My first inkling that people couldn’t get their hormone medication was a phone call from a patient in December. She’d been my patient since 2022, when chemotherapy for colon cancer had damaged her ovaries and put her into menopause, triggering hot flashes and night sweats that wrecked her sleep. Her doctors at the time had dismissed her concerns and told her she didn’t need hormone therapy.
This happens all too often. Women are told that menopause is “natural” and are expected to just deal with it. Together, my patient and I decided hormone therapy could help her. For the past three years, it had.
But now her estrogen patches were back-ordered and she was worried about getting them before she was set to travel for the holidays. The United States is experiencing an estrogen patch shortage that involves several manufacturers and is expected to continue through the end of the year.
This shortage is the direct effect of more demand. Estrogen patch prescriptions increased 72 percent between 2021 and the fall of 2025, according to medical record data from Epic Research. They picked up further after the Food and Drug Administration in November removed a black-box warning that had linked hormone therapy to cancer and heart disease.
The growing interest in menopause treatment and the spotlight it puts on women’s health is a huge step forward. For decades, many women didn’t get medication that could have significantly improved their lives, because doctors and patients thought treatment was too risky, and symptoms weren’t taken seriously. Now, with more women, including celebrities, sharing their experiences with menopause, and the re-evaluation of scientific evidence around the risks and benefits of treatment, more doctors and patients are embracing hormone therapy. As welcome as the recent attention to women’s health is and as much as I still worry about unmet need, I’m seeing signs that the pendulum might be swinging too far from “estrogen for no one” to “estrogen for all.” Menopause influencers are promoting high doses of estrogen for overall health or to achieve hormonal balance. Telehealth sites include estrogen under their “longevity” plans. One of my patients half-jokingly said to me, “All the cool girls are doing it.”
Women deserve high-quality care. The best evidence supports taking hormone therapy in menopause because it’s the most effective treatment for hot flashes and night sweats, bar none. There’s no good evidence that hormones will help you live longer or keep you from getting dementia.
Many of these claims are particularly ironic, given the findings two decades ago that led so many women to abandon hormones in the first place. In the early 2000s, the Women’s Health Initiative, a large, randomized controlled trial designed to test whether hormone therapy might protect women from diseases of aging, instead found that participants given hormone therapy had an increased incidence of heart disease and breast cancer. Women across the country tossed their hormone therapy into the trash, and doctors refused to prescribe it. In 1999, nearly 27 percent of menopausal women took hormone therapy. In 2020, just 4.7 percent of menopausal women took it.
Within months of the release of the Women’s Health Initiative results, some experts expressed concerns about the trial’s design. But the real change in treatment came as more women entered medicine and scientific research; the fact that they had their own experiences of menopause helped spur a meaningful re-evaluation of the science.
A closer look at the data shows that many of the participants recruited into the study were older (up to 79 years old) and years past menopause. Most women start hormone therapy much younger, in their 50s. Younger women enrolled in the trial did not have the same risk for heart disease as women who were over 60 at the start of the trial. Today, doctors feel estrogen is safe for most women if started within 10 years of their last menstrual period or before the age of 60.
Additionally, the increased risk of breast cancer, which was far smaller than the headlines made it out to be, was only seen among women who received a synthetic version of the hormone progesterone. (Progesterone is prescribed alongside estrogen for women who haven’t had a hysterectomy.) Doctors now use a different form, known as micronized progesterone, which is identical to the hormone made in women’s bodies and not associated with increased cancer risk.
There’s a bigger lesson to be learned here. One of the weaknesses of the Women’s Health Initiative study and the exaggerated panic over its initial findings was how little attention was paid to women’s menopause symptoms. The goal of the trials was not to study whether hormone therapy was effective for these symptoms, and as a result, the trial and the ensuing discussions only focused on the risks, not the benefits, of treatment.
The fact is, some women experience hot flashes that leave them drenched in sweat dozens of times a day. Night sweats can wake women many times a night, leaving them exhausted. A recent study found that women diagnosed with menopause symptoms earned 7 percent less four years later than women without such symptoms, largely because they reduced work hours or even left the labor force. Treatment appears to lessen these losses.
When women ask me whether they should be taking estrogen to prevent health problems later, I turn the conversation back to how they feel today. Many women admit to severe menopause symptoms, but minimize the importance of treating them.
Perhaps that’s why a recent survey found that 87 percent of women experiencing menopause symptoms did not seek treatment. As much as I worry about overhyping these medications, I still think a bigger concern is that, even with increases in prescribing, a large number of women who would benefit from them are suffering needlessly.
My patient was able to switch from her patch to an estrogen gel that she could get more quickly, but she won’t be the last such case. I hope by the time the shortage ends, women and the doctors who care for them will understand that hormone therapy is not some fountain of youth, but it doesn’t need to be. Menopause symptoms can be life-disrupting, and that alone is enough to warrant effective treatment.
Gillian Goddard is an adjunct assistant professor of medicine at the N.Y.U. Grossman School of Medicine and the author of the forthcoming book “The Hormone Loop.” Her newsletter is The Savvy Patient.
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