Hormone Replacement Therapy Is Making a Comeback! Here’s Why.

More women are taking hormone replacement therapy, progesterone prescriptions are climbing, and the FDA just made one of the biggest changes to menopause treatment in decades.

After years of women being told to tough out their hot flashes, sleepless nights, and mood swings, something pretty exciting is happening in women’s healthcare. Hormone replacement therapy (HRT) is making a comeback. Between 2021 and 2025, reported use of menopausal hormone therapy increased 63%, according to a survey of approximately 7,000 women. Compounding pharmacy Carie Boyd Pharmaceuticals has also reported a 309% increase in progesterone prescribing within its business. And it’s not just patients getting interested. Applications for The Menopause Society’s professional certification reportedly jumped 500% between 2022 and 2024. More women are asking about hormones. More providers are learning how to prescribe them. And the FDA is finally updating warnings that have shaped menopause care for more than 20 years. So, what’s changed? And what does it mean if you’re in your 40s, 50s, or beyond?

Why Is Hormone Replacement Therapy Suddenly So Popular?

For a long time, the conversation around menopause went something like this: You’re having hot flashes? That’s normal. You’re waking up at 3 a.m.? Welcome to your 40s. Your mood is all over the place? Must be stress. And while some of these symptoms are common, common doesn’t mean you have to put up with them. Women are becoming more aware of the symptoms associated with perimenopause and menopause, including:

• Night sweats and hot flashes
• Waking up in the middle of the night
• Brain fog and trouble concentrating
• Irritability, anxiety, and mood changes
• Vaginal dryness and painful intercourse
• Changes in menstrual cycles

They’re also learning that there are effective treatments available, and that they don’t necessarily need to wait until their periods stop to get help. That’s a big deal. At Flow Wellness, we see women who have spent years trying to figure out why they don’t feel like themselves. Sometimes hormones are a major part of the picture. Sometimes other factors are involved, too. The important thing is figuring out what’s actually going on rather than dismissing symptoms as an inevitable part of getting older.

The FDA Just Changed the Conversation Around HRT

Here’s one of the biggest developments. In November 2025, the FDA announced plans to remove several longstanding boxed warnings from menopausal hormone therapy medications. The first updated product labels were approved in February 2026. For years, hormone therapy products carried prominent warnings about breast cancer, cardiovascular disease, and probable dementia. The FDA removed those statements from the boxed warnings on applicable products and moved away from the familiar instruction to use hormones at the lowest effective dose for the shortest possible duration. That’s a major change after more than two decades of caution surrounding HRT. Does this mean hormone therapy is suddenly risk-free? Of course not. Breast cancer risk, cardiovascular health, blood clots, and other considerations still matter. The FDA also retained the endometrial cancer boxed warning for systemic estrogen used without adequate endometrial protection. But we’re moving away from treating hormone therapy as something women should automatically avoid and toward making decisions based on individual risks, symptoms, and goals. And that’s how healthcare should work. Read the FDA’s announcement about updated hormone therapy labeling.

Wait, Weren’t We Told Hormone Replacement Therapy Was Dangerous?

Yes. And there’s a reason so many women are confused. In 2002, the Women’s Health Initiative published findings that raised serious concerns about hormone therapy, including breast cancer and cardiovascular risks. The news made headlines, hormone prescriptions plummeted, and an entire generation of women became understandably nervous about HRT. But here’s what often gets lost in that story. The original trials primarily studied specific oral hormone formulations, including conjugated equine estrogens and medroxyprogesterone acetate. Over the following two decades, researchers learned more about how hormone therapy risks vary depending on the woman’s age, when treatment begins, which hormones are prescribed, and how they’re delivered. For many healthy women who start systemic hormone therapy before age 60 or within 10 years of menopause, the benefits for bothersome menopausal symptoms generally outweigh the risks. That doesn’t erase the original findings. It means we understand them better now. And importantly, we have more treatment options to consider.

Progesterone Is Having a Moment, Too

Estrogen usually gets the spotlight when we talk about menopause, but progesterone deserves some attention. During perimenopause, ovulation becomes less predictable. Since progesterone production depends largely on ovulation, levels can fluctuate significantly. For some women, these hormonal changes happen alongside poor sleep, irregular periods, and other frustrating symptoms. Oral micronized progesterone may help with sleep and night sweats in certain women, although research on progesterone used alone is still developing. Progesterone also plays an essential role in protecting the uterine lining when women with a uterus take systemic estrogen. So it’s encouraging to see more interest in understanding when progesterone might be helpful. But more progesterone isn’t automatically better, and not every woman with sleep problems needs a prescription. At Flow Wellness, we look at symptoms, menstrual patterns, medical history, and the bigger hormonal picture before recommending treatment.

Doctors Are Going Back to School for Menopause

Here’s another trend we’re excited about. Applications for The Menopause Society’s professional certification reportedly increased 500% between 2022 and 2024. Why does that matter? Because menopause affects nearly every woman who reaches midlife, yet many healthcare providers receive surprisingly limited training in managing it. A March 2026 article published in JAMA, Opportunity for Improved Menopausal Hormone Therapy Prescribing, highlighted just how many women are affected:

• More than 1.3 million American women enter menopause every year.
• Approximately 55 million women in the United States are postmenopausal.
• Up to 80% experience hot flashes or night sweats.

