Treatment literacy | 6 min read

Peptide Therapy for Women: How to Tell Evidence From Hype

Editorial draft — clinical review pending.

Short answer: "Peptide" just means a short chain of amino acids. Some peptides are well-tested, FDA-approved medicines. Semaglutide and tirzepatide are examples. Others sold for recovery, anti-aging or "hormone balance," such as BPC-157, have no FDA approval and limited human safety data, and the FDA has raised safety concerns about them. Judge each product on its own evidence, not on the word "peptide." [1,2]

Key takeaways

• Being a peptide says nothing about whether a product is safe or works.
• FDA approval covers a specific product for a specific use, not every product containing a similar ingredient. [1]
• The FDA has flagged BPC-157 and some other peptides for risks such as immune reactions and impurities. [2]
• "Research use only" products are not meant for people.

Approved peptides vs. wellness peptides

Approved peptide medicines have been tested in clinical trials in people, reviewed by the FDA for safety, effectiveness and manufacturing quality, and come with a label describing proper use. Examples include insulin, semaglutide and tirzepatide.

Wellness peptides such as BPC-157, TB-500 and various "anti-aging" blends are often supported mainly by animal studies, small human studies or testimonials. Results in rats do not show that a product is safe or effective in women. [1]

What the FDA has said

The FDA keeps a list of bulk substances that may pose significant safety risks when used in compounding. Its material on BPC-157 notes potential immune reactions, peptide-related impurities and limited information about safety in humans. [2] A substance being studied or discussed online doesn’t make it approved.

Red flags

• One product promising many unrelated benefits: recovery, glow, fat loss, longevity and libido.
• Labels saying "research use only" or "not for human consumption" alongside dosing advice.
• No prescription or medical history required.
• Testimonials and before-and-after photos in place of clinical studies.
• Purity certificates presented as proof the product works. Purity and benefit are different questions.

A five-question checklist

Before paying for any peptide treatment, ask:

1. What is the exact ingredient, dose and form?

2. Is this specific product FDA approved? For what?

3. If not approved, is it compounded, investigational or neither?

4. What human studies support it for my goal?

5. Who prescribes it, who makes it, and who manages side effects?

If you can’t get clear answers, that tells you something.

Why people are interested

Interest in peptides is understandable. Several approved peptide medicines have changed how conditions like diabetes and obesity are treated, and that success has made the word sound like a guarantee. Curiosity is a good starting point. The goal is to turn it into questions that protect your health and your money.

Frequently asked questions

Is BPC-157 safe?

Its safety in people hasn’t been established, and the FDA has listed safety concerns. [2]

Are GLP-1s peptides?

Yes. Semaglutide and tirzepatide are peptide medicines with FDA approval for specific uses.

Can a clinician prescribe wellness peptides?

Regulations limit which substances can be compounded. Ask any prescriber about approval status and evidence before starting.

Next step

Have a question about a peptide or wellness claim you’ve seen? Bring it to a HerScripts clinician for a straight answer. Ask your questions.

Sources

[1] FDA, The drug review process

[2] FDA, Certain bulk drug substances for compounding that may present significant safety risks

Educational information, not personal medical advice. Care decisions require an individual clinical evaluation.

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Hormones and menopause | 5 min read

Bone Density Screening After Menopause: When Do You Need a DXA Scan?

Editorial draft — clinical review pending.

Short answer: The U.S. Preventive Services Task Force recommends osteoporosis screening, usually with a DXA bone density scan, for all women 65 and older. It also recommends screening postmenopausal women under 65 who have a higher risk of fracture, based on a risk assessment. Bone loss speeds up after menopause, so your forties and fifties are the time to understand your risk. [1,2]

Key takeaways

• Screening is recommended at 65 for all women and earlier for postmenopausal women with risk factors. [1]
• Bone loss accelerates in the years after menopause. [2]
• Calcium, vitamin D, strength and balance exercise, and avoiding smoking all help protect bone.

Why menopause affects bone

Estrogen helps keep bone breakdown and rebuilding in balance. When it falls, bone breaks down faster than it’s replaced. Bone loss is fastest in the first several years after menopause, which raises the risk of osteoporosis and fractures later. [2]

Risk factors that may mean earlier screening

• A previous fracture from a minor fall after age 50.
• A parent who broke a hip.
• Low body weight.
• Smoking or heavy drinking.
• Long-term steroid use or certain other medicines.
• Early menopause, before 45.
• Conditions such as rheumatoid arthritis.

