The HRT Reckoning: Why Your Kitchen Is 35X Riskier

HRT Reckoning: Why the FDA’s reversal proves women have been gaslighted for 20 years

The headlines are shifting, and the FDA’s new stance on HRT finally acknowledges what women should have been told decades ago. When the FDA removed the infamous “black box” warnings from Hormone Replacement Therapy labels, backed by clarity from research such as the 2024 JAMA review, the change became more than an administrative update. It became proof of a systemic failure in women’s health.
It really makes no sense to think that any medical intervention or treatment can be universally equivalent for every person at the same dose. We are individuals and should demand an individualized approach to healthcare.

For over twenty years, millions of perimenopausal and menopausal women were denied life-changing treatment because of fear-driven conclusions from the Women’s Health Initiative (WHI). It is time to retire the fear and expose the ethical narrowness that created this health crisis.

The Narrow Lens of the WHI: An Ethical Failure 

The 2002 WHI study that halted widespread HRT use had a fatal flaw: an extremely limited scope. Its blanket warnings were based on only three pharmaceutical products:

1. Premarin (Conjugated Equine Estrogens): Estrogen derived from pregnant mare urine – bioidentical to a horse, not a human.
2. Provera (Medroxyprogesterone Acetate): A synthetic progestin chemically engineered to mimic progesterone but not progesterone itself.
3. Prempro: A combination of Premarin and Provera.

Here is the central ethical issue: By basing universal recommendations on just these products, the WHI ignored vast experience and research involving other hormone options. This narrow approach was not science — it was a reflection of the “one size fits all” pharmaceutical model.

The Chemical Lie: Progestins Are Not Progesterone 

The WHI’s most concerning finding — higher breast-cancer risk in combined-therapy users — was tied directly to Provera, the synthetic progestin. This distinction matters:

• Progesterone is a human hormone with protective effects in the breasts, brain, cardiovascular system, and more.
• Progestin (like Provera) is chemically altered, interacts differently with receptors, and follows different metabolic pathways.

Applying the cancer-risk findings from a synthetic progestin to bioidentical human progesterone was scientifically unsound and intellectually dishonest.

Re-analysis of the WHI clearly showed that estrogen-only users (women with hysterectomies) experienced reduced breast-cancer risk and lower all-cause mortality, strongly suggesting the synthetic progestin — not hormone replacement itself — was the real problem.

35X Safer Than Your Kitchen: The Risk Reframed

New data from re-evaluated WHI trials found that for women under 60 starting HRT early in menopause, the risk of an additional serious adverse event is less than one in 1,000 per year.

To put that in perspective: You are 35–40 times more likely to suffer a medically significant injury in your own home — falls, cuts, burns — than from early HRT. The sustained fear around hormones is completely illogical when compared to the everyday risks we accept without hesitation.

The Missing Piece: Bioidentical Hormone Replacement Therapy (BHRT)

A critical question lingers: What if the WHI had studied bioidentical hormones?

Functional medicine focuses on BHRT — hormones like estradiol, estrone, progesterone, and testosterone that are chemically identical to human hormones. These are individualized, often compounded, and free from the “one-size-fits-all” approach.

For years, the FDA and the pharmaceutical sector pushed to restrict compounded BHRT. This new reversal is almost a tacit admission that women were steered away from individualized therapies that could have transformed their health and aging experience.

The WHI was limited, ethically flawed, and responsible for decades of unnecessary suffering. Women were denied the right to explore their options.

The time for fear is over. The time for honest discussion about BHRT, individualized hormonal support, and evidence-based care has begun. Now that the FDA has corrected the record, it is time for practitioners who denied women options to offer a sincere apology.

Written by Bryan Treacy for ravoke.com — and at Ravoke we proudly support women’s health. Dr. Bryan Treacy’s journey began with over three decades of dedicated service as an Obstetrician and Gynecologist. His extensive experience in women’s health laid a strong foundation in medical science and patient care. Recognizing the limitations of traditional medicine, Dr. Treacy transitioned to holistic health consultancy, merging scientific knowledge with a comprehensive understanding of wellness.