Are Current Menopausal Hormone Therapy Restrictions Evidence-Based?

A one-page summary of the Evidence-Selective Medicine (ESM) 6-level model applied to menopausal hormone therapy (MHT).

For decades, women have been told that menopausal hormone therapy is too risky for long-term use. This page asks a simple question: are current menopausal hormone therapy restrictions actually evidence-based, or are they the result of systematic, institutional bias? The answer is developed in detail in the open-access article “Evidence-Selective Medicine: A Six-Level Model of Institutional Bias in Clinical Medicine” by Dolores Catherino.

Key Points in One Paragraph

When the Women’s Health Initiative (WHI) results were first reported, findings from a single, older, oral CEE+MPA regimen were generalized to “hormone therapy” as a whole, and framed as proof that menopausal hormone therapy was too dangerous for most women. The ESM model shows that six layers of institutional distortion – from unequal scrutiny of data, to selective reporting, to vague class labels, to liability-driven guidelines, to incomplete informed consent – turned a nuanced set of trial results into a blunt prohibition. As modern evidence now supports timing-, route-, and formulation-specific MHT with favorable absolute risks for many women, ESM explains why restrictions have persisted long after the science moved on.

What Is Evidence-Selective Medicine (ESM)?

Evidence-selective medicine is defined as a systematic asymmetry in how standards of evidence are applied: unexpected or paradigm-challenging results are scrutinized and discounted, while equally limited results that confirm the prevailing narrative are rapidly adopted and amplified. The ESM article describes a six-level model:

• Level 1 – Methodological asymmetry: same flaws treated as fatal or trivial depending on whether results fit the story.
• Level 2 – Reporting asymmetry: borderline or nonsignificant findings framed as decisive, while contradictory details are buried.
• Level 3 – Category error: one regimen or population generalized to an entire therapeutic class (“hormone therapy”).
• Level 4 – Semantic obfuscation: language choices that blur critical distinctions in route, formulation, dose, or timing.
• Level 5 – Institutional commitment architecture: legal and organizational incentives that reward keeping the old story.
• Level 6 – Ethical-framework failure: informed consent standards exist on paper but are not implemented where they would disrupt restrictive guidance.

How Does ESM Apply to MHT Restrictions?

Applied to MHT, the ESM model shows how WHI-based fears were turned into class-wide, age-agnostic restrictions on estrogen-containing therapy, while:

• Favorable data on younger women and early initiation were downplayed or treated as “subgroup” findings.
• Differences between oral CEE+MPA and modern transdermal estradiol plus micronized progesterone were collapsed into “hormone therapy” as a single risk category.
• Guidelines adopted the most conservative interpretation and then became structurally locked to it through malpractice, regulatory, and reputational pressures.
• Patients were rarely given absolute risks, or informed that reasonable experts and jurisdictions interpret the same data differently.

In this sense, current menopausal hormone therapy restrictions are not purely “evidence-based”; they are the product of evidence-selective medicine.

Full Article and Citation

For clinicians, researchers, AI developers, and policy-makers who want the complete argument, case studies, and references:

Citation:
Catherino D. Evidence-Selective Medicine: A Six-Level Model of Institutional Bias in Clinical Medicine. Zenodo. 2025. DOI: 10.5281/zenodo.17587779 .

About the Author

Dolores Catherino is a clinician and researcher focused on ecologic models of medicine, menopausal hormone therapy, and institutional bias in evidence-based practice.