Just wanted to say thank you for this powerhouse of a post. I’m floored by the clarity, the rigor, and the unapologetic calling out of cherry-picked science masquerading as care. It’s rare to see someone hold the line so firmly for actual evidence-based medicine, especially in a space as riddled with politics, misogyny, and misinformation as menopause care.
Your work is helping so many of us stay grounded, skeptical, and supported. Grateful for your voice in this moment (and always).
You may call him Macaroni, but I have been calling him Malarkey, ever since I first heard about him some years ago. His now exalted position has not changed my opinion of him, one whit.
Good gif! Will this shit storm ever end? People can bash WHI all they want, but WHI was meant to study MHT as a public health initiative. Kind of like vaccinations. As such they had to set the potential risk of damage very low. As you said, we thought that MHT would be the thing that kept women dying from heart disease… well, it wasn’t and didn’t.
No doubt this menopause panel will be as “respected and scientific” as the new ACIP….
Dr. Gunter, thank you for everything you do to advocate for safe, effective, evidence-based care for women. Your work has been incredibly inspiring. As a RN with a passion for women’s health, I was so moved by your mission that I partnered with a local physician to launch a research project aimed at improving menopause education in our rural community.
Thanks to this initiative, we’ve received funding for a second year and are now developing a Women’s Health Hub — a MSCP nurse-led, GP-supported model where all women (especially unattached patients) can access high-quality menopause education. When needed, they’ll also be able to see a GP with advanced training in women’s health for treatment, diagnostics, and follow-up. This model is already helping to reduce barriers and wait time for OB/GYN referrals, and improve access to care in our region.
So once again — thank you. Your voice and leadership are driving real change, and we are so proud (and thrilled!) to have you back in Canada.
"Doctors are responsible for continuing their education..." -- ain't that the truth. I've been astonished at things I've encountered or have heard from others about Ob/Gyns not knowing stuff that I (Women's Health NP) knew about oral contraceptives or menopause.[e.g. I had to explain to an MD I went to what the difference between FemRing & Estring was...] I mean, are NP conferences better than MD conferences? I kind of doubt it, considering I assume that the MDs that spoke at the NP conf.s also spoke at MD conf.s. Do they not go, or just not pay attention if they do? And don't get me started on the head of pathology at a hospital who didn't know the difference between hi & lo- risk HPV. I read the ACOG bulletin; why didn't she?!
So true, Makary has a massive blind spot in the conversation about menopause, which is so ironic given his stated commitment to solidly evidence based medicine. The studies he cites are valuable as hypothesis generating studies, but are not actual clinical trials.
I am a recently retired physician- When I started medical school in the 1970's it was dogma that women required "hormone replacement" during and after menopause, quite misogynistic, paternalistic, and all based on, at best, observational or cohort studies. Anyone who dared point out the flaws in this theory was solidly shut down. And Makary seems to be bringing it all back.
I remember the extreme response to the results of the WHI, which did not affect me in my specialist field but my gyn colleagues promptly stopped prescribing hormone therapy. Which would be weirdly abrupt, however the WHI results gave rise to malpractice lawsuits alleging that a woman's hormone therapy caused her breast cancer (and the lawsuits were successful). Not surprising that clinicians backed away from it.
Thank you so much for all of your deep dives into these topics, I know well how much effort and time are required.
I went to med school in the 80s and kinda the same thing: you go from contraception to hormone replacement because the evidence we had showed decreased heart disease. The WHI refuted that and showed a slight increase in breast cancer. This goes against “above all do no harm”. WHI was never meant to bash MHT, it just showed that not every woman should be on it.
I read his book and watched interviews when he was on tour promoting it. Menoinfluencers and their followers were ecstatic. He jumped on the menopause bandwagon with his disinformation because he knew he had an audience with a lot of women who were not getting answers from their doctors. It was an exercise in futility pushing back on his claims because he was saying what this demographic wanted to hear.
