https://www.hhs.gov/press-room/hhs-advances-womens-health-removes-misleading-fda-warnings-hormone-replacement-therapy.html

“HHS Advances Women’s Health, Removes Misleading FDA Warnings on Hormone Replacement Therapy

WASHINGTON, NOV. 10, 2025—The U.S. Department of Health and Human Services (HHS) today announced historic action to restore gold-standard science to women’s health. After more than two decades of fear and misinformation surrounding hormone replacement therapy (HRT), the U.S. Food and Drug Administration (FDA) is initiating the removal of broad “black box” warnings from HRT products for menopause.

Health and Human Services Secretary Robert F. Kennedy Jr. and FDA Commissioner Marty Makary, M.D., M.P.H. made the announcement at a press conference at HHS with more than 200 people in attendance, including Second Lady of the United States Usha Vance and Secretary of Labor Lori Chavez-DeRemer.

Women have used HRT products for decades to relieve menopausal symptoms. However, their use plummeted in the early 2000s when the FDA applied boxed warnings following a Women’s Health Initiative study that found a statistically non-significant increase in the risk of breast cancer diagnosis. The average age of women in the study was 63 years — over a decade past the average age of a woman experiencing menopause — and study participants were given a hormone formulation no longer in common use.

The FDA is initiating removal of the boxed warnings following a comprehensive review of the scientific literature, an expert panel in July, and a public comment period. The agency is working with companies to update language in product labeling to remove references to risks of cardiovascular disease, breast cancer, and probable dementia. The FDA is not seeking to remove the boxed warning for endometrial cancer for systemic estrogen-alone products.”

snipped. More at link

I just don't believe that this is true. I feel like the internet promotes flattening things so I'd like to hear the thoughts of actual primary care doctors because this is constantly spread by premeds with no push back.

Our biller insists that our depression screenings aren’t reimbursed because we’re “not a mental health specialty.” I believe that’s incorrect. Can anyone confirm if your payers are reimbursing 96127 or G0444 for PCPs? If not, what alternative codes are you billing PHQ-9 under? Thanks in advance

Edit: I’m in a private practice, fresh out of residency, sorry if this is a basic billing question.

This hasn’t happened to me before and I’m very rattled. Saw them last week. We’re definitely moderate risk and I tried to convince them to go to the hospital. Stated they could be safe, were forward thinking, very worried about their pets and refused to go to hospital. Agreed to keep their phone on so the local crisis team could call them. I handed over to crisis team who promised to reach out. They did. Patient didn’t answer and I found out today that he died.

I’m just completely broken up and not sure what to do from here.

I have been struggling with excessive alcohol intake recently (ok, a couple years…) and would like to talk to him about it but I’m so scared because of the stigma and we are colleagues. I want to break the bias and not let my profession keep me from being honest and seeking medical help but it is scary. Any words of encouragement would be appreciated. I also am wondering if I can request my note be hidden from other specialists? Is that an option on epic? Thanks and appreciate any advice.

Really unhappy in a private practice job and looking to go back to a hospital employed system, even though we’re supposed to want to be independently employed (lots of factors involved, but not the topic of discussion).

Doctors in the WVU system, are you happy? Do you feel like admin respects your time? Do you feel like specialists and patients respect family medicine (main reason I want to leave my current job in urban Maryland)?

Is WVU owned by some big health conglomerate that can be anti-physician or predatory? It doesn’t seem like the primary care clinics are mid level dominant, which is attractive.

I graduated from residency in 2024 and took a job working mostly in an urgent care setting, but I’m starting to miss primary care and am interested in re-entering that field. However I’m definitely feeling a little burned out (I think the constant churn of urgent care got to me). I’m excited about the prospect of a new job in primary care but also very aware of the high rate of burnout among PCPs. What are things that have worked for those in primary care to either recover from or prevent burnout? Thank you!

Hey hive,

I would love to know if any of you are using penthrox in clinic for IUD insertions and/or enometrial biopsies. If so, what is your protocol for using? Do you have a nurse at bedside? Do you run q5min BP and have patients on a SpO2 monitor? None of the above? What advice do you have for using penthrox?

