Stephanie Pastor and her family were trudging up a hill at Rockefeller State Park last fall when her young son let out an exasperated sigh.
“I’m having a hot flash,” PJ, then six, announced, sending his parents into a fit of laughter.
But as their amusement faded, Pastor, now 48, was struck with a realization: Her daily struggles with perimenopause had become so pervasive that even her son had picked up on them.
Relief would finally came with hormone replacement therapy (HRT), but only after years of suffering and red tape — including repeated refusals for health insurance coverage and doctors telling her to do her own research.
And she’s far from alone. For decades, women and their doctors have shied away from hormones used to treat menopause symptoms due to old research linking them to breast cancer and other serious side effects.
But the tide may be shifting: Last week, it was announced that the FDA will ask drugmakers to remove strict “black box” warnings from the medications, calling them “misleading” and based on “bad science.”
“It’s about time,” Pastor, from Westchester, told The Post. The challenge now, she said, is undoing decades of fear and “misinformation” that kept women like her from getting help sooner.
Hot flashes and heartbreak
Pastor first noticed her body was changing when menstrual cycle went haywire. At 40, she’d recently given birth to her son, and her gynecologist dismissed the symptoms as her body simply readjusting after pregnancy.
Then came hot flashes. At first, they were mild and sporadic. But soon they hit harder and more frequently, leaving her flushed and drenched in sweat.
At the NYC public school where she teaches fifth grade, she started carrying around a portable fan.
“Otherwise, it would be so bad that I would get flustered and so overwhelmed by it that I couldn’t talk,” Pastor said.
She often woke at 3 a.m., soaked and unable to fall back asleep. The physical symptoms were debilitating, and mood swings made things even harder.
“The hot flashes would cause irritability, and that would make me short,” Pastor said. She and her husband, Chris, began arguing over “silly, silly things.”
Their intimacy suffered. On an anniversary trip in January, vaginal dryness made sex painful enough that the couple had to stop.
“It was very frustrating for them to say, ‘It is what it is, you just have to deal with it.’ No — It can’t be. It can’t be. It can’t be.”
Stephanie Pastor
“To think that, because we go through these normal biological changes, it could affect our most important relationship and then, in turn, affect our children — it’s terrible,” Pastor said. “I had to do something.”
But when she turned to her gynecologist for help, she was told there was nothing to be done.
“It was very frustrating for them to say, ‘It is what it is, you just have to deal with it,’” Pastor said. “No — It can’t be. It can’t be. It can’t be.”
Fear and facts
Searching for solutions, Pastor discovered HRT, which eases symptoms by replacing the hormones like estrogen and progesterone that naturally decline after menopause.
But her research also turned up warnings about significant health risks.
Since 2003, the FDA has required HRT medications to carry a black box warning — its strictest label — following a large 2002 study linking them to higher chance of experiencing heart attacks, strokes, blood clots and breast cancer.
Her fear was enough to deter her — and countless others. After the black box warning was enacted, studies show that HRT use in the US plummeted from about 27% of menopausal women in 1999 to less than 5% in 2020.
But newer research paints a more nuanced picture.
A study presented at the Menopause Society’s 2025 Annual Meeting — which has not yet been published or peer-reviewed — found that women who started HRT during perimenopause had 60% lower rates of breast cancer, along with fewer heart attacks and strokes.
“Clinicians who provide menopause care have known for a long time that the black box warning on menopause hormone therapy should not be there,” Dr. Nora Lansen, a family physician and chief medical officer at Elektra Health, previously told The Post.
Eventually, Pastor learned the growing consensus that HRT isn’t unsafe — and the federal government is catching up, too. The Department of Health and Human Services recently announced it will remove “misleading FDA warnings on hormone replacement therapy,” a move that may lead more women to pursue the treatment.
“They don’t approve that until you’re 49, and this was two days after my 48th birthday. I was 363 days too young to get this medicine.”
Stephanie Pastor
“For more than two decades, bad science and bureaucratic inertia have resulted in women and physicians having an incomplete view of HRT,” HHS Secretary Robert F. Kennedy Jr. said in a statement. “We are returning to evidence-based medicine and giving women control over their health again.”
Doctors hope the change will make accessing treatment a bit less complicated.
Cooling down the chaos
In March, just before turning 48, Pastor again sought help, asking her gynecologist for a prescription for HRT.
By that point, she was experiencing hot flashes multiple times per hour. Along with mood swings and vaginal dryness, she was also dealing with anxiety, brain fog and even relentlessly itchy ears.
Pastor’s doctor prescribed Prempro, a combination of estrogen and progestin, but told her the medication wasn’t covered by insurance and would cost more than $1,200 out of pocket.
When she called her doctor’s office to ask for alternatives that might be covered, she was told to research options herself.
Frustrated, Pastor began searching online and found Elektra, a telehealth provider specializing in menopause care that accepted her insurance. Soon, she had booked a virtual appointment with Dr. Laura Edmundson, a Menopause Society-certified practitioner.
She was ultimately prescribed progesterone, transdermal estradiol patches and vaginal cream for dryness. But when Pastor tried to fill the prescription, her insurer refused to cover the patches because of her age.
“They don’t approve that until you’re 49, and this was two days after my 48th birthday,” she explained said. “I was 363 days too young to get this medicine.”
The patches were only approved after she got a letter of medical necessity — and Pastor’s hot flashes “stopped almost immediately.”
Her mood swings also eased, along with her anxiety and itchy ears. Intimacy with her husband improved too.
“It wasn’t painful anymore,” Pastor said. “That was something that bothered my husband, because he didn’t want to hurt me. We’ve worked together to find a good balance.”
Celebrating the FDA’s decision to revise black box warnings, Pastor said there now needs to be a concerted effort to reeducate women and dispel the fears that kept so many from exploring HRT.
“We need to give women hope that they don’t have to carry fans around their place of work,” she said. “They don’t have to wake up at three o’clock in the morning with insomnia, and they don’t have to deal with anxiety and itchy ears.”
Her advice? “Be an advocate for yourself. Read, learn — and don’t let anyone make you feel hopeless.”
