FFor years, patients have come to Dr. Megan Lochner’s office with the same complaints: hot flashes, brain fog, sleepless nights. They were experiencing the common symptoms of perimenopause and menopause, and they were unhappy.
Lochner, an obstetrician-gynecologist at Stony Brook Medicine, would discuss the benefits of hormone therapy and, if he was a good candidate for the treatment, write a prescription.
Dr. Megan Lochner, affiliated with Stony Brook University, in her Centereach office. Credit: Newsday/Steve Pfost
“They would come back and tell me they never started taking the medicine,” Lochner recalls. “I asked why. One woman told me her pharmacist asked her if her doctor was trying to kill her. Or if they got the prescription, they would see the ‘black box’ warning – which was scary – and they would never start.”
The warning described the risks of cardiovascular disease and breast cancer from the use of combined hormones.
Newsday’s Women’s Health series explores what Long Island women need to know during perimenopause and menopause.
This week’s articles will examine menopause hormone therapy, separate fact from fiction on social media, and explore how women deal with menopause in the workplace. Come back to Newsday.com starting November 10 for Part 2.
But now, following updated federal recommendations, Lochner’s waiting room is filled with patients seeking hormone treatment for menopause. Pharmacists are turning away customers because their supply of hormone patches is exhausted.
“I counsel my patients the same way I did a year ago,” she said. “Except now my patients are more comfortable starting their treatment because the black box warning is gone. »
I advise my patients in the same way as a year ago. Except now my patients are more comfortable starting their treatment because the black box warning is gone.
— Dr. Megan Lochner, obstetrician-gynecologist at Stony Brook Medicine
In November 2025, the U.S. Food and Drug Administration announced plans to remove the warning triggered by a 2002 study that many experts said was flawed in its analysis of the risks of menopausal hormone therapy for most women. And earlier this month, The American College of Obstetricians and Gynecologists has updated its guidelines on hormone therapy (formerly called hormone replacement therapy, or HRT) for menopausal symptoms, with a strong recommendation that most patients should receive it.
Not all women experience uncomfortable symptoms during menopause, doctors note. But those who do say finding relief is vital to their well-being.
Interest in the treatment — which can involve a combination of estrogen and progestin via a pill, transdermal patch, gel, spray and vaginal cream — has exploded. But the decision to continue hormonal treatment remains a personal decision. And finding the right path is not always easy.
I don’t feel well
Angela Pesa, of Deer Park, shrugged off her irritability and insomnia amid the stress of planning a wedding. Her doctor did blood tests twice and said she was not in perimenopause. His symptoms continued.
Angela Pesa, of Deer Park, was hesitant to start hormone therapy. Credit: Newsday/Steve Pfost
“My jeans didn’t fit well, but I was very active,” Pesa, 46, said. “I run my dog three miles a day. I eat healthy. I wake up at 3 a.m. like clockwork and my brain is spinning. I didn’t feel good, I knew something was wrong.”
Pesa considered hormone treatment for menopause, but said she was initially hesitant because she heard about its possible link to cancer.
Her concerns reflect the uncertainty of a treatment that, in the mid-to-late 20th century, was widely prescribed to treat the symptoms of menopause.
“The pendulum has swung”
Menopause is said to occur when a woman goes 12 months without a period, marking the end of her natural fertility. The transition that leads to it, known as perimenopause, can cause hot flashes, night sweats, trouble sleeping, mood swings, vaginal dryness and pain during sex. In the United States, the average age at which a woman reaches menopause is 52 years old.
The history of HRT
Efforts to relieve symptoms of menopause and perimenopause date back at least to the 1800s, when scientists created medications from the ovarian tissue of cows, according to a scientific article titled “The History of Estrogen Therapy.” In 1941, Premarin, made from the urine of pregnant mares, was marketed as a way to replace women’s estrogen.
For decades, menopausal hormone therapy has been touted as a way to prevent hot flashes and night sweats, as well as prevent bone and heart disease in women. In the 1960s and 1970s, estrogen was commonly used as hormonal therapy, with progestin then added to the regimen to protect the uterine lining.
“Years ago, this was considered the answer to everything,” said Dr. Erika Banks, chair of the department of obstetrics and gynecology at NYU Langone Hospital on Long Island. “Then the pendulum swung.”
