If you’re menopausal, chances are you’ve spent some time scavenging the internet for advice on how to cope with the wide variety of symptoms that can ensue before or after onset. And we all know what that means: An overwhelming deluge of data about excruciatingly complex issues like changing bone health, shifting nutritional needs, and sleep interruptions. Then, you see it: Hormone replacement therapy. Is it the answer to your prayers? The cure-all for menopause-induced conundrums? The answer may vary depending on where you’re getting your info.

We’ve gone over the basics of HRT with you all before — the benefits, when to start, etc. (Katie’s OBGYN has been endlessly patient with our onslaught of questions) — but if you’re still unsure about it, you’re not alone. To make matters more frustrating, our understanding of HRT has been warped by a Women’s Health Initiative study abruptly halted in 2002: The study showed that HRT causes a slight increase in strokes, clots, and breast cancer. Though this increase was less than a tenth of one percent per year for each individual, a massive miscommunication snowballed and the risk became exaggerated. Suddenly, menopausal people and their healthcare providers alike were afraid of this helpful hormone treatment that can treat menopause symptoms (think hot flashes and night sweats), help prevent bone loss, and lower cardiovascular risk.

On the latest episode of the Next Question podcast, Katie is setting the record straight. She chats with her own OBGYN, Dr. Rebecca Brightman, who’s offered Katie Couric Media plenty of invaluable advice on all things menopause. They’re joined by journalist Susan Dominus, who recently authored a viral article about how we’ve been misled about menopause and the devastating impact of that landmark study.

Katie Couric: I have to ask a personal question because I was diagnosed with breast cancer — as Dr. Brightman knows — in June. I was on HRT — an estrogen patch — for probably 10 or 11 years, and I loved it. I didn’t look great with bikinis, but that’s OK. I’m kidding. I don’t wear bikinis anymore. But, I couldn’t help but wonder — as Carrie Bradshaw would say — did the patch result in my breast cancer?

Dr. Brightman: I would say no, it didn’t. As one of my friends was told by her breast surgeon when my friend asked, “Why did I get breast cancer?” — she got breast cancer because she’s a woman. One in eight women will get breast cancer during the course of their lifetime. That’s why.

I think for many women — if appropriately counseled — the benefits of HRT outweigh any potential risk.

But now that I have gotten breast cancer, I can’t go back on the patch, can I?

Dr. Brightman: Not really, no. There are certain situations with appropriate counseling where women have resumed hormones, but they are few and far between. And I venture to say the majority of physicians would say it’s a hard no.

So [the Women’s Health Initiative study] was the first big study to determine — scientifically — the pros and cons of hormone replacement therapy. But the [estrogen-plus-progesterone hormone portion of the] trial was stopped [in 2002]. Why?

Susan Dominus: It was stopped after five years. The group that was taking both estrogen and progestin were women who have uteruses [as opposed to participants who’d had a hysterectomy, who were given different hormones]. In this group, they were seeing an increased risk of breast cancer.

Dr. Brightman: In that group, there was an uptick in breast cancer. But they continued the study, and they didn’t see it in the group of women using estrogen alone. It’s so interesting because estrogen is what gets the bad rap. But in the group that, again, with estrogen alone — no increased risk.

So the study changed midstream.

Susan Dominus: It was supposed to last for eight and a half years. And the idea that they halted it unexpectedly after five years was very big news. They also held a very big press conference. And when people hear that a treatment study has been stopped unexpectedly, I think they think that translates to, Therefore you, too, must stop using this medication.

I remember covering this back in the day. What happened next was an exercise in poor communication that would have profound repercussions for decades to come.

Susan Dominus: Basically, representatives of the WHI, who were very well-intended but not particularly media-trained, went on television shows and started engaging in conversations in which a lot of statistics were rattled off. And some of those statistics sounded very, very scary.

So how did these numbers get so misunderstood or misreported?

Susan Dominus: Well, they were definitely not misreported. They were accurate. Those numbers were accurate per the WHI. I just think, again, it takes a little bit more time to say, “OK, so what does that actually translate into for the average woman?”

And what did it translate into?

Susan Dominus: Well, [according to The New York Times], a woman’s risk of having breast cancer between the ages of 50 and 60 is around 2.3 percent. [WHI data saw] an increase in that risk by 26 percent. That means now you’ve elevated [the 2.3 percent chance] to 2.94 percent.

So you know that in the grand scheme of things, everybody can have their own comfort level with a 2.94 percent risk and how much you’ve increased it. But I don’t think that’s how women heard it at the time.

And in fact, you point out that smoking by contrast increases cancer risk by 2600 percent.

Susan Dominus: Yes. So we’re talking about a very, very small uptick in comparison.

The study was flawed in a whole host of ways it seems. Can you all talk about why this study really wasn’t accurate?

Dr. Brightman: I think women take this information and say, “How does it affect me?” Well, the truth of the matter is the average age of the women in the study was between 62 and 63.

Many of these women did have some comorbidities. Many of them on average were 12 years beyond their final period. The majority of these women didn’t even have menopausal symptoms. So it was a lousy population to study. What we really needed to go back and do was look at the 50- to 60-year-olds. How did they do? They did pretty well. And once things are teased apart and we look at [the data] decade by decade, it’s very, very different.

We’re not supposed to talk about hormones and the benefits they may have in terms of disease reduction and everything else. But I think we’ve come a long way. It used to be that hormones were strictly for night sweats and hot flashes, and [symptoms] had to be really, really, really bad to prescribe them. But we know that they improve the quality of one’s life greatly if in need, and they also may serve a role in disease prevention.

Can HRT be used if you have a family history of ovarian cancer?

Dr. Brightman: There is a tiny bit of data that there may be a minuscule increase in ovarian cancer in women who use menopausal hormone therapy (MHT), or hormone replacement therapy.

Again, it really needs to be individualized. Much more goes into counseling a woman with a family history of ovarian cancer. There are certain things one can do to reduce risks. But it wouldn’t mean that someone with that family history can’t be on hormones, they just need to discuss it thoroughly with their doctor.

What if you’re at a high risk for breast cancer? Is HRT absolutely out of the question?

Dr. Brightman: No, and it depends again on family history and genetic predispositions. With appropriate counseling, it’s a very individualized, personalized decision.

Should women take hormones if they’re only experiencing slight symptoms?

Dr. Brightman: Yes, I think so. They should be offered hormones and it should be part of the discussion.

Susan Dominus: You don’t actually know the benefits [of hormones] until you’ve tried them. If you’re sailing through and you’re completely symptom-free, then maybe it’s not something even to think about. But if you’re wondering about it, there’s very little harm in trying.