Being a kindergarten teacher requires an extraordinary amount of energy and patience. And for most of her 35-year teaching career, Kirsten Sebold routinely brought both to her classroom. A few years ago, that abruptly changed.
“For many years, I was very patient. Kids could come up to me and ramble about things that didn’t make sense,” Sebold said. But in her early 50s, as menopause symptoms hit, she suddenly grew more irritable at her young charges’ babbling. “I couldn’t take it,” she said.
Sleep disturbances, a hallmark symptom of menopause, likely fueled Sebold’s irritability. She went from a self-described “great sleeper” to being unable to fall asleep at night, or waking up multiple times throughout the evening. A few times, Sebold acknowledges, she called in sick to work because of the overwhelming fatigue.
After about a year of suffering from menopausal symptoms without relief or guidance from her gynecologist, Sebold, now 56, made her way to a health institute where she paid out of pocket for extensive medical testing and, eventually, a prescription for hormone replacement therapy (HRT).
Most traditional gynecologists and primary care physicians have, for more than two decades, steered women away from HRT due to results of landmark research in the early 2000s highlighting its potentially harmful risks, including increased threat of cancer. Subsequently, the Food and Drug Administration applied “black box” labels on HRT packaging, warning users of potential serious health risks associated with HRT. But these warnings are about to disappear.
This week, the U.S. Department of Health and Human Services announced that the FDA is removing these warnings from HRT products for menopause. Recent reanalysis of the original data on HRT, plus new studies, led researchers to conclude that, for many women, HRT has beneficial effects on menopausal symptoms as well as overall health benefits.
“In practical terms, this change means doctors can discuss HRT with patients without an automatic black mark in the fine print. It’s a powerful signal: Hormone therapy is safe for most healthy women close to menopause, and the old warnings have been based on distorted risk perceptions,” said Dr. Marie Nakhoul, an OB-GYN at the University of Maryland Medical Center and assistant professor at the University of Maryland School of Medicine.
This news will matter to hundreds of thousands of K-12 teachers and administrators. An estimated 77% of K-12 public school teachers, and nearly 90% of all elementary school teachers, are women. Further, women in their 40s and 50s make up 51% of all K-12 teachers, according to Pew Research Center data. More than half of principals are also women, and the average age of a school principal is 49, federal data show.
Most women begin the transition toward menopause in their mid-40s. During this period, known as perimenopause, which can last a decade or longer, many women experience one or more symptoms, which may include, but aren’t limited to, night sweats, sleep disturbances, mood changes such as irritability and anxiety, and brain fog. The symptoms can significantly impact work productivity. But historically, most women have suffered in silence.
Little support in schools for women going through menopause
Sebold describes teaching during menopause as fairly isolating. She found little support or acknowledgement among her male administrator or her coworkers, most of whom she said were much younger than she was.
“I never brought it up or tried to fight for any [benefits or supports],” she said.
It’s not an easy topic to broach, educators say.
“The aging process itself is very hard for some people, and so this idea of you sharing this information with your colleagues and your supervisor is kind of an awkward situation,” Nicole Carter, the principal of Novi High School in Novi, Mich., told Education Week in 2023. “The fact that you are having hot flashes, the fact that you may be gaining weight as a result of something. ... I don’t think it’s necessarily one of those topics that people feel comfortable talking about.”
Nor is menopause an issue that many workplaces proactively address.
Only 5% of U.S. employers offer menopause-specific benefits, according to a 2024 survey by NFP, a global benefits consultant and property and casualty insurance broker.
But even the perception that an employer is offering support can help ease symptoms, according to a 2025 study of 284 elementary and junior high teachers in Japan. Researchers in that study concluded that 94% of menopausal respondents cited “feeling tired or lacking in energy,” and the intensity of these and other symptoms correlated with job stress. Teachers who reported more severe menopausal symptoms also noted higher job-related stress and lower levels of support from supervisors or co-workers.
Changes to hormone replacement therapy warnings may lead to more open support
The pending removal of the black box warning labels from HRT may be an impetus for health care providers, and maybe even employers, to offer support more freely to menopausal women in the workplace.
“The ‘fear machine’ that began in 2002 has been dismantled,” Nakhoul said. “As FDA leaders put it, after 23 years of dogma they wanted to return to evidence-based medicine—and give women ‘control over their health again.’”
Seeing the positive impact that HRT can have on menopausal symptoms when taken under the supervision of a health provider could embolden more women to inquire about it. Sebold, for one, hopes so.
“I have friends who are fighting through all this miserableness,” she said.
For her part, Sebold happily reports that she is no longer suffering from debilitating symptoms of menopause, and says she now has more energy than her much younger co-workers.
While HRT can effectively alleviate symptoms in many menopausal women, it’s not the only management solution available. Nor is it right for everyone. Dr. Marie Nakhoul, an OB-GYN at the University of Maryland Medical Center, advises patients to take a holistic approach to managing menopause that includes the following:
- Educate yourself with up-to-date information. The new FDA decision comes from large reviews of data and expert panels. Talk with your doctor about modern evidence rather than relying on old headlines.
- Discuss your personal health profile with your doctor. Book a thorough check-up with your health care provider that includes a review of heart and stroke risk, family cancer history, bone density, etc. The key is an honest, individualized risk-benefit conversation with a trusted provider.
- Consider all your medication options. Not all HRT management is the same. Low-dose or local hormone therapy differs from systemic HRT. Ask your doctor about non-hormonal medications, too.
- Consider lifestyle support. Symptom relief is not just medications. Practice stress-reduction and mind-body techniques. Studies show that yoga, tai chi, meditation, and relaxation practices can ease hot flashes and mood swings. Gentle exercise (even brisk walking or dancing) and strength training help your bones and overall well-being. Maintain a balanced diet with plenty of calcium and vitamin D (for bone health) and stay hydrated. Routines like keeping cool at night, dressing in layers, and avoiding triggers (spicy food, caffeine) can help manage nighttime hot flashes. Cognitive-behavioral therapy or support groups can help with anxiety and sleep issues. Acupuncture and hypnotherapy have shown emerging evidence for symptom control.
- Build a support network. Consider joining a menopause support group or online forum. Talking with other women, friends, or colleagues who are going through the same thing can be incredibly validating.
- Take a holistic, patient-centered approach. Combine what feels right for you (medications, self-care, therapies) under the guidance of a knowledgeable provider.