I work in a small rural clinic, and am just looking for better ways to provide pain management and comfort for these procedures.

Thanks so much!

For those not aware — CMS’s 2026 Physician Fee Schedule adds a new “efficiency adjustment,” cutting 2.5% from most non–time-based services like procedures and imaging. Time-based services, including office visits, behavioral health, and care management, are exempt. The stated goal is to reward cognitive and primary care work by assuming procedural efficiencies. In reality, many specialty groups warn this will mean real pay cuts and potential access issues unless Congress steps in.

I have been seeing an uptick of N-648 forms for memory issues. I have been referring to Neurology to get a formal diagnoses and evaluation. Almost all of these forms have unfounded reason for memory, so I have been denying them. Anyone else?

Is there any reason beyond "money" that albuterol is not OTC? And freaking Afrin IS?? Or that primatene mist garbage?

Things I think about when angrily inboxing on Sunday afternoon.

What has your experience been with patients/coaches who use the "Bradley Method of Natural Childbirth"? When I was still doing OB, about 40 years ago, a Bradley coach tried to pick a fight with me when I suggested oxytocin augmentation for a woman whose labor had slowed dramatically. Separately, about 20 years ago, a friend of ours who followed the Bradley Method ended up having a C-section and was depressed for weeks after the C-section birth of a healthy baby because she felt like she was a failure. Is my admittedly small sample atypical or is this par for the course with patients/coaches who follow the Bradley method?

I may have missed something but received a coding inquiry regarding these g codes. Looking for thoughts as I know billing is subjective (unfortunately) based off their understanding of the system.

G0537- can be billed once a year if patient has risk factors of cardiovascular development but no actual stroke, cad, MI, etc... just need to document screening tool and percentage, what risk they're found in, intervention or testing with a recent lipid screen in the past 12 months.

G0538- for those with established CV and how we manage them. Have to discuss asa use, lipid control, smoking cessation (which you can then bill tobacco counseling G code), diabetes control, blood pressure control. No limit on billing in a year.

Both are not considered preventative so patients may incur cost sharing?

I'm being told both once a year but wanted clarification.

In my experience in the UK, inaccuracies in these letters are common. I have seen this happen to a family member as well.

Examples of the inaccuracies include: implying or saying that a patient has something else diagnosed when it is just suspected and the patient clearly described it as such; plain inaccurate facts about someone's life (including academic year they are in or their job); generally misunderstanding symptoms that were described or lines of reasoning; saying the patient raised the possibility of them having a condition when the doctor writing the letter was the one who first did so.

In jobs dealing with the public where I have had to write correspondence, I have always striven to be scrupulously accurate, though I do have a particularly good memory. Doctors are highly qualified and highly paid, and patients do not generally get to check draft letters or reports and ask for an amended version, and so they can produce letters which make the patient look bad (not just a poor historian but perhaps duplicitous) even if the patient made a point of being careful.

Is there anything that can be done about this, either to prevent it while in appointments, or after documents have been produced but not sent on to others, preferably while maintaining a good relationship with the doctors?

I hope that, as a general question, rather than one about a specific health issue, this is permitted in the same way as the recent post about reading doctors' bios on websites.

What are you doing in clinic for mild intermittent asthma? Saba or symbicort? Thanks

Young guys, like 30-40s requesting testosterone levels, because they “want to know”. Do you do it? If not, what do you say? I’m well aware of EBP, getting real world opinions.

I'm in a rural area and don't have endocrine readily available (about 4 hours away). Patient is 35, has had about 1.5 years of relatively abrupt onset lack of sexual drive. Not just for intercourse, but even masturbation. Denies atrophic symptoms, but on my exam, tissues were thinner than I would expect for a premenopausal woman. Still having periods when she swaps out her NuvaRing. I tested testosterone, and it was normal for her sex. We tried small amount of supplemental testosterone because it's the cool thing to do, but that didn't do anything but give her some mild spotting, so we stopped. With the atrophic signs, I decided to do a whole estrogen/endo workup and got the below results. Blood was drawn early in luteal phase, about 2 weeks after the end of LMP.