Clinicians often use a tool such as FRAX to estimate your 10-year fracture risk and decide whether a scan is useful before 65. [1]

What a DXA scan involves

A DXA scan is a quick, painless, low-radiation X-ray of the hip and spine. Results are given as a T-score:

• −1.0 or higher: normal.
• Between −1.0 and −2.5: low bone mass (osteopenia).
• −2.5 or lower: osteoporosis.

The result is combined with your other risk factors to decide whether treatment is needed.

Protecting your bones now

• Calcium: women 51 and older need about 1,200 mg a day from food and supplements combined. [3] Food first.
• Vitamin D: 600 IU a day up to age 70 and 800 IU after. [3]
• Exercise: weight-bearing activity like walking, plus strength training and balance work.
• Avoid smoking and limit alcohol.
• Reduce fall risk: good lighting, sturdy shoes and fixing trip hazards.

Check whether your multivitamin already contains calcium or vitamin D before adding more.

If treatment is suggested

Several medicines lower fracture risk. Hormone therapy is FDA approved to prevent bone loss and may be considered if you also have menopause symptoms. Ask about benefits, side effects, how long you’d take it and how it will be monitored.

Frequently asked questions

At what age should women get a bone density test?

At 65, or earlier after menopause if you have risk factors for fracture. [1]

Can I get a DXA scan in my 40s?

Usually only if you have specific risk factors or conditions. Ask your clinician.

Does hormone therapy protect bones?

Yes, it’s approved to prevent postmenopausal bone loss, but it’s usually chosen when there are also symptoms to treat.

Next step

Add bone health to your next midlife check-in. A HerScripts clinician can review your risk and whether screening makes sense now. Learn about strength and body changes.

Sources

[1] USPSTF, Osteoporosis to Prevent Fractures: Screening, 2025

[2] Office on Women's Health, Menopause and your health

[3] NIH Office of Dietary Supplements, Calcium fact sheet

Educational information, not personal medical advice. Care decisions require an individual clinical evaluation.

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Weight care | 6 min read

What to Eat on a GLP-1: Protein, Nutrients, and Managing a Smaller Appetite

Editorial draft — clinical review pending.

Short answer: When a GLP-1 cuts your appetite, focus on quality: protein at every meal, plenty of vegetables, fruit, whole grains and healthy fats, and enough fluids. A 2025 joint advisory from four nutrition and obesity medicine organizations names adequate protein, preventing nutrient deficiencies, managing digestive side effects and strength training as key priorities. [1]

Key takeaways

• The advisory lists eight priorities, including baseline nutrition assessment, nutrient-dense minimally processed food, adequate protein and strength training. [1]
• Most people on GLP-1s eat far less, which raises the risk of falling short on protein, fiber, iron, calcium, vitamin D and B12.
• Your protein target should be personalized. The basic adult minimum is 0.8 g per kilogram of body weight a day, and many clinicians aim higher during weight loss.

Put protein first

Protein helps protect muscle while you lose weight. Because you’ll feel full sooner, eat the protein part of the meal first. Good sources:

• Eggs, Greek yogurt, cottage cheese and milk.
• Fish, chicken, turkey and lean meat.
• Tofu, tempeh, edamame, beans and lentils.
• Protein-fortified foods or shakes if solid food is hard.

Ask your clinician or a dietitian for a daily target based on your weight, kidney function and activity. Don’t borrow a number from social media.

Avoid nutrient gaps

Eating smaller portions makes variety more important. Aim for colorful vegetables and fruit, whole grains, and dairy or calcium-fortified alternatives. The advisory recommends checking for deficiencies and considering a multivitamin where intake falls short. [1] Ask before taking high-dose supplements.

Manage nausea and other side effects

• Eat small meals slowly and stop at the first sign of fullness.
• Avoid very fatty, fried or spicy foods if they make you queasy.
• Sip fluids through the day rather than drinking a lot with meals.
• Increase fiber and water gradually if you’re constipated.
• Don’t lie down right after eating.

A sample day

• Breakfast: Greek yogurt with berries and a spoon of nuts.
• Lunch: Lentil soup with a slice of whole-grain bread.
• Snack: Cottage cheese or a hard-boiled egg.
• Dinner: Salmon, roasted vegetables and a small portion of quinoa.

