How misread WHI data reshaped menopause care and training

Clinician approaches to menopausal hormone therapy have shifted dramatically over the past 5 decades, from broad acceptance to near abandonment to a renewed surge of interest, according to Mary Jane Minkin, MD, FACOG. A single study reshaped both prescribing and physician training, and the field is still working to recover, Minkin said at The Menopause Society 2026 Annual Meeting.

When Minkin began medical school in 1971, hormone therapy was viewed favorably not only for symptom relief but also for broader health benefits. Its protective effect on bone was well recognized by that point, and potential cardiac benefits were under investigation.

That changed on July 9, 2002, when results from the estrogen plus progestin arm of the Women’s Health Initiative (WHI) were released, showing a slight increased risk of breast cancer among women receiving combined therapy. According to Minkin, the findings were widely misinterpreted, and estrogen went from being viewed as beneficial to harmful essentially overnight—a moment she described as “the day the music died.” The distinction between the 2 arms of the WHI was largely lost in early messaging.

“[T]hat showed only the slight increased risk in breast cancer in women taking estrogen plus progestin. The estrogen-only arm never showed that,” Minkin said.

Beyond misleading patients, the more lasting consequence was the erosion of menopause education. The WHI findings coincided with reductions in resident duty hours, forcing programs to prioritize core obstetric and surgical training.

“Menopause got short shrift because they said, well, if nobody’s going to be prescribing estrogen, why should we bother to teach menopause?” Minkin said.

Survey data have documented that gap. A Johns Hopkins–led needs assessment of obstetrics and gynecology residency programs found that approximately 20% were teaching menopause as a formal subject.¹ A similar national survey published a decade later, in 2023, found that approximately 30% of residency programs were teaching menopause.²

Also in 2023, The New York Times Magazine published an article titled “Women Have Been Misled About Menopause,” which examined how the WHI data had been misinterpreted. According to Minkin, many women began questioning why they had been denied estrogen therapy, prompting a surge of patient and clinician interest in menopause care.

Residency programs are now working to catch up on menopause education, and the shift is reflected in the growth of The Menopause Society. Membership held at roughly 2000 to 2500 for years before climbing to approximately 4000 about 4 years ago, then to 6000, then 12000, and now approximately 15000, according to Minkin. Attendance at the 2026 Annual Meeting required an overflow room for clinicians unable to enter the main session. Despite that momentum, Minkin emphasized that substantial work remains to ensure that all ob-gyns are adequately educated in menopause management.

References

1. Christianson MS, Ducie JA, Altman K, et al. Menopause education: needs assessment of American obstetrics and gynecology residents. Menopause. 2013;20(11):1120-1125. doi:10.1097/GME.0b013e31828ced7f
2. Allen JT, Laks S, Zahler-Miller C, et al. Needs assessment of menopause education in United States obstetrics and gynecology residency training programs. Menopause. 2023;30(10):1002-1005. doi:10.1097/GME.0000000000002234