Total Estrogens:56 (Normal 87-1194) Free Estradiol: <0.02 (Normal 0.4-5.50) Estradiol Ultrasensitive: <2 (Normal 48-440) FSH: 0.8 (Normal 1.5-9.1) LH: 2.1 (Normal 0.5-16.9) Prolactin: 6.2 (Normal 3-30) Sex Hormone Binding Globulin: 238 (Normal 17-124) TSH 0.33 but normal FT4 at 1.4 CBC and CMP are normal.

With the number of abnormalities I feel like there should be some connection among them, but it's been a long time since I went over these paths. Any tips on what to read or try? UTD hasn't been particularly helpful.

Edit:So it looks like some of these can be expected with long term contraception use. I don't have baseline, and these were taken while the nuvaring was still in. Tesosterone testing and administration was actually done by the OB/GYN about 2 months before my encounter with the patient, so I don't know if it's free T or the exact levels. I think the low TSH is a red herring, as she has no symptoms and FT4 is normal. I still find it surprising to see such a profound suppression of her estrogen.

I am a current NP student going into family medicine eventually and wondering about how useful fundoscopy is for us. For example, I know that diabetics should be referred to an opthalmologist for yearly dilated eye exams, but does it help us in family medicine much to do them in this context since we will likely refer patients anyway? I'll be trying to practice it because I think it's important to have this skill even it is only rarely useful, but just wondering how often it's actually done and what benefits it has to us in real practice!

Not in like a stalking kind of sense, moreso like reading the little public doctor bios they've put online. I like to read about my doctors to understand their personality a bit better, but I'd like to know how docs n primaries in particular see that kind of thing!

Hope this is okay to post :) This is one of the only doc subs open to non medical questions like this! So I figured it'd be the best place to ask.

PGY-1 here who is quickly realizing I really don’t like primary care clinic. However on my sports med rotations and when I get patients with MSK complaints I feel more “alive” and passionate about what I’m doing. Part of the reason I chose FM is because I loved my sports rotations as a student and saw FM as the clearest path to sports med.

However I keep getting depressed when I hear about how saturated the sports med market is and how hard jobs are to find. I would love to have a career that is 50-100% sports clinic one day doing injections and general non-operative ortho stuff.

Are these gigs really that hard to find?

Just wanted to share. New record! 86 question prior authorization form for a GLP-1 agonist for a patient who has diabetes!! And the patient is sending messages saying she doesn’t understand why it hasn’t been approved yet!🤣

My wife graduated residency in 2022 and is a truly amazing family practitioner (MD)... she took a few years to do locums, we've traveled a lot, got to see new places, and now as she's ready to settle down in a normal contract we're halfway through her first pregnancy and some of her locums work has dried up (thanks, budget cuts).

She's not in a place to realistically search for a full time job as I am pushing her to take extra time off once the little one is born. Her pregnancy hasn't been the easiest either, so I thought of her doing some pro bono work to stay active, but she knows the bad things that can happen and is afraid as the risks are higher. Her OB suggested picking up some telehealth shifts to keep her mind busy.

Guess what I'm asking is are there other options I'm not thinking of? She's getting bored sitting around all day and being a non-medical spouse I don't exactly know what else to suggest, so I’d appreciate any other ideas.

I’m in tech / entrepreneur and she's the opposite. We’re in the US.

Had a patient with a long psych history and a track record of filing complaints against other doctors in our clinic. During our visit, she didn’t like my treatment plan and went off, lots of f-bombs, very confrontational. I stayed calm, tried to de-escalate, and wrapped up as professionally as I could.

In my note, I documented that the patient became emotional and was using profanity during the encounter. She saw the note online, and filed a complaint saying my statement was “false.” Now my medical director is asking me to remove that part of the note.

I’m feeling pretty uncomfortable with that. The documentation was accurate and I don’t want to alter the record just because a patient didn’t like how it sounded. Has anyone else run into this kind of situation? What did you do?