Weight care | 5 min read

Does Tirzepatide Affect Birth Control Pills? What the Zepbound Label Says

Editorial draft — clinical review pending.

Short answer: Yes, it can. Tirzepatide slows stomach emptying, which may reduce how well oral contraceptives are absorbed. Zepbound’s label advises people using birth control pills to switch to a non-oral method, or add a barrier method such as condoms, for 4 weeks after starting and for 4 weeks after each dose increase. [1]

Key takeaways

• The warning applies to oral hormonal contraceptives: the combined pill and progestin-only pill.
• It does not apply to IUDs, implants, injections, patches or vaginal rings, which do not depend on stomach absorption.
• The extra protection is needed at the start and after every dose increase, not just once. [1]

Why it happens

Tirzepatide slows how quickly food and medicines move from the stomach into the intestine. That effect is strongest when treatment begins and right after each step up in dose. During those windows, hormone levels from a pill may be lower than expected, so the pill may not prevent pregnancy as reliably. [1]

Tirzepatide is also sold as Mounjaro for type 2 diabetes. Ask your pharmacist about the label for whichever product you’re prescribed. This specific advice should not be assumed to apply to every weight-loss medicine.

What a typical schedule looks like

Standard tirzepatide dosing increases every 4 weeks or more. If you follow that schedule and use the pill, you could need backup contraception for most of the first several months. For many people, that is a good reason to consider a long-acting method instead.

Ask your prescriber:

• When exactly does each backup window start and end?
• If my dose is held at the same level, do I still need backup?
• Would an IUD, implant, ring or patch suit me better?

Why pregnancy planning matters on GLP-1s

GLP-1 medicines are not recommended during pregnancy, and weight loss itself can improve fertility. Some women find they ovulate more regularly as they lose weight. Contraception is worth taking seriously even if you’ve had trouble conceiving before. If you’re planning a pregnancy, tell your prescriber early, because some labels advise stopping weeks before trying.

If you’re in perimenopause

Irregular periods do not mean pregnancy is impossible. The Menopause Society advises continuing contraception until menopause is confirmed. [2] The tirzepatide precaution still applies if your contraceptive is a pill.

Practical tips

• Write the dates of each dose increase and the 4-week backup window on your calendar.
• Keep condoms on hand before you start.
• If you vomit within a few hours of taking a pill, follow your pill’s missed-dose instructions.
• Take a pregnancy test and contact your prescriber if you miss a period or think you might be pregnant.

Frequently asked questions

Does semaglutide affect birth control?

Semaglutide’s label does not carry the same specific advice. Ask your clinician about the medicine you’re prescribed.

Do I need backup if I have an IUD?

No. IUDs and implants are not affected by stomach emptying.

How long do I need backup after a dose increase?

Four weeks after each increase, according to the Zepbound label. [1]

Next step

Mention your contraception at the start of a HerScripts weight care assessment so it’s built into your plan from day one. Start weight care.

Sources

[1] Zepbound prescribing information, DailyMed

[2] The Menopause Society, Perimenopause

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

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Hormones and menopause | 5 min read

Do You Still Need Birth Control in Perimenopause?

Editorial draft — clinical review pending.

Short answer: Yes, if you don’t want to get pregnant. Ovulation becomes less predictable during perimenopause, but it doesn’t stop until menopause. Menopause is confirmed after 12 months in a row without a period, and contraception is recommended until then. Menopause hormone therapy is not a form of birth control. [1]

Key takeaways

• Irregular or skipped periods do not mean you can’t get pregnant.
• Hormone therapy for hot flashes does not prevent pregnancy. [1]
• Some contraceptives also help perimenopause symptoms such as heavy or irregular bleeding.

Why pregnancy is still possible

During perimenopause, some cycles release an egg and some don’t. You can go months without a period and then ovulate. Unplanned pregnancy rates in women in their forties are higher than many people expect, partly because people stop contraception too early.

