By Regina Molaro
Hot flashes, night sweats and mood changes. These are just a few of the severe, disruptive and irritating symptoms associated with menopause – the biological stage in a woman’s life when menstrual periods cease. Officially diagnosed after 12 consecutive months without a period, menopause marks the end of natural fertility. The average age for menopause in the U.S. is 51 to 52 years old.
When menopause sweeps in, estrogen and progesterone levels decline, causing physical and emotional changes. Estrogen, which is present throughout a women’s lifespan, supports a healthy brain and aids the heart, muscles and metabolism as well as the skin, bladder and reproductive tissues. It also helps with healthy pregnancies and childbirth.
Prior to menopause, progesterone balances the menstrual cycle, stabilizes the uterine lining and helps maintain pregnancies. Without enough progesterone, whether pre-menopausal or post-menopausal, women can suffer from anxiety, sleep disturbances, breast tenderness, and endometrial tissue growth. Progesterone is also the calming, anti-anxiety sleep hormone.
During menopause, fluctuating hormones, physical symptoms and all the psychosocial stressors of midlife join forces often resulting in depression. Due to changes in metabolism, many experience weight gain. Unfortunately, the workouts of yesteryear suddenly stop working. All this uncertainty often drives confidence levels down.
Over time, estrogen deficiency accelerates bone loss called osteopenia, is often a precursor for osteoporosis (a more severe level of bone loss), increases cardiovascular risks, and leads to thinning of the urinary tract and skin. It may also cause cognitive decline, sleep disruption, vaginal dryness, urinary infections and issues with libido.
Hormonal Help
During perimenopause and post menopause, hormone therapies can be used to restore memory and cognition, elevate cardiovascular health, maintain healthy blood vessel function and favorable cholesterol metabolism, improve insulin sensitivity, and regulate mood. These therapies also protect the bones, helping to decrease fracture risk. Estrogen also increases blood flow to the vaginal area, which adds lubrication and helps prevent urinary tract infections.
“Many women are turning to hormone replacement therapy (HRT), which has been a big topic in the news ever since the FDA made recent changes to its recommendations about the use of estrogen-containing products in November 2025,” said Noel Latore, MSN, APN, a nurse practitioner at Finally Functional Medicine in Atlantic Highlands.
Latore specializes in integrative/functional medicine. Her alternative approach, which fuses traditional practices with modern techniques, focuses on natural healing methods to enhance well-being. Finally Functional Medicine offers a range of services that aim to improve health and vitality.
Prior to establishing Finally Functional Medicine in 2025, Latore worked as an NP at various ob/gyn offices in Monmouth and Ocean counties. She brings more than 25 years of expertise to her role.
“Working on balancing hormones, eliminating dietary triggers, managing food sensitivities, addressing gut health, and the elimination of toxins and infections are just some of the ways to help bring a woman’s body into balance,” said Latore.
Shifting Mindsets
She explained that throughout the last two decades, many people’s opinions about HRT were based on FDA recommendations and data released by other medical governing bodies. This was the result of a Women’s Health Initiative (WHI) study launched by the National Institutes of Health (NIH) in the 1990s to evaluate the risks and benefits of HRT.
Nearly 162,000 women were enrolled in the studies, which included hormone therapy, diet modification, and calcium and vitamin D therapies.
More than 27,000 women were enrolled in the study’s hormone therapy branch; the average age of participants was 63 years old. More than 70% of participants were over age 60, so they were already 10 to 12 years post-menopausal. The study initially concluded that hormone replacement elevated the risk of cancer, heart disease, and blood clots. Upon reexamination years later, it was determined that the NIH study was flawed.
“During that time, the FDA placed a black box warning on all products containing any type of estrogen (not just the estrogen, Premarin, which was used in the study) and aimed to evaluate specific health outcomes rather than determine how well hormones can treat menopausal symptoms,” said Latore.
The study evaluated heart disease risk, reduction of coronary artery disease and osteoporosis, breast cancer and blood clot risk, stroke and overall disease burden and cognitive function. These topics were evaluated due to observational studies held earlier, which demonstrated various benefits when hormones were taken.
“Based on this flawed study, many people in the healthcare community feared the use of hormones. When women stopped taking these hormones, many began to suffer from the symptoms typically associated with menopause,” said Latore.
