Left Out of Menopause’s Moment: Millions Denied Hormones
Menopause is having a cultural moment. Celebrity advocates like Halle Berry have taken the conversation public, the FDA removed a long-standing black-box warning on estrogen therapy in 2025, and new drugs are entering the market. But for millions of women who cannot take hormone therapy — including breast cancer survivors and those with a history of blood clots, stroke, or liver disease — this progress has created a painful paradox: the more menopause awareness grows, the more excluded they feel.
As The New York Times reported on June 15, a significant population of women who are medically barred from using hormone replacement therapy (HRT) say they are being left out of the very movement meant to help them.
The Hormone Therapy Dilemma
For decades, hormone replacement therapy has been the gold standard for treating menopausal symptoms, reducing hot flash frequency by up to 80 to 90 percent. However, HRT is not recommended for individuals with hormone-responsive breast cancer, a history of blood clots, stroke, liver disease, or unexplained uterine bleeding. Clinicians also generally avoid prescribing it to women over age 65.
The contraindications affect a substantial population. Approximately 1 in 8 women will develop breast cancer in their lifetime, and many breast cancer treatments — including chemotherapy and anti-estrogen therapies like tamoxifen — can induce premature menopause or worsen existing symptoms. For women with hormone-receptor-positive breast cancers, standard HRT could potentially stimulate cancer growth.
According to the Parsemus Foundation, a nonprofit research organization, clinicians have quickly adopted new non-hormonal alternatives for these patients — but access remains deeply uneven.
New Drugs, New Hope — And New Barriers
Two FDA-approved non-hormonal drugs — fezolinetant (Veozah, approved 2023) and elinzanetant (Lynkuet, approved 2025) — belong to a new class of neurokinin receptor antagonists. Rather than introducing hormones into the body, these drugs work by blocking the brain’s “overheating” signals at the source, targeting the thermoregulatory center in the hypothalamus.
An analysis published in May 2026 found that 20.5 percent of fezolinetant users had a diagnosis of breast cancer, confirming high interest in non-hormonal options among this population. A phase III clinical trial of elinzanetant reported significant reductions in hot flashes and night sweats for people being treated with anti-estrogen therapy for hormone receptor-positive breast cancer.
Yet these advances come with significant hurdles. As NBC News reported, the new drugs cost hundreds of dollars per month — Veozah costs at least $550 for a 30-day supply — and insurance companies often require women to try and fail with cheaper, off-label drugs before covering them. Kaiser Permanente, for example, requires trying two other drugs first.
“Women are being asked to try drugs that are not specifically FDA-approved for management of hot flashes before they get to a drug that actually is FDA-approved to treat hot flashes,” Dr. Stephanie Faubion, medical director of the North American Menopause Society and director of the Mayo Clinic Center for Women’s Health, told NBC News. “It’s frustrating.”
The Estrogen Patch Shortage
Even for women who can safely take HRT, access is not guaranteed. The estrogen patch — one of the most popular delivery methods — has been in short supply since early 2026, driven by surging demand following the FDA’s removal of the black-box warning.
NPR reported on the “monthly mad scramble” patients face to fill prescriptions. Jennifer Skoog Mondesir, a perimenopausal patient in New Jersey, described calling pharmacy after pharmacy: “I went to CVS. I can’t tell you the amount of times I’ve been there and they’re like, ‘We’re out of patches.’”
The USA Today reported that the FDA is in talks with the five largest estrogen patch manufacturers to address the shortages, which have been exacerbated by a doubling of estrogen-based HRT prescriptions from 2018 to 2026.
Dr. Alexis Dunne, a Chicago-area menopause specialist, told USA Today: “Women shouldn’t have to skip treatment or wonder if they can get their medicine. They’re not sleeping, they’re having hot flashes again and they’re miserable.”
The Adherence Challenge
Even when patients can access the new non-hormonal drugs, staying on them is another matter. Real-world data shows that only about 20.5 percent of fezolinetant patients demonstrated persistent use — defined as refilling a second prescription. The drug requires rigorous liver function testing at baseline and at months 1, 2, 3, 6, and 9, which can be burdensome for patients.
Elinzanetant, which targets both NK1 and NK3 receptors, has shown additional benefits for sleep quality without the same liver enzyme elevation concerns. But its cost remains unclear, and analysts suggest it could be priced at or above Veozah’s $550-per-month price tag.
What’s Next
The paradox of the menopause movement is that its very success has created a new class of excluded patients. While the FDA warning removal, celebrity advocacy, and new drug approvals represent genuine progress, these gains have not been equally distributed.
Alina Salganicoff, senior vice president and director of women’s health policy at KFF, told NBC News: “It’s not like a doctor can write a prescription and you go to the pharmacy and pick it up. New drugs tend to cost a lot of money, and insurance plans can be very reluctant to cover them.”
As the conversation around menopause continues to evolve, advocates and clinicians are calling for more research into non-hormonal treatments, better insurance coverage, and a more inclusive movement — one that addresses the needs of all women, not just those who can safely take hormone therapy.
For the millions of women who cannot use HRT, the question remains: will menopause’s moment include them too?