Long Island doctors are seeing a surge in patients seeking menopause hormone therapy following updated federal recommendations and clinical guidelines. The American College of Obstetricians and Gynecologists recently issued updated guidelines that include a strong recommendation that most patients receive the treatment to manage menopause symptoms.
The shift comes as the U.S. Food and Drug Administration announced in November 2025 that it plans to remove a “black box” warning from menopausal hormone therapy products. That warning, triggered by a 2002 study that many experts now consider flawed in its risk analysis, cited risks of breast cancer and cardiovascular disease associated with combination hormone use. “Providers were afraid to prescribe it,” said Banks.
Guidelines for Hormone Therapy
According to Dr. Robert Kauffman, a guidance author for the American College of Obstetricians and Gynecologists, the decision to use hormone therapy should be based on a patient’s specific symptoms, medical history, and baseline risk for blood clots, breast cancer, and cardiovascular disease. Kauffman stated the risks are “relatively low” and the safety data is “reassuring.” For those eligible, the guidelines recommend starting therapy before age 60 or within 10 years of the start of naturally occurring menopause.
Treatment options may include a combination of progestin and estrogen delivered via:
- Transdermal patches
- Pills
- Gels
- Sprays
- Vaginal creams
For women who prefer not to use hormones or are unable to do so, doctors suggest non-medical options like acupuncture and exercise, as well as antidepressants for mood changes or FDA-approved non-hormonal medications for night sweats and hot flashes. Kauffman described these as a “big toolbox of evidence-based options.”
Impact on Patient Care
The transition to menopause, or perimenopause, can cause moodiness, sleeplessness, brain fog, vaginal dryness, and hot flashes. Perimenopause is the transition leading up to menopause, which occurs when a woman has gone 12 months without a period. Some women find relief vital for their well-being, as more than 1 million U.S. women experience menopause annually. However, access to care has not been uniform. Research from the SWAN study indicates that Black women reported more symptoms than white women but were less likely to receive treatment.
Medical professionals are now encouraged to proactively ask midlife patients about their symptoms rather than waiting for patients to initiate the conversation. Three direct questions during routine visits may uncover significant symptoms and prevent patients from managing a symptom burden without a treatment plan. This approach aims to address inequities influenced by gender identity, sexual orientation, socioeconomic status, race, and culture.
It remains unclear how much additional research funding will be directed toward understanding and closing the gaps in care for different patient populations. Pier stated the hope that the document drives more research funding to understand and begin closing these gaps.