(NOTE: ‘women’ in this project refers to individuals who identify as such and/or are born with a genetic makeup that necessitates undergoing the female menopausal transition – peri-menopause, menopause, and post-menopause. For convenience, I will use the term ‘menopause’ to encompass the whole transition as well as the second half of women’s lives.)

It is impossible to do research on menopause without coming across hormones. Here are some of the things I have learned so far:

• Every woman deserves to know about hormones with the latest evidence-based knowledge, so they can make an informed choice whether to have hormonal top-up during the menopause transition.
• Here is a conversation between Dr Louise Newson (a renowned UK menopause expert) and Dr Ceri Cashell (Australian GP and advocate for menopause) about the basics of hormones and the current situation of menopause: https://www.healthyhormones.au/c/live-events-e4b85e/power-of-hormones
• We need well-balanced hormones to function throughout our lives. If hormones are imbalanced, our lives can get awful in every direction, because hormones are present everywhere in our body.
• It comes down to women telling their experiences to clinicians, who listen and judiciously diagnose them for perimenopause. But it gets tricky. Many clinicians are not trained enough to identify perimenopausal symptoms, so there are plenty of undiagnosed, unsupported, and/or misdiagnosed perimenopausal women out there right now, struggling alone to make sense of their changing bodies and brains.
• Medical schools globally teach menopause for 30 minutes – 3 hours in their entire medical training. Some universities only include menopause in a footnote.
• Research shows that one of the best baselines for women’s functioning is to top up the adequate levels of hormones we lose as we age – body-identical hormones such as oestradiol, progesterone, and testosterone. They are called HRT (Hormone Replacement Therapy), also referred to as MHT (Menopausal Hormone Therapy), and HT (Hormonal Therapy).
• The menopause experts state that HRT should be considered the first line to support menopausal women, not antidepressants. Yet many clinicians are more comfortable prescribing antidepressants to address many menopausal symptoms than supporting their low hormonal symptoms with a hormonal top-up. Here is a standard example most of the menopause experts share: A woman with night sweats and hot flushes keeps waking up several times at night for weeks, months, or years. Losing sleep like this, she is understandably at the end of her tether whilst expected to perform consistently well at work and care for her family. She keeps losing focus and energy. She has crazy brain fog. Her food intolerance and pooping problems also appear. She asks her doctor for help. To address all the varying symptoms, many doctors routinely prescribe antidepressants – a band-aid approach – which do nothing for the night sweats, hot flushes, brain fog, and gut issues. Whereas the right balance of HRT can. Antidepressants adversely block existing hormones from functioning.
• The media announced in 2002 that the Women’s Health Initiative (WHI) trial on synthetic hormones reported that all HRT gives women breast cancer. This study was flawed and further misconstrued by the media. But overnight, millions of women around the globe stopped using HRT. Medical students, globally, have also missed out on learning about HRT and menopause ever since to this day. Not that there was much attention to menopause studies to begin with, but even this dismal amount of study got taken out of their curriculum. This fear-mongering misinformation remains the dominant medical knowledge today. Soon after the report was released, the researchers involved in the original study revealed its flaws, but no one heard them, nor did the media rectify the damage they’d caused. Many of the current medical professionals in menopause advocacy – such as Dr Mary Claire Haver, Dr Kelly Casperson, Dr Louise Newson, and Dr Ceri Cashell – have openly said they were self-taught in menopause studies because they were never taught in their years of medical training. Although they worked in the menopause field, they themselves were blindsided by their own perimenopause symptoms. Many of these incredible medical practitioners now provide education to other clinicians and to the public, disseminating accurate, evidence-based information.
• My mother missed out on HRT support because of the WHI conundrum. My aunties and all the other women who had cared for me have also missed out. They now have a long list of serious illnesses. I can’t stop wondering if they had taken HRT, whether their devastating daily struggle could have been more manageable, or even prevented. The more I learn about this area, the more it breaks my heart. I know HRT is not a panacea, but I also know now that a hormone top-up can never be underestimated for optimising our body functions and mental health. It provides an excellent baseline so we can move forward with what we want to do throughout the second half of our lives.
• Body-identical hormonal therapy, which most HRT is these days, comes with very low risk and can effectively support many symptoms. If women didn’t like them, they could stop taking them anytime and naturally return to their menopausal state with their usual symptoms within days, without any hang-ups. On the other hand, antidepressants actively suppress hormones and come with many side effects. They have never supported common symptoms like hot flushes, headaches, sleep, and digestive issues, yet these medications have often been the go-to prescriptions since the 2002 WHI incident. If women (or men) didn’t like them, it could be a hellish shitshow to come off them.
• Almost every woman in their menopause transition, with a very small percentage of exceptions, is safe to take HRT. Because HRT is body-identical, it’s cheap to produce and cheap to buy. Pharmaceutical companies can’t profit from HRT.
• Bio-identical oestradiol patches/cream/gel are mostly derived from wild yams or soy. The synthetic estrogen tablets from olden days for the WHI study in 2002 were derived from pregnant horses’ urine at a very high concentration, called Conjugated Equine Estrogens (Premarin). These are not the same types of estrogen as what we use now.
• The human body naturally produces estradiol. We do not produce Premarin. Beware of lumping all ‘estrogens’ into one box. If it gets too confusing, just remember estradiol. Estradiol specifically is the anti-inflammatory hormone. This is the good estrogen type. This is the one we had in abundance when we were younger, smoother, tighter and healthier. We lose this as we get older, and topping up with this one is a good idea. Estradiol.
• We need to top up with progesterone, testosterone, and estradiol, as they work synergistically. Progesterone is estradiol’s trusty sidekick. We need it, even if women no longer have a uterus.
• Women have more testosterone than estrogen. So most menopausal women also need a testosterone top-up. All three work together.
• Except for a very small percentage of women, most women in menopausal transition would benefit from a hormonal top-up, if they choose to have it.