Rescripting the Rules on HRT

Just last week, I listened to a friend (a brilliant, informed, healthy 39-year-old) hesitate to start hormone replacement therapy for perimenopause because of “the breast cancer risk.” A myth she’d carried for years. A myth millions of women have carried for decades. And honestly, it made me pause: we think we know better, but sometimes... we don’t.

I jumped in, obviously, but what if I hadn’t? How many women walk away believing the same story, passed down by headlines, fear, and misread science? That story has shaped and limited women’s health for over twenty years.

The Women’s Health Initiative study of the early 2000s was wildly misinterpreted. It triggered a 70% drop in HRT use, left a generation of clinicians unsure about prescribing it, and forced countless women to silently endure hot flashes, sleepless nights, mood swings, and the strange feeling that their own bodies were betraying them. Mothers, daughters, sisters, friends stepping back when their bodies wouldn’t let them step forward.

So when the FDA announced they were removing the black box warning from vaginal estrogen this week, it felt — and is — historic. Finally, a long-overdue correction. A chance for women to reclaim clarity, confidence, and care that had too often been clouded by outdated fear.

Of course, HRT isn’t a free pass (timing, dosage, and personal medical history all matter), but having the right information, without a sensationalized warning label, is the first step toward making decisions that actually fit our lives.

For once, it feels like women’s health is catching up to us: listening, learning, and finally treating us as the nuanced, complicated, formidable humans we are.

Ask Clara: What is hormone replacement therapy?