Thousands of women in America feel they aren’t receiving sufficient support for their menopause symptoms. The reasons are myriad, and include reliance on outdated, problematic studies; a lack of providers who are well-versed in menopause treatments; and limited access to care. As a result, many women are turning to third-party providers that specialize in menopause therapies. (These providers offer HRT and other specialized care for women going through perimenopause, menopause and postmenopause, but for the purposes of this article we will use the term “menopause” as all-encompassing.)
There’s no shortage of options these days. Heaven help your personal algorithm if you ever search a phrase related to menopause symptoms; you’ll be bombarded by services advertised by A-list celebrities like Halle Berry, Naomi Watts and Drew Barrymore — an elite circle cleverly dubbed the “Hollywood Menoposse” by beauty-industry journalist Cheryl Wischhover. She notes in her substack “Hey Whatever Nevermind” that the growing menopause market for telehealth services, beauty products and supplements is currently worth around $18 billion, and could reach $27 billion by 2030, according to Axios. “Meno-care has a lot of parallels to the beauty industry — it’s an area without a lot of solid scientific information, geared towards women’s insecurities and anxiety as their bodies change with age,” she writes. “Not surprisingly, companies are selling products using well-worn beauty founder tropes, vague clinical studies for PR, and popular technology and ingredients that are buzzy in beauty at the moment.”
If you’re seeking menopause care, you essentially have two options: trusting your medical provider — who may have already shrugged off your complaints with a disheartening lack of interest — and sorting through this barrage of misinformation. That makes it difficult to figure out a reliable source of relief for your symptoms.
Increased Access to Hormone Replacement Therapies
A Yale School of Medicine review of insurance claims from more than 500,000 women in various stages of menopause found that while 60% of women with significant menopausal symptoms seek medical attention, nearly three-quarters of them are left untreated.
Until recently, one of the reasons for this discrepancy may have been the FDA’s “black box” warnings on hormone replacement therapies. In 2003, the FDA applied black box warnings — its strictest safety alert possible — to Hormone Replacement Therapy (HRT) products, highlighting the “serious or life-threatening” risks associated with their use to treat menopausal symptoms. At the time, early findings from the Women’s Health Initiative (WHI), a landmark, long-term study focused on the prevention of heart disease, cancer and osteoporosis in postmenopausal women, showed a possible correlation between HRT and cardiovascular disease, breast cancer and dementia.
In the last few years, however, research has shown that those early findings were not only based on a flawed study (the average age of women in the study was 63 years — over a decade past the average age of a woman experiencing menopause — and the study participants were given a hormone formulation no longer in common use) but the FDA’s broad warning was based on “outdated interpretations” of the study’s results. Following a comprehensive review of the scientific literature and an expert panel conducted in July of 2025, the FDA announced the removal of black box warnings from all menopausal hormone therapy products.
This is good news for women. Extended follow-up by the WHI and more contemporary evidence have shown that the risks are actually markedly lower when hormone therapy is initiated in women younger than 60 years, or within 10 years of menopause. In addition to providing some protection against cardiovascular disease, dementia and osteoporosis, hormone therapy is one of the only proven treatments for menopausal symptoms like hot flashes and night sweats (known as vasomotor symptoms, or VMS) and symptoms due to changes to the vagina, vulva and urinary tract caused by decreased estrogen (known as genitourinary syndrome of menopause, or GSM).
In a press release about the removal of the black box warning, the FDA admitted that Menopausal Hormone Therapy (MHT) “may be under-utilized among women likely to benefit from MHT” — a statistic they hope will change.
Anecdotally, many women don’t even seek medical attention for what we would consider “minor ailments” or “lady troubles” because they know, deep down, that it’s futile. Furthermore, too many doctors haven’t been properly educated about women’s health, prompting many women to struggle through their symptoms under the mistaken impression that there’s nothing they can do.
A damning 2017 survey of residency programs in family medicine, internal medicine and OB-GYN revealed that only 6.8% of residents felt they were being adequately prepared to manage menopausal patients effectively. Of 177 respondents, 20% reported not receiving any menopause lectures during residency. The survey concluded that residency trainees recognized the importance of understanding menopause management, but were being inadequately trained by their educational institutions. This has led to an entire generation of doctors who suffer from a potentially significant blind spot.
Some businesses and entrepreneurs have realized this leaves a medical hole they can fill. These providers, such as Alloy, Winona and Midi (to name a few), act as intermediaries between frustrated, menopausal women and the medical industry at large.
How Does it Work?
Third-party menopause care providers operate in similar ways: The prospective patient fills out a survey online or participates in a telehealth consultation, then a medical professional who specializes in menopause care reviews the information and writes up a treatment plan. Following that, prescriptions are delivered to the patient’s home. Typically, the provider also offers unlimited follow-up via telehealth appointments.
Options vary from state to state, so it’s important to research carefully before choosing. Midi, for example, accepts insurance from major providers, and usually covers both visits and prescriptions. It also doesn’t require a subscription fee; basically, it acts like a doctor-patient matchmaker. Alloy, on the other hand, charges a subscription fee for its services.
Considering Your Options
Before you choose a third-party provider for your menopause care, you should know about The Menopause Society, a nonprofit organization with the mission of “empowering healthcare professionals and providing them with the tools and resources they need to improve the health of women during the menopause transition and beyond.” In other words, their goal is to bridge the gap between the accepted, current science and what medical professionals did (or didn’t) learn in school, so that women can get better care. The society offers training in menopause and midlife women’s health, and a competency examination for healthcare professionals seeking to become credentialed as a Menopause Society Certified Practitioner (MSCP). You can search for an MSCP near you here.
If you do decide to use a third-party provider, you’ll want to vet them thoroughly before embarking on a treatment plan — just as you should with anything related to your health. Pay attention to these details in particular:
- Do they charge a subscription fee? What does it cover? Can you easily cancel?
- Do they accept insurance? If they do, what does insurance cover?
- Who are the medical care providers, and what licensing/certifications do they have?
- What types of products do they advertise? Are they FDA-approved? Here are some red flags to look out for:
- Bioidentical Hormones: Be wary of any company advertising the use of bioidentical hormones for HRT. Bioidentical hormones are hormone replacements that are identical to, and have the exact same chemical and molecular structure as, hormones produced in the human body. Sounds good, right? But this definition includes not only commercially available hormones approved by the FDA but also custom-compounded preparations made in pharmacies that are not regulated by the FDA. “Bioidentical” is actually a marketing term rather than a medical one, and it has not been proven that custom-compounded bioidentical hormone therapy is more effective or safer than FDA-approved preparations. If you use any hormones/hormone replacements that aren’t regulated by the FDA, you run the risk of receiving a dose lower or higher than intended that may also be of questionable purity.
- Other Supplements: You might see products containing black cohosh, red clover, evening primrose, vitamin B and soy products (among others) marketed for treating menopause-related symptoms. These herbal supplements are similarly not regulated by the FDA, so the risks include incorrect dosing, unreliable purity and, possibly, problematic interactions with other drugs or health conditions.
We should also advise you to consult with your physician or gynecologist — although we do acknowledge that may or may not be helpful in this situation. At the very least, however, you should double-check with your doctor or pharmacist about any potential problematic interactions before taking anything they haven’t prescribed.
Top image: Africa images, via Canva.com
*Article updated from original post on 9/4/24
