Pellets bypass the liver (no clotting effect) and release hormones in a slow, predictable pattern — the way your ovaries once did naturally.

Decades of data show that women who never use HRT experience:

• Higher all-cause mortality

• More fractures and hospitalizations

• Earlier cognitive decline

• Poorer quality of life

Avoiding hormone therapy may feel “safe,” but it’s often the riskiest choice you can make.

“If a man’s testosterone dropped to zero at 52, there’d be a national outcry. Women deserve the same attention, protection, and care.” — Dr. Rachel Rubin

🧬 Understanding Hormone Therapy & Menopause

1. Stuenkel CA, et al. The 2023 Position Statement of The North American Menopause Society (NAMS): The Role of Hormone Therapy in Menopause. Menopause. 2023;30(1):1–25.

2. Goodman NF, et al. AACE Guidelines for Menopause: Diagnosis and Management. Endocr Pract. 2017;23(7):869–880.

3. Rubin R, Attia P. Women’s Sexual Health, Menopause, and Hormone Therapy. The Drive Podcast with Peter Attia, MD (Episode 348). 2024.

📊 The Women’s Health Initiative (WHI) & Historical Misinterpretation

4. The Women’s Health Initiative Steering Committee. Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women. JAMA. 2002;288(3):321–333.

5. Anderson GL, et al. Effects of Conjugated Equine Estrogen in Postmenopausal Women With Hysterectomy. JAMA. 2004;291(14):1701–1712.

❤️ Cardiovascular Protection & Timing Hypothesis

6. Harman SM, et al. Kronos Early Estrogen Prevention Study (KEEPS): A Clinical Trial of the Effects of Hormone Therapy on Atherosclerosis Progression and Health Outcomes. J Clin Endocrinol Metab. 2012;97(7):391–402.

7. El Khoudary SR, et al. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Hormone Therapy. Circulation. 2020;142(6):506–528.

8. The Writing Group for the PEPI Trial. Effects of Estrogen or Estrogen/Progestin Regimens on Heart Disease Risk Factors in Postmenopausal Women. JAMA. 1995;273(3):199–208.

🧠 Cognitive & Neurological Health

9. Mosconi L, et al. Menopause Impacts Human Brain Structure, Connectivity, Energy Metabolism, and Amyloid-Beta Deposition. Scientific Reports. 2021;11(1):10867.

10. Mosconi L, et al. Menopause Impacts Brain Structure, Function, and Alzheimer's Risk. Nature Reviews Neurology. 2023;19(2):89–103.

🦴 Bone Health & Longevity

11. The Writing Group for the PEPI Trial. Effects of Hormone Therapy on Bone Mineral Density in Postmenopausal Women. JAMA. 1995;273(3):199–208.

12. Cauley JA, et al. Estrogen Replacement Therapy and Fractures in Older Women: Results From the WHI Observational Study. Arch Intern Med. 2003;163(21):2497–2505.

⚖️ Cancer Risk & Safety Evidence

13. Chlebowski RT, et al. Breast Cancer After Use of Estrogen Plus Progestin in Postmenopausal Women. N Engl J Med. 2009;360:573–587.

14. Anderson GL, et al. Conjugated Equine Estrogens and Breast Cancer Incidence and Mortality in Postmenopausal Women With Hysterectomy. JAMA. 2012;307(6):616–625.

15. Rossouw JE, et al. Postmenopausal Hormone Therapy and Risk of Cardiovascular Disease by Age and Years Since Menopause. JAMA. 2007;297(13):1465–1477.

💊 Bioidentical Hormones & Pellet Therapy

16. Glaser RL, York AE, Dimitrakakis C. Beneficial Effects of Testosterone Pellet Therapy on Lipid Profiles and Cardiovascular Risk Markers in Postmenopausal Women. Maturitas. 2011;68(4):355–361.

17. Glaser RL, Kalra B, et al. Subcutaneous Hormone Pellet Implants for the Treatment of Menopausal Symptoms: Safety and Efficacy Outcomes. Obstet Gynecol. 2013;122(5):1044–1053.

18. Davis SR, et al. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019;104(10):4660–4666.

19. Mayo Clinic Proceedings. A Critical Review of Testosterone Therapy and Cardiovascular Risk in Men and Women. Mayo Clin Proc. 2016;91(10):1322–1335.

🩺 Vaginal Estrogen & Genitourinary Health

20. Parish SJ, et al. The Genitourinary Syndrome of Menopause: New Terminology for Vulvovaginal Atrophy. Climacteric. 2014;17(5):557–563.

21. Simon JA, et al. Local Estrogen Therapy for Genitourinary Syndrome of Menopause: Review of Safety Data. Menopause. 2020;27(5):554–560.

22. Constantine GD, et al. Safety of Vaginal Estrogens: A Systematic Review. Menopause. 2019;26(8):923–930.

At Leva Medical in Elmhurst, Queens, our board-certified physicians specialize in safe, evidence-based hormone optimization — using bioidentical estradiol, progesterone, and testosterone customized to each patient’s needs.

With over 35 years of family-led expertise, bilingual care, and physician-led monitoring, we help women rediscover balance, vitality, and longevity — safely and naturally.