Yale Women's Mental Health Conference 2026 Resources
📚 Additional Reading
- Navigating Perimenopause: A published conversation in Milford City Lifestyle with Dr. Courtney Holmes, APRN, sharing insights on symptoms, treatments, and the importance of support.
The New Menopause: Navigating Your Path Through Hormonal Change with Purpose, Power, and Facts by Mary Claire Haver, MD
The New Perimenopause: An Evidence-Based Guide to Surviving the Zone of Chaos and Feeling Like Yourself Again by Mary Claire Haver, MD
The Menopause Brain by Lisa Mosconi, PhD: Groundbreaking science on how hormones affect memory, mood, and brain health.
Estrogen Matters by Avrum Bluming, MD & Carol Tavris, PhD: An evidence-based look at hormone therapy and why estrogen deserves a place in women’s health.
The Science: Oral vs. Transdermal Estradiol
Over the last two decades, major clinical studies have transformed how we understand this relationship:
1️⃣ The ESTHER Study (Straczek et al., 2005)
In women carrying Factor V Leiden, oral estrogen significantly raised the risk of venous thromboembolism (VTE).
But women using transdermal 17β-estradiol (patch, gel, or spray) had no significant increase in clot risk compared with non-users.
👉 Read the study in Circulation
2️⃣ Follow-Up ESTHER Cohort (Canonico et al., 2007)
Confirmed that oral estrogen increases VTE risk, while transdermal estrogen does not — even when combined with progesterone.
👉 Read the study in Circulation
3️⃣ Review Article (Olié & Canonico, 2010)
Explains why: oral estrogen travels through the liver first, activating clotting proteins; transdermal estrogen bypasses the liver and avoids those changes.
👉 Read on PubMed
4️⃣ ACOG Committee Opinion (2013)
The American College of Obstetricians and Gynecologists recognizes that transdermal estrogen has little or no effect on clotting factors, unlike oral forms.
👉 ACOG Guidance
The Women’s Health Initiative (WHI): A Lesson in Scientific Interpretation
In 2002, results from the Women’s Health Initiative trial were widely interpreted to mean that hormone therapy increased the risk of breast cancer and heart disease.
The study led to a dramatic drop in hormone therapy use worldwide.
However, later analysis revealed important context.
The average participant in the WHI trial
Was 63 years old (older than most people start therapy in real clinical practice)
Often more than 10 years past menopause (missed window of opportunity for cardiovascular protection)
Subsequent re-analysis of the data found that:
Age and timing of therapy matter
Starting hormone therapy closer to menopause may have different cardiovascular effects than starting many years later. This concept is now known as the “timing hypothesis.”
Estradiol alone found to reduce breast cancer risk
Sources:
Reappraising 21 years of the WHI study: Putting the findings in context for clinical practice