By Kristen Godfrey Maddocks, Union Leader Staff
For years, women have endured hot flashes, mood swings and fatigue in the transition leading up to menopause. Previous studies had warned that treating these symptoms with hormone replacement therapy, or HRT, came with risks that outweighed its benefits, including cancer and cardiovascular disease.
That changed in November 2025, when the Food and Drug Administration removed warnings from hormone therapy products, citing outdated interpretations of a Women’s Health Initiative study that overstated the risks of HRT in older women.
Since then, prescriptions for estrogen patches and progesterone cream have skyrocketed. The American Society of Health-System Pharmacists, a professional organization for pharmacists, included 20 brands or dosages of estrogen patches in its most recent list of drugs in shortage. Women now see digital ads that openly promote HRT as a cure for sleepless nights and brain fog.
The dramatic shift has left many women asking their health care providers: Is hormone replacement therapy safe for me, and does it really make a difference? GETTY PHOTOS Menopause can affect nearly every part of the body, causing symptoms that range from hot flashes and fatigue to joint pain and brain fog. Experts say women should work with their health care provider to determine whether hormone replacement therapy or other treatments are appropriate.
“Even before the black box warning, there was this kind of churning of reinterpreting the same information,” said Sarah Bay, a women’s health nurse practitioner and certified nurse midwife at St. Joseph Hospital OBGYN & Midwifery, a Menopause Society Certified Practitioner and owner of the practice Hearts & Hands Women’s Care, in Peterborough. “The same study in 2002 that said no hormone replacement therapy (is safe) is the exact study that we’re using now to say everyone should be on hormone replacement therapy.”
The growing buzz around the promise of HRT has created opportunities, drug shortages and even more confusion. Because HRT is an umbrella term used to describe different combinations and dosages of estrogen, progesterone or testosterone, in-depth discussions with a health care provider should guide decision-making, according to local women’s health care providers. “For each patient, you have to individualize it,” said Dr. Jacqueline Baselice, an obstetrician and gynecologist with Core Physicians Obstetrics and Gynecology in Exeter. “Each patient is so different in what they’re looking for and where they are (in their transition).”
How does HRT work?
Hormone replacement therapy includes different combinations, dosages and delivery systems of estrogen, progesterone or testosterone. Understanding what type of HRT will work best is determined by symptoms and conversations with a health care provider, Bay said.
“When I see patients, I give them a checklist of all of these symptoms. And when I look at the checklist, I can already tell if she’s deficient or out of ratio,” she said. “So, for example, if you’re quick to cry, or teary all the time, that means your estrogen is elevated or you have estrogen dominance compared to your progesterone (levels). You might need a little bit of progesterone and everything settles out.”
Blood tests can be helpful, but they can’t accurately gauge a woman’s hormone levels leading up to menopause, nor are they used to prescribe an exact formulation of any particular hormone, Bay said.
“It would be nice to test estrogen and progesterone with more accuracy, but in the context of menopause care, we do not have good labs for it,” she said. “If I see a woman who hasn’t had a period in six months, I know it’s going to be low, so I don’t need to do labs.”
There are standard protocols healthcare providers follow when it comes to prescribing HRT. Women who get a prescription for systemic estrogen, in a patch or pill form, and still have a uterus are also prescribed progesterone or another form of uterine protection. Testosterone, which has not been approved by the FDA to treat women for menopause symptoms, can sometimes be prescribed off-label to help women suffering from low libido. Baselice does not prescribe testosterone as a first-line treatment for every menopausal woman experiencing fatigue, weight gain or brain fog.
“I usually will start people on estrogen and progesterone first,” she said. “Online, you’ll find that people want to use it to help with their athletic endurance or fatigue or (to boost) overall energy levels.”