Adjust portions to your appetite. If you can only manage part of a meal, eat the protein first.

Be careful with supplements

Many products promise to protect muscle or boost metabolism. Quality and evidence vary widely, and supplements are not a substitute for food. [2] Bring any product to your care team before buying.

When to call your care team

Contact your prescriber if you:

• Can’t keep food or fluids down.
• Feel dizzy, weak or very tired most days.
• Have severe or ongoing stomach pain.
• Are eating very little most days.
• Notice hair shedding, which can happen with rapid weight loss or low protein.

Frequently asked questions

How much protein should I eat on a GLP-1?

It depends on your size, health and activity. The basic minimum for adults is 0.8 g/kg a day, and many clinicians recommend more during weight loss. Ask for your own target.

Do I need vitamins on a GLP-1?

Possibly, if your intake is low. The advisory recommends checking for and preventing deficiencies. [1]

What foods make GLP-1 nausea worse?

Large, greasy, fried or very sweet meals are common triggers.

Next step

Bring your typical day of eating to your HerScripts follow-up, and your care team can help make it work with your treatment. See weight care support.

Sources

[1] Joint advisory, Nutritional Priorities to Support GLP-1 Therapy for Obesity, 2025

[2] NIH Office of Dietary Supplements, Exercise and athletic performance

Educational information, not personal medical advice. Care decisions require an individual clinical evaluation.

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Skin and hair | 6 min read

Female Hair Thinning: Causes and Treatments That Work

Editorial draft — clinical review pending.

Short answer: The right treatment depends on the cause. For female pattern hair loss, the most common cause of gradual thinning, topical minoxidil is the only FDA-approved medicine and the standard first treatment. Spironolactone and low-dose oral minoxidil are widely used off label. Sudden shedding often has a different cause, such as stress, illness or low iron, and may need a different approach. [1,2,3]

Key takeaways

• Gradual thinning at the part or crown is usually female pattern hair loss. [2]
• Heavy shedding 2 to 3 months after illness, surgery, childbirth or major stress is often telogen effluvium, which usually recovers. [1]
• Treatments take about 6 months to judge and must be continued to keep results. [2]

Common types of hair loss in women

Female pattern hair loss. A widening part and thinning on top, with the hairline usually intact. It runs in families and becomes more common after menopause. [2]

Telogen effluvium. Sudden diffuse shedding a few months after a trigger like illness, surgery, crash dieting, childbirth or stress.

Other causes include thyroid disease, iron deficiency, certain medicines, tight hairstyles, and autoimmune or scarring conditions that need a dermatologist. [1]

Treatments for female pattern hair loss

Topical minoxidil (2% solution or 5% foam) is FDA approved for women. Some women notice extra shedding for the first few weeks, which usually settles. Results take 6 months or more, and hair loss resumes if you stop. [2]

Spironolactone is a tablet that blocks androgen effects. It’s used off label and a small randomized trial found adding it to topical minoxidil improved hair density in premenopausal women. [3] It isn’t safe in pregnancy, so reliable contraception is needed for women who could conceive, and blood potassium or blood pressure may need checking.

Low-dose oral minoxidil is increasingly prescribed off label for people who can’t use the topical form. Side effects can include unwanted facial or body hair, ankle swelling and dizziness, so it needs medical supervision. [1]

Other approaches include treating low iron or thyroid problems, and procedures such as platelet-rich plasma or hair transplants for some people.

Before you start any treatment

Ask:

• What type of hair loss do you think this is, and why?
• Is an exam or blood test needed first?
• Is this treatment FDA approved for this use, or off label?
• What side effects and monitoring should I expect?
• When should I expect results, and what if it doesn’t work?

Mention any pregnancy plans and list all medicines and supplements, including biotin, which can interfere with some lab tests.

When to see someone in person

Get an in-person exam if hair loss is patchy, the scalp is red, scaly, itchy or painful, the hairline is receding, or you’re losing eyebrow or body hair. Photos and questionnaires have limits for these patterns.

Track progress fairly

Take photos in the same light and position every 3 months. Daily mirror checks can make changes hard to see.

Frequently asked questions

What is the best treatment for female hair thinning?

For female pattern hair loss, topical minoxidil is the first-line, FDA-approved option. Others may be added depending on your situation. [2]

Does biotin help hair loss?

Only if you’re deficient, which is rare. Biotin can also distort some blood test results.

Is hair loss reversible?

