Hormone Replacement Therapy for Menopause

By U.S. News & World Report
December 14, 2025 | 7:00 PM

Impulsive, anxious, overheated, scatter-brained, depressed and in pain are just some of the terms that many women use to describe themselves when they reach perimenopause, or the years that precede reaching menopause. These descriptions were brought on by the mental and physical symptoms caused by declining hormonal levels.

Yet after starting hormone replacement therapy (HRT), also called hormone therapy, these same women say they finally have relief from these symptoms. They describe feeling like they’ve “lost” years of their lives to the impact of hormonal changes, but regain clarity and sense of self after HRT.

Over the past few decades, controversy surrounding HRT’s side effects has led to declining rates of use.

However, thanks to the efforts of doctors, researchers and medical institutions, the Food and Drug Administration announced in November 2025 it would remove a misleading black box warning from combination HRT therapy products that has historically discouraged women from taking hormone therapy.

What Is Hormone Replacement Therapy?

Hormone replacement therapy is a medical treatment that uses estrogen and progestin, a form of progesterone, to help reduce symptoms women may experience in perimenopause and menopause, when these hormones naturally decrease.

The surgical removal of the ovaries, an oophorectomy, is often performed to prevent or treat ovarian cancer. This procedure can induce early menopause, a condition referred to as surgical menopause, and is often treated with HRT to reduce the risk for heart disease and bone loss.

Also referred to as hormone therapy (HT), this treatment can also be used in other circumstances, such as for infertility, cancer or gender transition, says Dr. Kecia Gaither, double board-certified in OB-GYN and maternal fetal medicine and director of perinatal services/maternal fetal medicine at NYC Health + Hospitals/Lincoln in the Bronx, New York.

Types of hormone replacement therapy

HRT is available in two main forms:

[CHART]

A health care professional will review the pros and cons of each form of hormone therapy based on any other health conditions you may have and your individual needs. For example, if you have psoriasis, you may want to avoid a patch as it’s placed on the skin and instead opt for a pill.

The 2025 FDA announcement of the removal of the black box label will apply to combination therapy products and low-dose estrogen-only therapy. However, systemic estrogen-only medications, like the estrogen-only pills, will retain their warning labels.

[At-Home Menopause Tests: Pros and Cons, What They Test and When to See a Provider]

Benefits of Hormone Replacement Therapy

Hormone therapy in perimenopausal and menopausal women can help treat several symptoms including:

— Hot flashes

— Joint aches

— Mood swings

— Night sweats

— Bone loss

— Vaginal dryness, which also may lead to painful intercourse

Although some women going through menopause may have virtually no symptoms, others may experience many symptoms.

In fact, an estimated 80% of women will experience hot flashes during or around menopause, according to the American College of Obstetrics & Gynecology.

Hot flashes can occur as frequently as six times a day, disrupting sleep and mental well-being. As a result, these symptoms can significantly affect a woman’s quality of life.

“You’re going to be irritable, and you’re not going to be a very pleasant person to be around,” Dr. Wen Shen, associate professor of clinical gynecology and obstetrics and director of the Women’s Wellness & Healthy Aging Program at Johns Hopkins Medicine in Baltimore.

[READ: The Menopause Diet: The best diet plan for mitigating symptoms and weight gain.]

Risks of Hormone Replacement Therapy

Hormone therapy has certain risks; however, the extent of these risks may vary depending on the HRT preparation, dosage and method of use.

— Blood clots. The risk for blood clots increases a small amount when using oral hormone therapy. Skin and vaginal use of hormone therapy aren’t metabolized through the liver, so the risk associated with blood clots is lower. If you’re already at a higher risk for blood clots, talk with your health care professional about the best options for you.

— Breast cancer. The risk for breast cancer increases the most after three to five years of estrogen plus progestin therapy and after seven years of using vaginal estrogen hormone therapy, according to The Menopause Society.

— Endometrial and ovarian cancers. The risk of endometrial and ovarian cancers is lowered when both estrogen and progestin are used versus estrogen alone, according to an analysis of clinical trial data presented at the 2024 American Society for Clinical Oncology meeting.

— Heart attacks. Although heart attack risk can increase when HRT is used in women age 70 and older, the risk isn’t present in postmenopausal women who are younger than this, according to a November 2025 study in JAMA Internal Medicine.

It’s important to consider if hormone therapy is right for you. Your health care professional may advise against HRT if you have a history of:

— Abnormal vaginal bleeding

— Blood clots

— Breast, ovarian or uterine cancer

— Heart attack

— Stroke

It’s important to talk to your health care professional, specifically from a health care professional who specializes in hormone therapy and menopause, about the benefits and risk factors based on your medical history.

If a woman is having hot flashes or other menopausal symptoms at age 60 or beyond, health care professionals will typically discuss nonhormonal treatments. Some women may choose to continue hormone therapy beyond age 60 despite associated risks.