ZDOGGMD interviewed MM and Prasad. Prasad expressed a little bit of skepticism at MM's claims but didn't go far enough, probably bc he was vying for a position in the administration at the time.
You are incredible and I thank you for all the effort you put into these posts!! And I am sorry for the toll that it takes on you. Misinformation does not rest, and I appreciate your work to combat it. Thank you!
***
IMHO: Before I retired, I was a technical researcher/editor, and I wonder if you meant to say "MHT causing breast cancer" and not "breast cancer causing MHT" (or maybe "breast cancer causing-MHT") in the sentence: "And based on how Wyeth faced thousands of lawsuits for breast cancer causing MHT and hiding information from women, that concern seems valid in retrospect." ?
Interesting information. The WHI study has been re evaluated by several "experts" in the field of menopause as well as other specialists that deal with women's health. I wonder since there are so many variables regarding that study , for example (and I have read the study) how many of the women taking the prescribed oral estrogen and progesterone had low or even high thyroid levels? Since thyroid issues are more common in women who are experiencing peri and menopause how many times were their levels checked during that study? Thyroid issues present with the same issues and low thyroid can impact the heart, muscles, moods etc. The WHI used oral estrogen and progesterone if required which from what researchers have included in recent studies (2020-2024) impacts women more. Also as you have mentioned in a previous blog there are several different types of estrogen in premarin is that where the issue lies, animal versus plant based products? WOmen who use transdermal estrogen only to help prevent osteoarthritis or slow is progression have to take some risks of other issues as well. I certainly could be wrong , but I have read and do understand the material and statistics presented by the researchers.
Just wanted to say thank you for this powerhouse of a post. I’m floored by the clarity, the rigor, and the unapologetic calling out of cherry-picked science masquerading as care. It’s rare to see someone hold the line so firmly for actual evidence-based medicine, especially in a space as riddled with politics, misogyny, and misinformation as menopause care.
Your work is helping so many of us stay grounded, skeptical, and supported. Grateful for your voice in this moment (and always).
As ever, Dr. Gunter, thank you for the hard and necessary work you do.
Thank you. This one just about killed me!
Dear Dr. Jen,
You may call him Macaroni, but I have been calling him Malarkey, ever since I first heard about him some years ago. His now exalted position has not changed my opinion of him, one whit.
Thank you for providing accurate information.
How do you do it all and so eloquently? Your effort, perspective and insight is treasured. Thank you.
You're the best. Thank you.
Good gif! Will this shit storm ever end? People can bash WHI all they want, but WHI was meant to study MHT as a public health initiative. Kind of like vaccinations. As such they had to set the potential risk of damage very low. As you said, we thought that MHT would be the thing that kept women dying from heart disease… well, it wasn’t and didn’t.
No doubt this menopause panel will be as “respected and scientific” as the new ACIP….
Stick with the actual experts!
Yup
Dr. Gunter, thank you for everything you do to advocate for safe, effective, evidence-based care for women. Your work has been incredibly inspiring. As a RN with a passion for women’s health, I was so moved by your mission that I partnered with a local physician to launch a research project aimed at improving menopause education in our rural community.
Thanks to this initiative, we’ve received funding for a second year and are now developing a Women’s Health Hub — a MSCP nurse-led, GP-supported model where all women (especially unattached patients) can access high-quality menopause education. When needed, they’ll also be able to see a GP with advanced training in women’s health for treatment, diagnostics, and follow-up. This model is already helping to reduce barriers and wait time for OB/GYN referrals, and improve access to care in our region.
So once again — thank you. Your voice and leadership are driving real change, and we are so proud (and thrilled!) to have you back in Canada.
Thank you for this review
Another home run!
"Doctors are responsible for continuing their education..." -- ain't that the truth. I've been astonished at things I've encountered or have heard from others about Ob/Gyns not knowing stuff that I (Women's Health NP) knew about oral contraceptives or menopause.[e.g. I had to explain to an MD I went to what the difference between FemRing & Estring was...] I mean, are NP conferences better than MD conferences? I kind of doubt it, considering I assume that the MDs that spoke at the NP conf.s also spoke at MD conf.s. Do they not go, or just not pay attention if they do? And don't get me started on the head of pathology at a hospital who didn't know the difference between hi & lo- risk HPV. I read the ACOG bulletin; why didn't she?!