Telogen effluvium usually recovers. Female pattern hair loss can often be slowed or partly reversed with ongoing treatment.

Next step

Start with the pattern you’ve noticed. A HerScripts clinician can help work out the likely cause and the treatment that fits it. Learn about hair thinning in women.

Sources

[1] American Academy of Dermatology, Hair loss diagnosis and treatment

[2] British Association of Dermatologists, Female pattern hair loss

[3] Randomized trial of oral spironolactone for female pattern hair loss

Educational information, not personal medical advice. Care decisions require an individual clinical evaluation.

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Hormones and menopause | 5 min read

Heavy Periods and Fatigue: When to Check for Anemia

Editorial draft — clinical review pending.

Short answer: Heavy periods are one of the most common causes of iron deficiency and anemia in women, and anemia is a common cause of exhaustion. If your periods are heavier than usual and you feel unusually tired, weak or breathless, mention both together. A clinician can check for anemia and look for the cause of the bleeding. [1,2]

Key takeaways

• Bleeding is considered heavy if it lasts more than 7 days, needs a new pad or tampon in under 2 hours, or involves large clots. [2]
• Heavy bleeding has many causes, including perimenopause, fibroids, polyps, bleeding disorders and some medicines. [1]
• Iron supplements can treat low iron, but they don’t fix the cause of the bleeding.

Is my period heavy?

You may have heavy menstrual bleeding if you: [2]

• Soak through one or more pads or tampons every hour for several hours in a row.
• Need to change products in less than 2 hours.
• Need to change during the night or double up on protection.
• Pass large clots.
• Bleed for more than 7 days.
• Plan your life around your period or miss work or activities because of it.

Common causes in your 40s

Perimenopause. Cycles without ovulation can cause the uterine lining to build up and shed heavily.

Fibroids and polyps. These noncancerous growths are common in midlife and can cause heavy or prolonged bleeding.

Adenomyosis. Tissue from the uterine lining grows into the muscle wall.

Bleeding disorders, such as von Willebrand disease, are more common than many people realize.

Medicines, including blood thinners, can increase bleeding.

Less commonly, changes in the uterine lining that need investigation, especially with bleeding between periods. [1]

Don’t assume heavy bleeding is just perimenopause. A new or changing pattern deserves a check.

Signs of anemia

• Fatigue that doesn’t improve with rest.
• Shortness of breath with activities that used to be easy.
• Feeling dizzy or lightheaded.
• Pale skin, headaches or cold hands and feet.
• Fast heartbeat.
• Restless legs or craving ice.

A simple blood test can check hemoglobin and iron stores (ferritin).

What to tell your clinician

• How many days you bleed and how often you change products on the heaviest days.
• Whether you have clots, bleeding between periods or after sex.
• How tiredness affects stairs, work and exercise.
• Any medicines and supplements you take.

You don’t need to measure blood loss exactly. Practical details are enough.

Treatment options

Treatment depends on the cause and whether you want to preserve fertility. Options include a hormonal IUD, hormonal birth control, tranexamic acid, anti-inflammatory medicines during periods, and procedures for fibroids or polyps. Iron is often given at the same time to rebuild stores. [1]

When to get urgent help

Call 911 or go to an emergency department if bleeding is very heavy and you feel faint, have chest pain, a racing heart or trouble breathing.

Frequently asked questions

Can heavy periods cause anemia?

Yes. Heavy menstrual bleeding is a common cause of iron-deficiency anemia. [2]

Should I just take iron?

Talk to a clinician first. Iron can treat low iron, but the cause of the bleeding still needs to be found.

Are heavy periods normal in perimenopause?

They’re common, but not something you have to live with, and other causes should be ruled out.

Next step

Bring both symptoms to one HerScripts conversation and get a plan that looks at the cause and the effects. Learn about changing periods.

Sources

[1] ACOG, Heavy Menstrual Bleeding

[2] CDC, About Heavy Menstrual Bleeding

Educational information, not personal medical advice. Care decisions require an individual clinical evaluation.

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Sleep and wellbeing | 6 min read

Menopause Brain Fog: Causes, What Helps, and When to Worry

Editorial draft — clinical review pending.

