Cybele Maylone, 46, has been hearing about hormone therapy nonstop. Whether it is her friends going through menopause or posts from influencers on her social media feed, the subject has seemed unavoidable: who was on it, which doctor finally took their symptoms seriously and, most importantly, how good it felt to be on the medication. The hot flashes waning. Brain fog lifting. Sleep returning.
To Ms. Maylone, it sounds like a miracle drug. But for her and millions of other women, it is not an option.
She was diagnosed in 2023 with a type of breast cancer fed by estrogen, and now takes a drug that suppresses the hormone to reduce her risk of recurrence. While breast cancer is the most widely recognized reason women may not be able take hormone therapy, which delivers estrogen or progesterone through pills and patches, the list also includes endometrial cancer, certain cardiovascular issues, severe liver disease and blood clotting disorders.
Ms. Maylone and other women said they feel deeply frustrated that they can’t take a drug that so many women around them seem to have benefited from.
“The messaging about HRT is so positive and all-consuming right now,” Ms. Maylone said. It seems like “you can experience this phase of your life totally differently, and there is relief,” she added.
“I feel totally cut off from that,” she said.
Rebecca Hastings, 46, cannot take hormone replacement therapy because it raises the risk of blood clots, which she is already more likely to develop because of a genetic mutation that she carries.
At a recent family party, she started commiserating with another woman about perimenopause symptoms, which for Ms. Hastings have included night sweats and hot flashes. They were half-complaining, half-laughing when the woman became serious: She had wasted two years suffering before starting hormone therapy, she told Ms. Hastings. It had fixed everything.
“I immediately lost connection and felt isolated,” Ms. Hastings said.
There are other options to treat some of these symptoms. But because of a lack of awareness, doctors don’t always suggest them, and patients don’t often know to ask for them.
Ms. Hasting’s gynecologist recommended an herbal supplement for hot flashes and also suggested avoiding caffeine, limiting hot beverages and sleeping with a fan. The supplement has helped slightly, she said, but definitely has not eliminated the hot flashes. The dietary changes help somewhat too, but come with what feel like constant trade-offs — no morning cup of tea, less sugar.
“I have to work hard to feel better, struggling through it all, while other people get to slap on a patch and live their best lives,” she said.
“I recognize it’s not that simple, but it is how it feels,” she added.
Jamie Davis Smith, a 51-year-old writer and adjunct professor in Washington, D.C., said her doctor advised against hormone replacement therapy because she is at increased risk of stroke, but has not suggested any alternative ways to treat her symptoms, including brain fog that often causes her to lose a word midsentence while she is writing or teaching.
Ms. Maylone said that when she tried to raise the subject with her providers, she hit a wall. “Through no fault of their own, they’re like, ‘We’re trying to have you not have cancer,’” she said. “It just feels like you hit a dead end.”
There is a “humongous provider knowledge gap” when it comes to menopause care, said Dr. Rajita Patil, director of the Comprehensive Menopause Program at UCLA. While demand has exploded, many clinicians are still not up to speed on the full range of treatments, including nonhormonal options, she said.
Those include a drug called fezolinetant (brand name Veozah), which was approved in 2023 and is the first non-hormonal pill specifically for moderate to severe hot flashes. The Food and Drug Administration approved a similar drug, elinzanetant (brand name Lynkuet), in 2025. Both medications work by targeting the neurological mechanism behind hot flashes, rather than replacing estrogen.
Cognitive behavioral therapy can also be beneficial for hot flashes and sleep issues, and certain antidepressants and other drugs can be used off-label for hot flashes and sleep. Lifestyle adjustments, like those Ms. Hastings’ doctor recommended, can ease some symptoms, but won’t do away with them entirely. Those include regular weight-bearing exercise, which can help maintain bone density lost during menopause, as well as avoiding caffeine and alcohol and managing stress.
Most women who can’t take systemic hormone therapy can also use topical vaginal estrogen for things like vaginal dryness or pelvic pain.
“We have so many other things in our tool kit,” said Dr. Stephanie Faubion, medical director of The Menopause Society and director of the Mayo Clinic Center for Women’s Health. But very few women have heard of these options, which may be a reflection of how squarely the conversation around menopause has focused on hormone therapy.
“I would love it if any of the menopause influencers were like, ‘Hey, women with breast cancer — I know you are out there, doing all the strength training, doing all the things. Bummer.’ Just acknowledge it,” said Sarah Tuneberg, 46, who cannot take hormone replacement therapy because she has a history of breast cancer.
Alternatives to hormone therapy have helped Ms. Tuneberg, but juggling all of them can be taxing. She takes an antidepressant for mood swings, sleep issues and anxiety, as well as supplements for hot flashes. Ms. Tuneberg, 46, also gets infusions every six months for osteoporosis (“It’s me and the 80 year olds,” she said) and uses a cream to address vaginal dryness, including before having sex.
“Is there anything less sexy than saying, are we going to have sex tonight? Because if so, I need at least 30 minute notice so I can do my vaginal moisture routine,” she said.
The idea of a single, convenient pill or patch that can treat all these issues at once is very appealing to Ms. Tuneberg. She said that many of her friends talk about hormone therapy as “absolutely saving their lives.”
“I’m so glad for them,” she said. “But also very jealous.”
Dr. Faubion said that the messaging around hormone replacement therapy has contributed to women like Ms. Tuneberg feeling left out. The treatment is only approved to relieve hot flashes and night sweats, and to help maintain bone density. But influencers and menopause care companies also tout it as a way to relieve all sorts of other symptoms, protect the brain and the heart and even slow aging.
Dr. Faubion said that can leave women who cannot take it feeling like they have “missed out on the golden ticket.”
“I want to tell them they haven’t.”
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