Navigating menopause with care, clarity and evidence

For more than 15 years, Dr. Nina Ali, associate professor of obstetrics and gynecology, has dedicated her career to caring for women through the menopause transition, one of the most misunderstood and underserved phases of life. Trained at Baylor and now a long‑standing faculty member, she has built her clinical practice around supporting women through midlife hormonal changes. She discusses more about her passion and where menopause care needs to go next.

A collaborative approach to menopause care

What makes Ali’s work unique is the multidisciplinary model she helped build at Baylor’s Menopause Center. Launched in 2014, the center integrates OBGYN with specialists in reproductive psychiatry, urogynecology and pelvic health expertise.

As she explains, many women don’t realize that symptoms like hot flashes, mood changes and sleep disruption reflect how the brain’s neurotransmitters respond to hormonal shifts. Bringing multiple specialties together allows the team to address menopause not as a single‑symptom issue but as a whole‑body transition.

The urgent gaps in research and policy

When asked about the most pressing ethical and policy issues in menopause care, she doesn’t hesitate: Women have been historically underrepresented in clinical research. For decades, the foundational studies that shaped how clinicians diagnose and treat chronic disease were conducted primarily in men. Only recently have women been consistently included in large‑scale trials, and that late start continues to put women at a disadvantage as clinicians and researchers build the evidence base for midlife and menopause care.

In recent years, the evidence base and enthusiasm for hormone therapy has grown significantly, but Ali notes that misinformation remains a major challenge. Clinicians now spend considerable time re‑educating patients about what hormone therapy is and isn’t supported for.

A big moment in menopause care: New treatments and regulatory changes

There’s been a lot of attention to elinzanetant, the newly approved non-hormonal menopause drug. What makes this development significant to Ali is that for women who cannot or prefer not to use hormone therapy, such as those with a history of breast cancer or blood clots, this new class of drugs works on the same part of the brain influenced by estrogen, but without using hormones at all.

She calls it “really exciting,” especially for patients who previously had limited options and thinks there will be even more options coming out.

In November, the FDA removed the black‑box warning from hormone therapy. For two decades, the warning, rooted in the design limitations of the original study, created fear and confusion for both clinicians and patients. Ali notes that the risks highlighted at the time likely were overstated, and subsequent trials have provided a clearer, more reassuring safety profile. Removing the black box is an important step toward more accurate, evidence‑based counseling. But she emphasizes that it doesn’t mean hormone therapy is risk‑free, and the right choice depends on discussing with your doctor your individual health history and goals.

Another issue is the ongoing estrogen patch shortages, which have been frustrating for patients and clinicians alike. There has been a lot of news and there are many reasons such as manufacturing issues and increased demand that have made it difficult to maintain consistent therapy. Switching products mid‑treatment isn’t ideal, she notes, and can disrupt progress for women who get in a good cadence.

Looking ahead

Her passion for menopause care is rooted in the transformations she sees every day. She recalls a recent patient: Healthy, in her 40s, struggling to verbalize why she “didn’t feel like herself.” After extensive evaluations by multiple specialists, a simple, evidence‑based intervention helped her realize it was early hormonal changes.

Moments like that, she says, are why she finds this work so gratifying. Taking good care of midlife women not only helps with symptom relief today, but also helps prevent long-term health issues like osteoporosis, heart disease and urinary tract infections.

Ali is optimistic about the future. She thinks women are generally being more informed and assertive than ever and that this momentum will impact not only OBGYN but also primary care and subspecialties like cardiology. Over time, this shift should translate into better, more equitable care for women across the entire health system.

But she also warns about the growing influence of misinformation, especially on social media: “I want people to come in with good questions and have good information but some voices with large followers blend partial truths with non‑evidence‑based claims, leaving women vulnerable at a moment when they most need clarity.”

Her hope is for better research, better education and better tools to help women become informed consumers of their own health.

By Clarice Jacobson, lead, Business Strategy and Development, Center for Medical Ethics and Health Policy; the above is based on an in-depth conversation with Dr. Ali.