Many experts acknowledged that the study’s results were overgeneralized. The findings in older women were applied to younger women. Most of the women in the study were over age 60. Being more than 10 years post-menopause already placed them at greater risk for cardiovascular disease, blood clotting, and breast cancers.
Another issue: The study solely used synthetic hormones rather than comparing synthetic hormones with bio-identical hormones, which mirror the ones naturally produced by our bodies. Bio-identical hormones include estradiol, estriol, and progesterone.
Humans have different genetic makeups and risk profiles, so they respond to hormones in diverse ways. Today’s healthcare providers realize that therapies should be tailored to individual needs rather than a one-size-fits-all approach.
Today’s Stance
Since the WHI study, we have learned that outcomes differed depending on when HRT was initiated. For example, the younger a woman is when she starts HRT, the lower her risk. When the FDA placed the black box warning, it broadly extended across all hormone therapies even though the study only evaluated Premarin and Provera rather than other hormone preparations.
“This incorrectly put all hormones in the same category as the synthetic ones that caused issues in the study and caused great fear and lack of understanding about hormones for women for many years, which left many women suffering,” said Latore.
Testosterone, most often associated with men, can also play a role in perimenopause and post-menopausal treatment. “Women have testosterone in moderate amounts, and it’s at its highest during the teenage years into a woman’s 20s. When most women reach their 20s, levels start to drop,” said Latore.
Although most women have testosterone deficiency, too much of it can lead to imbalances such as Polycystic Ovary Syndrome (PCOS), a hormonal disorder that causes hair growth, weight gain and acne.
When levels are balanced, testosterone can increase muscle mass, strengthen bones, improve insulin sensitivity, balance blood sugars and boost self-confidence, energy and strength. It is also helpful for libido.
Candidates and Risks
Women should be aware that certain factors exclude them from being good candidates for estrogen therapy. The list includes women with known or suspected estrogen sensitive breast cancers, estrogen dependent malignancies, active endometrial cancer and certain uterine cancers as well as those with unexplained vaginal bleeding that has not been evaluated. These patients are also poor candidates for HRT due to their risk factos.
Women who have had recent blood clots in their veins (DVT) or a blood clot that travels to the lung (PE) or those who have suffered a recent heart attack (MI) are also at increased risk when taking HRT.
In certain patients, oral estrogen may increase the risk of blood clots. Many in the healthcare industry consider transdermal (through the skin) estradiol and estriol to have substantially lower risk. Since oral estrogen passes through the liver before entering the circulation, it may stimulate certain clotting factors and other markers in the blood that can elevate risk.
Transdermal estrogen in gels, patches and creams are absorbed directly through the skin into the bloodstream. Since it bypasses the liver, it has minimal stimulation on clotting factors and less effect on pathways that lead to blood clotting. For those with a history of blood clots and active smokers, transdermal estrogen may be considered.
It’s important to note that bio-identical hormones are not free of risk either. “We assess each patient’s individual risk and make decisions based on that. We need to be aware of symptoms that can arise from imbalanced hormones and continue to evaluate risks as they arise,” said Latore.
Warnings are still in place for endometrial cancer risk when using unopposed estrogen (without pairing it with progesterone) in women who still have their uteruses. In these cases, progesterone should always be taken with estrogen for protection.
First Steps
Since every woman’s health history is different; those who are interested in exploring HRT should discuss these therapies and treatments with their healthcare providers and have their individual risks and benefits evaluated.
Prior to prescribing hormones, Latore uses baseline labs to evaluate the starting point and better gauge a patient’s progress. She also does repeat labs and checks in with patients every few months until their hormones are balanced.
Some providers do not check a menopausal women’s hormones before initiating therapy. “The assumption is that if she hasn’t had her period for one year or more, she’ll have very low levels of estrogen and progesterone. Since a woman’s ovaries stop producing estrogen and progesterone in large quantities, the adrenal glands and fat cells will step in to produce some amount. Some women will have nearly nonexistent levels while others will have low but heartier levels,” said Latore.
Although certain doses and forms of HRT can be prescribed through traditional pharmacies, other forms and dosages, including testosterone therapy, may need to be obtained through a compounding pharmacy.
The article originally appeared in the June 4 – 10, 2026 print edition of The Two River Times.