In 2002, the Women’s Health Initiative, a long-term national health study, released a report of more than 16,000 women ages 50 to 79 taking these drugs and finding an increased risk of heart disease and breast cancer.
The reaction was immediate: the women stopped taking hormones.
“Providers were afraid to prescribe it,” Banks said. “People learned less in training programs. »
Some doctors considered the study too large, focusing on a group of older women, which did not reflect women taking hormones during the perimenopausal years.
“The average age was 64,” Dr. Stephanie Trentacoste McNally, director of OB-GYN services at the Katz Institute for Women’s Health at Northwell Health, said of the study. “They reanalyzed the data and said that a woman in menopausal transition at that average age of 51 or 52 had a different risk profile.”
Dr. Stephanie Trentacoste McNally, director of OB-GYN services at Northwell Health’s Katz Institute for Women’s Health and clinical lead of its Menopause and Midlife Medicine program Credit: Northwell Health
In an updated 2013 article, Women’s Health Initiative researchers said hormone therapy is “a reasonable option for the management of moderate to severe menopausal symptoms in generally healthy women early in menopause,” while cautioning against its use to prevent chronic disease.
“I think it’s important to be transparent about which symptoms we know to treat with hormone replacement therapy and which ones we don’t,” Banks said. “For hot flashes, it’s a no-brainer.”
Although many report great success in treating symptoms, hormone therapy is not for everyone. Women who take it may have a higher risk of developing a stroke, blood clots or breast cancer, according to the Menopause Society. They may also experience side effects such as nausea, breast tenderness, and irregular bleeding.
“Sometimes people can feel bloated,” McNally said. “I spoke with a woman who told me she felt worse. So she changed her diet, her lifestyle, her physical activity and felt better by not taking hormones.”
Results vary
For Pesa, the answers came after a friend persuaded her to go see Dr. Katie Rowan, a menopause specialist in West Islip. Rowan said Pesa’s previous blood tests did not accurately represent what was really happening in her body.
Dr. Katie Rowan at her hormonal health and menopause care practice in West Islip. Credit: Morgan Campbell
Pesa started hormone therapy and had to try several formulations before finding an effective treatment. The oral progesterone she was taking with an estrogen patch only made her feel worse, but the transdermal patch combination was perfect.
“I feel happier, in a better mood,” she said. “I look forward to my daily errands, when it used to feel like a chore. I feel positive about everything in my life again.”
She is also looking for a sunnier vacation with her husband.
“Last year I couldn’t sit in the sun and I was unhappy,” Pesa said. “So being able to enjoy the sun and vacation again is huge for us.”
His experience shows why hormone therapy must be patient specific.
Dr. Ilene Gewirtz, a gynecologist and menopause specialist in East Islip who is affiliated with NYU, said the treatment decision should begin with reviewing a patient’s medical history.
Gewirtz noted that each patient needs individualized care, even if some come to the office wanting to get the same therapy as their friends.
“What works for one person won’t always work for another,” she said. “You need patience when you go there, because in three months we may have to change it again.”
What works for one person won’t always work for another. You need patience when you go there, because in three months we may have to change it again.
— Dr. Ilene Gewirtz, East Islip gynecologist and menopause specialist affiliated with NYU
“I look like myself again”
Heather Umhafer was 47 when she knew she had to do something about the fatigue and hot flashes that made getting through the day difficult.
“It was getting brutal,” the Seaford resident said. “I literally felt like my body was on fire. That’s the only way I can explain it.”
Heather Umhafer of Seaford, left, talks with Dr. Megan Lochner, affiliated with Stony Brook University, about hormone therapy. Credit: Newsday/Steve Pfost
Umhafer went to see Lochner, who prescribed menopause hormone treatment in the form of an estrogen patch and a progestin-only pill. But a nationwide shortage of patches made them hard to find. So she used the estrogen gel on her leg.
“The hot flashes stopped by the second or third night, and I haven’t had them since,” she said. “I definitely feel more clear-headed.”
Patches applied to a patient’s skin are the most popular form of menopausal hormone therapy. Many consider taking hormones through the skin to be safer than a pill because it does not need to be processed by the body and…
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