{"id":8953,"date":"2026-03-19T05:55:47","date_gmt":"2026-03-19T10:55:47","guid":{"rendered":"https:\/\/westplexnews.com\/index.php\/2026\/03\/19\/missouri-patients-dont-know-who-to-trust-when-it-comes-to-menopause-hormone-therapy\/"},"modified":"2026-03-19T05:55:47","modified_gmt":"2026-03-19T10:55:47","slug":"missouri-patients-dont-know-who-to-trust-when-it-comes-to-menopause-hormone-therapy","status":"publish","type":"post","link":"https:\/\/westplexnews.com\/index.php\/2026\/03\/19\/missouri-patients-dont-know-who-to-trust-when-it-comes-to-menopause-hormone-therapy\/","title":{"rendered":"Missouri patients don\u2019t know who to trust when it comes to menopause hormone therapy"},"content":{"rendered":"
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\n

In 2023, Sloane Heller was diagnosed with Atypical Lobular Hyperplasia, a condition that puts her at a 40% risk of developing breast cancer. At the time, despite severe perimenopause symptoms impacting her quality of life, her doctors marked her chart \u201cpatient cannot be on HRT” (photo submitted).<\/p>\n<\/figcaption><\/figure>\n

Sloane Heller woke up one summer morning in her suburban Kansas City home in 2023 with a loud internal alarm.\u00a0<\/span><\/p>\n

\u201cI didn\u2019t feel like I\u2019m in my own body,\u201d Heller said.\u00a0<\/span><\/p>\n

Across the state in St. Louis,\u00a0 mother of two Niya Foster was experiencing something similar:\u00a0 sudden shifts in her mood, her menstrual cycle and her mental health.\u00a0<\/span><\/p>\n

\u201cI felt crazy,\u201d Foster said.<\/span><\/p>\n

At the time, neither woman had a name for what they were going through. But their experiences reflect a growing recognition of the difficult-to-describe hallmark of perimenopause \u2014 the years-long transition before menopause when hormone levels fluctuate unpredictably. This window of time can last up to 10 years, and until a person has stopped menstruating for one full year.<\/span><\/p>\n

This transition is described as \u201ca time of hormone volatility\u201d, said Dr. Bret Gordon, a board certified OBGYN and Menopause Society certified provider at St. Luke\u2019s Hospital in Kansas City. This hormonal rollercoaster ride can cause an array of symptoms that go far beyond the well-known hot flashes and night sweats.<\/span><\/p>\n

For Michelle Renee Holland of Richmond, Missouri, those symptoms have been so severe they have kept her at home.<\/span><\/p>\n

\u201cThe way I describe it to people, I\u2019d be sitting there and it felt like someone took a pan of hot water and slowly poured it over my head,\u201d she said. \u201cIt just slowly seeps down my body. It\u2019s embarrassing because I sweat like a man.\u201d\u00a0<\/span><\/p>\n

Now nearly a decade into menopause, Holland said the symptoms that began during perimenopause have remained disruptive.<\/span><\/p>\n

\u201cIt\u2019s uncomfortable, stressful, I get upset. I don\u2019t want to go anywhere,\u201d she said. \u201cThere have been several times when we\u2019re getting ready to go and I have to start all over and I just tell my family to go without me.\u201d\u00a0\u00a0<\/span><\/p>\n

Missouri legislators are considering a bill that would require insurance coverage for FDA approved treatments for menopause symptoms. It\u2019s an emerging medical topic that\u2019s taken popular culture and the health care industry by storm.<\/span><\/p>\n

The bill, sponsored by Sen. Patty Lewis, a Democrat from Kansas City, would address access in a state where women face a patchwork of care shaped by conflicting guidance on hormone therapy, uneven physician training and limited access to specialists \u2014 especially for those relying on insurance.<\/span><\/p>\n

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Niya Foster, a mother of two from St. Louis (photo submitted).<\/em><\/figcaption><\/figure>\n

While Holland, Heller, and Foster have reliable insurance coverage, their access to menopause support has been anything but. Both Holland and Heller have pre-existing medical conditions that have led to their health care teams at St. Luke\u2019s and University of Kansas Hospital in the Kansas City metro area to discourage menopause hormone therapy, including estrogen.\u00a0<\/span><\/p>\n

Foster said her doctors never mentioned hormonal changes could be the culprit for her symptoms.\u00a0<\/span><\/p>\n

