Executive Summary In this episode of MedCity Fem Forward, host Marissa Plescia sits down with Janna Manjelievskaia, Director of Health Economics and Outcomes Research at Veradigm, to unpack the company's 2026 Women's Health Report. The conversation covers the flawed science behind the 2002 Women's Health Initiative press conference that drove HRT prescribing to near zero, how real-world EHR data shows prescribing is finally climbing again, and what physician clinical notes reveal about the fear-based medicine that still shapes conversations between providers and patients today. Key Takeaways HRT prescribing collapsed after a 2002 WHI press conference due to a misrepresentation of risk: the reported 24% relative increase in breast cancer incidence corresponded to an absolute risk increase of just 0.1%. Veradigm's EHR data shows HRT use among eligible women has more than doubled since 2020, reaching 11% among women 50 and older in 2024, with a notable uptick beginning around 2022. Analysis of physician clinical notes reveals that risk communication centered on breast cancer still dominates HRT discussions, with virtually no mention of cardiovascular benefits, despite modern evidence supporting them. Women's health research remains chronically underfunded: less than 8% of the NIH budget is dedicated to it, and women were only required to be included in federally funded clinical trials 33 years ago. Contraindications are not the primary driver of HRT underutilization. A sensitivity analysis with no restrictions showed rates nearly identical to the restricted cohort, pointing to other barriers. Links & Resources Marissa Plescia, Host Email: mplescia@medcitynews.com LinkedIn: linkedin.com/in/marissaplescia Keywords hormone replacement therapy, HRT, women's health, perimenopause, menopause, real world evidence, EHR data, Veradigm, Women's Health Initiative, WHI, breast cancer risk, PCOS, PMOS, cardiovascular health in women, women's health research funding, menopause treatment trends, HRT prescribing, MedCity Fem Forward, Janna Manjelievskaia, Marissa Plescia, fear-based medicine, NIH women's health Episode Highlights [00:01:17 - 00:03:59] Janna describes her background in health policy and epidemiology and how Veradigm's EHR network powers real world evidence research across therapeutic areas. [00:04:00 - 00:06:05] Janna explains why women's health remains underfunded, citing the less than 8% NIH budget share and the 33-year-old requirement for women's inclusion in federally funded trials. [00:06:06 - 00:07:34] Janna shares her personal experience with nearly two decades of misdiagnosis before a correct PCOS identification, and how that shaped her research priorities. [00:07:35 - 00:09:40] Discussion of why midlife was chosen as a key focus: it is when women are often at their professional and financial peak, yet many leave the workforce due to menopausal symptoms. [00:09:41 - 00:10:03] Janna explains that menopause is technically just a day, determined retroactively, and that no single medical specialty owns it. [00:10:04 - 00:14:46] Walk-through of the Women's Health Initiative: its design, the synthetic hormones used (not the FDA-approved products in use today), and how the press conference preceding publication caused a collapse in prescribing. [00:14:47 - 00:15:18] The 24% relative risk increase vs. the 0.1% absolute risk increase in breast cancer incidence, and why reporting only the relative number was an egregious misinterpretation. [00:15:26 - 00:19:58] Veradigm's EHR analysis: HRT use reached 11% in 2024 among women 50+, more than double the 2020 level, with the sharpest rates in the 54 to 56 age range at 17%. [00:19:59 - 00:23:22] Analysis of 2024 physician clinical notes shows breast cancer risk still dominates HRT discussions, with virtually no mention of cardiovascular benefits. [00:23:23 - 00:25:02] Janna's call to action: persistent gaps in diagnosis, treatment, and evidence alignment exist across all stages of women's health, from adolescence through post-menopause.
