Science Fictions Paid-only episode 25: The menopause and hormone replacement therapy
Dec 2, 2025
The discussion revolves around the complexities of hormone replacement therapy (HRT) for menopause. The hosts explore the shifting evidence on HRT's benefits, from hot flushes to cognitive issues. They delve into the FDA's recent removal of HRT's black box warning, impacting prescribing trends. The influence of Davina McCall's documentary in increasing public interest in HRT is highlighted. Personal improvements reported by McCall, like enhanced mood and libido, spark further conversation about the therapy's relevance.
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Episode notes
Focus On Menopausal HRT Evidence
- Tom and Stuart emphasise the episode focuses on menopause-related HRT rather than male hormone therapy.
- They frame discussion around evidence quality and controversy rather than activism.
Regulatory Reversal Changed Risk Perception
- The FDA removed the black-box warning on menopausal HRT, changing its risk framing significantly.
- Stuart Ritchie and Tom Chivers note this reversal shifted prescribing and public perception since 2002.
Prescribing Patterns Shifted Over Time
- Prescribing rates for HRT collapsed around 2002 after the warning and only recently began rising again.
- The types of HRT shifted too, with patches and gels becoming more common after 2016.