Interviews for this story \u2014 and in anecdotes shared through online forums, friends and family \u2014 revealed a pattern: many women described either pushback from doctors who they felt had not kept pace with evolving research or encounters with clinicians who dismissed their symptoms altogether.<\/span><\/p>\n

In November 2025, the Food and Drug Administration removed a 23-year-old black box warning label for estrogen used to stabilize fluctuating hormones that can cause a host of symptoms, including hot flashes, night sweats, mood changes and mental health changes. Black box labels are the most severe warnings issued by the FDA for prescription drugs it oversees.\u00a0<\/span><\/p>\n

The move marked a significant shift a handful of physicians across the country have worked to achieve, in a medical landscape long shaped by fear and misinformation around estrogen.<\/span><\/p>\n

One of those physicians is Dr. Avrum Bluming, emeritus clinical professor of medicine at the University of Southern California, a board certified medical oncologist, a former senior investigator at the National Cancer Institute,\u00a0 master of the American College of Physicians and co-author, with social psychologist Carol Tavris, of <\/span>Estrogen Matters<\/span><\/a>.\u00a0<\/span><\/p>\n

The book lays out what Bluming and others say are often-overlooked benefits of estrogen, including bone density, supporting vaginal and urinary health, helping prevent recurrent urinary tract infections, and potentially reducing the risk of colon cancer and heart disease. Estrogen Matters also explains a long-standing controversy that led to a generation of perimenopausal and menopausal women navigating their transition without hormone treatment. <\/span>
\n<\/span>
\n<\/span>The Women\u2019s Health Initiative, a $1 billion study conducted in the 1990s concluded that combined progesterone-estrogen therapy caused an increased risk of heart attacks, stroke and breast cancer, which led to a steep decline in the use of hormones to manage menopause symptoms.\u00a0<\/span><\/p>\n

But Bluming and others criticized the interpretation.\u00a0<\/span><\/p>\n

Dr. Carrie Wieneke, OBGYN clinical services lead for the University of Kansas Health System, says when she lectures on the history of menopause care, she shows a New York Times headline that followed the Women\u2019s Health Initiative press conference. The announcement, she said, came while she was still in residency.<\/span><\/p>\n

\u201cI went through four years of residency training and never saw a person that I had a conversation with about menopause, perimenopause, or for that matter, hormone therapy,\u201d she said. \u201cAt that time, we saw the changes already happening.\u201d\u00a0<\/span><\/p>\n

Bluming was even more blunt.\u00a0<\/span><\/p>\n

\u201cWhat they did was dishonest,\u201d Bluming said.\u00a0<\/span><\/p>\n

The announcement described an \u201calmost nominal significance\u201d in breast cancer risk in women using progesterone-estrogen hormone therapy. In data science, Bluming explained, \u201calmost\u201d never warranted the public panic that shaped care and halted medical education for decades.<\/span><\/p>\n

The impact reached far beyond treatments for vasomotor symptoms like hot flashes and night sweats. The absence of estrogen is associated with bone fractures from low bone elasticity, as well as heart attack and stroke related to cholesterol and weight gain \u2014 all side effects of declining estrogen.<\/span><\/p>\n

\u201cWe know with certainty the presence of estrogen within five years of menopause will slow bone demineralization, will reduce risk for coronary artery disease and stroke,\u201d said Gordon, the St. Luke\u2019s Hospital OBGYN.\u00a0\u00a0<\/span><\/p>\n

<\/strong><\/p>\n

Navigating risk<\/h4>\n

\t<\/p>\n

\u201cMost information and noise stems from WHI,\u201d Gordon said, referring to the Women\u2019s Health Initiative.<\/span><\/p>\n

He described the study as disorganized and said it failed to adequately stratify patients by factors such as age, ethnicity and medical history \u2014 all relevant to breast cancer risk.<\/span><\/p>\n

The American College of Obstetricians and Gynecologists is the leading membership organization for practicing OBGYNs. Its<\/span> clinical guidance on menopause symptom management still cites the Women\u2019s Health Initiative study in guiding physicians about \u201crisk.\u201d That guidance, written in 2014 and reaffirmed in 2018, has not been updated since. It focuses on vasomotor symptoms and vaginal changes, but does not mention other commonly associated symptoms that emerge in perimenopause.\u00a0<\/span><\/p>\n

Whether hormone therapy increases breast cancer risk remains a source of disagreement.<\/span><\/p>\n

