Hey! I'd love to hear your thoughts, send me a voice note. Part one of a two-part series on menopause, covering systemic hormone therapy for vasomotor symptoms, drawing on documents plus three April 2026 ACP Internal Medicine Meeting sessions (Monica Christmas, Lisa Larkin, and a UCLA speaker). It opens with the regulatory story — the November twenty twenty-five FDA announcement removing the boxed warnings for cardiovascular disease, breast cancer, and dementia, the first revised labels approved in February twenty twenty-six, the fact that implementation is still product by product, and the criticism of both the process and the benefit claims. It then goes back to what the Women's Health Initiative actually showed in absolute numbers and by age, and why the regimen it tested differs from what most clinicians prescribe now. It covers the new American College of Physicians guideline published October sixth, with its recommendation grades, its clinical considerations, and the accompanying Mayo Clinic editorial, including where the guideline departs from the Menopause Society and from the ACP meeting speakers on route of administration, family history of breast cancer, age cutoffs, and duration. Then the practical prescribing: candidacy and contraindications, transdermal versus oral and the venous thromboembolism data, doses, progestogen choice and endometrial protection, bleeding, duration and the end of the arbitrary stop date, perimenopause, and premature ovarian insufficiency. It closes with the nonhormonal ladder, including fezolinetant's liver monitoring and the newly approved elinzanetant, and a note on compounded hormones.