Hormonal contraception can also hide the signs of menopause. If you use the pill, a hormonal IUD or an implant, your periods may be light or absent regardless, so you can’t count 12 months the usual way. Your clinician can advise when it’s reasonable to stop based on your age and method.

Choosing a method in your forties

There is no single best method. CDC’s Medical Eligibility Criteria rate each method’s safety based on health factors such as smoking, migraine with aura, high blood pressure, blood clots and heart disease. Age alone doesn’t rule out most methods, but those factors become more common in midlife. [2]

Common options and what they may offer:

• Hormonal IUD: very effective, often makes periods lighter, and can provide the progestogen part of hormone therapy if you later start estrogen.
• Copper IUD: hormone free and lasts for years. It may make heavy periods heavier.
• Implant: very effective, but bleeding can be unpredictable.
• Combined pill, patch or ring: may regulate cycles and ease hot flashes, but not suitable for smokers over 35 or people with certain risks. [2]
• Progestin-only pill: an option when estrogen isn’t suitable.
• Barrier methods and sterilization remain options.

Contraception and symptom treatment together

Many women want both: protection from pregnancy and relief from hot flashes or heavy bleeding. Sometimes one plan handles both, such as a hormonal IUD plus low-dose estrogen. Sometimes they need separate treatments. Ask your clinician to name what each part of your plan is for.

What to bring to an appointment

• Your current contraceptive and how you use it.
• Your bleeding pattern over the past 6 to 12 months.
• Your symptoms and which ones bother you most.
• Health history, including smoking, migraines, blood pressure and blood clots.

Frequently asked questions

At what age can I stop birth control?

It depends on your age, method and periods. Many clinicians use 12 months without a period as the guide, with adjustments for hormonal methods. Ask yours.

Does HRT prevent pregnancy?

No. Hormone therapy for menopause symptoms uses lower doses and is not a contraceptive. [1]

Can a home test tell me I’m done?

No. Home FSH tests cannot confirm menopause or tell you when to stop contraception. See our article on home hormone tests.

Next step

Bring both questions, symptoms and contraception, to one HerScripts conversation. Learn about changing periods.

Sources

[1] The Menopause Society, Perimenopause

[2] CDC, U.S. Medical Eligibility Criteria for Contraceptive Use, 2024

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

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Hormones and menopause | 5 min read

Can a Home Test Tell You If You’re in Perimenopause?

Editorial draft — clinical review pending.

Short answer: Not reliably. Home menopause tests measure follicle-stimulating hormone (FSH) in urine. A positive result means FSH is high on that day, but FSH rises and falls a lot during perimenopause, so a single result can’t confirm or rule it out. Doctors usually diagnose perimenopause from your age, symptoms and period changes, not a hormone test. [1,2]

Key takeaways

• Home tests show whether FSH is raised at one moment. They do not diagnose perimenopause or menopause. [1]
• Never use a home test to decide whether to stop contraception. [1]
• Blood hormone tests are also usually unnecessary for typical perimenopause, but can help in specific situations, such as symptoms before age 45. [2]

How the tests work

FSH signals the ovaries to develop eggs. As the ovaries respond less, FSH tends to rise. Home kits detect FSH in urine above a set level. The FDA notes that the tests can suggest you may be in menopause, but cannot tell you for certain, and that hormonal birth control and some other medicines can affect results. [1]

The problem is timing. In perimenopause, FSH can be high one week and normal the next. One test, or even a few, gives a snapshot of a moving target.

When testing is useful

ACOG says hormone testing is generally not needed to diagnose perimenopause in women over 45 with typical symptoms. Testing can help when: [2]

• You’re under 45 and your periods have changed or stopped.
• Early or premature menopause is a concern.
• Symptoms could have another cause, such as a thyroid problem, which needs its own tests.

