Menopause Finally Gets Its Moment: A Year of Progress and What’s Next

After decades of neglect, menopause care is becoming law—and that scary warning label is finally gone

Something remarkable happened in 2025. After being ignored, dismissed, and undertreated for generations, menopause became a legislative priority. Not in one state—in nineteen. Not with one bill—with thirty-six.

And then, in November, the FDA did something many of us thought we’d never see: they removed the “black box” warning from hormone therapy products. The same warning that scared millions of women away from effective treatment for over two decades.

This is what progress looks like. And 2026 is shaping up to be even bigger.

The Legislative Breakthrough

Let’s take stock of where we are. In the past year alone:

Four states now mandate insurance coverage for menopause treatments. Illinois and Louisiana require coverage for all patients. Oregon and Washington cover some patients. New Jersey joins them with the Menopause Insurance Coverage Act, signed into law by Governor Phil Murphy.

California passed a bill requiring insurance coverage and improving menopause education for healthcare providers—and Governor Gavin Newsom vetoed it. Twice. Despite bipartisan support. He’s indicated he may include provisions in the state budget, but that’s temporary. California advocates will need to keep pushing for permanent law.

Rhode Island now provides workplace protections for employees on the basis of menopause. Philadelphia passed a similar ordinance taking effect in 2027.

Maine requires its Department of Health and Human Services to provide menopause informational materials.

Illinois created a permanent statewide Menopause Awareness Week.

This is unprecedented. Menopause—a biological reality affecting half the population—is finally being treated as a legitimate healthcare issue worthy of legislative attention.

The Black Box Is Gone

On November 10, 2025, the FDA announced it would remove the black box warning from all hormone therapy products containing estrogen. This is the strongest warning the agency can place on a medication, and it had been there since 2003.

For twenty-three years, that label told women and their doctors that hormone therapy increased the risk of breast cancer, heart disease, stroke, and dementia. Prescriptions plummeted. Use dropped from 27% of menopausal women in 1999 to just 5% by 2020.

Millions of women suffered through hot flashes, night sweats, sleep disruption, mood changes, vaginal atrophy, and accelerated bone loss—because they were afraid to take a medication that could have helped them.

“This is, in my opinion, one of the greatest mistakes in modern medicine—the demonization of hormone replacement therapy,” said FDA Commissioner Marty Makary at the announcement.

He’s not wrong.

How We Got Here: A Story of Bad Science and Worse Communication

The black box warning came from the Women’s Health Initiative (WHI), a large study that reported alarming findings in 2002. Headlines screamed about breast cancer risk. Doctors stopped prescribing. Women flushed their pills.

But here’s what got lost: the WHI enrolled women with an average age of 63—well past menopause. Many already had cardiovascular disease. The study wasn’t designed to answer the question most relevant to symptomatic menopausal women: Is hormone therapy safe for women in their 40s and 50s who are having symptoms?

Subsequent analysis told a different story. Women who start hormone therapy within 10 years of menopause onset, or before age 60, show:

• Reduced all-cause mortality

• 50% reduction in heart attack risk

• 35% lower risk of Alzheimer’s disease

• 50-60% reduction in bone fractures

The WHI scared women away from treatment that, for most, would have helped them. The FDA’s original warning painted all women with the same brush, ignoring the critical importance of timing.

The new guidance recommends starting systemic hormone therapy within 10 years of menopause onset or before age 60. This is evidence-based medicine—finally.

What the FDA Change Means (and Doesn’t Mean)

Let me be clear about what’s changed:

The black box warning is being removed from all estrogen-containing products. This includes pills, patches, gels, creams, and vaginal estrogen.

The warning about endometrial cancer for estrogen-only products remains. Women with a uterus who take systemic estrogen still need progesterone to protect the uterine lining. That hasn’t changed.

Individual risk assessment still matters. Women with a history of breast cancer, blood clots, or certain other conditions need careful, individualized discussions with their providers. Removing the black box doesn’t mean hormone therapy is right for everyone.

Vaginal estrogen is extremely safe. The removal of the warning from low-dose vaginal estrogen is particularly welcome. This treatment—used for vaginal dryness, painful sex, and recurrent urinary tract infections—has an excellent safety profile and was being avoided unnecessarily because of the scary label.

