What the WHI Stole from 3 Women I Love

This Week’s Signal

Three women. Three states. Three completely different lives — and somehow, the exact same outcome: they were all failed by women’s longevity care.

In 1994, a 43-year-old Chicago stockbroker — the kind of woman who could negotiate a multimillion-dollar deal and still make it home for bedtime — walked into her PCP’s office and said she didn’t feel like herself. Not depressed. Not overwhelmed. Just… different. Two young daughters, a live-in au pair, a high-stress marriage, a career built on grit and adrenaline — but something deeper was shifting. Her doctor didn’t ask about hormones, sleep, thyroid, iron, stress, or literally anything else. He prescribed 40mg of Celexa — double today’s FDA-safe max — and sent her home. More than 30 years later, she’s still on the same dose.

In 1997, a 45-year-old New Jersey dentistry professor developed headaches and vision changes. After a medical maze, she finally got an answer: a benign meningioma. The plan was standard — monitor it. But then came the blanket rule that has harmed so many women with brain tumors: no hormones, ever. No nuance. No distinction between synthetic progestins and bioidentical estrogen. No acknowledgement that estrogen supports cognition, mood, and brain metabolism during menopause. Twenty-plus years later, her tumor has turned malignant, she has undergone surgery, and she’s now experiencing dementia-like symptoms — likely from a cocktail of factors, including the decades her brain spent without estrogen.

And then there’s the Houston woman. In 2000, at 43, she was the unicorn who actually received good perimenopause care — briefly. Her doctor put her on HRT, evaluated her whole-body health, and even screened her bone density early, catching osteopenia before it worsened. But when the WHI study detonated in 2002, her doctor panicked and took her off hormones overnight. The study didn’t apply to women like her, but that didn’t matter. Now, at 67, she’s managing bone density challenges that almost certainly didn’t need to be this bad.

These three women are women I love. One of them is my mom. And my mom — who is famous for saying that every single year of her life has gotten better — is proof that perimenopause isn’t a cliff. It’s not an ending at all. It’s the beginning of the longest, richest chapter of a woman’s life. So why are women in their late 30s and early 40s acting like their lives are over the second someone utters the word perimenopause? If these stories teach us anything, it’s that perimenopause is about longevity — choosing how well you’ll live the decades that come after.

What We’re Missing

I wanted to write an entire newsletter celebrating the removal of the black box warning on HRT — a moment women’s health advocates have been fighting for since the early 2000s. But removing the warning is just the beginning. Before I celebrated, I wanted to understand what the WHI era actually cost real women. So I gathered these stories. And honestly? I’m furious.

Because even with all the progress we’ve made inside the women’s health bubble — the conferences, the research, the clinicians rewriting the science — most women still aren’t getting care. Last month’s Mayo Clinic survey makes that painfully clear. Among nearly 5,000 women, 34% reported moderate to severe menopausal symptoms, yet 83% never sought treatment. Why?

• 1 in 5 felt judged

• 1 in 6 felt embarrassed

• many believed they should “handle it naturally”

• most didn’t know where to go, or what their options were

And these are women who look like these three women I love — white, highly educated, insured. If they’re falling through the cracks, what does that say about everyone else? In America in 2025, the disparities are predictable — and devastating.

The black box warning may be gone, but the stigma, confusion, and medical neglect that fueled it are very much still here.

What We’re Seeing

Studies from SWAN, ELITE, and KEEPS have shown again and again that estrogen protects the very systems that determine how well we age — the heart, the brain, the bones, metabolic function. HRT is not a fountain of youth, but it is one of the most powerful tools we have to improve healthspan.

And yet women in their 30s and early 40s — my peers — hear “perimenopause” and immediately think decline, irrelevance, invisibility. Meanwhile, women live longer than men… but we do not live well longer. Not unless we intervene.

What It Means

We don’t need to “start talking about perimenopause.” In the women’s health world, we talk about it nonstop. We are practically hoarse. But we’re also in an echo chamber — nodding at one another while the rest of the world still whispers “the change” like it’s Voldemort.

What we need now is reach. Translation. A cultural shift. We have to break out of our own industry and talk to the women who don’t know the word estradiol. The women who think night sweats and anxiety and joint pain are just “getting older.” The women silently suffering — like the three women I love.

And it doesn’t require a medical degree. Every woman can help another woman understand what’s happening in her body. Here’s how:

• Normalize the language. Say the word perimenopause out loud. Casually. At dinner. At work. With your friends. In front of men. The more we say it, the less power it has.

• Share your symptoms. Your rage spikes, brain fog, insomnia? Tell someone. Women learn from lived experience, not pamphlets.

• Send one evidence-based resource a month. A podcast, a book, an article, a doctor’s post. Not as a lecture — as a gift. “Saw this and thought of us.”

• Compare notes with friends. Create a group chat where people can ask, “Is this normal?” without shame. We should treat midlife health like we treat parenting groups — collaborative, not secretive.

• Encourage annual bloodwork and a hormone eval. Not to chase numbers, but to understand baseline health. Knowledge is power, no matter your age.

• Demystify HRT. You don’t have to be pro-HRT for everyone — but you can be pro-information. “There are safe options. Want me to send you some studies?”

• Share your doctor. If you have a great provider, tell everyone. Hoarding menopause-literate clinicians is out. Redistribution is in.

• Reframe what these years even mean. Women spend 40% of their lives in some stage of menopause. That’s not a decline — that’s a lifespan. A chapter. A phase that deserves the same visibility and respect as puberty or pregnancy. Let’s all start thinking about life differently — because every year is a blessing, and the holidays are the perfect time to remember that.

We can rewrite the next generation’s story. We can make sure the women who are 35-60 today age with strength, clarity, and agency. We can help women focus on not just living longer — but better.

Perimenopause is not the beginning of decline. It’s the beginning of the longest, healthiest, strongest years of a woman’s life — if we stop repeating the mistakes that stole so much from the women who raised us. Let’s make this next chapter look different.

Not quieter.
Louder.
Sharper.
And finally, finally, guided by evidence instead of fear.

With more signal and less noise, Spotting is your weekly lens on what’s next in women’s health and why. See you right here next time, in your inbox (and if a friend sent this your way, hit subscribe!).

With hugs, science & freedom,
Abby

P.S. Whether this hits or misses for you, I’d love to hear your thoughts — just hit reply. Thanks for being here 🤗

Reaching 20M women monthly and partnering with trusted brands like Pfizer, Kotex, BetterHelp, and Noom, Rescripted is the leading media platform for all women and their health, from first period to last period.