Roni Caryn Rabin, The New York Times, Nov. 10, 2025
The Food and Drug Administration will remove the so-called black box warning from all hormone replacement products containing estrogen, Dr. Marty Makary, the agency’s commissioner, announced on Monday.
The labels will be rewritten with age-specific guidance indicating that there are long-term health benefits if treatment is begun within 10 years of the onset of menopause.
The changes, expected within six months, represent a radical turnabout in what women have been told about hormone replacement therapy.
In 2003, large government-run clinical trials concluded that hormone pills did not protect against heart disease or dementia, and in fact raised the risk of blood clots and breast cancer. Medical guidelines since then have told women to use hormones only sparingly for menopausal symptoms like hot flashes.
Dr. Makary, long a champion of the treatment, asserted on Monday that in fact hormones can reduce cardiovascular disease and cognitive decline, and can improve bone health in postmenopausal women.
“The long-term health benefits have been largely misunderstood,” Dr. Makary said. “Hormone replacement therapy may improve the health outcomes of women at a population level more than any other intervention, arguably, with the exception of antibiotics or vaccines.”
Asked whether hormone use was safe for all women, he added that any patient with a predisposition to blood clots or a history of breast cancer fueled by hormones should avoid it. He acknowledged that there may be other contraindications.
Critics opposed to removing the warning, the strongest kind the F.D.A. issues, had urged Dr. Makary to convene a scientific advisory panel to carry out a careful assessment of the evidence before making any changes to the label.
“Removing the black box and putting warnings in a lengthy label that many doctors and most patients will not read is taking women’s health backward,” Diana Zuckerman, a scientist and president of the National Center for Health Research, said on Monday.
“The claim that hormones for menopause is the best way to improve the health of women is inconsistent with years of research and will harm millions of women,” Dr. Zuckerman said. “There are many better ways to reduce the chances of osteoporosis, heart disease, cancer and dementia than hormone therapy for menopause.”
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Hormone therapy has been used to relieve menopausal symptoms since the 1940s. By the 1980s, hormones were increasingly being prescribed to prevent cardiovascular disease and osteoporosis, as well, even in women well past menopause, despite concerns that the treatment might raise the risk of breast cancer.
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But large randomized trials subsequently tested this hypothesis, and concluded that there were no benefits to hormone replacement therapy in terms of heart attacks — and that it actually increased the risk of blood clots and strokes.
The trials also concluded that combined hormones — progestin and estrogen — in pill form increased the risk of breast cancer. But the danger to individual women was small, especially in early menopause, and there was no increase in breast cancer with estrogen alone, which lowered heart attack risk among women in their 50s.
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