The American College of Obstetricians and Gynecologists applauded the change, while noting that systemic hormone therapy still requires nuanced discussion. As ACOG President Dr. Steven Fleischman put it: “The updated labels will better allow patients and clinicians to engage in a shared decision-making process, without an unnecessary barrier.”

That’s exactly right. The goal isn’t to put every woman on hormones. The goal is to remove fear-based obstacles to an informed conversation.

What’s Coming in 2026

If 2025 was the year menopause got attention, 2026 is the year to cement the gains.

States to watch:

• Michigan has four live bipartisan bills supporting initiatives like statewide medical school curriculum and public education campaigns. Governor Gretchen Whitmer made menopause the topic of a listening tour.

• New Jersey has additional proposals on the table beyond the insurance coverage law: bills for physician licensing credits, an inter-agency council on menopause research, and state-supported treatment services.

• New York, Florida, Georgia, and Virginia all have momentum building.

Federal action:

Several bills were introduced over the past two years:

• The Improving Menopause Care for Veterans Act

• The Advancing Menopause Care and Mid-Life Women’s Health Act

• The Menopause Research and Equity Act

• The WARM (We’re Addressing the Realities of Menopause) Act

Getting these through Congress will be difficult given the current political environment. But the FDA’s action on the black box warning creates an opening. When the regulatory agency acknowledges that hormone therapy has been unfairly maligned, Congress has political cover to invest in menopause research and education.

What the FDA still needs to do:

Testosterone. Women increasingly use testosterone as part of menopause care—for libido, energy, and muscle maintenance—but the FDA only approves it for men. An FDA-approved women’s formulation, backed by research and appropriate dosing guidelines, is an important next step.

What This Means for Patients

If you’re a woman in perimenopause or menopause, here’s what you should know:

The conversation has changed. Your doctor should no longer reflexively refuse hormone therapy based on outdated fears. If they do, find a provider who stays current with the evidence.

Timing matters. The benefits of hormone therapy are clearest when started within 10 years of menopause onset or before age 60. This is the “window of opportunity” that the WHI obscured.

Vaginal symptoms deserve treatment. Vaginal estrogen is safe for the vast majority of women, including many breast cancer survivors. Don’t suffer from painful sex or recurrent UTIs because of a warning label that’s being removed.

Insurance coverage is expanding. Check whether your state mandates coverage. If not, advocate for it. The legislative language now exists—it just needs to be adopted.

Your symptoms are real. Hot flashes, night sweats, insomnia, brain fog, mood changes, weight gain—these aren’t minor inconveniences. For many women, they’re debilitating. You deserve treatment.

The Bigger Picture

Menopause affects roughly half the human population. The average woman spends a third of her life post-menopause. And yet, until recently, medical schools taught almost nothing about it. Insurance often didn’t cover treatment. Research funding was negligible.

The past year represents a turning point. Legislative action, regulatory reform, and private investment—like the Gates Foundation’s $2.5 billion commitment to women’s health, including $100 million specifically for menopause research—are finally treating this as the public health priority it is.

But there’s still work to do. As menopause advocate Jennifer Weiss-Wolf notes, the movement must prioritize women at the margins: those facing domestic violence, addiction, incarceration, poverty. If standard menopause care is inadequate for resourced women on a good day, it’s exponentially worse for those already underserved by the healthcare system.

What You Can Do

Know your options. If you’re symptomatic, talk to your provider about hormone therapy. Understand the timing considerations. Ask about vaginal estrogen if you have genitourinary symptoms.

Advocate. Contact your state legislators. The legislative language exists. California’s bill can be adapted for any state. Rhode Island’s workplace protections can be replicated. Your voice matters.

Demand coverage. If your insurance doesn’t cover menopause treatments, push back. File appeals. Write to your employer’s benefits team. The more patients demand coverage, the faster it becomes standard.

Stay informed. The science is evolving. The Menopause Society, ACOG, and reputable medical sources provide evidence-based information. Be wary of social media claims—both the fear-mongering and the oversimplification.

A Turning Point

For decades, menopause was treated as something women should just endure. Hot flashes? Deal with it. Vaginal atrophy? That’s just aging. Sleep disruption? Try relaxation techniques.

That era is ending. The black box warning is coming off. States are mandating coverage. Research funding is increasing. Medical education is improving.

It took too long. Millions of women suffered unnecessarily. But we’re finally moving in the right direction.

2025 was the breakthrough year. 2026 is the year to make it permanent.