[READ: Health Questions to Ask Your Doctor]

Side Effects of Hormone Therapy for Menopause

Not everyone using hormone therapy for menopause will have side effects from it, but certain side effects may occur.

Common side effects of hormone therapy include:

— Breast sensitivity

— Headaches

— Irritation on the skin where the hormonal patch is placed

— Mood changes

— Vaginal bleeding

Hormone therapy isn’t associated with weight gain, although weight gain may occur during menopause due to decreasing estrogen levels.

Changes to Hormone Replacement Therapy Guidance

The November 2025 announcement that the FDA would be removing the broad “black box” warning from most hormone replacement therapies for menopause comes after decades of pushback from gynecologists, patients and medical organizations. Specifically, the FDA will remove warnings related to the risk of cardiovascular disease, breast cancer and probably dementia — all of which were based on a flawed 2002 study from the Women’s Health Initiative.

The shift in messaging comes as a result of new research showing benefits outweigh risks for many when started early.

Here’s a brief history of the misconceptions and controversy surrounding HRT.

1960s through 1990s: Hormone therapy was regularly recommended to treat menopause symptoms and to prevent chronic health conditions, like heart disease and dementia. Initially, estrogen-only HRT was used, but after findings of increased risk of endometrial cancer, progestin was added to create the combination HRT.

2002: A study from the Women’s Health Initiative, which included 68,000 women between the ages of 50 and 79, focused on the effects of estrogen plus progestin hormone therapy and found that it raised the risk for blood clots, breast cancer, dementia, heart attacks and stroke. This led to a marked decrease in the use of HRT.

However, the average age of women in the study was 65, or 14 years beyond the average age for menopause. That represents a long time period when the body may undergo a variety of health changes, including development of a greater risk for blood clots and heart disease.

The decrease in HRT use “was rather unfortunate because we’re still suffering from the consequences of that misinterpreted result,” Shen says. “To this day, I have patients who come to me and say their doctor refused to prescribe hormone therapy for them even though they’re having horrific symptoms.”

2025: The FDA announced that it will initiate the removal of black box warnings on hormone therapy products for menopause and is working with companies to update product labeling and remove references to the risk of health issues, such as cardiovascular disease, breast cancer and probable dementia. Instead, age-specific guidelines will be printed on the medication, indicating its long-term benefits for those who are within 10 years of the onset of menopause.

The FDA is not seeking to remove the label warning for endometrial cancer from systemic estrogen-alone products. However, the warning will be removed from products with combined estrogen and progesterone and low-dose vaginal estrogen therapies.

“For women who are under the age of 60 and within 10 years of menopause onset, the benefits (of hormone therapy) will typically outweigh the risks,” says Dr. Stephanie Faubion, director of the Mayo Clinic Center for Women’s Health and medical director of The Menopause Society. She hopes that more women will be offered and will use hormone therapy to manage their menopause symptoms and prevent bone loss.

Both ACOG and The Menopause Society issued statements in support of the black box warning label removal.

Other Ways to Manage Hot Flashes and Other Menopause Symptoms

If you don’t qualify for hormone therapy, there are other options to help with hot flashes and related menopause symptoms:

— Nonhormonal menopause drugs. Two drugs specifically geared toward menopause hot flashes are fezolinetant and elinzanetant. Additionally, a generic version of Premarin (conjugated estrogens) was also approved in November 2025 for moderate to severe hot flashes and night sweats.

— Antidepressants. Low-dose antidepressant drug paroxetine is approved by the Food and Drug Administration to treat hot flashes.

— Birth control pills. In women who are perimenopausal, the use of birth control pills, another type of hormone therapy, is an option. These have the dual purpose of preventing pregnancy.

— Lifestyle changes. Lifestyle changes such as regular exercise, avoiding hot drinks, adopting a plant-based diet and reducing stress can improve symptoms.

Shen cautions against spending lots of money on herbs and supplements that are said to help with menopause, as their effectiveness is often not based on medical evidence. Plus, they aren’t regulated by the FDA like prescription drugs are.

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Hormone Replacement Therapy for Menopause originally appeared on usnews.com

