Evolving Perspectives on Menopause Care Over Five Decades

Over the past fifty years, the medical community's approach to menopausal hormone therapy has experienced significant fluctuations. From a broad acceptance of the therapy for symptom relief and health benefits to a near-total rejection, the narrative is evolving once again, thanks in part to ongoing research and shifting attitudes. Dr. Mary Jane Minkin, an expert in the field, shared her insights at The Menopause Society 2026 Annual Meeting.

The Initial Confidence in Hormone Therapy

When Dr. Minkin started her journey in medical school in 1971, hormone therapy was celebrated for its advantages, not just in alleviating menopausal symptoms but also for its potential health benefits, particularly in bone health. The idea that hormone therapy might also benefit cardiovascular health was actively being researched at that time.

The Turning Point: WHI Study Fallout

The trajectory of hormone therapy changed dramatically on July 9, 2002. The Women’s Health Initiative (WHI) released findings from its estrogen plus progestin arm, indicating a modestly increased risk of breast cancer for women undergoing combined therapy. According to Dr. Minkin, the results were misconstrued by many, leading to a rapid shift in perception—from seeing estrogen as beneficial to it being deemed harmful almost overnight. She characterized this moment as “the day the music died.”

Importantly, early reports did not differentiate between the estrogen plus progestin arm and the estrogen-only arm of the study, which showed no similar risks. This oversight contributed to a widespread misunderstanding about the safety and efficacy of hormone therapy.

The Impact on Menopause Education

One of the more profound consequences of this shift was the decline in menopause education within medical training programs. As the focus on estrogen therapy diminished, medical education programs, particularly in obstetrics and gynecology, began to deprioritize menopause training. This trend coincided with changes in resident duty hours, leading to a refocus on more traditional obstetric and surgical training.

Data from several studies revealed this educational gap. A needs assessment by Johns Hopkins in 2013 showed that only about 20% of obstetrics and gynecology residency programs treated menopause as a formal subject. A decade later, that percentage had risen slightly to 30%, indicating a slow but persistent shift.

A Renewed Interest in Menopause Care

The stigmas surrounding menopause and hormone therapy have recently come under scrutiny, particularly following a 2023 article in The New York Times Magazine titled “Women Have Been Misled About Menopause.” This piece reignited discussions about the importance of estrogen therapy and encouraged women to question the previous denial of such treatments. Consequently, both patients and healthcare providers have expressed renewed interest in menopause care.

Efforts are being made to enhance menopause education in residency programs. This increased demand is reflected in the growing membership of The Menopause Society, which saw its numbers swell from about 2,000-2,500 to approximately 15,000 in just a few years. The response at the 2026 Annual Meeting exemplified this growth, as many clinicians overflowed the main session due to the high turnout. Despite this progress, Dr. Minkin highlighted the critical need for ongoing education to ensure all obstetricians and gynecologists are sufficiently trained in menopause management.

As the understanding of menopause care evolves, it becomes increasingly essential to address the misconceptions generated by past studies, ensuring that women have access to informed care and treatment.