Short answer: Many women notice forgetfulness, trouble finding words or difficulty concentrating around menopause. It’s common, it’s real, and for most women it improves after the transition. Brain fog in midlife is not usually a sign of dementia. Poor sleep and hot flashes are major contributors, so treating those often helps. [1,2]

Key takeaways

• Memory and concentration problems are recognized symptoms around menopause. [1]
• Research links hot flashes and sleep disruption with changes in memory and brain function. [2]
• Hormone therapy is not recommended for brain fog alone. [1]
• Sudden confusion or trouble speaking is an emergency. Call 911.

What brain fog feels like

• Walking into a room and forgetting why.
• Losing a word mid-sentence.
• Rereading an email several times.
• Struggling to juggle several tasks that used to feel easy.
• Feeling mentally slower or less sharp.

What’s behind it

Hormone changes. Estrogen influences brain areas involved in memory and attention, and fluctuating levels may affect them during the transition.

Poor sleep. Night sweats, insomnia and sleep apnea all impair concentration and memory the next day.

Hot flashes. Research suggests frequent hot flashes, especially at night, are linked with memory changes. [2]

Mood. Anxiety and depression, which can increase during perimenopause, affect thinking.

Other causes. Thyroid problems, low iron or B12, some medicines, alcohol and stress can all contribute. These are worth ruling out.

What helps

• Treat sleep problems. This is often the most effective step. See our article on sleep apnea.
• Treat bothersome hot flashes. Fewer night sweats can mean better sleep and clearer thinking.
• Exercise regularly. Aerobic activity supports brain health and mood.
• Reduce load. Lists, calendars and doing one thing at a time are not signs of weakness. They work.
• Limit alcohol, which disrupts sleep and memory.
• Address mood. Treatment for anxiety or depression can lift thinking too.

Hormone therapy and the brain

Hormone therapy treats menopause symptoms like hot flashes, which may indirectly improve sleep and focus. But it is not recommended specifically to treat brain fog or to prevent dementia. [1]

When to get checked

Book an appointment if:

• Memory problems are getting steadily worse.
• Others are noticing and worried.
• You’re getting lost in familiar places or struggling with tasks you’ve done for years.
• It’s affecting your work or safety.

Call 911 immediately for sudden confusion, trouble speaking or understanding, drooping on one side of the face, weakness or numbness on one side, sudden vision loss or a sudden severe headache. These can be signs of stroke. [3]

Preparing for your appointment

Note two or three specific examples, when they started, how you’re sleeping, your mood, and all your medicines and supplements. Specific examples help more than "I feel foggy."

Frequently asked questions

Is menopause brain fog a sign of early dementia?

Usually not. It’s common during the transition and typically improves afterwards. Worsening or severe symptoms should be checked.

How long does menopause brain fog last?

It’s most common during perimenopause and early postmenopause and often eases after that.

Will HRT fix brain fog?

It may help indirectly by improving hot flashes and sleep, but it isn’t recommended for brain fog alone. [1]

Next step

A HerScripts clinician can look at sleep, hormones, mood and other causes together to find what’s driving the fog. Learn about brain fog in women.

Sources

[1] Office on Women's Health, Menopause symptoms and relief

[2] NIH, Menopause research overview

[3] CDC, Signs and symptoms of stroke

Educational information, not personal medical advice. Care decisions require an individual clinical evaluation.

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Sleep and wellbeing | 5 min read

Always Tired After a Full Night’s Sleep? Sleep Apnea Could Be Why

Editorial draft — clinical review pending.

Short answer: If you get enough hours in bed but still wake exhausted, obstructive sleep apnea is one possible cause. It’s often missed in women because the symptoms differ from the stereotype of a loudly snoring man. Women are more likely to report fatigue, insomnia, morning headaches and low mood, and risk rises during and after menopause. [1]

Key takeaways

• Sleep apnea causes repeated pauses in breathing during sleep, which break up deep sleep without you noticing. [2]
• In women it often shows up as tiredness, trouble sleeping, headaches and mood changes. [1]
• A sleep study is the only way to diagnose it. Effective treatments exist.

Why it’s missed in women

Women with sleep apnea tend to snore more quietly and may have fewer obvious breathing pauses. Fatigue and insomnia are easily blamed on stress, busy lives or menopause. Lower estrogen and progesterone after menopause may affect the muscles that keep the airway open, which helps explain why risk increases at this stage. [1]

Signs to watch for

• Waking unrefreshed, even after 7 to 8 hours.
• Morning headaches or dry mouth.
• Snoring, gasping or choking during sleep (ask a partner).
• Waking often during the night.
• Daytime sleepiness, especially when sitting still.
• Trouble concentrating, irritability or low mood.
• High blood pressure that’s hard to control. [2]

Risk is higher with excess weight, a larger neck, high blood pressure, type 2 diabetes and a family history of sleep apnea.

