Hormone Therapy after the Era of «Boxed Warnings»: The Role of Transdermal Estrogens in Shaping a New Paradigm

Following the WHI publications and the introduction of «Boxed Warnings» in the labeling of menopausal hormone therapy (MHT) products, MHT received negative media and clinical attention, leading to a substantial decline in prescriptions and widespread fear of therapy, even among younger women. Recent FDA guidance and updates from leading international societies have revised the «Boxed Warning» formulations and shifted the focus toward a differentiated, age- and risk-oriented approach to prescribing MHT. In particular, transdermal estrogen formulations, such as Lenzetto^® (estradiol 1.53 mg spray), demon­strate a favorable safety profile, high efficacy, and avoid systemic overload of hepatic metabolic pathways, which is particularly important for patients with thromboembolic risk or metabolic disorders. Prospective, multicenter observational studies have shown significant reductions in vasomotor, urogenital, and psycho-emotional symptoms after just 3–6 months of Lenzetto^® use. Lenzetto^® spray, with its unique estrogen delive­ry technology, ensures stable therapeutic estradiol concentrations, ease of use, and high patient satisfaction, supporting long-term adherence. Progestin is added only for women with an intact endometrium and can be administered in cyclic or continuous regimens depending on clinical context and individual risk factors. These properties make Lenzetto^® an effective tool for implementing the modern concept of «individualization, safety, efficacy, and adherence», enabling safe and effective management of menopausal symptoms and establishing a new paradigm for MHT in the post-«Boxed Warning» era. Lenzetto^® represents an optimal option for individualized therapy, integrated into clinical decision-making and shared treatment planning, enhancing quality of life alongside the patient.