Signs that point to perimenopause

• Periods that become irregular, often closer together at first and then further apart.
• Hot flashes or night sweats.
• Disrupted sleep.
• Mood changes, irritability or anxiety.
• Vaginal dryness.
• Brain fog or trouble concentrating.

A timeline of these changes usually tells a clinician more than a test strip.

What to bring to an appointment

• When your periods started changing and how.
• Which symptoms you have and how they affect your day.
• Any medicines, supplements and contraception.
• Any home test results, with the brand and dates, not just a screenshot.

Be careful with large hormone panels

Some online services sell broad hormone panels with dozens of markers. More numbers do not mean clearer answers, and abnormal-looking results can lead to unnecessary worry or treatment. Ask what each test will help decide before paying for it.

Frequently asked questions

Are home menopause tests accurate?

They detect FSH accurately, but a single FSH result doesn’t reliably show where you are in the transition. [1]

Should I get my hormones checked?

Usually not if you’re over 45 with typical symptoms. Testing can help if you’re younger or the picture is unclear. [2]

Can a negative test mean I’m not in perimenopause?

No. FSH can be normal on the day you test even if you are in perimenopause.

Next step

Your symptoms are reason enough to get help, with or without a test result. A HerScripts clinician can review your history and decide whether any testing would change your care. Explore hormone care.

Sources

[1] FDA, Menopause home-use tests

[2] ACOG, Do I need testing of my hormone levels during perimenopause?

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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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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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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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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Hormones and menopause | 6 min read

What the FDA’s 2026 Menopause Hormone Therapy Label Changes Mean for You

Editorial draft — clinical review pending.

Short answer: On February 12, 2026, the FDA approved new labels for six menopausal hormone therapy products that removed statements about cardiovascular disease, breast cancer and probable dementia from the boxed warning, the most prominent warning a medicine can carry. The medicines did not become risk free. The change means the most alarming summary on the label now better reflects who was actually studied and when they started treatment. [1]

Key takeaways

• Six products across all four hormone therapy categories got updated labels first, including vaginal estrogen. Others are still in review. [1]
• Risks are still described in the full prescribing information. They are no longer presented as a blanket warning for every woman.
• Age and timing matter. The FDA pointed to evidence that starting within 10 years of menopause, usually before 60, carries a different balance of benefit and risk than starting later. [1]

Why the warning existed in the first place

The boxed warning dates back to the Women’s Health Initiative, a large study published in 2002 that linked combined hormone therapy to higher rates of heart disease, stroke and breast cancer. Prescriptions dropped sharply afterward. The trouble was that many participants were in their sixties and seventies and had started hormones years after menopause. That is a very different group from a 51-year-old woman with disruptive hot flashes.

The FDA started the review in November 2025 and asked manufacturers to submit revised labels. Twenty-nine companies did. The six products approved in February are the first batch, not the full list. [1]

What changed, and what stayed

For most of the updated products, the boxed warning was removed. For systemic estrogen-alone products, a boxed warning about endometrial cancer remains, because unopposed estrogen raises that risk in women who still have a uterus. [3]

Everything else in the label still applies. Blood clots, stroke, gallbladder disease and other risks are still listed in the warnings and precautions sections. The FDA keeps a page listing which products currently have updated labeling, so you can check the exact product you use or are considering. [2]

What it means if you are considering hormone therapy

If you ruled out hormones years ago because of a headline, it is reasonable to revisit the question. The FDA has approved hormone therapies for moderate to severe hot flashes, vaginal dryness and discomfort, and prevention of bone loss. [1] Those are the conditions to discuss, not general anti-aging.

The most useful details to bring to an appointment are your age, how long ago your periods stopped or changed, which symptoms bother you most, and any personal or family history of breast cancer, blood clots, stroke, heart disease or liver disease. Those facts shape whether hormones make sense and which route is better. A patch, gel, pill or vaginal product each has a different profile.