Thank you, Dr. Gunter! What can we do to advocate for more studies and research on women’s health, especially menopause?
So true, Makary has a massive blind spot in the conversation about menopause, which is so ironic given his stated commitment to solidly evidence based medicine. The studies he cites are valuable as hypothesis generating studies, but are not actual clinical trials.
I am a recently retired physician- When I started medical school in the 1970's it was dogma that women required "hormone replacement" during and after menopause, quite misogynistic, paternalistic, and all based on, at best, observational or cohort studies. Anyone who dared point out the flaws in this theory was solidly shut down. And Makary seems to be bringing it all back.
I remember the extreme response to the results of the WHI, which did not affect me in my specialist field but my gyn colleagues promptly stopped prescribing hormone therapy. Which would be weirdly abrupt, however the WHI results gave rise to malpractice lawsuits alleging that a woman's hormone therapy caused her breast cancer (and the lawsuits were successful). Not surprising that clinicians backed away from it.
Thank you so much for all of your deep dives into these topics, I know well how much effort and time are required.
I went to med school in the 80s and kinda the same thing: you go from contraception to hormone replacement because the evidence we had showed decreased heart disease. The WHI refuted that and showed a slight increase in breast cancer. This goes against “above all do no harm”. WHI was never meant to bash MHT, it just showed that not every woman should be on it.
I read his book and watched interviews when he was on tour promoting it. Menoinfluencers and their followers were ecstatic. He jumped on the menopause bandwagon with his disinformation because he knew he had an audience with a lot of women who were not getting answers from their doctors. It was an exercise in futility pushing back on his claims because he was saying what this demographic wanted to hear.
ZDOGGMD interviewed MM and Prasad. Prasad expressed a little bit of skepticism at MM's claims but didn't go far enough, probably bc he was vying for a position in the administration at the time.
You are incredible and I thank you for all the effort you put into these posts!! And I am sorry for the toll that it takes on you. Misinformation does not rest, and I appreciate your work to combat it. Thank you!
***
IMHO: Before I retired, I was a technical researcher/editor, and I wonder if you meant to say "MHT causing breast cancer" and not "breast cancer causing MHT" (or maybe "breast cancer causing-MHT") in the sentence: "And based on how Wyeth faced thousands of lawsuits for breast cancer causing MHT and hiding information from women, that concern seems valid in retrospect." ?
Oh thanks, good catch! Will fix
Thanks!
And congratulations for moving back to Canada. I missed that news (only saw it in the Comments here) but read this to learn more - https://www.cbc.ca/news/canada/manitoba/jen-gunter-trump-canada-1.7508222.
Our loss is Canada's (re)gain.
I hope you're stocked up on G, T, ice, and lime. It sounds like those would be useful to you this week.
Thank you so much for clarifying this!
Interesting information. The WHI study has been re evaluated by several "experts" in the field of menopause as well as other specialists that deal with women's health. I wonder since there are so many variables regarding that study , for example (and I have read the study) how many of the women taking the prescribed oral estrogen and progesterone had low or even high thyroid levels? Since thyroid issues are more common in women who are experiencing peri and menopause how many times were their levels checked during that study? Thyroid issues present with the same issues and low thyroid can impact the heart, muscles, moods etc. The WHI used oral estrogen and progesterone if required which from what researchers have included in recent studies (2020-2024) impacts women more. Also as you have mentioned in a previous blog there are several different types of estrogen in premarin is that where the issue lies, animal versus plant based products? WOmen who use transdermal estrogen only to help prevent osteoarthritis or slow is progression have to take some risks of other issues as well. I certainly could be wrong , but I have read and do understand the material and statistics presented by the researchers.