Evidence based health promotion: Correcting health misinformation

The landmark Women’s Health Initiative (WHI) was a large U.S. trial that, in 2002, reported that certain types of menopausal hormone therapy slightly increased some health risks, however, the way those results were analyzed and publicized led to a much more frightening message than the data justified (Vogel, 2017).

Claims about breast cancer and “HRT being dangerous” led to a frenzy of misinformation and sensationalized risk framing by the media. Media headlines oversimplified the message to “HRT causes breast cancer and heart disease,” without explaining age differences, type of hormones used, or the small absolute risk (Vogel, 2017). In 2002, early results from the estrogen‑plus‑progestin arm caused the study to be stopped. This was announced via press conference and high‑profile publications emphasized increased risks of breast cancer, heart attack, stroke, and clots (Vogel, 2017).

Reports stated a “26% increase in breast cancer” when in fact only approximately 8 additional breast cancer cases per 10,000 women per year on combined HRT compared with placebo, were identified. This difference was not statistically significant at the time of the initial report (Bluming & Tavris, 2009).

The implications surrounding the misinformation of this study have been catastrophic for women. Use of menopausal hormone therapy dropped by up to 70–80% in the years after 2002, and many women stopped or never started HRT, despite severe symptoms and potentially favorable risk–benefit profiles (Bluming & Tavris, 2009). News-hungry media, including social media is responsible for fear mongering when reporting data. Bluming and Tavris (2009) explain that it is critical to identify the baseline of absolute numbers and not only as a percentage change or relative risk, which can be highly misleading. Promoting statistical literacy—especially the ability to help the public and clinicians understand actual versus inflated risks of diseases and treatments requires knowing the baseline absolute numbers when comparing groups (Bluming & Tavris, 2009).

The Ottawa Charter health promotion action areas can support translation of new understanding of the WHI study and the consequences of the widespread misinformation. For example, building public policies grounded in accurate risk assessment and communication. Creating policies that correct misinformation and reduce harm from outdated interpretations.

Creating supportive environments could look like normalizing menopause as a significant health transition, encouraging informed, shared decision‑making and reducing stigma around women’s midlife health needs, for example.

Reorienting health services toward health promotion rather than narrow biomedical risk management is another action area to be explored. Clear, updated evidence for all physicians, encourage person‑centered

, individualized care that recognizes women’s diverse needs and creating a values shift from disease‑avoidance to preventative, quality‑of‑life promoting menopause health care.  

References

Bluming, Avrum Z. MD; Tavris, Carol PhD. Hormone Replacement Therapy: Real Concerns and False Alarms. The Cancer Journal 15(2):p 93-104, March 2009. https://www.menopausecare.com/wp-content/uploads/2025/04/Hormone_Replacement_Therapy_Real_Concerns_and_Fals.pdf

Vogel L. (2017). Trial overstated HRT risk for younger women. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 189(17), E648–E649. https://doi.org/10.1503/cmaj.1095421