Ecological Women’s Health

Research Archive/Dolores Catherino/Ecological Women’s Health
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An Ecological Analysis of Menopausal Hormone Restoration

Reframing menopause as endocrine insufficiency, and weighing restoration against the harms of deprivation through an Evidence-Selective Medicine lens.

Dolores Catherino, M.S.
Evidence-Selective Medicine & Ecological Women’s Health
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June 2026 Also on figshare SSRN
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Structured summary

The argument, in four moves

A methods-and-implications panel for clinicians.

1
Framing
Menopause is treated as endocrine insufficiency, so the relevant comparison is restoration versus continued deprivation — not therapy versus an untreated “natural” baseline.
2
Evidence lens
A six-level Evidence-Selective Medicine (ESM) framework surfaces asymmetry: the methodological laxity applied to evidence supporting MHT restrictions versus the elevated standards imposed on evidence to revise that restriction.
3
Formulation specificity
Oral CEE+MPA signals are separated from transdermal estradiol with micronized progesterone, so class-wide claims are tested against route- and molecule-specific data.
4
Medico-legal implication
The reasoning is framed to be current, formulation-specific, and documentable — defensible under a 2024 malpractice standard oriented toward evidence-based practice.
ESM × ALI

The evidence framework

The appraisal moves through six ordered levels — each depending on the one before it — ending in clinician-facing, evidence informed, shared decision-making process.

01
Problem recognition

Where restriction came from

Identify where policy generalized from formulation-nonspecific or age-blind evidence into class-wide restriction.

02
Evidence asymmetry

Two burdens of proof

Compare the standards of evidence sufficient to restrict therapy against those imposed on evidence contradicting those restrictions.

03
Comparative physiology

Replacement, not baseline

Assess modern bioidentical MHT within endocrine-replacement logic rather than treating menopause as palliative symptom management.

04
Formulation specificity

Route and molecule matter

Separate oral CEE+MPA signals from transdermal estradiol and micronized progesterone when weighing risk.

05
Clinical balancing

Counting deprivation harms

Recognize deprivation harms alongside treatment harms so the benefit-risk calculation is symmetric and integrates a woman’s full physiology.

06
Level 06 + ALI · Documented judgment

Current, specific, defensible

Integrate the evidence into a comparative benefit/risk analysis and shared decision-making that is current, formulation-specific, and congruent with a modern malpractice orientation toward evidence-based practice.

Publication index

Author archive

The complete publication index — related articles, essays, preprints, and ongoing scholarly work.

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Selected references

Reconstructing MHT Guidelines — A New Era of Menopause Care

28 sources Each link opens in a new tab
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