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Written by David Nazarian, MD — Board Certified in Internal Medicine
There has been a significant change over the last decade in how many physicians and patients think about menopause and hormone therapy. I see this change firsthand in my practice. Women often come to me with symptoms that are affecting their sleep, energy, sexual health, mood, and overall quality of life, but many still carry fears about hormone therapy that began with the early reporting of the Women’s Health Initiative.
Why are women still worried about hormone therapy?
A question I hear frequently is: “Does hormone therapy cause breast cancer or heart disease?” That question deserves more than a yes-or-no answer.
The Women’s Health Initiative changed the way an entire generation thought about menopausal hormone therapy. Over time, however, the medical discussion became more nuanced. Age, time since menopause, the specific hormones used, route of administration, whether a woman has a uterus, and her individual medical history all matter when evaluating benefits and risks.
The regulatory discussion has changed as well. In November 2025, the FDA requested removal of boxed-warning language concerning cardiovascular disease, breast cancer, and probable dementia from menopausal hormone therapy products. In February 2026, the FDA began approving revised labeling. Importantly, this did not mean that hormone therapy became risk-free or that these risks disappeared from all prescribing information. It reflected a more individualized interpretation of the evidence and benefit-risk discussion.
For the FDA’s current information, see the FDA’s 2026 menopause hormone therapy labeling update.
How I evaluate a woman before considering hormone therapy
I do not believe hormone therapy should be prescribed simply because a woman has reached menopause or because a laboratory value has changed. I start with the patient.
I review her symptoms, age, timing of menopause, personal and family medical history, cardiovascular and thrombotic risk, breast cancer history, medications, whether she has a uterus, and other health factors. Some women may not be appropriate candidates for systemic hormone therapy, and others may need additional evaluation before a treatment decision is made.
This is also why I prefer shared decision-making. My role is to help a patient understand what we know, what we do not know, what her individual risk factors are, and what alternatives exist. Then we can decide together whether treatment makes sense for her.
Preventive care remains important during hormone therapy
When I prescribe and monitor hormone therapy, I also talk to patients about the rest of their preventive health. Appropriate mammography, cervical cancer screening, colorectal cancer screening, routine medical visits, blood work when indicated, and follow-up with a physician remain important.
These screenings do not make hormone therapy automatically safe and they do not replace careful patient selection. Rather, I consider appropriate screening, monitoring, and periodic reassessment part of responsible long-term medical care.
Timing matters
One of the most important changes in the modern discussion is recognition that the benefit-risk profile is not identical for every woman at every age. Current guidance emphasizes individual risk assessment, including age and time since menopause. For many healthy symptomatic women younger than 60 or within approximately 10 years of menopause onset, the benefit-risk profile can be favorable when there are no contraindications.
That does not mean every woman in that window should receive hormones. It means we should stop treating menopause hormone therapy as a single yes-or-no decision for all women.
What I tell patients who are still afraid of HRT
I tell them that their concerns are reasonable. The message women received for many years was frightening, and it does not disappear overnight. I also explain that medicine changes as evidence accumulates.
My approach is to look at the woman sitting in front of me rather than treating a headline from 20 years ago. We discuss her symptoms, goals, medical history, risk factors, treatment options, and what monitoring would look like. For an appropriate candidate, the potential improvement in menopausal symptoms and quality of life may be meaningful. For another woman, the risks or her personal preferences may lead us toward a different approach.
That individualized discussion is, in my view, where modern menopause care should be.
Related hormone therapy resources
Patients who want to learn more can read about our menopause treatment approach, perimenopause evaluation and treatment, women’s hormone care, and bioidentical hormone therapy.
Medical note: This article is educational and is not a substitute for individualized medical evaluation. Hormone therapy has benefits, risks, contraindications, and alternatives that should be discussed with a qualified clinician.
