HJAR Jan/Feb 2026

HORMONE THERAPY BEYOND THE BOXED WARNING: RECLAIMING EVIDENCE-BASED HORMONE THERAPY by Mandy Burton, FNP-C, APRN, MSCP 8 JAN / FEB 2026 I  HEALTHCARE JOURNAL OF ARKANSAS   A Contemporary Review of the WHI Legacy, Regulatory Change, and the Path Toward Competent Menopause Care Editor’s Note by Dianne Marie Normand Hartley I recently asked an 80-year-old woman in France what her hobbies were. She answered without hesitation: hiking. Hiking. Later, she mentioned that she — like most of her friends — had been on estrogen. It was not controversial. It was not framed as risky or indulgent. It was simply part of how menopause had been treated. My own mother, in the United States, was never offered that choice. Years later, I found myself trying to talk my own doctor out of prescribing estrogen — convinced it caused cancer — until he told me what many clinicians already knew: The study had been misinterpreted. A generation of American women was denied estrogen after a misinterpretation of theWomen’s Health Initiative hardened intopolicy, training, and fear. The boxed warning that followed did not encourage careful, individualized prescribing; it effectively shut conversations down. We moved on, as if nothing had happened. Menopause was minimized, its consequences normalized, and its treatment sidelined. This was a failure of judgment. The FDA’s decision to remove the boxed warning is a long-overdue acknowledgment that harm can come not only from what we prescribe, but from what we withhold — and who we listen to. It’s hard not to wonder what might have been different.