That’s a lot of women who deserve access to knowledgeable, up-to-date care. The increased interest in menopause education is a great sign, although changes in medical practice don’t happen overnight. Even with updated FDA labeling and clinical guidelines, some providers may still be hesitant to prescribe hormone therapy. And that’s why staying current with the research matters so much.

So, Should Every Woman Be Taking Hormone Replacement Therapy?

No. And we wouldn’t want that to be the takeaway. Hormone replacement therapy can be incredibly helpful for the right woman, but it isn’t a universal solution. Systemic estrogen is the most effective treatment for hot flashes and night sweats. It can also help prevent bone loss and improve menopause-related sleep disruption. But treatment decisions need to account for medical history, risk factors, symptoms, and personal preferences. At Flow Wellness, we also look at sleep, metabolic health, body composition, cardiovascular health, and other factors that influence how women feel as they age. Sometimes HRT is an important piece of the puzzle. Sometimes another approach makes more sense. The goal isn’t to get every woman on hormones. It’s to make sure every woman has the opportunity to understand her options.

Frequently Asked Questions About Hormone Replacement Therapy

Is hormone replacement therapy safe in 2026?

For many healthy women who begin systemic HRT before age 60 or within 10 years of menopause, the benefits for bothersome symptoms generally outweigh the risks. The FDA’s updated labeling reflects a more individualized approach, but hormone therapy still requires careful consideration of medical history and risk factors.

Why did the FDA remove the black box warning on HRT?

The FDA removed certain risks from the boxed warnings on applicable menopausal hormone therapy products after reviewing the evidence. The changes do not eliminate all safety warnings or mean every hormone formulation carries the same risks. The endometrial cancer warning for unopposed systemic estrogen remains.

Can I start hormone replacement therapy during perimenopause?

Yes! You don’t have to wait until your periods stop to discuss treatment. Some women benefit from hormone therapy during perimenopause, particularly when hot flashes, night sweats, or other symptoms begin affecting daily life. The best approach depends on your symptoms, cycle patterns, and medical history.

Does progesterone help with sleep during perimenopause?

It can. Some research suggests oral micronized progesterone may improve sleep and night sweats in certain women. However, sleep problems can have several causes, and progesterone isn’t the right treatment for everyone.

Does hormone replacement therapy cause weight gain?

Generally, no. HRT isn’t associated with significant weight gain. Menopause itself can contribute to changes in body composition, including increased abdominal fat. Hormone therapy may modestly influence fat distribution, but it isn’t a weight loss medication.

Can hormone replacement therapy help with menopause belly fat?

Possibly, to a degree. Declining estrogen levels are associated with increased abdominal and visceral fat. Hormone therapy may modestly reduce this shift in some women, but nutrition, resistance training, and overall metabolic health remain important.

What’s the difference between estrogen and progesterone?

Estrogen helps regulate reproductive function and influences bone health, temperature regulation, and vaginal tissues. Progesterone helps regulate the menstrual cycle and protects the uterine lining when systemic estrogen is prescribed to women with a uterus. Both hormones change during perimenopause and menopause.

Is bioidentical hormone replacement therapy better than traditional HRT?

Bioidentical hormones have the same molecular structure as hormones produced by the human body. FDA-approved bioidentical estradiol and micronized progesterone are available. Compounded bioidentical hormones may be appropriate in selected circumstances, but they haven’t been proven safer or more effective than FDA-approved formulations.

How long can you stay on hormone replacement therapy?

There’s no universal expiration date for HRT. Some women use it for a few years, while others continue longer because the benefits remain meaningful. The decision should be revisited periodically based on symptoms, health history, and individual risks.

Where can I get hormone replacement therapy in Bend or Seattle?

Flow Wellness offers personalized hormone evaluations and hormone replacement therapy in Bend, Oregon, Seattle, Washington, and through telehealth across Oregon, Washington, and California. Our providers develop individualized treatment plans and adjust care as your needs change.

We’re Excited About Where Women’s Healthcare Is Heading

For years, women were told that hot flashes, poor sleep, mood changes, and other menopause symptoms were simply part of getting older. Now we’re seeing a different conversation. More women are asking questions. More providers are getting educated. And the FDA is updating longstanding hormone therapy warnings to reflect a more individualized understanding of the evidence. We still have more to learn, and HRT isn’t right for everyone. But women deserve more than being told to tough it out. They deserve good information, thoughtful treatment options, and providers who take their symptoms seriously. And we’re really glad to see healthcare moving in that direction.

Curious Whether Hormone Therapy Could Help You?

Maybe you’re waking up at 3 a.m. every night. Maybe your mood, energy, or menstrual cycle has changed. Or maybe you’ve just been wondering whether HRT is something you should consider. You don’t need to have all the answers before coming in. At Flow Wellness, we’ll help you understand what’s happening, explore your options, and develop a plan that makes sense for you. Schedule a hormone consultation at Flow Wellness in Bend, Seattle, or through telehealth. Let’s figure out what might help you feel better.