Ecological MHT Practice: ESM Pathways to Precision Women's Health

This article applies Evidence-Selective Medicine (ESM)—author's established six-level framework for institutional bias propagation—to dissect MHT breast cancer dogma origins: E3N paradox artifacts, Lancet 2019 synthetic dominance (>90% cohort), guideline citation cascades. Evidence reanalysis: E3N tE2-alone RR 1.29 artifactual (25% prior synthetics + surveillance bias); tE2+micronized progesterone RR 0.96 null Norwegian cohort: oral E2+synthetic HR 2.42 (95% CI 2.31-2.54) vs transdermal ~1.2-1.5 (underpowered) Competing risks: Bioidentical MHT 25-50% CV mortality reduction, 50% fracture prevention vs AI harms (CV events +7-12%, major FX +8-13%) in low-risk HR+/HER2- DCIS/stage 1 IDC Novel paradigm: "Orphan endocrine insufficiency"—menopause requires systemic restoration across fragmented OBGYN-oncology-primary-geriatrics care. Clinical toolkit: ESM checklist, COMET de-escalation (>95% 10yr survival, 44% surgery crossover), Canterbury-standard consent templates, absolute risk-benefit tables. Timing: Post-FDA 2026 black-box removals (Nov 2025 announcement; Feb approvals: Prometrium, Bijuva, etc.)—translates regulatory shift into implementable precision care.