What it means if you already take it

You do not need to change anything because of the label update. Check whether your product is on the FDA’s updated list, and read the new patient information if it is. If you were told to stop at a certain age or after a fixed number of years, ask whether that still applies to you. Current guidance focuses on regular review rather than a single cutoff.

Frequently asked questions

Does this mean hormone therapy is safe for everyone?

No. It means the boxed warning no longer applies one summary of risk to every woman. Individual risk still depends on age, timing, health history and the type of product.

Was vaginal estrogen included?

Yes. Topical vaginal estrogen was one of the four categories in the first group of approved changes. [1]

Will my pharmacy leaflet change?

Over time, yes. Updated labels roll out product by product, so your leaflet may still show the old wording for a while.

Next step

If hot flashes, night sweats, sleep disruption or vaginal symptoms are affecting your life, a HerScripts clinician can review your history and talk through whether hormone therapy, a nonhormonal option or no medication fits you best. Start with hormone care.

Sources

[1] FDA news release, February 12 2026

[2] FDA list of products with updated prescribing information

[3] Public Citizen Health Letter, March 2026

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

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Weight care | 6 min read

Compounded GLP-1s vs. FDA-Approved Semaglutide and Tirzepatide: What’s the Difference?

Editorial draft — clinical review pending.

Short answer: A compounded GLP-1 is a preparation made by a pharmacy for an individual patient. It is not FDA approved, and the FDA does not review it for safety, effectiveness or quality before it is dispensed. An FDA-approved brand or generic has gone through that review. Both can be prescribed, but they are not interchangeable, and you should know which one you are receiving. [1]

Key takeaways

• "Compounded" and "generic" are different legal categories. A generic must show it matches the approved drug; a compounded preparation does not. [1]
• The FDA has documented dosing errors and counterfeit or mislabeled GLP-1 products, mostly from outside licensed pharmacies. [2]
• The right question is not only the price. It is what the product is, who made it, and what support comes with it.

Three categories, three pathways

FDA-approved brands such as Wegovy (semaglutide) and Zepbound (tirzepatide) were tested in large clinical trials, and the FDA reviewed their manufacturing.

FDA-approved generics must show they contain the same active ingredient in the same strength and dosage form and work the same way as the brand.

Compounded preparations are made by state-licensed pharmacies or registered outsourcing facilities. Compounding has a legitimate role, for example when a patient needs a formulation the approved product does not offer. But the finished product is not FDA approved, and calling it a generic is inaccurate. [1]

Why this matters for GLP-1s specifically

Demand for semaglutide and tirzepatide outpaced supply in 2022 to 2024, and compounding expanded quickly. The FDA has since declared both shortages resolved, which narrows when copies of approved drugs can legally be compounded. [2]

The FDA has also received reports of patients hospitalized after measuring the wrong dose from multidose vials, of products with incorrect labels, and of counterfeit products sold online. Many of these issues came from sellers operating outside legitimate pharmacies. [2]

None of this means every compounded prescription is unsafe. It means the source and the instructions matter more than they do with a prefilled brand-name pen.

Questions to ask any provider

• Is this an FDA-approved product or a compounded preparation?
• Which pharmacy makes and dispenses it, and is it state licensed or an FDA-registered outsourcing facility?
• Does it contain anything besides the active ingredient, such as added vitamins? If so, what evidence supports that combination?
• Is it a prefilled pen or a vial I draw up myself? Who will show me how to measure the dose?
• What does the monthly price include: clinician visits, medication, supplies, shipping and follow-up?

A trustworthy service will answer each of these in writing without hesitation.

Safe-use basics

Never convert a dose from one product to another yourself. Milligrams on a brand pen and units on a syringe are not the same measurement. Do not use a friend’s dosing chart. If a package, label or concentration looks different from your last shipment, call the pharmacy before injecting.

Frequently asked questions

Is compounded semaglutide the same as Wegovy?

It contains the same named active ingredient, but it is a different product that has not been FDA approved or tested in the same trials.