Why it matters

Untreated sleep apnea is linked to high blood pressure, heart disease, stroke, type 2 diabetes and accidents caused by drowsiness. Treatment often improves energy, mood and concentration noticeably.

How it’s diagnosed and treated

Diagnosis needs a sleep study, either overnight in a lab or with a home test device. A clinician decides which suits you. [2]

Treatments include:

• CPAP, a machine that keeps the airway open with gentle air pressure.
• Oral appliances fitted by a dentist for mild to moderate cases.
• Weight loss, which can reduce severity. Tirzepatide (Zepbound) is FDA approved for moderate to severe obstructive sleep apnea in adults with obesity. [3]
• Sleeping position changes and avoiding alcohol close to bedtime.

About sleep trackers

Wearables can show patterns such as frequent waking or low oxygen readings, which are worth bringing to an appointment. They can’t diagnose sleep apnea, and a normal score doesn’t rule it out.

Sorting it from menopause symptoms

Night sweats and sleep apnea can both disrupt sleep, and you can have both. If treating hot flashes improves your sleep but you’re still exhausted, ask whether sleep apnea has been considered.

Frequently asked questions

Can you have sleep apnea without snoring?

Yes. Many women with sleep apnea snore quietly or not at all. [1]

Is a home sleep test accurate?

For many people with suspected moderate to severe sleep apnea, home tests work well. A clinician will advise if a lab study is needed.

Does menopause cause sleep apnea?

It doesn’t directly cause it, but risk increases during and after menopause. [1]

Safety note

If you feel drowsy while driving, stop driving and get medical advice soon.

Next step

Describe how your sleep affects your day, and a HerScripts clinician can help work out whether sleep apnea, menopause or something else is behind it. Get help with poor sleep.

Sources

[1] NHLBI, Sleep Apnea and Women

[2] NHLBI, Sleep Apnea Symptoms

[3] Zepbound prescribing information, DailyMed

Educational information, not personal medical advice. Care decisions require an individual clinical evaluation.

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Intimate health | 6 min read

Testosterone for Women: Who It Helps, What the Evidence Says, and the Risks

Editorial draft — clinical review pending.

Short answer: Testosterone has one well-supported use in women: treating hypoactive sexual desire disorder (HSDD), meaning low sexual desire that causes distress, in postmenopausal women after other causes have been looked at. In that group, it modestly improves desire and satisfaction. There isn’t good evidence that it improves energy, mood, memory, weight or bone health in women. [1,2]

Key takeaways

• A global consensus of medical societies concluded HSDD in postmenopausal women is the only evidence-based reason for women to use testosterone. [1]
• In trials, testosterone added on average about one more satisfying sexual event per month compared with placebo, along with improved desire and less distress. [1]
• There is no FDA-approved testosterone product for women in the US, so prescribing is off label. The consensus recommends against compounded testosterone. [1]

What HSDD is

HSDD is persistent low interest in sex that bothers you. Low desire that doesn’t bother you is not a disorder. Diagnosis is based on a clinical conversation, not a blood test. There is no testosterone level that separates women with and without low desire. [1,3]

A good assessment looks at everything that can affect desire:

• Pain during sex or vaginal dryness (often from menopause).
• Medicines, especially some antidepressants.
• Depression, anxiety and stress.
• Relationship issues.
• Poor sleep, fatigue and other health conditions.

Treating one of these may help more than testosterone would. [2]

What testosterone can do

In postmenopausal women with HSDD, testosterone at doses that keep blood levels in the normal premenopausal range improved desire, arousal, orgasm and pleasure, and reduced distress about sex. [1] The effect is real but moderate. It isn’t a dramatic change for most women.

What it can’t do

The consensus found insufficient evidence to use testosterone for any other symptom or condition in women, including cognition, mood, energy and disease prevention. [1] Marketing that promises confidence, fat loss and youthfulness all at once goes beyond the evidence. The Endocrine Society also advises against diagnosing "androgen deficiency" in otherwise healthy women. [3]

Risks and monitoring

At appropriate doses, short-term studies show mainly mild side effects such as acne and increased hair growth. Long-term safety hasn’t been established. [1] Higher doses, which can occur with pellets, injections or compounded products, can cause voice deepening, hair loss and other lasting changes.

