Exposing the Category Errors Behind Decades of Misapplied Evidence in Menopausal Hormone Therapy

Since 2002, the treatment of menopausal women has been rooted in a symptomatic care heuristic (“lowest dose, shortest duration”), rather than an orientation toward effective health promotion and disease prevention. Current, entrenched MHT guidelines extrapolate evidence from earlier systemic formulations (i.e. oral Premarin, Prempro), with vastly different pharmacology, physiologic effects and therapeutic risks, onto modern bioidentical formulations. Meanwhile, extensive evidence continues to accumulate establishing the disease prevention benefits of modern bioidentical formulations. A clarification of the logical and scientific errors sustaining current MHT guidelines is long overdue. Women deserve an accurate, evidence-based medical language that recognizes molecular, metabolic, and mechanistic reality.