A Note from Miguel: The New Era of Hormone Health
Happy Lunar New Year!
This one is primarily for the ladies, but if you're a guy and missed episode 5 of the Data-Driven Health Rx podcast, it applies to you and you can listen here:
So... Here's what got me on today's topic.
Recently, women across the country started calling their pharmacies and they're being told - estrogen patches are out of stock.
23 years after the FDA finally removed a black box warning from hormone replacement therapy, women who had been waiting, wondering, or quietly suffering - they finally said yes.
Unfortunately, there aren't enough patches to go around.
Here's where the frustration lies -
In 2002, a large clinical trial called the Women's Health Initiative made national news when researchers stopped it early.
The headlines were immediate and terrifying: HRT causes breast cancer, heart disease, and blood clots.
Obviously, providers stopped offering it, and women stopped taking it or asking for it.
What those headlines didn't tell us: the women in that study had an average age of 63. Most were over a decade past menopause, nearly 78% had pre-existing health conditions, and the hormones used weren't bioidentical hormones. They used conjugated equine estrogen derived from horse urine, and a syntheic progestin called medroxyprogesterone acetate.
Different compounds with different effects.
When researchers later looked at younger, healthier women who started HRT earlier (within the first decade of menopause), the picture looked completely different.
Lower rates of heart disease.
Lower overall mortality.
We scared an entire generation of women away from something that, if used appropriately, may have been protecting them.
Here's what I want you to know if you're in your 30's, 40's, 50's, or beyond:
Hormonal changes don't begin at menopause. Perimenopause can start in your mid-30's and the first thing to go isn't estrogen - it's progesterone.
The imbalance between the two is what drives the anxiety, sleepless nights, brain fog, and irritability that feels like it belongs to someone else. Most women are told this is stress. Quite often, it's more than that.
Once menopause hits (12 consecutive months without a period), both estrogen and progesterone are gone. Bone density drops. Cardiovascular risk increases. Cognitive decline can begin to accelerate.
These are long-term health risks.
HRT, when appropriate and properly managed, addresses this. The conversation has been overdue for two decades.
I go into this topic a little more in the most recent episode of the Data-Driven Health Rx podcast here:
I hope you find the episode beneficial and enjoy the various ways I'm able to connect with you.
Do me a favor and hit that like and subscribe button when you listen, and send me a message to let me know if you have any thoughts, comments, or questions.
This Lunar New Year is the year of the Fire Horse. It's a rare high-energy year that occurs once every 60 years. Let's go.
Be well,
Miguel
References:
NBC News - "Why are some estrogen patches for menopause hard to find?" February 3, 2026. https://www.nbcnews.com/health/womens-health/estrogen-patches-menopause-hard-find-hormone-replacement-therapy-rcna257224
Writing Group for the Women's Health Initiative Investigators. Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women. JAMA. 2002;288(3):321-333.
