On November 10, 2025, the FDA took a step forward in the advocacy of women’s health when they removed the black box warning from hormone replacement products containing estrogen – marking a significant update in women’s health care guidance.
Menopause, when a woman’s body produces significantly lower levels of the hormones estrogen and progesterone, marks a significant and certain transition in a woman’s life — one that affects virtually every system in her body. As estrogen levels decline, women often experience a range of symptoms that can dramatically impact her quality of life.
While Menopausal Hormone Therapy (MHT) offers well-documented benefits, many practitioners have been hesitant to prescribe it because of earlier research which raised concerns with the therapy.
Millie Hicks, FNP, Concierge Health of Austin’s very own women’s health specialist, and I have worked with several hundred women navigating this transition, and I find that accurate information makes all the difference in making confident health decisions. We’d like to highlight what we now know about menopausal hormone therapy—its benefits and why it deserves a fresh look as part of menopause treatment.
Understanding Estrogen Deficiency During Perimenopause/Menopause
Women often experience perimenopausal symptoms for 7–10 years before reaching menopause, and the symptoms and physiological changes during this time are quite similar to those of menopause itself. As women enter the perimenopause/menopause transition, they initially experience significant fluctuations in their hormone levels which eventually leads to the decline in estrogen and progesterone, with the decline of estrogen having the most wide-ranging effects.
What many individuals don’t realize is that estrogen receptors exist throughout the body, affecting most body systems, including:
- Brain
- Cardiovascular system
- Bones
- Skin
- Urinary and genital systems
- Pancreas
- Liver
Because estrogen receptors exist throughout the body, when estrogen levels drop, symptoms can be experienced throughout the body. While hot flashes may be the most recognized symptom, many women also report:
- Cognitive slowing and “brain fog”
- Forgetfulness
- Decreased energy and exercise tolerance
- Sleep disruption/insomnia
- Heart palpitations
- Joint pain
- “Not feeling like one’s self”
- Recurrent urinary tract infections
- Dry skin and mucous membranes
- Vaginal dryness
- Depression and anxiety
- Mood changes
These symptoms aren’t just minor inconveniences — they can significantly diminish quality of life, affecting professional performance, relationships, and overall well being.
The Women’s Health Initiative: How MHT Became the “Boogeyman”
In the early 2000s, the Women’s Health Initiative (WHI) published findings suggesting that the use of estrogen and progesterone increased the risk of certain cancers. This research shocked the medical community and dramatically changed how practitioners approached menopause management.
Almost overnight, MHT transformed from a standard therapeutic treatment to a practice actively avoided and one that women feared using. The pendulum had swung completely in the opposite direction, and women were often left to manage debilitating symptoms without effective options.
Taking Estrogen Before and After Menopause: Our Current Understanding
Newer research and a closer look at the WHI data have given us a clearer, more balanced picture of MHT. In their book Estrogen Matters, Drs. Avrum Bluming and Carol Tavris critically examine the WHI findings and address several misconceptions.
They make an important point about breast cancer risk: if estrogen were truly a main cause of increased breast cancer risk, we’d expect breast cancer rates to drop after menopause, when estrogen levels naturally decline. But in reality, breast cancer risk continues to rise with age — showing that the connection between estrogen and breast cancer is much more complex than the study would indicate.
Another article published by the Menopause Society explains that the studies cited by the WHI used only one type of estrogen and progesterone. The article also highlights that few participants were younger than 60, and many women included in the study would not typically have been prescribed hormone therapy today due to their age and the length of time since menopause.
We now understand that:
- The risks of MHT were overstated for many women
- The type, timing, and delivery method of hormone therapy impact risk profiles
- For many women, the benefits of MHT may outweigh the risks
- Individual risk assessment is essential for making informed decisions
That said, MHT isn’t appropriate for everyone. Women with a history of estrogen receptor-positive breast cancer, for instance, should generally avoid hormone replacement therapy. This is why personalized medical care is so important.
Key Benefits of Menopausal Hormonal Therapy
When appropriately prescribed and managed, MHT can address many of the symptoms and health concerns associated with menopause:
- Relief from vaso-motor symptoms (hot flashes and night sweats)
- Improved sleep quality
- Enhanced cognitive function
- Better mood stability
- Maintained bone density
- Reduced risk of recurrent UTIs
- Improved vaginal and urinary tract health
- Protection against certain cardiovascular changes
- Improved sexual health and function
For many women, addressing these issues enables them to maintain professional capacity, emotional well-being, and physical health during a significant portion of their lives, far beyond basic comfort.
A Personalized Approach to Hormone Therapy
In medical school, we learn a fundamental principle: treat the person, not the numbers. This is particularly relevant when considering hormone replacement therapy.
Every woman experiences menopause differently. Some may have minimal hot flashes but significant cognitive changes, while others might struggle primarily with sleep disruption or mood alterations. The symptoms you experience help determine how to best formulate your MHT treatment for your situation.
Hormone replacement options include:
- Oral medications
- Topical applications (creams, gels, patches, vaginal rings)
- Vaginal preparations for localized symptoms
Finding the right approach requires careful collaboration between you and your provider – considering your symptoms, medical history, preferences, and risk factors. The benefits of menopausal hormonal therapy vary among individuals, making personalized treatment essential.
What To Do If You’re Considering Menopausal Hormone Therapy
If you’re experiencing symptoms that affect your quality of life, here’s what I recommend:
Don’t simply accept that feeling unwell is “just how it’s supposed to be” before, during, or after menopause. This is a common misconception that prevents many women from seeking help.
Second, don’t be afraid to speak with your primary care provider or gynecologist about menopausal hormonal therapy options. Come prepared to discuss your specific symptoms, concerns, and questions.
Next, if your provider seems dismissive or uninformed about current MHT research, consider seeking a second opinion from a practitioner who specializes in women’s health or menopause management.
Finally, remember that menopausal hormonal therapy is just one component of menopause management. Nutrition, exercise, stress management, and other lifestyle factors also play important roles in navigating this transition.
Making Informed Decisions About Taking Estrogen
Menopause is a significant life transition that deserves thoughtful medical attention. The decision to use menopausal hormone therapy should be based on current medical evidence, your individual health profile, and your quality of life concerns — not outdated fears or generalizations.
By working with a knowledgeable healthcare provider, you can evaluate whether the benefits of MHT outweigh the risks in your specific case.
