For many women, menopause is not a single moment but a long stretch of confusion, mixed messages and symptoms that do not quite add up. They know something has changed but cannot get a clear answer or a plan that truly works.
According to physician and author Dr. Angela DeRosa (known as Dr. Hot Flash), a hormone health specialist, the issue is not a lack of treatment options but a lack of structure, education and consistency in how menopause care is delivered.
During part two of NewBeauty’s HRT Playbook webinar series, sponsored by Belmar Pharma Solutions, Dr. DeRosa explained why so many women feel dismissed by the system and what meaningful hormone replacement therapy should actually look like.
Most women never receive a complete hormone evaluation
One of the biggest gaps in menopause care is testing. Dr. DeRosa emphasized that many women are told their labs are normal without ever receiving a full picture. “Women are often told everything looks fine because one number falls into a reference range,” she said. “That does not mean hormones are optimal, and it does not explain why a woman feels exhausted, disconnected or unlike herself.”
She explained that reference ranges are broad and designed to capture population averages rather than what allows an individual woman to function well. Without comprehensive testing and interpretation, symptoms are often dismissed or treated in isolation.
Menopause care varies dramatically depending on who you see
Another issue Dr. DeRosa highlighted is inconsistency across providers. Many women bounce between OB-GYNs, primary care physicians and wellness clinics, each offering different advice. “If patients hear one thing from one provider and the complete opposite from another, they lose confidence in the entire process,” she said. “That inconsistency is one of the reasons women stop treatment or never start at all.”
She noted that hormone therapy requires specific training that is not uniformly taught in medical education, which leads to wide variation in how care is delivered.
Good HRT is a process, not a prescription
A common misconception is that hormone therapy is as simple as receiving a prescription. Dr. DeRosa made it clear that optimal menopause care involves ongoing assessment. “Hormone therapy is not a one-time decision,” she said. “It requires follow up, monitoring, dose adjustments and listening to how the patient actually feels.” She stressed that managing menopause well means treating symptoms and lab values together rather than relying on one without the other.
Problems arise from inconsistency, not hormones themselves
Fear around hormone therapy often stems from outdated information or poorly managed treatment. Dr. DeRosa emphasized that hormones are not the problem. “When hormone therapy is done correctly, patients typically experience very few issues,” she said. “Problems arise when providers are not trained, protocols are inconsistent or patients are not followed closely.”
The goal of menopause care is stability and function
Dr. DeRosa repeatedly returned to one core message. Menopause care is not about reversing age or chasing perfection. “The goal is not to turn back time,” she said. “The goal is for women to feel stable, clear and functional again, so menopause does not disrupt their quality of life.”
She explained that when hormone therapy is done thoughtfully, women often report better sleep, improved focus, steadier mood and a stronger sense of self.
What women should expect from proper menopause care
Dr. DeRosa believes women should feel empowered to ask questions and set expectations before starting HRT. Proper care should include thorough testing, clear explanations, ongoing follow up and a provider who treats symptoms seriously. “If a woman feels rushed or unheard, that is not good hormone care,” she said. “Menopause is complex, and women deserve providers who respect that.”
The takeaway
Menopause should not feel like a guessing game or a series of dead ends. With the right education and structured protocols, hormone therapy is designed to address each woman’s unique needs. As Dr. DeRosa made clear, the real issue is not whether menopause care exists. It is whether women are receiving care that is informed, consistent and designed to help them feel like themselves again.
Read the BHRT Playbook for a deeper breakdown of hormone testing, treatment protocols and what comprehensive menopause care should include.