Asia’s next great gourmet destination? Inside Indonesia’s fine-dining revolution

By CNN
August 11, 2026 | 5:44 AM

More than 120 years ago, Eliza Ruhamah Scidmore, National Geographic magazine’s first female writer, photographer and board member, chronicled her travels through colonial Indonesia in her book “Java: The Garden of the East.”She was particularly fascinated by a feast known as the rijsttafel (rice table), a multi-dish banquet that was served in the grand Hotel de Nederlanden in Batavia, as Jakarta was known then.Scidmore vividly recalled a “conglomerate mountain” of food, including bits of fish, duck, chicken, beef, omelettes and onions piled alongside steaks, salads, curries, chutneys, spices and tropical fruits.The sumptuous spread had something to satisfy everyone amongst the 100 or so guests that filled the grand dining hall — even the “squeamish folk, unseasoned tourists and well-starched Britons with a small sense of humor.”Like Scidmore, most early Western documentation of Indonesia’s flavors focused on the opulent colonial feast. Little else was known about the diverse and rich flavors found across the enormous archipelago, in spite of it being home to the fabled Spice Islands, which sparked a 16th- and 17th-century “spice rush” for cloves, nutmeg and mace by Portuguese, Dutch and British traders.In more recent decades, the world has become better acquainted with some of the beloved humble foods found in Indonesian homes and warungs (street-side eateries), with satay, nasi goreng and beef rendang among the most familiar dishes beloved by travelers.But now, there’s a rising number of contemporary chefs who are elevating the national cuisine on the global stage by reimagining its famous spices into fine-dining experiences, while sharing the sophisticated stories of Indonesian flavor through a different lens.Made up of thousands of islands dotted across two oceans, Indonesia is the world’s largest archipelagic country. It would be an understatement to say the country’s cuisine is wildly varied.As a result, “the existing understanding of Indonesian food culture is very shallow,” says William Wongso, an Indonesian culinary expert and author.Boasting an enviable array of regional ingredients and flavors, the country’s chefs have been working to educate international gourmets — and even locals — about the beauty of Indonesian cuisine.And Jakarta, its capital city, has become a breeding ground for the movement. Wongso compares it to the dining scenes in New York or Shanghai, which draw talent from all over their respective countries. “Everybody wants to come here to make a thing,” he says. “So people from different regions bring flavors and food cultures.”Some open humble warungs and serve their home cooking. A few look beyond recipes and focus on elements that make Indonesian cuisine unique for a wider audience, reinventing the whole experience.A modern, fine-dining blueprintEnter August, which opened in 2021 inside a gleaming skyscraper in Jakarta’s central business district.The duo behind the concept, Jakartan Hans Christian and Budi Cahyadi from the Indonesian island of Lombok, were definitely not the first people to promote Indonesian flavors — Christian emphasizes figures like Wongso, for example, who have been championing gastro-diplomacy abroad for decades.But August has spearheaded a new format and standard for the country’s fine-dining restaurants: a modern, Indonesia-inspired tasting menu operating at a world-class level of culinary execution and service.The industry has already noticed. August became one of the few Indonesian restaurants to achieve international recognition, placing 42nd on Asia’s 50 Best Restaurants 2026 and earning accolades at The Best Chef Awards.“When I came back to Jakarta, you either had classic French fine dining or very casual bistros, mostly run by expat chefs,” says Christian, who sharpened his skills in Malaysia and the United States before returning to Jakarta in 2016.“There were no locally grown chefs doing their own thing with their own roots or interpretations. For me, August is about the pride of telling our own story … and a responsibility to not only embrace our roots, but also relearn them.”Cahyadi, with more than a decade of hospitality experience in a luxury hotel, agrees. He currently helms the front of house in August’s dining room.“In Jakarta, you either had to pick a place where the food was good but the service was lousy, or a casual place where service was bad but food was decent. When I met Hans, I knew it was time for a place where food is excellent and hospitality is delivered at the exact same time,” he says.In 2019, the two started August as a private kitchen concept before turning it into the current restaurant in 2021.Inside August’s intimate dining room — warmly lit with dark wood accents and a bright, open stainless-steel kitchen at the end of the dining room — the restaurant’s two tasting menus blend familiar Indonesian flavor profiles into completely unexpected forms.Their daikon dish is inspired by the format of Japanese agedashi tofu — silken tofu coated in starch, deep-fried until golden brown and traditionally dressed in dashi sauce.August’s version is served with a cuko sauce — a sweet and sour reduction made with tamarind and palm sugar featuring a tangy umami taste.It reminds locals of eating pempek, the Indonesian fishcake. A drizzle of andaliman pepper oil, Indonesia’s version of Sichuan peppercorns, gives the dish a unique, numbing spicy kick.Another highlight features Japanese Kimendai fish cooked by pouring hot oil over the scales until it crisps up while keeping the flesh tender. It sits in a kuah garang asem (yellow sour curry sauce) from the Central Java region.The sourness comes from a native green fruit called belimbing wuluh (or bilimbi), which looks like an oblong tomato but tastes extremely acidic, while ginger flowers provide a touch of freshness.The curry base is made from a yellow bumbu — made of aromatics such as turmeric and lemongrass. Often compared with France’s mother sauces (a group of five master sauces, such as Béchamel and Hollandaise, that are said to be the foundation of classical French cooking), Indonesian bumbu are spiced sauces that take hours to caramelize and form the base of many different dishes.Christian says that August has slowly evolved over the years, with more Indonesian flavors being incorporated into his menu as the team gains confidence and the demand grows.