Why women are rethinking menopause hormone therapy: UAE doctors debunk myths as FDA sparks hope

Hot flashes at 2 am, brain fog at work, frustration in the mirror, and the unshakable feeling that something is off—millions of women know this reality too well. Many were told to 'just cope,' all due to fear rooted in outdated science.

But that era may finally be ending.

In a groundbreaking move, the US Department of Health and Human Services (HHS) and FDA have removed the long-feared “black box” warnings from most hormone replacement therapy (HRT) products, restoring evidence-based guidance for menopausal women. For over 20 years, there has been much fear around HRT, leaving symptoms like hot flashes, sleep disturbances, mood swings, and bone loss untreated.

HRT replenishes estrogen and progesterone, supporting the brain, heart, bones, and muscles. Studies show that women who start HRT within 10 years of menopause—or before 60—can reduce fracture risk by 60 per cent, cardiovascular disease by 50 per cent, and Alzheimer’s by 35 per cent.

What is HRT?

Dr. Aysha Salam, a specialist in obstetrics and gynecology, explains it simply: Hormone Replacement Therapy (HRT) replaces hormones, mainly estrogen, and sometimes progesterone, that a woman’s body stops producing as she goes through menopause. This helps ease common symptoms like, hot flashes, night sweats and urinary issues.

Understanding how HRT works

By bringing hormone levels back into balance, HRT can make daily life a lot more comfortable. It not only reduces symptoms but can also protect long-term health. For example, it helps maintain strong bones and may lower the risk of conditions like osteoporosis and heart disease—especially when started at the right time for women who are eligible.

Dr. Rajul Matkar explains HRT in straightforward terms: “These hormonal shifts trigger the symptoms many women experience. HRT simply replaces the hormones your body is no longer making.”

The benefits of HRT include:

• Relief from hot flashes and night sweats

• Improved sleep, mood, and quality of life

• Protection of bone density and reduced fracture risk

• Estrogen for dryness and urinary issues

• Support for long-term heart, brain, and bone health, particularly for younger women or those with premature menopause

Modern HRT comes in various forms, including patches, gels, creams, sprays, and tablets. Progesterone or progestogens are added for women with a uterus to protect the uterine lining, while local estrogen applications can relieve symptoms with minimal systemic absorption.

Cardiovascular health and HRT

One area of particular concern has been cardiovascular health. After menopause, women’s risk of heart disease rises sharply, eventually equaling that of men. Dr. Yogeeswari Vellore Satyanarayanan, Specialist Cardiologist at Medcare Royal Speciality Hospital, emphasized the protective role of estrogen:

“Before menopause, women generally have lower rates of heart disease compared to men of similar age groups. One important reason for this is estrogen, which supports healthy blood vessels, cholesterol balance, and sugar control. After menopause, estrogen levels fall, impacting these functions and increasing the risk of atherosclerosis, cholesterol issues, insulin resistance, and, ultimately, heart attacks and strokes.”

She emphasised that while HRT can offer real protection for the heart, it isn’t a one-size-fits-all solution. Hormone replacement therapy may not be suitable for every menopausal woman,” she explained. Before we begin systemic therapy, we need to look closely at cardiovascular risk factors, existing medical conditions, and family history. Whenever possible, patches, gels, or localised forms are preferred over oral pills, which have wider systemic effects.

Dr. Satyanarayanan also underscored that HRT isn’t designed to cure existing heart disease—it works best as a preventive tool. “When started early and used appropriately, hormone replacement therapy can be safe for the heart and may even support cardiovascular health in some women,” she said.

Risks and misconceptions

Despite its proven benefits, HRT has long been surrounded by myths. Dr. Salam points out that one common misconception is that HRT must stop after a set period. In reality, current guidelines recommend regularly reviewing each woman’s individual benefits and risks, rather than adhering to a fixed timeline.

Many also mistakenly believe that all forms of hormone therapy carry the same risks. Evidence shows that transdermal options, like skin patches, may pose a lower risk of blood clots and stroke compared to oral pills. Another frequent misunderstanding is that “bioidentical hormones” are inherently safer or more effective than conventional HRT, though there is no strong scientific proof to support this.

One of the most persistent myths is that HRT always causes breast cancer. Dr. Matkar clarifies: “Some types of combined HRT can slightly increase risk with long-term use, but the size of the risk varies dramatically depending on formulation, duration, age, and personal factors. With the right selection, the risk can be very low.”

Other common myths include:

• 'It’s only for older women'—HRT is often most beneficial for women in their 40s or 50s experiencing severe perimenopausal symptoms

• 'All HRT is the same'—the method of delivery, type of progesterone, and dosage significantly influence safety and efficacy

• 'Natural is safer'—bioidentical hormones prescribed by doctors remain the most studied and safest option

When to consider HRT

Guidelines now recommend considering HRT for women:

• Experiencing moderate to severe menopausal symptoms

• Under 60 years of age or within 10 years of menopause onset

For women with premature ovarian insufficiency (before age 40), HRT is advised until at least the average age of menopause.

Dr. Salam, emphasises a personalised approach: “A woman’s symptoms, age, uterine status, medical history, and risk factors are all assessed before selecting estrogen type, progesterone necessity, administration route, and dosage. Lifestyle, genetics, and personal preference further guide therapy, ensuring safety and efficacy.”

Lifestyle choices amplify HRT benefits

As Dr Salam says, simple lifestyle changes can work hand-in-hand with HRT to help women feel better during menopause. Eating a balanced diet, staying active, and managing stress can all make a noticeable difference in symptoms and overall well-being.

For example, foods rich in calcium and vitamin D help keep bones strong, supporting HRT’s role in protecting against osteoporosis. Regular exercise—especially walking, swimming, or other aerobic activities—can improve heart health and lift mood. And prioritising good sleep habits can ease common issues like irritability and insomnia.

In short: healthy daily habits can enhance the effectiveness of HRT and help women feel stronger, calmer, and more in control.

The experts recommend:

• Regular physical activity such as walking, strength training, Pilates, or swimming

• A Mediterranean-style diet rich in whole foods, vegetables, protein, and healthy fats

• Adequate vitamin D and calcium

• Stress management through yoga, mindfulness, and breathwork

• Good sleep hygiene, limiting caffeine and alcohol, and avoiding smoking

These strategies optimise hormonal balance and overall health, particularly in UAE women who face unique lifestyle and dietary challenges.

Expanding options: New drug approvals

Alongside revising warnings, the FDA has approved two new treatment options:

1. A generic version of Premarin (conjugated estrogens)—the first in over 30 years—expected to improve affordability and access while maintaining the same quality and efficacy.

2. A non-hormonal treatment for moderate to severe vasomotor symptoms, providing relief for women who cannot or choose not to use hormone therapy.

These approvals broaden options for women, ensuring that personal choice and medical need guide treatment rather than fear.

The removal of broad FDA warnings marks a pivotal moment in women’s health, guided by modern science and comprehensive evidence. With proper evaluation, HRT is a safe and effective tool to alleviate menopausal symptoms, protect bones, support cardiovascular health, and enhance overall quality of life.

Experts emphasise that HRT is not a miracle solution. Individualised therapy, combined with lifestyle optimization, ensures women can navigate menopause with clarity, confidence, and control.