If you start testosterone, expect:

• A baseline blood test to check your level isn’t already high.
• A repeat test after a few weeks to make sure levels stay in the female range.
• A review at around 3 to 6 months. If there’s no meaningful benefit by then, stopping is usually advised. [2]

Frequently asked questions

Can testosterone help with fatigue or brain fog?

The evidence doesn’t support it for those symptoms. [1]

Do I need a blood test to qualify?

A blood test doesn’t diagnose HSDD, but it’s used to check your baseline and monitor treatment safely. [2]

Can premenopausal women use testosterone?

There’s not enough evidence to recommend it for premenopausal women. [1]

Next step

Low desire is common, and you deserve a conversation that looks at the whole picture. HerScripts clinicians can help work out what’s driving it and which options fit. Learn about low libido in women.

Sources

[1] Global Consensus Position Statement on the Use of Testosterone Therapy for Women, 2019

[2] ISSWSH clinical practice guideline on systemic testosterone for HSDD

[3] Endocrine Society, Androgen Therapy in Women guideline

Educational information, not personal medical advice. Care decisions require an individual clinical evaluation.

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Intimate health | 6 min read

Vaginal Estrogen vs. Systemic Hormone Therapy: Which One Treats What?

Editorial draft — clinical review pending.

Short answer: They treat different problems. Low-dose vaginal estrogen works locally on the vagina and urinary tract to relieve dryness, irritation, painful sex and some urinary symptoms, with very little reaching the rest of the body. Systemic hormone therapy, taken as a pill, patch, gel or spray, travels through the bloodstream to treat whole-body symptoms such as hot flashes and night sweats. [1]

Key takeaways

• Genitourinary syndrome of menopause (GSM) is the medical name for vaginal and urinary changes caused by low estrogen. It affects many postmenopausal women and usually doesn’t improve without treatment. [1]
• Low-dose vaginal estrogen keeps blood estrogen levels within the normal postmenopausal range, so its risk profile differs from systemic therapy. [1]
• Vaginal estrogen was among the first products to have its boxed warning updated by the FDA in 2026. [3]

What GSM feels like

Common symptoms include:

• Vaginal dryness, burning or itching.
• Pain or discomfort during sex.
• Light bleeding after sex.
• Needing to urinate urgently or often.
• Repeated urinary tract infections.

Unlike hot flashes, which often ease over time, GSM tends to get worse without treatment. [1]

Treatment options, from first steps up

Vaginal moisturizers used a few times a week help with everyday dryness.

Lubricants reduce friction during sex. Water- or silicone-based products are widely used.

Low-dose vaginal estrogen comes as a cream, tablet, insert or ring. It treats the tissue itself and is effective for GSM. [1]

Other prescription options include vaginal DHEA (prasterone) and ospemifene, an oral tablet. [1,2]

Why the route matters

With systemic therapy, estrogen circulates through the body. That is how it relieves hot flashes, and it’s why systemic risks such as blood clots are discussed. A low-dose vaginal product delivers a much smaller amount where it’s needed. Guidelines generally do not require adding a progestogen with low-dose vaginal estrogen, which is usually needed with systemic estrogen for women who have a uterus. [1]

Some women need both: systemic therapy for hot flashes and a vaginal product because systemic therapy doesn’t fully relieve vaginal symptoms.

Special situations

If you’ve had breast cancer or another hormone-sensitive cancer, vaginal estrogen may still be possible, but the decision should involve your oncologist. Nonhormonal options are usually tried first. Say so at the start of your appointment.

When symptoms need an exam

Not every itch or burn is GSM. Infections, skin conditions and other problems can look similar. See a clinician in person if you have unusual discharge, sores, bleeding after menopause that isn’t linked to sex, or symptoms that don’t improve with treatment.

Making the conversation easier

Intimate symptoms can feel awkward to describe. Writing them down beforehand helps. Plain words are fine: "sex hurts," "I feel raw," "I keep getting UTIs." Clinicians hear this every day.

Frequently asked questions

Is vaginal estrogen safe long term?

Guidelines support continued use of low-dose vaginal estrogen as long as it’s needed for most women, with periodic review. [1]

Will vaginal estrogen help my hot flashes?

Usually not. Low-dose vaginal products act locally and aren’t intended to treat hot flashes.