\u201cI bet the risk of breast cancer is going to go up as more women use hormone therapy,\u201d said Dr. Esther Eisenberg, an ACOG fellow and hormone specialist. She said the Women\u2019s Health Initiative showed \u201can association of hormone therapy and breast cancer.\u201d<\/span><\/p>\n

Eisenberg is the vice-chair of ACOG\u2019s editorial board overseeing the release of its newly published book <\/span>Menopause: What Your OBGYN Wants You To Know<\/span><\/a>.\u00a0<\/span><\/p>\n

Bluming disputes that interpretation.<\/span><\/p>\n

\u201cThere are several major issues with this assertion,\u201d Bluming wrote in a recently <\/span>published<\/span><\/a> paper.\u00a0<\/span><\/p>\n

He notes that breast cancer incidence in the United States began declining before the\u00a0 Women\u2019s Health Initiative results were released. The decline, was seen among white women but not Black women, and many countries that also saw steep drops in hormone therapy prescriptions did not experience a decline in breast cancer rates.<\/span><\/p>\n

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<\/div>\n
\n

The way I describe it to people, I\u2019d be sitting there and it felt like someone took a pan of hot water and slowly poured it over my head.<\/p>\n<\/div>\n

\n

\u2013 Michelle Renee Holland<\/b><\/p>\n<\/div>\n<\/div>\n

For patients like Heller, the back-and-forth over risk is a barrier to care.<\/span><\/p>\n

In 2023, Heller was diagnosed with Atypical Lobular Hyperplasia, a condition that puts her at a 40% risk of developing breast cancer. At the time, despite severe perimenopause symptoms impacting her quality of life, her doctors marked her chart \u201cpatient cannot be on HRT.\u201d\u00a0<\/span><\/p>\n

Every subsequent doctor visit she scheduled to seek relief for her symptoms was met with refusal and push back against hormone therapy.<\/span><\/p>\n

\u201cThere was no conversation,\u201d she said. \u201cThat is my biggest issue across all of these appointments \u2014 that at no point was my health and my quality of life a conversation. It was \u2018this is what you need to do, this is what you can\u2019t do\u2019, end of story.\u201d\u00a0<\/span><\/p>\n

Holland\u2019s experience has been similar<\/span><\/p>\n

In 2016, she was on an oral estrogen medication to help relieve her hot flashes when she suffered a stroke. She says doctors immediately blamed her estrogen pill and took her off \u201ccold turkey\u201d.\u00a0<\/span><\/p>\n

She still remembers what her gynecologist told her.<\/span><\/p>\n

\u201cThe person who blamed it on the estrogen was my neurologist,\u201d she said. \u201cMy gynecologist said \u2018estrogen gets blamed for everything.\u2019\u201d\u00a0<\/span><\/p>\n

Despite emerging data that estrogen patches and creams drastically reduce risk of blood clots and strokes, and with other non-hormonal medications coming to market, Holland said no one has offered or explained those alternatives to her.<\/span><\/p>\n

\u201cThere has not been any education given to me,\u201d she said. \u201cBut sometimes I think I would take the risk because I\u2019m so miserable.\u201d\u00a0<\/span><\/p>\n

Recognizing the uneven state of medical guidance \u2014 and the liability concerns many physicians face \u2014 Bluming worked with a group of physicians to create an <\/span>informed consent form<\/span><\/a> any patient can take to their doctor.\u00a0<\/span><\/p>\n

He says it\u2019s one barrier they can easily remove for patients like Holland who are weighing their quality of life and risks.\u00a0<\/span><\/p>\n

\u201cFind a doctor who will share the decision about your future. Who allows your input,\u201d he said. <\/span>\u00a0<\/span>\u201cDoctors always control the conversation, and always hold the power, and that\u2019s unfair.\u201d\u00a0<\/span><\/p>\n

<\/strong><\/p>\n

Access disparities<\/h4>\n

\t<\/p>\n

Foster says as a Black woman, she has experienced the power dynamic Bluming described first hand, recalling her experience giving birth to her first child.\u00a0<\/span><\/p>\n

\u201cI\u2019ll never forget my doctor reaching their hand inside of me,\u201d she said, \u201cand inducing me without talking to me first or telling me what was happening.\u201d\u00a0<\/span><\/p>\n

