Somehow this has become controversial, but it feels to me that there might be a few things HRT can’t do for you.
I say this while acknowledging various forms of HRT are helping many of us feel better so that we can go on to tackle some of these things, which I believe really do need to be done at this time of our lives to reckon with the past and set us up for the rest of our years.
And I say it while acknowledging that some people are seeing HRT work miracles on their lives. For example this week I learned that not only did American influencer Marcella Hill (who has grown to 645k followers on TikTok) get her libido back eight months ago with testosterone, it also helped her fall madly in love with her husband again and “fix my whole entire being”.
But back to my list of things I’m not sure HRT can do:
• get you walking + lifting weights (the perimenopause power combo)
• heal your adverse childhood experiences or trauma
• meet and make some peace with your inner critic – essential for a more peaceful future
• do the work you need to do processing regrets and events from the past
• face your own mortality
• do any work that needs to be done on relationships with your significant other
• address problematic drinking, food issues or even pharmaceutical dependencies
• help you grieve unlived lives so you can access greater inner freedom
• address your relationship with alcohol, shopping, food and the other ways you numb yourself
• help you with an eating disorder, including orthorexia
• do the work you need to do to feel like you deserve love, care, rest etc
• help you learn to process your emotions as they arise rather than numbing them
• help you figure out what you like to do, and what you want to do next, now that you are changing and things around you are likely changing too
• have that difficult discussion with your partner about the changes you’d like to make in your sex life (aka find the voice you’ve been silencing by putting others first)
• get you to stop abandoning yourself
• figure out who YOU really are
• create a vision for the next part of your life that is in alignment with who you are, now
• clean out the big closet (literally and metaphorically)
I’m curious – are there any things HRT has done for you that you wouldn’t have anticipated, even directly? Maybe I’m wrong with my list, and if so, I want to hear about it. Hit the comments.
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It’s not always menopause, chemical edition
More studies these days are looking at the array of frustrating health problems women are facing in midlife, and what role our environment is playing in them, and it’s about time. Because many of these health problems are being linked directly to menopause, which which is my mind is a simple and convenient explanation for a much more complicated situation. These are contributing factors our ancestors didn’t have to deal with; that even our mothers faced to a much lesser extent, and they contribute to the “evolutionary mismatch” theory of why our modern menopause woes seem to be so much worse than those of prior generations.
Before you freak out, the more you know, right? Here are three from the last year:
• Higher levels of byproducts from phthalates, an endocrine disruptor found in many household and personal care products, found in middle-aged White women were associated with a significantly greater risk of developing type 2 diabetes over a six-year period. These findings, which were not reflected in Black or Asian women, are from the Study of Women’s Health Across the Nation Multipollutant Study and recently published in the Journal of Clinical Endocrinology & Metabolism.
• In a large, prospective study – one that watches for outcomes – researchers found an association between higher blood levels of PFAS, a widely used class of synthetics known as "forever chemicals", and an increased risk of high blood pressure in middle-aged women. Women with the highest PFAS concentrations had a 71 percent increased risk according to the study’s findings, published in Hypertension in June 2022. And even if you clean things up now, but as one researchers told Medscape, the risk came from “long-term cumulative exposure, even before midlife”.
• The global rates of non-alcoholic fatty liver disease (NAFLD) are out-of-control, impacting about a third of adults, according to this review. In what may be the first major review of its kind of both human and animal studies, published in May 2022 in Environmental Health Perspectives, the authors found “consistent” evidence that PFAS exposure led to liver damage in rats, suggesting the “forever chemical” found in non-stick cookware, waterproof makeup, food wrappers and even water, could be a factor in the rising rates of NAFLD.
Flipping the script on perimenopause problems
A headline I saw this week in the Hindustan Times: Heart attack warning signs that women may confuse with menopause symptoms
Might I suggest “Menopause symptoms that women may confuse with the warning signs of a heart attack”?
I’m not suggesting that anyone ignore the warning signs of a heart attack, but as psychologist and Wisdom of Anxiety author Sheryl Paul advises those who suffer from health anxiety, if something is really wrong, “it will become apparent”.
I’m a big fan of getting things checked out, and indeed this is how my early perimenopausal years began. A memorable moment came during a middle of the night visit to the ER when I woke up sure my chest pain was a heart attack (after having called myself an ambulance, which I waited for like a taxi outside my apartment building). That led to a full cardio workup and the all-clear. From that day forward, whenever I had chest pain or tightness, I made sure to breathe, tell myself “you haven’t been having a heart attack for X years”, and it passed.
So: chest pain should never be ignored (only peace of mind came from my ER visit), heart attacks are real, albeit rare, and they are our nightmare. A bunch of people benefit from freaking you out about them and heart disease in general. All true. But it’s really important not to make the fear too big, and to remember that heart attacks are dependent on a host of risk factors, many of them obvious, others less so. Also, the average age for women to have a heart attack is 72, according to the American Heart Association.
By the way, health anxiety is a huge problem for us at this time. Paul’s work has been a lifesaver through anxious times for me. And even if it is “just perimenopause”, I still think her thesis – that pain and discomfort is sometimes the body’s way of telling us it needs a kind of care we aren’t providing, and we must listen – is useful.
This week on the podcast: Kate Deering is a San Diego-based personal trainer, holistic nutritionist band author of the ground-breaking book How to Heal Your Metabolism. Kate has some no-nonsense guidance for healing a broken metabolism and how to make the transition through menopause as easy as possible by drawing on the pro-metabolic approach to nutrition. That involves learning to understand your body and giving it the fuel it needs to function properly. She explains why menopause symptoms, and slow metabolism, can both come as a result of over-exercising, eating too little and putting yourself under too much stress in earlier life, and dispels popular myths such as the idea that eating carbs will make you put on weight. I watched a friend of mine transform in her 40s by doing this, and I’ve done it myself and felt the difference. Her take is that throwing hormones and supplements at the symptoms of menopause was never going to be an effective solution. Instead, we need to learn to look at healing any underlying issues, and and nurture and heal our body so that it can go through the process feeling healthy and strong.
