Menopause Is Finally on the Agenda

In a banner week for menopause, a CNN headline declared a national policy movement underway in state legislatures across the country. This past Thursday, the U.S. Food and Drug Administration (FDA) held the first roundtable in over a decade that brought together a dozen experts to discuss menopause hormone therapy (MHT) and potential reforms to FDA labeling requirements.

It may seem out-of-the-blue for any women’s health issue to garner so much bipartisan interest, especially menopause. But truth be told, it comes as no surprise to three of us—Maria Shriver, Dr. Mary Claire Haver, and me. It is everything we set out to catalyze when we teamed up in January to publish the Citizen’s Guide to Menopause Advocacy, together with leading medical experts like Dr. Sharon Malone, Dr. Kelly Casperson, Dr. Rachel Rubin, and Dr. Corinne Menn, among others.

In Shriver’s foreword, she calls upon readers to “reach out to your community, state and national leaders to demand greater funding for—and policy and education around—menopause and women’s health.” And that they have! Six months later, advocates and lawmakers alike are advancing change at all levels of government.

What’s happening at the State Level

Knowing there are limitations in the federal legislative progress, the Citizen’s Guide deliberately zeroes in on priorities that states could readily assume—policies that would invest in public education about menopause, improve training for healthcare providers, and ensure better access to menopause treatments.

All told, in 2025 a total of fifteen states—nearly a third of the country!—introduced upward of two dozen bills. As soon as the legislative term comes to a close (generally by the end of July, as a few states remain in special session), we will issue an update to the Citizen’s Guide with links to every bill introduced thus far and whether or not it passed, so readers can see where their state stands.

For now, here is the full tally of menopause laws now on the books:

• California: continuing medical education opportunities for providers

• Illinois: mandatory insurance coverage for menopause treatments and a dedicated Menopause Awareness Week

• Louisiana: mandatory insurance coverage for menopause treatments

• Maine: state health department educational resources

• Rhode Island: workplace protections

• Washington: support for accessing treatment

This is truly remarkable progress. The wheels of change tend to turn slowly in statehouses, and that is exponentially true for issues long stigmatized and out of the public eye, like menopause.

It is so powerful to see lawmakers normalizing and putting a human face on menopause. In Michigan, for example, Governor Gretchen Whitmer and numerous legislators are holding town hall conversations around the state, enabling women to tell their stories and set the stage for future reforms.

Even for bills that have not yet crossed the finish line, they provide intrinsic value: snippets of provisions, even full text, often find their way into budgets and other mandates; hearings yield compelling testimony.

What’s Happening at the Federal Level

On Thursday, July 17, the Food and Drug Administration held a two-hour public briefing on menopause hormone treatments; you can watch the full recording of the livestream here.

Among the key issues addressed was the decades-old boxed labeling requirement for estrogen products, which is the most stringent warning provided by the FDA (also called a “black box warning”). The Citizen’s Guide argues the FDA should eliminate the warning on packaging for local vaginal estrogen, which is uniformly considered safe and is the most effective treatment for genitourinary symptoms of menopause—things like vaginal dryness and painful sex.

The history of the label is rooted in a decades-old push and pull. When estrogen became all the rage in the 1970s, the FDA issued a mandate to provide written warnings about benefits and risk on all usages, including the birth control pill. In the 1990s, the agency began to allow a more iterative labeling process for menopause. But by 2003, after the disastrous Women’s Health Initiative announcement linked systemic menopause hormone treatment to elevated risk of breast cancer, the FDA adopted the boxed labeling format and an across-the-board warning of risks of endometrial cancer, cardiovascular disorders, breast cancer, and probable dementia.

Too many women, after reading that label, throw the prescription right in the trash. Too many doctors not trained in menopause care (translation: the vast majority, including OB-GYNs) refuse to prescribe it at all.

At the briefing, doctor after doctor after doctor told FDA leadership of the harms caused by slapping on that label indiscriminately. “The black box warning should never have been there in the first place,” said Dr. Mary Jane Minkin, clinical professor of obstetrics and gynecology and reproductive sciences at Yale School of Medicine. “The systemic [risk] from using the estrogen vaginally are minuscule—there is no significant absorption.”

After making the case that “there is not a single study in the literature that says local vaginal estrogen causes what your box says,” you could hear a pin drop when urologist Dr. Rachel Rubin looked directly at FDA Commissioner Dr. Martin Makary and said, “I’m here for a personal reason. Honestly? Your label tried to kill my mother.” She described how an emergency medical team refused local vaginal estrogen to her mother—comatose, immunocompromised, and in danger of going into urosepsis—and the urgent advocacy required, not only with the doctors but also the pharmacy, which refused to dispense the prescription. [Dr. Rubin is also part of a team that published a 2024 report showing that if Medicare patients regularly received vaginal estrogen, the program could save billions per year.]

Over a decade ago, a group of physicians filed a petition to counter the FDA requirement, which the agency eventually denied. Now that effort is reignited: the Citizen’s Guide points to the Unboxing Menopause campaign, led by the nonprofit Let’s Talk Menopause, to mobilize a groundswell of support from everyday people.

In the aftermath of the FDA panel and with so much momentum in the states, it is critical that we continue to make our voices heard and that we hold our leaders accountable.

Of course, we all want transparency and a fair, open process. Federal agency-driven change is never a simple feat and the challenges in the current political climate are manyfold starting (within the FDA). Dr. Makary’s own statement that the FDA aims to “move faster than the typical government process” must not omit or bypass requisite committee consideration and public comment.

These are challenging times for women’s health, no doubt. But all the momentum for menopause makes clear that we have an extraordinary opportunity to leverage.

Jennifer Weiss-Wolf is executive director of the Birnbaum Women’s Leadership Center at NYU School of Law. She also leads strategy and partnerships at Ms. Magazine.