Sandy Thornhill, 35, is a St. Louis-based birth doula. She focuses on caring for Black and brown people who are pregnant or parenting. Thornhill says the doctor-patient power dynamic commonly experienced by Black women like Foster is what inspired her to create inter-generational \u201cSacred Womb Circles,\u201d a gathering of people with diverse age ranges to share reproductive health experiences.<\/span><\/p>\n

\u201cThat\u2019s where I started to hear about menopause and \u2018sacred transitions,\u2019\u201d Thornhill said, noting perimenopause has never been brought up in her medical care.\u00a0<\/span><\/p>\n

\u201cBut birthing and Black bodies in America is more public because you get a baby,\u201d she said. \u201cIt\u2019s more celebrated. At least there\u2019s hope for it. I don\u2019t hear that with menopause.\u201d\u00a0<\/span><\/p>\n

Foster said that the same pronatalist culture \u2014 one centered on reproduction \u2014 helps explain why she spent years navigating perimenopause without a consistent provider.<\/span><\/p>\n

Foster said the obstetrician who delivered her second and final child refused to care for her once she was no longer considered to be in her reproductive years.<\/span><\/p>\n

\u201cHe told me after I had my last child, you need to go find another obstetrician because I\u2019m out of the child bearing age and all he did was deliver babies,\u201d Foster said.<\/span><\/p>\n

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Sandy Thornhill, a St. Louis-based doula, with her client Rochelle Hughes shortly after she gave birth (photo by Destiny Loera).<\/em><\/figcaption><\/figure>\n

Thornhill believes Black communities \u2014 who are disproportionately underinsured, experience discrimination in the health care system and face a three-fold risk of maternal mortality \u2014 have an even steeper hill to climb when it comes to accessing information and experts on menopause.<\/span><\/p>\n

Black women are more likely to reach menopause at an earlier age than white women and may experience more severe vasomotor symptoms, according to a <\/span>recent study<\/span><\/a>. It\u2019s a demographic that faces chronic accessibility challenges in the health care system, which often means they don\u2019t have the luxury of picking and choosing their doctor.<\/span><\/p>\n

While barriers to consistent hormone-related care is the smoke, Bluming said physician education is the fire.\u00a0<\/span><\/p>\n

\u201cEducating doctors is a very important part of this,\u201d Bluming said.\u00a0<\/span><\/p>\n

The path from medical school to clinical practice contains few requirements or accountability related specifically to menopause or hormone education, even though hormones affect nearly every major organ in the body.<\/span><\/p>\n

The Liaison Committee for Medical Education, the accreditation body for medical schools nationwide, said in an email to The Independent that it does not have curriculum requirements. Whether medical students are learning about the systemic impact hormones have on the body often depends on the school they attend.<\/span><\/p>\n

Once medical students graduate, they choose a residency program. For those who choose an OBGYN residency, a recent study showed just under <\/span>one-third<\/span><\/a> offer any menopause training.<\/span><\/p>\n

The American Board of Obstetrics and Gynecology, which oversees board certification for OB-GYNs, did not respond to requests from The Independent asking whether hormone therapy is required knowledge before board exams.<\/span><\/p>\n

The American College of Obstetricians and Gynecologists, a professional association of physicians specializing in obstetrics and gynecology, said in an email that it does not support topic-specific educational or curriculum mandates for physicians. It does offer educational resources on menopause and perimenopause to clinicians, the group said, \u201cacross the career span.\u201d\u00a0\u00a0<\/span><\/p>\n

But none of those resources is required in clinical practice.<\/span><\/p>\n

The result is an uneven landscape. Doctors interviewed for this story said they pursued additional education on menopause and hormone therapy largely because their patients were aging beyond their reproductive years, not because their institutions required it.\u00a0<\/span><\/p>\n

That leaves patients to determine for themselves whether a physician has the training and knowledge to help them through perimenopause and menopause. Major health systems across Missouri \u2014 St. Luke\u2019s Health, University of Kansas Health System and BJC HealthCare \u2014 do not require any form of continuing education around hormone therapy and menopause management for their practicing OBGYNs.\u00a0<\/span><\/p>\n

Eisenberg stresses the value of specialists who have focused training and expertise. But specialists can be difficult to access, especially for lower-income patients and for those who rely on safety-net clinics and have little say over where they seek care.<\/span><\/p>\n

\u201cThey can read our book. The internet is full of resources,\u201d Eisenberg said.<\/span><\/p>\n