Is compounding legal?

Yes, under specific federal and state rules. Those rules limit when copies of commercially available approved drugs can be made. [1]

How do I know if a pharmacy is legitimate?

Ask for its name and license, then check it with your state board of pharmacy. Be cautious of sites that sell without a prescription.

Next step

HerScripts clinicians explain exactly which product is being prescribed, where it comes from, and how to use it. See how weight care works.

Sources

[1] FDA, Compounding and the FDA: Questions and Answers

[2] FDA, Concerns with unapproved GLP-1 drugs used for weight loss

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

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Weight care | 6 min read

GLP-1 Microdosing: What It Is, What the Evidence Shows, and What to Ask

Editorial draft — clinical review pending.

Short answer: "Microdosing" a GLP-1 usually means taking a semaglutide or tirzepatide dose below the standard starting dose, often for general wellness or gentle weight loss. It is not a defined, studied regimen. No large clinical trial has tested it, and the term means different things to different sellers. Some clinicians do prescribe lower doses for individual reasons, but that should be an explained decision, not a marketing promise.

Key takeaways

• Approved GLP-1 medicines have a set starting dose and a planned increase. Microdosing is a departure from that label. [1]
• Very small doses are often measured from multidose vials, where the FDA has documented serious dosing errors. [2]
• Benefits promised for microdosing, such as less inflammation, longevity or better mood, have not been established for these doses.

How standard dosing works

Take tirzepatide as an example. Zepbound’s label starts at 2.5 mg once weekly for four weeks. That first dose is meant to help the body adjust, not to cause weight loss. The dose then increases in 2.5 mg steps, at least four weeks apart, to a maintenance dose of 5, 10 or 15 mg. [1] Semaglutide for weight management follows a similar stepwise plan.

That structure exists because higher doses cause more gastrointestinal side effects if introduced too quickly. A clinician may slow the increases or stay at a lower dose if someone is responding well or struggling with side effects. That is ordinary clinical judgment. It is different from a program built around staying below the starting dose indefinitely.

Why the evidence gap matters

Clinical trials measured weight loss, side effects and safety at specific doses. Results at those doses cannot be assumed to apply to a much smaller amount. A smaller dose may produce fewer side effects, but it may also produce less benefit, and nobody has carefully measured the trade-off.

Ask any provider offering microdosing: what outcome are we aiming for, how will we measure it, and what evidence supports this dose for that goal?

The measuring problem

Microdoses are often drawn from compounded multidose vials. The FDA has reported patients receiving five to twenty times the intended amount because of confusion between milligrams, milliliters and syringe units. Some were hospitalized with severe nausea, vomiting, dehydration or low blood sugar. [2]

If you are using a vial:

• Ask for the concentration in writing (milligrams per milliliter).
• Ask for your dose in both milligrams and syringe units.
• Use the syringe the pharmacy supplies, not one from another source.
• Call the pharmacy if anything does not match your last prescription.

Red flags in an offer

Be cautious when a program promises broad benefits without a medical reason, skips a health history review, offers no follow-up, or uses the same plan for every customer. A responsible offer explains its limits as clearly as its benefits.

Frequently asked questions

Is GLP-1 microdosing safe?

It has not been studied as a defined regimen, so its safety and benefit at very low doses are unknown. Dosing errors from vials are a documented risk. [2]

Can a clinician prescribe a lower dose?

Yes. Clinicians can adjust doses for individual reasons. They should tell you if a plan is off label and why they recommend it.

Will microdosing help me lose weight?

There is no reliable trial evidence on how much weight people lose at doses below the label’s starting dose.

Next step

If you want a gentler start because of side effects or health concerns, raise it during your assessment. A HerScripts clinician can explain the standard plan and whether adjusting it makes sense for you. Learn about weight care.

Sources

[1] Zepbound prescribing information, DailyMed

[2] FDA alert on dosing errors with compounded semaglutide

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

Explore related care