Menopause Financial and Insurance Planning: What Every Woman Needs to Know

How long menopause symptoms last

Perimenopause lasts about 4 years on average and can last up to 10 [3]. In the SWAN study (3,302 women enrolled at 7 US sites; 1,449 had frequent hot flashes or night sweats and were analyzed), frequent symptoms lasted a median of 7.4 years overall and a median of 4.5 years after the final menstrual period. Women who first reported frequent symptoms while premenopausal or early perimenopausal had the longest course, a median over 11.8 years [4]. Genital and urinary symptoms can worsen over time without treatment [3].

Which menopause products are FDA-approved

FDA-approved examples include oral Premarin for moderate to severe menopausal vasomotor symptoms and vulvar/vaginal atrophy, Duavee for vasomotor symptoms and osteoporosis prevention in women with a uterus, and Estring for vaginal symptoms [5][6][7]. The Menopause Society's 2022 position statement rates the benefit-risk ratio favorable for women younger than 60 or within 10 years of menopause onset who have bothersome symptoms and no contraindications [11].

Approved non-hormonal options for vasomotor symptoms are paroxetine 7.5 mg (Brisdelle), fezolinetant (Veozah) and elinzanetant (Lynkuet) [8][9][10]. Two non-estrogen drugs are approved for painful intercourse due to menopause: ospemifene (Osphena) and prasterone (Intrarosa) [12][13]. Gabapentin, other SSRIs and SNRIs, and oxybutynin are used for hot flashes but are not FDA-labeled for them [8].

What the labels require during treatment

The Veozah label requires liver blood tests before starting, monthly for the first 3 months, then at months 6 and 9, and the drug carries a boxed warning for liver injury [9][14]. The Lynkuet label requires a baseline liver test and a follow-up at 3 months, with pregnancy excluded before starting because the drug is contraindicated in pregnancy [10].

Compounded bioidentical hormones

FDA says it has no evidence that compounded bioidentical hormones are safe and effective and recommends FDA-approved hormone therapy. There is no FDA-approved estriol drug [1]. ACOG Clinical Consensus No. 6 (2023) says compounded bioidentical menopausal hormone therapy should not be prescribed routinely when FDA-approved formulations exist, and that patients who ask for it should be told it lacks FDA approval [2].

What the 2025 and 2026 labeling changes did

On 10 November 2025 FDA asked makers of menopausal hormone therapy to remove the cardiovascular, breast cancer and probable dementia statements from boxed warnings, while keeping the endometrial cancer box for systemic estrogen-alone products [15][16]. On 12 February 2026 it announced that labeling changes had been approved for six products across four categories, with 29 companies having submitted proposed changes [17]. Many labels still carry the older box, including oral Premarin (effective 4 June 2026) and Prempro (effective 28 April 2026), which still list cardiovascular disorders, breast cancer, endometrial cancer and probable dementia [5][18].

Coverage and cost

Dollar figures for commercial plans, Medicare Part D, HSAs and FSAs are not given here, and FDA labels and clinical guidance do not address them. Coverage is set by the individual plan.