It\u2019s ultimately up to the patient to dig for this information, Eisenberg said. Patients cannot rely on doctors to do that.<\/span><\/p>\n

\u201cThat\u2019s the way our system works,\u201d she said. \u201cIt\u2019s up to you to make your appointment. It\u2019s up to you to find your doctor. Nobody is mandating anything for you. It\u2019s up to you whether you go seek help. It\u2019s patient centered.\u201d\u00a0\u00a0<\/span><\/p>\n

<\/strong><\/p>\n

Filling in the gap<\/h4>\n

\t<\/p>\n

When patients don\u2019t get the information they need in doctor\u2019s offices, many turn to their community to try and find answers.\u00a0<\/span><\/p>\n

Social media influencers \u2014 including a group of physicians known as the \u201cmenoposse,\u201d of which Bluming is a part \u2014 have helped flood algorithms with information about menopause hormone therapy and contributed to a broader public reappraisal of treatment.<\/span>
\n<\/span><\/p>\n

Telehealth apps, projected to grow into a <\/span>$600 billion<\/span><\/a> industry by 2030, are capitalizing on the reality that for many patients they are the only place to find a willing hormone therapy prescriber.\u00a0<\/span><\/p>\n

So far, 15 states, including Missouri, have introduced legislation aimed at menopause care.\u00a0<\/span><\/p>\n

Missouri\u2019s bill requiring <\/span>insurance coverage for FDA-approved treatments<\/span><\/a> for perimenopause and menopause has yet to make any progress in the state Senate. Other state bills around the country focus on clinician training and public education.<\/span><\/p>\n

Whether addressing menopause care access is legislatively mandated or professionally guided has yet to work itself out. In the meantime, Holland says she feels harmed just the same.\u00a0<\/span><\/p>\n

\u201cIt\u2019s absolutely ridiculous. To me, that is like you have no idea how much suffering this is. This affects my family,\u201d Holland said.<\/span><\/p>\n

The issue of physician education marks a new chapter in the decades-long fight to reclaim a narrative about hormone therapy that never had data to support it. Nonetheless, Heller says she sees progress.\u00a0<\/span><\/p>\n

\u201cI\u2019m overall thrilled that this has become a mainstream conversation. That it\u2019s talked about on social media as much as it is. There\u2019s tv shows. I think all of that is amazing,\u201d Heller said.<\/span><\/p>\n

Today, Heller has a doctor who prescribes her hormones while carefully monitoring her for breast cancer. She gets checked every six months, understands her risks and feels empowered with the information to make her own decision about it.<\/span><\/p>\n

\u201cHRT has increased my quality of life significantly,\u201d Heller said. \u201cI can\u2019t imagine my life without it.\u201d<\/span><\/p>\n

\n
\n
\n\t\t\t\tPatients can visit <\/span>The Menopause Society<\/span><\/a> search page and find Menopause Society Certified Practitioners. The Society lists 104 certified Missouri providers. Nearly half of them (45) only accept out-of-pocket payment, excluding patients who rely on insurance to cover their costs.<\/span>\t\t\t<\/div>\n<\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"

In 2023, Sloane Heller was diagnosed with Atypical Lobular Hyperplasia, a condition that puts her at a 40% risk of developing breast cancer. At the time, despite severe perimenopause symptoms impacting her quality of life, her doctors marked her chart \u201cpatient cannot be on HRT” (photo submitted). Sloane Heller woke up one summer morning in…<\/p>\n","protected":false},"author":2,"featured_media":8954,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"_kadence_starter_templates_imported_post":false,"_kad_post_transparent":"","_kad_post_title":"","_kad_post_layout":"","_kad_post_sidebar_id":"","_kad_post_content_style":"","_kad_post_vertical_padding":"","_kad_post_feature":"","_kad_post_feature_position":"","_kad_post_header":false,"_kad_post_footer":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-8953","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"yoast_head":"\nMissouri patients don\u2019t know who to trust when it comes to menopause hormone therapy - WestplexNews.com<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/westplexnews.com\/index.php\/2026\/03\/19\/missouri-patients-dont-know-who-to-trust-when-it-comes-to-menopause-hormone-therapy\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Missouri patients don\u2019t know who to trust when it comes to menopause hormone therapy - WestplexNews.com\" \/>\n<meta property=\"og:description\" content=\"In 2023, Sloane Heller was diagnosed with Atypical Lobular Hyperplasia, a condition that puts her at a 40% risk of developing breast cancer. 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