Click, follow, watch, read, listen…
• Has anyone been watching Shrinking on Apple TV+? This show has everything, including a crazy-good cast led by Jason Segel, supported by his wacky psychologist colleagues Jessica Williams and Harrison Ford, crazy neighbour Christa Miller – who create a beautiful case study of a woman figuring out who she is post-menopause, post-kids leaving – and others. The dialogue is seriously hilarious (like guffaw-ing good) and I’ve cried multiple times, because it’s all about grief and loss delivered in a story that breaks your heart it’s so beautifully told. (Along with Segel, it was created by Brett Goldstein and Bill Lawrence, who has been behind so many of my favorite funny-and-touching shows from Scrubs to Ted Lasso) There is also a consistent search to find a new term for “lady can’t get it up”, since “juiced” was stolen by the steroids community.
• Finally someone is tackling the issue I never hear HRT evangelists mention: the risk of drinking alcohol while taking it. (Several practitioners have expressed concern about this in interviews, but it’s rare to hear it “out there” – or from your doctor.) From Wise + Well peri-meno educators Maria + Kristen.
• We’ve entered a time where any article at all that questions menopause or any of the issues surrounding it unleashes a relentless cascade of predictable squawking. The angry Menopause Mafia of HRT Evangelicals – who can’t have a question raised about it – are now calling this sort of thing “medical gaslighting”. This used to refer to that situation where your doctor didn’t listen to you or believe you when you told them what was wrong with you, but now it’s being used to silence vital intellectual debate, and that’s dangerous. The Daily Mail article stemming from the Pharmaceutical Journal report about the explosion in testosterone demand in the UK is a good example; it was incredibly balanced, yet to many people, also completely out-of-line. No one liked this article either, by Sue Reid and also in the Daily Mail, which I thought it made some good points, and some weird ones – “the experience of menopause is not universal” (right!); “The female body is programmed to resist sexual encounters as particular hormones disappear with age” (pardon?) – and was doomed from the outset with a wretched “imagine this” lead about a worst-case corporate menopause leave scenario. Perhaps the clue is in the title: It's time to accept that the menopause is simply part of womanhood - and we mustn't let it turn us into victims or wreck our careers.
• Stacy London finally got that show she wanted, and no one deserves it more. Midlife Magic will debut exclusively on Pinterest TV, which I think is a really interesting choice. WWD (paywall)
• Men are getting the media’s scary “it wasn’t menopause at all – it was something much worse!” treatment. I think we are all going to be hearing a lot more about MM, by the way, including coming up on the Hotflash inc podcast. He Was Sweating Uncontrollably. Was It Male Menopause? New York Times
• I noticed about two years ago that the Daily Mail was doing some of the most responsible reporting on menopause, which weirded me out. I think that might be because it’s a contrarian paper and this is a topic that has a very strong narrative – menopause is a terrible problem, women need HRT to fix it – but unfortunately now it’s seen as right-wing to be appropriately cautious on this topic, and that’s a real shame.
• I was thrilled to come across the study on chemicals and NAFLD (above), because I am in the third of adults globally who has this situation going on, and it’s worrisome. Also, I can’t bear to hear one more person / expert / influencer tell me that this is because of the standard American diet, or fast food, or sugar, or inflammation. I’m talking about people who should know how complicated this is, including experts like Dr Mark Hyman, for example, who did an episode about it that was just about the laziest thing I’ve ever heard. As someone who has paid a lot of attention to her diet and exercise over the last 25 years, I deeply resent when my gastrointerologist gives me useless instructions not to eat things I’ve avoided for years including sodas, processed, fried, baked, sugary and fatty foods. I’ve no doubt I’ve done some things to contribute to this, and I’m dealing with it now, but I find it comforting (and scary) to see more evidence of what I’ve long suspected: that this is bigger than me. In my research I’ve turned up associations between NAFLD and long-term gut issues, thyroid conditions, blood sugar issues (all things I’m experiencing at the moment) and more. There are just too many people involved for this to be solely about a poor diet or lack of exercise.
• I noticed two doctors in different parts of the US say the exact same thing this week on social media: ‘Natural is a weapon to keep women in their place’. This is the second time it’s happened: the first time, one of the doctors who used the above phrase posted around the same time as another with a very similar message, along the lines of: ‘bioidentical is not a medical term; bioidentical is a scam’. Sure, maybe it’s a coincidence. Maybe one is borrowing content from the other; and maybe the negative messaging aimed at the compounding industry, which you can learn all about here right from the source, is coming from somewhere else.
Hey there! Well I've got a symphony of issues related to long-standing poor gut health, so it's different. So if you did have it, I'd look at what else is going on. I'm eating no added sugar, no alcohol, no processed or fried food, lean, organic meat, taking milk thistle, and glutathione vitamin E. I was eating fruit but I started on a new plan for gut and thyroid and that's gone for a bit. It's challenging! I had a FIB-4 test.
I think your list of "can HRT do this for you" is fabulous. Sadly, too many are always seeking the magic bullet that fixes everything because they don't want to do the "hard" work of inner work or self-evaluation. In my work, a big part of my focus is to get women to take a look at how their relationship with movement has changed over their life and why. Getting to the why is very powerful in making sustainable changes. I feel the same about HRT. although it has many benefits, it's touted as the ultimate treatment for everything menopause related and that is just not true.