Feeling Left Out

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“When menopause care professionals and influencers go online, they quickly realize that if you don’t overhype menopause hormone therapy or scare people about not taking it, you don’t get traction on social media,” writes Dr. Jen Gunter. 

Yes, there’s a lot of excitement around hormone therapy for middle-aged women right now. The FDA just removed its “black box” warning on estrogen patches, which was truly frightening when we read through it. Multiple midlife-focused telehealth startups have emerged to diagnose and dispense medications and treatments, including hormones, to patients desperate for doctors to listen to their issues and help them. Others are pivoting to hormones due to market demand.

But for the women whose health histories mean they are not candidates for hormone therapy, all this excitement and hype can feel depressing and alienating. In our feature this week, two breast cancer survivors discuss feeling left out of this whole menopause movement. Read on for that, plus a few recommendations for your weekend.

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Your friends at Gloria

They’re everywhere these days. The glowing midlife women announcing that hormone replacement therapy (HRT) — or menopausal hormone therapy (MHT) — have resurrected their libidos, eradicated their night sweats, and done their taxes (ok, not that). Menopause, we’re told, is no longer a grim biological prank. It’s a renaissance. A glow-up. Something to relish, nay, brag about. 

But for women with certain medical histories such as breast cancer, blood clots, or stroke risk, systemic hormone therapy is often considered unsafe or, at the very least, complicated. In an age when HRT is marketed as the end-all be-all, that exclusion can feel like being locked out of a club you didn’t even want to go to, but suddenly very much do.

As two breast cancer survivors, we’ve watched this HRT obsession with equal parts irritation and envy. Gila, who has a long family history of breast cancer, was diagnosed at 34. After a regimen of chemotherapy and having her ovaries removed, she was thrust into menopause years before any of her peers. The juxtaposition of being a young mom of four and a menopausal woman was confusing, isolating, and physically draining. Jessica was diagnosed with hormone receptor-positive breast cancer at 47, with two kids underfoot. Despite taking Tamoxifen, she still has monthly periods and — contrary to common assumptions — was not thrust into menopause by the estrogen blocker. Her oncologist has told her in no uncertain terms that HRT is not an option despite her ongoing struggles with crushing brain fog, perimenopause-induced anxiety, and consistent broken sleep. Now in our 50s, we are watching from the sidelines while the rest of the midlife universe is seemingly splashing around in a cool, clock-rewinding swimming pool of hormone therapies. 

Other women for whom HRT is off the table also struggle with physical symptoms as well as emotional and psychological impacts. 

Harlynne was 41 when she was diagnosed with triple positive breast cancer. Treatment catapulted her into menopause overnight. Now she’s managing hot flashes, mood swings, and bone loss. “It’s almost like my body and hormones failed me, like I am ‘less of a woman’,” she said. 

Jenny, now 40, was diagnosed with triple negative breast cancer at 37 and carries the BRCA1 mutation. She was advised against HRT based on recurrence concerns. “Now that menopause has entered the conversation, I feel a bit cheated,” she said.

Hormone therapy can be remarkably effective, particularly for vasomotor symptoms like hot flashes and night sweats. It also helps prevent bone loss and can improve vaginal dryness and painful sex, not to mention its mood stabilizing properties. For some women, it truly is transformative. The key word here being “some.”

Dr. Eleanora Teplinsky, a board-certified gynecologic oncologist, describes the decision to use MHT after breast cancer as “individual and nuanced.” Much of the data on hormone therapy after breast cancer, she explains, is outdated and predates modern formulations and treatments. “Limited data do not demonstrate an increased risk of recurrence in hormone receptor–negative breast cancer, but findings remain conflicting in hormone receptor-positive disease.”

Dr. Teplinsky emphasizes two critical truths: MHT is effective, and it is not magic. “Responses to MHT can be variable,” she told us. “We have many excellent non-hormonal options for both short- and long-term management of menopausal symptoms. Lifestyle factors (diet, exercise, sleep, stress management, alcohol use, and others) play a critical role in symptom burden and overall health. These measures remain foundational even when MHT is used.”

Dr. Anna Barbieri, a board-certified gynecologist and menopause practitioner at the Carolyn Rowan Center for Women’s Health and Wellness, echoes that sentiment. Hormone therapy, she says, “is not one-size-fits-all.” For some, it’s a “game changer.” For others, it only partially alleviates symptoms, especially complex ones like libido, energy, and sleep.

“It is currently often painted as the ‘silver bullet’ for anything and everything,” she said. “That is just not the case. Dose, formulation, route of administration, and timing all matter enormously.”

Systemic estrogen therapy has generally been avoided in women with a history of estrogen receptor-positive breast cancer. But many women can safely use local vaginal estrogen or DHEA for genitourinary symptoms (related to the genital and urinary system). “Equally important, there are evidence-based non-hormonal treatments for many menopause symptoms including vasomotor symptoms, sleep disturbance, sexual health concerns, and bone health that deserve far more attention and validation for this population.”

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TO WATCH Michelle Pfeiffer is going to be the gal to get us to watch a Taylor Sheridan Western drama. In The Madison (out tomorrow on Paramount+), she plays a wealthy Manhattanite who moves to Montana in the wake of a family tragedy. There’s also another zany docuseries from HBO and A24 (Born to Bowl, out Sunday) and a salacious look at the Murdoch family on Netflix.

TO SHOP Madewell’s Insider Sale is on now through March 17, with 25% off the entire site for Insiders. It’s a good moment to stock up for spring and summer for solid basics like a cute boxy tee, a classic button-down shirt, comfy linen pants, and a pair of simple sunglasses. Shop the sale here. #partner

TO MAKE This baked bean recipe looks whatever, but it tastes amazing. We used Gigantes and served it with greens and bread for an easy meal.

TO LISTEN ‘90s kids looking for the noise rock of Kim Gordon’s Sonic Youth days won’t find that vibe in her new album, Play Me. Go in expecting something much more strange and avant garde, and you won’t be disappointed. Here’s a good example.

Pediatrician moms are working to get immigrant children out of detention centers. • Just one reason why you should absolutely treat sleep apnea. • Learned a lot of strange and fascinating info about the first women to vote from this video. • The hubris, arrogance, and ignorance of these emails about the US in Iraq is stunning and nauseating. • No one wants to say “I told you so,” but…

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