I felt bile coming outta my mouth and didn't feel any way to control it.

The only one I wasn't mad at was the dog.

- [Isabella] Artist Tanya Glover was 45 years old when she started noticing symptoms that she couldn't explain.

- The anxiety big time.

That was the worst one.

The night sweats, the irregular periods, the heavy periods.

I just felt like I was kind of losing it a little bit.

And a friend of mine said something about perimenopause.

I'm like, "What is that?"

- It's a familiar story for Dr. Mary Jane Minkin.

- Menopausal symptoms, perimenopausal symptoms, can be extraordinarily disruptive to women.

- [Isabella] Those symptoms can include: increased anxiety, hot flashes, migraines, insomnia, vaginal dryness, and changes in sexual desire.

And Dr. Minkin says, all too often, they aren't taken seriously.

- I just feel horrible for so many of these women who come in and they've been miserable for so long for no good reason.

We have some great therapies for them so that people can lead totally normal lives.

- [Isabella] Those therapies are going unused because traditional treatment, hormone replacement therapy, developed a bad reputation in 2002.

Dr. Minkin says a study called the Women's Health Initiative, or WHI, changed everything.

- I remember where I was when JFK was shot, I remember where I was at 9/11, and I remember where I was on July 9th, 2002.

- [Isabella] The hormone estrogen has been successfully used to treat menopause symptoms since the '40s.

- [Dr. Minkin] And many people started viewing estrogen as sort of a fountain of youth.

- Scientists hypothesized that it could help with other diseases.

- Dr. Grant prescribed Premarin.

- [Isabella] And in the '90s it was put to the test.

- The birth of the Women's Health initiative was to study, does estrogen really help prevent heart disease?

- [Isabella] About 27,000 women were divided into two groups.

Women who had hysterectomies were given estrogen or a placebo, women with uterus were given estrogen and a synthetic progesterone or a placebo.

- It was supposed to go on for over 10 years.

Yes.

- Dr. Renee Eger is the director of the menopause program at Women & Infants Hospital.

- After five years, there was noted to be a statistically-increased risk of breast cancer in the women who took the estrogen plus the synthetic progesterone.

- That basically stopped the study dead in its tracks.

Indeed, I got more calls that day than ever before or ever after (chuckles) of everybody who's terrified, you know, "I'm taking this estrogen, I'm gonna get breast cancer and die."

- That study made it onto the front page of "The New York Times," it was the topic of talk shows.

The number of prescriptions for hormone replacement therapy decreased by 85%.

Those numbers have not rebounded.

- [Isabella] Today, Tanya Glover takes an anti-anxiety medication for her menopause-related depression and anxiety.

- Wait for me.

It's taken the edge off.

(chuckles) That's it though.

It's still there.

I probably couldn't do a job, a regular job.

I don't think I could handle it.

And that's not an option for a lot of people.

- Did you ever consider hormone therapy?

- I considered it.

My doctor told me most insurances don't cover it and it's pretty expensive.

And you know, you hear about the cancer risks and I don't know who to believe.

- [Isabella] Who and what to believe about the WHI's findings has been the question for the last 20+ years.

- The actual increased numbers of breast cancer was only 8 women out of every 10,000 women so from a clinical standpoint, it was questionable whether that was actually significant.

But from a statistical standpoint, the study was so large that they had to conclude that there was statistical significance.

- [Isabella] Plus, the women who were studied weren't your standard candidates for hormone therapy.

- The average age of women enrolled in the WHI was 63.

The average age of women going through menopause is 51 so you had these women who were way post menopause.

Oh, by the way, 20% of the women were between 70 and 79 in the WHI.

And do I enroll a lot of women or start women in their 70s in general on estrogen?

Not really.

- [Isabella] In May, a study published in "The Journal of the American Medical Association" took another look at data from the WHI and other studies and found that hormones were safe for many women under 60 to take.

- The hormone replacement therapy of 2024 looks very different than it did back in 2002.

We learned that the use of probably a synthetic progestogen does likely increase a woman's risk of breast cancer.

And we've changed the way in which we deliver our estrogen.

We used to deliver it orally and now it can be delivered through the skin and there's increased safety associated with delivering the medication that way.

- How safe do you consider hormone therapy to be?

- For women who are at low risk and appropriate candidates for hormone therapy, hormone therapy is very safe when you look at the risks versus the potential benefits associated with it.

We no longer tell women that they absolutely are or are not candidates for hormone therapy, but rather have individualized discussions with patients and take a look at their past medical history.

I think it's also important that people understand that there are alternatives to hormone therapy because hormone therapy isn't necessarily the right choice for every woman.

- Are most providers prepared to have this kind of in-depth conversation?

- I think a lot of that depends on when an individual completed their residency.

- [Isabella] Dr. Minkin says that's because the WHI changed the way doctors are trained.

- Because women stopped using estrogen in droves, most programs training residents in OB-GYN and some other specialties basically stopped teaching how to manage menopause.

- So they didn't think they had any good treatment options and therefore they stopped teaching about menopause altogether.

- Exactly.

Even as of last year, 70% of the OB-GYN programs in the United States were not teaching menopause management.

(Dr. Eger knocks) - [Dr. Eger] Hi, it's Dr. Eger.

- [Isabella] And many patients don't believe their symptoms can be treated safely.

- The data bears out that most women who are having hot flashes are actually not seeking medical attention.

- [Isabella] But there are signs that change is happening.

- This is a big year for menopause, by the way.

Big year.

Just a little over a year ago, it was the cover story of "The New York Times" Sunday magazine and the title was: Women Have Been Misled About Menopause.

And this started a revolution.

- Why is such a critical part of women's health being ignored?

- This is a normal part of the perimenopause-to-menopause transition.

- Menopause, on page 242, is mandatory, suffering is not.

- [Isabella] On social media.

- Good morning, menoverse.

Okay.

- Do your periods just stop when you enter menopause?

- Can you tell me what menopause is?

- When a woman no longer experiences their period?

I don't know.

Is that it?

- Good for you.

- [Isabella] And in government.

In March, President Biden requested $12 billion for women's health research, noting menopause as a particular area of interest.

(bright music) - [Advertiser] This is a hot flash.

- [Isabella] And a new non-hormonal drug - This is a hot flash.

- has become available and was advertised during the past Super Bowl.

- [Advertiser] This is a not flash.

- As for Tanya Glover, it's been a long, turbulent phase of life.

How many years has it been now?

- At least 10.

- Of perimenopause?

- I haven't had a period since last March, so I'm like a week or two away from full-blown menopause.

- How does that feel?

- I don't wanna jinx it, (laughs) but it feels like relief is right around the corner.

I need that.

- Finally tonight, on this episode of "Weekly Insight,"