Navigating Menopause: Experiences and Treatments

For quite some time, women have been visiting Dr. Megan Lochner, facing familiar struggles like hot flashes, sleepless nights, and brain fog. These symptoms are often associated with perimenopause and menopause, and the distress they cause can be overwhelming.

Dr. Lochner, who practices at Stony Brook Medicine, would explain the potential benefits of hormone therapy. If a patient seemed suited for it, she would provide a prescription.

“They would return and inform me that they hadn’t started the medication,” she remembered. “When I asked why, one woman mentioned that her pharmacist had a pretty alarming reaction—asking if her doctor was trying to harm her. Others, even after getting the prescription, were scared off by the ominous ‘black box’ warning.”

This warning mentioned risks associated with cardiovascular disease and breast cancer, particularly related to combination hormone use.

Fortunately, with recent updates to federal guidelines, Dr. Lochner’s waiting room now buzzes with patients eager for menopause hormone treatment. Some pharmacists are even running low on hormone patches.

“I’m still advising my patients the same way I did last year,” she noted. “However, now they seem more at ease when starting their medication since that black box warning has been lifted.”

In November 2025, the U.S. Food and Drug Administration announced plans to remove the warning associated with a 2002 study that many experts deemed flawed in its conclusions. Earlier this month, the American College of Obstetricians and Gynecologists updated its guidelines, strongly recommending hormone therapy for most patients experiencing menopause symptoms.

It’s important to note that not every woman endures severe symptoms during menopause, though those who do often find it essential to address their discomfort.

The treatment, which may include various delivery methods like pills, transdermal patches, gels, sprays, and vaginal creams, is gaining interest. Still, pursuing hormone therapy is a personal choice, and the journey can vary significantly.

Personal Stories and Decisions

Angela Pesa from Deer Park shrugged off her irritability and sleeplessness, chalking it up to wedding planning stress. Blood work suggested she wasn’t in perimenopause, but her symptoms didn’t improve.

“My jeans were fitting oddly, but I was active,” Pesa, 46, stated. “I run my dog daily and maintain a healthy diet. Yet, I was waking up at 3 a.m. with my mind racing. I felt something was off.”

Initially hesitant about hormone therapy, Pesa had heard about the potential cancer links. Her worries reflect the mixed feelings many have about a treatment once widely prescribed in the mid-20th century.

Understanding Menopause and Treatment History

Menopause is considered to start after a woman has gone 12 months without a period, bringing an end to her natural fertility. The transition, known as perimenopause, can involve symptoms like hot flashes and mood swings, typically beginning around the age of 52 in the U.S.

Historical efforts to alleviate menopause symptoms date back to at least the 1800s, with treatments emerging from animal ovarian tissue. In 1941, Premarin, derived from the urine of pregnant mares, was introduced as a source of estrogen for women.

For years, hormone therapy was believed to alleviate symptoms and prevent serious health issues like heart disease. However, the tide turned with the 2002 Women’s Health Initiative, a major study that reported heightened risks of heart disease and breast cancer among women using hormone medications. The reaction was swift—many women stopped taking hormones, and healthcare providers became hesitant to prescribe them.

Some experts criticize the study for being overly broad, as it included significantly older women, diverging from those experiencing perimenopause symptoms. “The average age of the participants was 64,” explained Dr. Stephanie Trentacoste McNally from Northwell Health. “Reanalysis indicated that women in their early 50s have different risk profiles.”

The updated 2013 report from the Women’s Health Initiative endorsed hormone therapy as a “reasonable option” for managing severe menopausal symptoms while advising against its use for chronic disease prevention.

“It’s crucial to clarify what symptoms hormone replacement therapy effectively treats,” Dr. Banks remarked. “It’s excellent for hot flashes, but there’s still so much we don’t know.”

Hormone therapy can lead to side effects and isn’t for everyone—there are risks of stroke, blood clots, and breast cancer alongside other potential symptoms like nausea and mood changes.

Diverse Experiences with Hormone Therapy

Pesa eventually found answers through another specialist, Dr. Katie Rowan, who pointed out that her earlier blood tests hadn’t fully captured her hormonal status. After starting therapy with a different approach, Pesa said she quickly felt a positive shift. “I’m much happier now and feel more like myself,” she shared. “I’ve even started looking forward to running.”

Heather Umhafer, suffering from extreme fatigue and hot flashes at 47, sought help from Dr. Lochner as well. After starting hormone therapy and switching to a gel delivery due to patch shortages, she experienced almost immediate relief. “The hot flashes stopped within a few nights, and my clarity improved significantly,” she explained.

Experts emphasize the need for a tailored treatment plan based on each woman’s health profile, recognizing that results can vary. “What suits one person may not work for another,” Dr. Gewirtz mentioned. “Patience is essential, as adjustments may be necessary after three months.”

Additional Symptoms of Menopause

While hot flashes and night sweats are synonymous with menopause, other symptoms often go unrecognized:

• Dry, itchy skin: Reduced estrogen affects the skin’s moisture retention, making it feel thinner and more susceptible to bruising.
• Dry mouth: Estrogen plays a role in saliva production, so lower levels can lead to dryness.
• Facial hair: Hormonal imbalances may result in the growth of excess facial hair for some women.
• Red, dry eyes: Changes in hormone levels can impact tear production, causing discomfort and sensitivity.