FDA Discontinuation of HRT Warning is a Poor Choice for Women

Barnard Medical Center Clinical Director Vanita Rahman, MD, responds to the FDA announcement that it will discontinue its warning label on menopausal hormone therapy. The FDA’s recent decision to remove warnings about breast cancer, heart attack, and stroke from hormone replacement therapy (HRT) labeling is premature and overlooks a critical fact: There are safer, evidence-based approaches to managing menopausal symptoms through diet and lifestyle. This change risks diverting attention from nonpharmacologic strategies that have consistently shown benefits without the associated risks of hormone therapy.

Research from the Physicians Committee for Responsible Medicine (PCRM) demonstrates that a low-fat, plant-based diet can reduce the frequency of moderate-to-severe hot flashes by 88% while supporting healthy weight management. Women who replace animal products with whole plant foods—such as fruits, vegetables, whole grains, and legumes—often experience improvements not only in menopausal symptoms but also in body weight, blood sugar, and cholesterol levels. While menopausal hormone therapy decreases hot flashes during treatment, over 50% of women will experience a recurrence of hot flashes after stopping the medications.

In addition, a new national poll shows that most women are unaware that dietary changes can meaningfully reduce hot flashes and improve quality of life. This lack of awareness underscores a missed opportunity in public health messaging. Rather than focusing solely on pharmacologic interventions, we should be empowering women with knowledge and tools to take control of their health through lifestyle choices that are safe, accessible, and beneficial at every life stage.

As clinicians, we can guide patients toward strategies that lower symptom burden while enhancing long-term health: adopting a whole food, plant-forward diet; maintaining a healthy weight; engaging in regular physical activity; improving sleep quality; managing stress; and avoiding tobacco and excessive alcohol. These interventions carry minimal risk.

The growing body of evidence supporting diet and lifestyle interventions should not be overlooked—or overshadowed—by regulatory changes that may inadvertently imply HRT is the default or safest option.

Menopause is a natural transition, not a disease requiring automatic drug therapy. As medical professionals, our priority should be to educate and support women in adopting approaches that align with both safety and long-term wellness.