By Dr. Sarah Mitchell, Certified Respiratory Therapist & Wellness Editor · Published 2026-08-14 · 8 min read
Menopause hormone therapy is having its scientific rehabilitation. The 2026 NAMS/Menopause Society update, plus fezolinetant, elinzanetant, and testosterone for women.
The Rehabilitation of HRT
Re-analyses of the Women's Health Initiative confirm that transdermal estradiol + micronized progesterone started within 10 years of menopause is safe and cardioprotective for most women.
2026 Toolkit
- Transdermal estradiol — patch, gel, or spray to avoid first-pass liver effects.
- Micronized progesterone (Prometrium) — breast-safe, sleep-promoting.
- Fezolinetant (Veozah) and elinzanetant — NK3 antagonists for hot flashes without hormones.
- Testosterone cream — off-label for HSDD, well-supported by International Menopause Society.
Sleep-disordered breathing rises sharply in perimenopause. If you snore or wake unrefreshed, ask about a home sleep test and CPAP evaluation.
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