HJAR Jan/Feb 2026

HORMONE THERAPY 10 JAN / FEB 2026 I  HEALTHCARE JOURNAL OF ARKANSAS   Hormone replacement therapy. These three words likely stir something in you — whether you’re a new prescriber, a cli- nician who never received formal training yet fields daily pleas from patients with life- altering symptoms, or a seasoned provider who lived through the turbulent Women’s Health Initiative (WHI) era. For more than two decades, estrogen has carried a reputation that never quite fit the evidence. The story of how one of medicine’s most effective therapies for women’s health earned — and is finally beginning to shed — a stigma is one of scientific missteps, public alarm, and ultimately, regulatory correc- tion. Today, with the FDA’s removal of the longstanding boxed warning on estrogen products, we are presented with an impor- tant inflection point. It is an opportunity to reexamine the data together, colleague to colleague, and to restore confidence in a therapy that remains the most effective — and often safest — option for appropriately selected patients. Mapping Menopause: Defining the Stages That Shape Our Clinical Decisions Let’s start with a shared understanding of the menopausal continuum, which is essential for accurate diagnosis, appropriate counseling, and safe initiation of hormone therapy. We’ll use the STRAW+10 staging system as the foundation for understand- ing the menopause continuum. It offers a standardized framework for describing reproductive aging, from the regular ovu- latory cycles of premenopause through the fluctuating and increasingly irregular pat- terns of early and late perimenopause, the retrospective diagnosis of menopause itself, and the distinct physiological changes that characterize early and late postmenopause. In the STRAW+10 staging system, early perimenopause typically begins when cycle length varies by seven or more days, while late perimenopause is marked by gaps of 60 days or longer and more pronounced symptoms as ovarian function declines. Menopause represents one day in a wom- an’s life and is confirmed after 12 consecu- tive months without bleeding. This is fol- lowed by the early postmenopause phase, during which estrogen remains consistently low and bone loss accelerates. Late post- menopause extends throughout the remain- der of life, when genitourinary symptoms often progress and age-related comorbidi- ties become more prominent. These definitions provide the clinical foundation needed to recognize patterns, guide patient conversations, and apply hor- mone therapy safely and effectively —mak- ing the STRAW+10 framework an essential reference for any provider caring for midlife women. Understanding these stages pro- vides essential context for the story of hor- mone therapy — a story marked by early promise, public misunderstanding, and eventual scientific clarity. A Brief History of Hormone Therapy: From Promise to Panic and Back Again Hormone therapy has a long and com- plicated history — one shaped as much by culture, marketing, and communication as by scientific discovery. In 1942, large quan- tities of estrogen were first extracted from the urine of pregnant mares, leading to the development of conjugated equine estro- gens, later marketed as Premarin. Prema- rin became the first FDA-approved estro- gen therapy for the treatment of vasomotor symptoms and remains available today. Before the era of digital media, phar- maceutical promotion occurred largely through medical journals, and early adver- tisements targeted physicians directly. Some even implied that prescribing Premarin could make a woman “pleasant to live with again,”reflecting the gendered assumptions of that time more than any scientific truth. Source: The North American Menopause Society. (2020). Menopause practice: A clinician’s guide (6th ed.). Mayfield Heights, OH: The North American Menopause Society.