Menopause Enters a New Era: Why the FDA Hearings Matter

“There is no greater agony than bearing an untold story inside you.”— Maya Angelou

Updated June 13, 2026 

I rarely get political. But when it comes to women's lives, I think it's time to speak up—especially about the midlife journey and the menopause transition.

So much has been missing from our cultural understanding of this life stage. And recent changes—like the FDA's expert panel on hormone therapy and the removal of the long-standing "black box" warning—affect not just women, but men, families, workplaces, and entire communities.

So let's unmask midlife and talk openly about menopause.

Facing the Journey

Perimenopause, Menopause, Postmenopause: Understanding the Hormonal Journey

Until about three or four years ago—yes, as recently as 2022 or 2023—mainstream media and even many providers simply used the word "menopause" to describe what is actually a decades-long biological and neurological transition.

A more precise term has finally been gaining traction: perimenopause. It describes the roughly ten-year lead-up to menopause—a stretch marked by significant hormonal shifts and nervous system changes. Perimenopause isn't just a prelude. It's a critical, often misunderstood chapter of a woman's health.

And after menopause comes postmenopause—the longest phase of them all. Women are no longer cycling, but they're still living in hormonally altered bodies that need just as much attention and support, care most of us were never taught to give ourselves.

Menopause Is a Midjourney, Not an Ending

There's now greater recognition of the full arc:

• Perimenopause — the ~10-year phase leading up to menopause, when estrogen and progesterone shift unpredictably and symptoms like brain fog, anxiety, insomnia, and cycle changes begin.

• Menopause — technically, the one-year anniversary of your last period.

• Postmenopause — the decades that follow, when symptoms may persist or evolve and risks like osteoporosis, cardiovascular disease, and cognitive decline rise.

Understanding these stages matters. And yet, too often, women are handed antidepressants instead of answers—instead of being shown how to care for a body that is neurologically and physiologically changing.

(To be clear: I fully support the proper use of SSRIs and anti-anxiety medications when they are the right diagnosis and treatment.)

The reflexive prescribing of SSRIs without any discussion of hormones—the misdiagnosis, the missing education about neurobiological shifts—is a symptom of a much larger problem: the historic lack of training and research in women's health. I'm not arguing against these medications. I'm arguing for real listening, accurate case conceptualization, and genuine education about women's bodies.

The FDA and the Black Box Warning on Hormone Therapy: What It Really Means

On July 17, 2025, the FDA convened an expert panel to re-examine the risks and benefits of menopausal hormone therapy. That conversation opened a door—and on November 10, 2025, the agency moved to remove the decades-old "black box" warning from estrogen-containing hormone therapies, a change phased in through early 2026 [1].

This matters because it means we can finally research, educate, and talk honestly about hormonal transitions that affect half the human population for half their lives.

For the record: I am not promoting hormone therapy as a one-size-fits-all solution. It isn't for everyone, and I will never suggest otherwise. But healthy options should be available to everyone—and right now, women are not being properly counseled about their choices, their aging, or their risks across the one-third to one-half of life spent in this transition.

What I'm advocating for is open, honest, nuanced dialogue about the intersection of hormones, trauma, mental health, and women's whole-body wellbeing.

Where Trauma Comes In

This is where ACEs enter the picture. ACE stands for Adverse Childhood Experiences, and the landmark CDC–Kaiser ACE Study found that adults with four or more ACEs had dramatically higher rates of depression, substance use, and suicide attempts, with higher ACE scores linked to greater risk of chronic health conditions and early death [4]. The meeting point of trauma history and hormonal transition is exactly what gets missed. PubMed CentralScienceDirect

And mental health providers need to be part of this conversation. Most of us were minimally trained in the biological realities of menopause and how trauma intersects with them. Just this week, on an intake call, I asked a new client about possible menopause-related symptoms. She stopped and said: "You're the FIRST mental health person to ever ask me about that."

Clients suffer in that gap—women, men, couples, families, friends. And the gap leaves people vulnerable to a rising tide of predatory "cures": wellness fads and youth-obsessed messaging that profit off women's confusion and pain. This is now a roughly $18 billion global industry [6].