How long does it take to work?

Many women notice improvement within a few weeks, with fuller benefit after a few months of regular use.

Next step

Vaginal discomfort and painful sex are medical problems with effective treatments. A HerScripts clinician can talk through local, systemic and nonhormonal options with you. Get help with vaginal discomfort.

Sources

[1] AUA/SUFU/AUGS guideline on genitourinary syndrome of menopause, 2025

[2] International Consultation on Sexual Medicine GSM recommendations, 2026

[3] FDA news release, February 12 2026

Educational information, not personal medical advice. Care decisions require an individual clinical evaluation.

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Hormones and menopause | 6 min read

Nonhormonal Hot Flash Treatments: Lynkuet, Veozah, and Other Options

Editorial draft — clinical review pending.

Short answer: Yes, there are prescription hot flash treatments that don’t contain hormones. Two newer medicines, Veozah (fezolinetant) and Lynkuet (elinzanetant), work by blocking signals in the brain area that controls body temperature. Older options include low-dose paroxetine. "Nonhormonal" does not mean side-effect free, and each medicine has its own safety checks. [1,2,3]

Key takeaways

• Lynkuet was approved on October 24, 2025, for moderate to severe hot flashes due to menopause. It is taken once daily at bedtime. [1,3]
• Veozah was approved in 2023. The FDA later added a boxed warning about rare but serious liver injury and requires liver blood tests. [2]
• These medicines are an option for women who can’t or don’t want to take hormones, including some with a history of breast cancer or blood clots, but suitability must be checked individually.

How the new medicines work

Hot flashes start in the hypothalamus, the part of the brain that regulates temperature. As estrogen falls, signaling through receptors called neurokinin receptors increases, and the brain’s thermostat becomes oversensitive. Veozah blocks the neurokinin 3 (NK3) receptor. Lynkuet blocks both NK1 and NK3 receptors. [3]

Lynkuet (elinzanetant)

Lynkuet’s approval was based on the OASIS clinical trials. In two 12-week trials of nearly 800 women, it reduced how often and how severely hot flashes occurred compared with placebo. A third trial followed women for up to a year to study safety. [1]

The recommended dose is two 60 mg capsules at bedtime. It can cause drowsiness, so the label advises avoiding driving or other tasks needing alertness until you know how it affects you. It also interacts with some other medicines, which your prescriber and pharmacist should check. [3]

Veozah (fezolinetant)

Veozah was the first NK3 blocker approved. After reports of serious liver injury, the FDA added a boxed warning and requires liver blood tests before starting and at regular intervals in the first months of treatment. Stop it and seek care if you notice yellowing skin or eyes, dark urine, pale stools, itching or pain in the upper right abdomen. [2]

Other nonhormonal options

• Low-dose paroxetine: an antidepressant approved at a low dose for hot flashes. It interacts with some medicines, including tamoxifen.
• Other antidepressants and gabapentin are sometimes used off label.
• Lifestyle measures such as layered clothing, a cool bedroom and avoiding personal triggers can help mild symptoms but rarely resolve severe ones.

Questions to ask before starting

• Which option fits my health history and other medicines?
• What tests do I need before and during treatment, and who orders and reviews them?
• How soon should I expect to notice a difference?
• What side effects should make me call?
• Is hormone therapy an option for me, and how would it compare?

Track your symptoms first

For a week before your appointment, note roughly how many hot flashes you have, whether they wake you, and what they interrupt. This helps set a starting point so you and your clinician can judge whether treatment works.

Frequently asked questions

Is Lynkuet better than hormone therapy?

They work differently and haven’t been compared directly in major trials. Hormone therapy is generally the most effective treatment for hot flashes. Nonhormonal options matter for women who can’t or prefer not to use hormones.

Can I take Lynkuet if I had breast cancer?

This needs an individual review with your clinician and possibly your oncologist. Lynkuet’s label has its own list of conditions and interactions to check.

Do I need blood tests on Veozah?

Yes. Liver tests are required before starting and during treatment. [2]

Next step

HerScripts clinicians can review hormone and nonhormonal options side by side based on your history. Get help with hot flashes and night sweats.

Sources

[1] FDA, Drug Trials Snapshot: Lynkuet

[2] FDA, Veozah liver injury safety communication

[3] Lynkuet prescribing information, DailyMed

Educational information, not personal medical advice. Care decisions require an individual clinical evaluation.

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