“In the beginning, our menu leaned more towards classic European because that was my formal training. When more international guests came, they expected more Indonesian flavor,” says Christian.Now, with half of their guests coming from overseas, the team tries to find the balance carefully without being intimidating.“Finding that balance was crucial — doing modern Indonesian cooking in a way that’s exciting for locals without just putting expensive ingredients in a traditional dish. We want to start from a product or a cooking method and create something new out of that idea,” says Christian.The founders admit that Jakarta has few fine dining concepts compared to fellow Southeast Asian cities such as Kuala Lumpur, Singapore, Manila and Bangkok.“We knew we were a few years behind, but we are in progress to catch up. Over the years, the interest from people who want to learn and taste the flavor of Indonesia is growing,” says Christian. “For the past five to six years, we’ve been on a mission to prove people wrong.”It wasn’t easy. It wasn’t just about the menus, but the operation.They were the first restaurant to impose a reservation fee for diners in Jakarta. It also took a few years to educate their diners to be punctual for the tasting menu so the table could start the menu together – an often tricky feat in Jakarta traffic.But August’s success helped set new operational benchmarks for the city, proving that local diners were ready to enjoy high-end tasting menus.In the years since, Jakarta’s fine-dining community has expanded rapidly.ESA, opened in 2023, proudly offers a menu called New Jakarta Cuisine. Kindling, which opened the following year, blends Indonesian-Chinese dishes with French technique. Selera, newly opened this year in the Keraton at the Plaza hotel, emphasizes the nation’s culinary heritage with local ingredients.Outside the capital, things are changing, too, particularly in the country’s tourist hotspots. Bali, for example, has evolved to offer more than just fine resort dining and Western restaurants catering to visitors.Locavore NXT, helmed by Dutch-Indonesian duo Eelke Plasmeijer and Ray Adriansyah, serves a tasting menu that highlights local ingredients. The independent concept also has a farm, laboratory and store.Meanwhile, young, local and independent concepts are slowly increasing elsewhere in the country.Overlooking the historical Prambanan Temple and Mount Merapi, Suwatu in Yogyakarta, the royal cultural heart of Java, is an upscale hillside restaurant with a menu packed with local dishes cooked by local villagers.In Bandung, both MMBS (Mari Merangkai Bunga Seroja) and Plataran Bandung serve local Sundanese cuisine, with hyper-seasonal tasting menus featuring a creative twist.Not just about the price tagAt the same time, classic Indonesian restaurants are reexamining the stories they would like to tell.For a long time, the 1945 Restaurant inside the Fairmont Jakarta has been regarded as the city’s only high-end Indonesian restaurant in a five-star hotel.Taking over as the chef de cuisine this year, Yopi Tumeru has been determined to inject fresh ideas into the 11-year-old establishment — and he was inspired by the traditional rijsttafel concept.His vision of the legendary feast isn’t only a sumptuous buffet but an educational exploration of Indonesian cuisine.“For many years, Indonesian food was presented either as home cooking, street food or part of a hotel buffet… Our Rijsttafel was designed as a culinary journey through the archipelago. We preserve the generous and communal character of the traditional experience while refining the portions, presentation and sequence,” Tumeru says.The menu includes dishes such as wagyu beef rendang, duck leg confit with sambal madura, tuna collar rica-rica (rahang tuna), tempe nachos and es teler cheesecake — all created to shine new light onto old dishes.For chefs like Tumeru, presenting Indonesian cuisine in a haute gastronomic format isn’t just about slapping on higher price tags and using expensive ingredients.They are proudly showcasing the often undervalued Indonesian cuisine — from the ingredients, the knowledge and the labor to the cultural heritage.“Rendang, for example, is not simply beef cooked in coconut milk. It requires patience, careful control of the heat, and an understanding of how the spices develop over time,” says Tumeru, who feels chefs have a responsibility to help guests appreciate that complexity.Despite giving Indonesian cuisine an upscale makeover, all of the chefs insist their roots and hearts remain with the humble, family-run warung. They encourage diners to ask for street-food tips, which might otherwise feel intimidating without a local guide.The movement isn’t about replacing affordable neighborhood joints. It’s about broadening how the world sees Indonesian food, using fine dining as a welcoming gateway into their country’s vast culinary heritage.“There is still a mindset that Indonesian food cannot be expensive — that is not true,” says Wongso.“These high-end restaurants, if they’re doing it right, they’re quite helpful in changing people’s mindsets. Indonesian food cannot be cheap. It takes immense labor and skill. A single sauce or spice paste takes hours of balancing and preparation. You can Google many things, but you can’t Google taste.”The-CNN-Wire™ & © 2026 Cable News Network, Inc., a Warner Bros. Discovery Company. All rights reserved.

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