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FDA to Remove Black Box Warnings From Many Menopause Hormone Therapies

New labeling emphasizes starting therapy before age 60 or within 10 years of menopause to better balance benefits and risks.

Overview

  • Boxed warnings for cardiovascular disease, breast cancer, stroke and probable dementia will be dropped, while a warning about endometrial cancer remains for systemic estrogen‑only products.
  • The shift follows an FDA expert panel in July and a comprehensive evidence review, with manufacturers expected to update labels within months.
  • Labels will add timing guidance, tailor safety information by product type, and remove the blanket directive to use the lowest dose for the shortest duration in favor of individualized decisions.
  • The FDA also approved a generic version of Premarin and a nonhormonal therapy for vasomotor symptoms such as hot flashes.
  • Major specialty groups, including ACOG, praised clearer, product‑specific guidance but urged caution with systemic therapies, as critics warned that less prominent warnings could undercommunicate real risks.