21 hormone therapy head-scratchers

so many questions...

Photo by Jon Tyson on Unsplash

I think about hormone therapy all the time.

I think about how much it helps some women, how some women don’t need it, others need it but won’t take it, still more need it but can’t get it. How it seems like everyone is pushing us to take it, or arguing about it.

And that is just the start of my questions.

I think about how when you search ‘menopause + hormone therapy’ on PubMed, the National Library of Medicine database, you get 5,740 results (as of Tuesday, November 4).

And when you do the same for perimenopause, you get 470.

In the grand scheme of things, that’s pretty much nothing, right? (For crying out loud, they do more research on cows and hormones. I checked: there are 35,406 results. But that’s business, right?)

These relative dearth of information is what’s got me scratching my head at some of the things I hear online, read in the media and right here on my podcast from the people I interview.

So here they are, in no particular order:

1. How many doctors don't really seem to understand the difference between progesterone and progestin.

2. That the menopause industrial complex has an “estrogen first, estrogen always” approach, while there is a whole cadre of forward-thinking practitioners successfully treating women in perimenopause and menopause with a progesterone-first approach, based on the premise that progesterone falls first and estrogen rises and falls over time as it slowly falls. You might be having symptoms because you have high estrogen with low progesterone. And a lot of doctors believe you need estrogen for that?

3. That it seems to be okay to say “high estrogen” but it’s definitely not okay to say “estrogen dominance”. Who makes these rules? The Board of Directors of the Way We Should Talk about Hormones?