Is It OK to Wear an Estrogen Patch… Forever?
Lauryn Higgins
Hormone replacement therapy (HRT) has always been a flashpoint in women’s health, but the latest debate isn’t happening in journals or clinics—it’s unfolding on stage. At a SXSW panel on menopause last year, a group of OBGYNs traded knowing looks and bold declarations.
Laughing, but only half-joking, several said they planned to “die with their estrogen patches on.”
The line landed like both a punchline and a manifesto. Women in the audience clapped, some cheered, others nodded in relief at hearing doctors voice out loud what they had been feeling privately: that life with estrogen feels fundamentally different than life without it. For these physicians—many of whom are navigating perimenopause or menopause themselves—the patch isn’t just a prescription, it’s a lifeline.
That rallying cry captures a generational shift. Gen X doctors are the first wave of physicians to move through menopause armed not only with medical training but also with decades of frustration at how women’s midlife health has been sidelined. Their insistence on patches-for-life isn’t just about symptom relief—it’s about reframing menopause as a stage of life that deserves aggressive, unapologetic care.
The Case for Staying on Patches for Life
For many Gen X doctors, the reasoning is simple: they see estrogen as protective, not just palliative.
“As a scientist, my role isn’t to tell women what to do with their bodies,” says Dr. Piraye Yurttas Beim, CEO of Celmatix Therapeutics, who was a panelist at the aforementioned SXSW discussion. “It’s to give them the clearest possible picture of the trade-offs. I’m enthusiastic because the alternative—doing nothing—is often presented as ‘natural,’ when in reality it’s historically unprecedented for women to live half their lives without ovarian hormones.”
Dr. Mary Claire Haver, an OB-GYN and also one of those SXSW panelists, explains why she feels so strongly about hormone therapy and why she too will stay on estrogen for life.
“I’ve seen firsthand, both in my patients and in my own life, how transformative it can be,” she says. “The biggest misunderstanding is that estrogen is inherently dangerous. For decades, women were told to fear it, often based on misinterpreted or outdated data. But when prescribed thoughtfully, at the right time and in the right formulation, HRT not only relieves symptoms like hot flashes, brain fog and sleep disruption, it also supports bone, heart and metabolic health.”
For Dr. Cathleen Brown, an OB-GYN and medical director of the menopause telehealth provider Winona, the statement that some women might “die with their estrogen patches on” is bold—but one she fully supports.
“We are the ones reading and scrutinizing the literature and seeing the benefits of HRT overall for women as they age,” she says. “And because we are also personally going through it, we clearly recognize how much better we feel on HRT than not. That’s why we feel so strongly about continuing it.”
And Brown points to the downstream health consequences of estrogen decline: osteoporosis and fractures, cardiovascular disease, and cognitive decline, including Alzheimer’s. “When you know that supplementary estrogen can help combat all of these issues, it is a no-brainer to offer HRT when it is safe for a woman,” she says.
Where the Science Urges Caution
Not all experts are convinced that lifelong use of estrogen patches is either wise or warranted.
“This is an overstatement,” said Dr. Rhonda Voskuhl, a professor of neurology at UCLA and inventor of CleopatraRx, a therapy for cognitive symptoms of menopause. “At perimenopause, most women notice hot flashes, and an estradiol patch is an excellent treatment. But menopause is more than hot flashes. Estrogen is good for multiple organs, but HRT is not a one-size-fits-all answer.”
Voskuhl stresses that women need to be screened for contraindications such as breast cancer, clotting disorders or cardiovascular disease. “If there are no contraindications, then a specific type and dose of estrogen and a progesterone should be optimally tailored for each woman’s health,” she said.
The risks, she adds, change with age. “The risk-benefit ratio for being on HRT is not the same for a woman aged 50 versus 65 versus 80,” she says. “At age 50, hot flashes are common, and the risk of cancer is lower. By 80, hot flashes no longer occur, and the risk of cancer is higher.”
Voskuhl also cautions against overstating benefits beyond symptom relief. “Estradiol patch is FDA approved for hot flashes,” she says. “It was not designed for protecting brain health. Women over 60 are more likely to get breast cancer, stroke and heart disease. At older ages, the risks can begin to outweigh the benefits.”
The Menopause Society’s Current Guidance
The Menopause Society has sought to bring nuance back into the conversation around hormone replacement therapy. In its 2022 position statement, the group reaffirmed that HRT remains the most effective treatment for vasomotor symptoms such as hot flashes, as well as for the prevention of bone loss and fractures.
Importantly, the society emphasizes that treatment should be individualized, using “the lowest effective dose for the appropriate duration,” rather than applying a one-size-fits-all approach. This guidance reflects the complexity of menopause care, recognizing that each woman’s health profile, symptom severity and personal risk factors require tailored consideration.
The society does not recommend indefinite or lifelong HRT for all women. Instead, it stresses ongoing re-evaluation: a woman in her early 50s may derive significant benefit, but the risk-benefit calculus shifts as women age into their 60s and 70s, when long-term risks such as cardiovascular disease, stroke or cancer may become more relevant.
Generational Passion, Medical Caution
Generational context shapes much of today’s debate around hormone therapy. Gen X physicians, many of whom are entering perimenopause or menopause themselves, trained in the long shadow of the Women’s Health Initiative (WHI)—the massive 2002 study that linked HRT to breast cancer and stroke. Though later criticized for its methodology and sweeping conclusions, its shadow lingers.
At the same time, these doctors have seen a wave of technology-driven solutions aimed at reshaping how women’s health is understood and treated. From watching millennials normalize egg freezing to period tracking and fertility care, for many, menopause feels like the next frontier in reproductive autonomy—and patches symbolize both relief and rebellion.
That energy fuels bold declarations like “I’ll die with my patch on,” which capture the passion of today’s menopause advocates but also raise questions about where enthusiasm ends and ideology begins. “Estrogen is good for multiple organs such as the brain, skin and bone,” says Voskuhl. “Women should discuss HRT with their doctor, the earlier the better for preventative treatment.” She stresses the need for individualized care, especially since women with a history of breast cancer, clotting, stroke, or heart disease should not take HRT
Haver agrees but is careful about tone. “I would never call HRT a ‘must-have’ for everyone. It’s a tool, an incredibly powerful one, but still a tool,” she says. “Some women will choose to stay on it long-term because the benefits for them are undeniable. Others may decide to stop after a season of life. Both are valid. The key is that the choice should be informed, individualize and free of fear.”
Still, doctors like Brown argue the benefits are too powerful to dismiss. “All forms of HRT are beneficial for most patients that can safely take them,” she says. “The estradiol patch just happens to be one of the most popular forms of HRT right now.”
Beim adds that she would never call estrogen patches a ‘lifelong must-have’.
“But I think the responsible framing is: this is an imperfect but powerful tool,” she says.”My hope is that Gen X and younger funders of innovation will see the huge opportunity in doing better for women than estrogen patches. The science is there, but the investment has lagged behind.”
For patients, the takeaway may be less about whether to “patch for life” and more about navigating the nuances. “Enthusiasm is not coercion,” says Beim. “Some women will decide long-term HRT is right for them, others will taper off. Both are valid, informed choices.”
