Perimenopause - Part 2: The Current State of Affairs in Perimenopausal Care
This is part 2 of a series on perimenopause. Please read Part 1 is here for context.
Let’s say you know your hormones are shifting and you’re experiencing symptoms you’re not a fan of. So you go to your family doctor for support.
Chances are, you’ll be met with one of 2 responses to your query about said symptoms:
“Your weight gain / poor sleep / memory loss / moodiness / dryness / hair loss / depression / anxiety / impatience, etc is just part of getting older.”
(F*** this answer. Not true.)
OR“Let’s do some blood work and check your hormones, then maybe we’ll talk about hormone replacement.”
Translation: “Let’s take a cursory glance at the levels of just a few of your major hormones, but leave out some of the really key ones that can give us more insight as to what’s going on for you under the hood mechanistically, and then we’ll make a wild guess at what to do to address this very complex issue based on 4 or 5 markers.” (***Reminder from Part 1 of this series: this reductionist approach is NOT your doctor’s fault! )
Once you results are in, if your numbers are low, they then might write you a prescription for hormones (hormone replacement therapy / HRT), buuuuut they may also tell you HRT is dangerous and advise against it. We’ll come back to the latter in a minute.
That HRT prescription may or may not be what your body needs at all, but you don’t know this so you take the hormones. You may feel better, you may feel nothing, or you may feel way worse.
If you have catastrophic results, you’ll probably swear off HRT forever and do your mental and physical health a tremendous disservice.
If you somehow immediately feel way better the first time round, then HOORAY, you’re in the vast minority.If, like most women, the supplemental hormones do improve some of your symptoms but not all of them, you’ll have to go back to your doctor several times (after weeks / months of more suffering) so they can keep rejigging your prescription, and you can go home each time and spin the wheel of hope once again.
Unfortunately, a lot of women do know to do this: they do not revise their initial prescription, even though it doesn’t really do the job; they continue to suffer, not realising that they need to keep trying.Why? Why doesn’t the doctor get it right the first time?
Because there is no formula for balanced hormones. Every woman is different. And we need to be prepared for that.
I don’t want to make you think I’m down on HRT or that it’s a drag: I am a BIG fan of HRT, when done well. HUGE. And after devouring resources on it for years and assessing the any potential risks to my health (nil) versus rewards (LIFE-CHANGING), I’m ALL about it and will be embarking on it soon myself.
AND, I know it will probably take some trial and error and time and effort and maybe some tears to get it right, but that it’s going to be absolutely 1000% worth it.
(*This is my case. There is a small slice of women who should not do HRT for reasons I won’t digress on here.)
Anyway, coming back to the 2 potential scenarios outlined above…
There’s a MASSIVE omission in both:
Neither raises the key lifestyle factors that are ESSENTIAL to supporting hormone production, regardless of whether you use supplemental hormones or not.
Lifestyle factors like sleep, nutritional status, stress, fitness, body composition, detoxification capacity, environmental toxins, circadian rhythm and others play HUGE roles in how female bodies produce (or don’t produce) hormones. These should be your first lines of defence!
Yet, no one has been talking about them…Doctors aren’t talking about them because they weren’t taught this stuff AND because it’s not in the research!
But if you’re reading this, now YOU know that can help your hormones and your perimenopausal transition by adopting habits that support them.
This one of my favourite topics, but it’s a whole other can of worms, which I’ll dive into in my next post (coming soon).
For now, let’s stick to the convo you’re gonna have with your doctor.
“Doesn’t HRT increase risk for cancer / heart disease?”
This comes up a lot in my conversations with clients.
In fact, your doctor probably still believes this.
HRT has unfairly gotten a bad rap in the past. Tragically, most doctors still wrongly advise against it.
This lines up with the fact that Medicine and Medical Schools are 14-17 years behind the research findings. (In other words, there’s a lag of 14-17 years between when scientists learn something significant from research and when health providers change their practices as a result. Eek.)
The bad rap comes from a seriously flawed, major study (“the Women’s Health Initiative/WHI”) published back in 2002 that suggested HRT increases cancer risk. Those results and conclusions have been totally revised since: we now know that is absolutely not true, and there is only a very small risk if the woman is more than 10 years into post-menopause and has not already been on hormone replacement. We’ve also learned that it’s critical to use “bioidentical” rather than synthetic hormones, which are structurally the same as what your body naturally produces (ie. not estrogen from pregnant horse urine).
In fact, many studies now show irrefutably that HRT is incredibly protective against not only the day-to-day symptoms of peri/menopause, but against diseases of aging, including various cancers, diabetes, osteoporosis, cognitive decline, dementia, Alzheimer’s and more. (More info here.)
In fact, a few “celebrity” doctors and scientists - including Drs Peter Attia, Andrew Huberman, Rhonda Patrick, Mark Hyman and others - have recently stepped into the limelight to turn this HRT train around. They’re speaking on about the incredible benefits of HRT, and calling out the BS that was the aforementioned WHI study and its continuing fall-out, which Peter Attia says is “hands down, the biggest screw-up in the medical field in the last 25 years.”
Ouch.
“Careful consideration of existing data reveals that the widespread panic over hormone therapy risks has not been remotely justified. Yet, tragically, literally millions of women today have been and continue to be denied this therapy by doctors who simply fail to study the results of the very same trial they use to lambast hormones. Results from the WHI and other studies offer no indication that HRT poses any meaningful threat when initiated early in menopause; on the contrary, it likely provides protection from chronic diseases such as breast cancer, dementia, and heart disease, in addition to its clear benefits for bone health and frailty prevention. ”
Sing it loud, Petey.
This is why US First Lady Dr. Jill Biden is taking action with her White House Initiative on Women’s Health: $100 million for ‘life-changing’ research and development into women’s health. First announced in November, the initiative aims to close funding gaps and invest in solutions that improve doctors’ abilities to diagnose and prevent diseases primarily affecting women.
It’s refreshing to know that the tides are changing; that women, doctors, scientists and anyone who cares for a woman going through peri/menopause are starting to speak out, demand change and start holding more conversations around women’s health.
And I’m happy you’re here, reading this, and becoming part of the conversation too.
Stay tuned: more blogs like this coming your way, including “Easing the perimenopause transition: natural ways you can support your hormones.”
If you’ve made it this far, THANK YOU. I appreciate you.
And I appreciate if you would leave a comment, share this post and have more conversations about women’s health with your doctor and with the women and men in your life who you care about. <3
On that note, if you want more help, check out The Better Beyond 40 Formula.