How We Got Here: The WHI and the Long Shadow of Fear

In 2002, the Women's Health Initiative (WHI) study led to widespread fear about hormone therapy and breast cancer. Before it was published, about 40% of postmenopausal women in the U.S. were using hormone therapy; afterward, use dropped by roughly 46% [2]. Bywinona

But later analyses revealed significant flaws. The trial gave an untested continuous combined regimen to women ranging in age from 50 to 79—many of them well past menopause and already predisposed to cardiovascular disease, and it didn't account for differences in hormone types or delivery methods [2]. The fallout was psychosocial as much as medical: hormones became something to fear, already wrapped in stigma and shame, and the menopause transition fell out of focus in women's healthcare for a generation. ScienceDirect

Today we understand it differently. The Menopause Society's current position is that for healthy women under 60, or within ten years of menopause onset and without contraindications, the benefit-risk balance of hormone therapy is favorable for treating bothersome symptoms and preventing bone loss [3]. (I encourage you to listen to the FDA panel itself.) Lippincott Williams & Wilkins

Why Support Matters

When the menopause transition is ignored or mismanaged, the consequences are emotional, relational, and occupational. Symptoms range from mild—mood dips, hot flashes, sleep disruption—to moderate—anxiety, insomnia, brain fog, daily distress—to severe.

And "severe" is not an exaggeration. Perimenopausal and postmenopausal women carry roughly twice the risk of depressive symptoms compared to premenopausal women, and the risk extends further: one study found perimenopausal women had an almost sevenfold higher risk of suicidal ideation than women in other stages or men of any age—independent of any underlying mood disorder [5]. In one UK menopause clinic, about one in six women reported thoughts of self-harm before beginning treatment [5]. PubMed Central + 2

Women with high ACE scores, surgical menopause, or trauma histories are even more vulnerable—and are often misdiagnosed with anxiety, depression, or personality disorders when, in fact, their bodies are calling for support.

We can stop pretending one solution fits all. Not every woman needs or wants hormone therapy. But we can explore it when it's appropriate—especially for severe symptoms or early-onset menopause—alongside social, physical, and mental-wellbeing approaches. And in mental health, we can begin screening for women in this vulnerability window.

A Paradigm Shift

Here's what I hope you take from this: something is finally changing. It's no longer taboo to talk about menopause as a biological, psychological, and sociocultural journey. We're entering a time when women's experiences are being researched, resourced, and—finally—respected.

This is my contribution to that unfolding conversation.

References

1. U.S. Food and Drug Administration. FDA Requests Labeling Changes Related to Safety Information to Clarify the Benefit/Risk Considerations for Menopausal Hormone Therapies. November 10, 2025. https://www.fda.gov/drugs/drug-alerts-and-statements/fda-requests-labeling-changes-related-safety-information-clarify-benefitrisk-considerations

2. Schierbeck L, et al. / critique of WHI design and aftermath. A Critique of the Women's Health Initiative Hormone Therapy Study, Fertility and Sterility. https://www.fertstert.org/article/S0015-0282(05)03422-9/fulltext

3. The North American Menopause Society. The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause. 2022;29(7):767–794. https://journals.lww.com/menopausejournal/abstract/2022/07000/the_2022_hormone_therapy_position_statement_of_the.4.aspx

4. Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14(4):245–258. CDC overview: https://www.cdc.gov/aces/about/index.html

5. Usall J, et al. (2009), summarized in MGH Center for Women's Mental Health, Suicidality in Midlife Women. https://womensmentalhealth.org/posts/suicidality-midlife/ — and Prevalence of Low Mood, Thoughts of Self-Harm and Suicidal Ideation in Women Affected by the Perimenopause and Menopause. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11738994/

6. Grand View Research. Menopause Market Size & Share, Industry Report, 2030. https://www.grandviewresearch.com/industry-analysis/menopause-market

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About the Author

Julie Cardoza, MS, LMFT is a licensed marriage and family therapist and EMDRIA Approved Consultant specializing in Somatic EMDR, based in California. She is also an IWHI Certified Perimenopause/Menopause Health Coach and the founder of Heartscapes, LLC, where she offers holistic coaching and wellness programs for midlife women.

Julie works at the intersection of trauma, neurobiology, and hormonal transition, bringing a compassionate, body-based, and science-informed approach to healing and transformation during the menopause midjourney.

Disclaimer

The content on this blog is for educational and informational purposes only. It does not constitute therapy, medical advice, or establish a therapeutic relationship. Reading this blog does not make you a client.

If you are experiencing a mental health crisis, please contact 988 (Suicide and Crisis Lifeline) or go to your nearest emergency room. For professional support, consult with a licensed mental health provider in your area.

You are responsible for how you use the information shared here. This content reflects my professional perspective and lived experience but should not replace individualized care.

Land Acknowledgment

I acknowledge that I live and work on the traditional and ancestral lands of the Yokut and Mono peoples.