Open conversations about perimenopause and menopause have grown significantly in recent years, driven by influencers, direct-to-the-consumer telehealth companies marketing to women in midlife, new books, podcasts, and candid discussions from celebrities including Michelle Obama, Halle Berry, and Drew Barrymore, as reported by phillymag.com. Legislators are also pushing for workplace accommodations for those navigating perimenopause and menopause.
The Shift in Menopause Hormone Therapy
Medical groups now recommend menopausal hormone therapy again for many patients after years of cautioning against it, according to family physician NPR. A major regulatory change occurred in November 2025, when the Food and Drug Administration began removing black box warnings—which signal serious health risks—from hormone therapy for menopause after more than two decades, as detailed by theconversation.com.
Understanding the History and the Reanalysis of Data
Hormone therapy was widely prescribed from the 1960s through the 1990s before usage came to an abrupt halt following the 2002 publication of findings from the Women’s Health Initiative study, which followed thousands of women in midlife taking hormones throughout the 1990s and early 2000s. Researchers stopped that study early because it suggested hormone therapy increased the risk of heart disease, breast cancer, stroke, and pulmonary embolism.
Following the initial findings, the FDA required black-box warnings on all estrogen and progesterone products, and doctors were advised to prescribe the lowest possible dose for the shortest possible time.
Researchers have since critiqued the Women’s Health Initiative study for its limitations, noting that its participants averaged 63 years old, well beyond the typical age of menopause (which usually occurs between 45 and 55), making them more vulnerable to red-flagged diseases. Reanalyses led to the timing hypothesis, which proposes that some groups experience more benefit and less risk based on age. The growing consensus is that menopausal hormone therapy is much safer than previously thought for women in their late 40s and 50s.
Formulations and Symptom Relief
As women age, their ovaries start losing the ability to produce estrogen and progesterone. When doctors prescribe menopausal hormone therapy, treatment typically involves either estrogen alone or estrogen plus a progestogen (including natural progesterone and synthetic hormones that mimic it). These medications come in formulations including transdermal patches, pills, and vaginal creams and rings.
The primary reason doctors recommend systemic hormone therapy is to treat vasomotor symptoms, known as hot flashes, which up to 80% of women experience during the menopausal transition and which can disrupt sleep, work focus, and quality of life.
Systemic hormone therapy and vaginal estrogen treatments can address dryness and irritation in the vulva, known as genitourinary syndrome of menopause. Systemic therapy can also help prevent fractures for those at high risk of osteoporosis.
Evaluating Risks for Breast Cancer Survivors
Breast cancer is the most commonly diagnosed cancer among women in the U.S., with diagnoses increasing among women under 50 by 1.4% each year between 2012 and 2021. Breast cancer survivors may suffer from natural menopausal symptoms or symptoms induced by cancer treatments that disrupt ovarian function.
Healthcare providers have often avoided prescribing MHT to breast cancer survivors due to a perception of increased recurrence risk, but research remains conflicting. Landmark studies like the HABITS trial and the Stockholm Trial evaluated safety for those previously diagnosed with breast cancer. The HABITS trial ended early in 2003 after 26 out of 219 women receiving MHT developed breast cancer, compared with 8 out of 215 women not receiving hormones, drawing significant attention to potential risks.
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