Hormone Therapy After the FDA Update: What Women Need to Know
- mariekesteen
- 6 hours ago
- 4 min read
(A Stress Detective Deep Dive)
If you’ve been anywhere near the internet this week, you’ve probably seen people cheering because the FDA removed the black-box warning from estrogen therapy. And honestly? I’m celebrating, too. Not because estrogen suddenly became “safe,” but because the warning was outdated, fear-inducing, and never reflected what we know from physiology.
If you want the full review of the Women’s Health Study that caused all this - go back to my article here.
But here’s the part most posts aren’t saying: Removing a warning label doesn’t magically guarantee women will get the right kind of hormone therapy… or the right dose… or a treatment plan that makes sense for their body.
And that’s where things can go off the rails.
As always, your Stress Detective is here to sort the signal from the noise. Let’s break down what this FDA change really means - and what women still need to understand so they can feel confident (not confused) about hormone therapy.
1. Hormone Therapy After the FDA Update: What Women Need to Know Before Starting HRT
Estrogen didn’t suddenly become “safe.” It was always safe when used physiologically.
The big misconception has always been that estrogen is the villain. But the truth?Your brain, bones, metabolism, heart, and mood THRIVE on balanced estrogen. That’s why so many women feel like themselves again on the right HRT.
The problem wasn’t estrogen - it was the way it was historically studied and prescribed. Wrong types. Wrong doses. Wrong delivery methods. And too many women are thrown into one big “hormonal” bucket with zero personalization.
Hormone Therapy After the FDA Update: What Women Need to Know About Safety & Personalization: What this FDA update signals is acknowledgment that the old fear messaging was oversimplified and misleading.
But here’s the kicker: The safety of hormone therapy depends on how it’s prescribed, the form used, and whether it’s tailored to the woman sitting in front of you.
And this is something that I don't really see changing still: women are prescribed hormones with standard dosing but left without support, explanation or instructions on how to apply, what to do if, how to find their right dosage…..
2. Bioidentical vs. Synthetic: Why the Type of Hormone Still Matters
Bioidentical hormones are still the gold standard when the goal is:
better symptom relief
fewer side effects
safer long-term use
true physiological signaling
For example: Topical/transdermal estrogen is a must. Oral estrogen can increase clotting risk, raise certain inflammatory markers, and as the liver needs to process it, the cancer risk is higher. When estrogen goes through the skin, it bypasses those issues and is generally better absorbed too.
Progesterone matters too - and it MUST be bioidentical. Not medroxy-whatever. Not synthetic progestins. If it’s not written progesterone in the ingredients, then it’s not.Real progesterone, used in the right amount, protects the uterine lining, supports sleep, calms the nervous system, and helps balance estrogen so it can do its job without causing chaos.
3. Estrogen Metabolism: The Step Everyone Forgets About
You can be on the most beautifully crafted HRT plan, but if your estrogen detox pathways are backed up, sluggish, or genetically wired to be inefficient…you’ll feel it.
This is the piece that gets almost no airtime in mainstream conversations, but it matters for your mood, breast health, weight, and overall safety.
Healthy estrogen metabolism depends on:
liver function
gut microbiome balance
inflammation levels
genetics (COMT, CYP1B1, GST, etc.)
what’s happening with detox, stress, and sleep
Supporting these pathways is not optional - it’s the foundation for getting great results on HRT or BHRT.
This is why I always pair hormone therapy guidance with nutrition, lifestyle, and targeted nutrient or herbal support to support optimal estrogen detox.
4. Dosing Is Bioindividual - One Woman’s “Perfect” Dose Can Be Hell For Someone Else
Women want to feel like themselves again. That’s it.And you only feel good when your dose is matched to your actual physiology. And your dosing can evolve or change too depending on what’s going on in your life.
Signs of too much estrogen look different from too little. When progesterone is too low, it can cause testosterone or cortisol to act up and also make you experience symtpoms of excess estrogen.
And balancing is a moving target because women… well, we’re dynamic. Especially in perimenopause when we’re trying to smooth out the fluctuations, your HRT also needs to reflect that.
This is why personalization matters. This is why tracking matters. This is why a one-size-fits-all prescription doesn’t cut it.
5. Genetics, Lifestyle & Current Health Always Matter
Two women can be the exact same age with the exact same symptoms and still need completely different HRT strategies.
Why? Because hormone therapy is impacted by:
stress load
adrenal function
gut health
inflammation levels
past hormone exposures
mold/mycotoxins
sleep
caffeine and alcohol
thyroid function
personal genetics
This is why real HRT support has to be more than “here’s your patch, see you next year.”
It’s a partnership.It’s detective work.It’s noticing patterns, adjusting doses, and supporting the whole body - not just prescribing hormones and hoping for the best.
So yes- this FDA update is good news. But women still deserve much better guidance.
The removal of the black box warning is a step toward sanity, but it doesn’t replace the need for:
bioidentical hormones
the right delivery method (topical estrogen ALWAYS)
personalized dosing
monitoring symptoms, labs, and metabolism
supporting detox pathways
understanding each woman's body as a whole system
And this is exactly why I created my support options for women navigating this:
👉 Get HRT Right: my 2-week group program
A fast, grounded, confidence-building way to understand EXACTLY how to use HRT safely, what forms to ask for, how to work with your doctor, and how to track your own symptom patterns like a Stress Detective.
👉 HRT Strategy Session (One-off)
If you want a personalized roadmap, clarity on your symptoms, guidance on labs, or help determining your ideal starting point, this is the deep-dive session for you.
Women deserve accurate information - not fear, not fluff, and not cookie-cutter hormone therapy.
And now that the world is finally waking up to the importance of HRT, this is the perfect time for women to learn how to use it well.