It struck me this week that in 2024, we are having a bunch of different conversations about hormone therapy all at once, and it’s very confusing. Here’s my totally subjective proposal for clarifying things, at last a bit:
Hormone therapy in early and surgical menopause
Women go through early menopause – before 40 – for a variety of reasons, including premature ovarian insufficiency, hysterectomy (complete or partial), cancer treatment and a range of medical conditions. The data is stacked pretty high on this one. Our outcomes are not good if we go through early menopause and don’t ‘replace’ our hormones. It appears we can lose our hormones slowly, at the designated time. But we can’t lose them early, or all at once. We need hormone therapy.
What to call it: hormone replacement therapy (HRT)
Hormone therapy in perimenopause
A decade ago, no one was talking about perimenopause, which is – as we now know – all the years before menopause. In the earliest stages, receding progesterone can throw sleep and mood off. Estrogen can be high as it’s falling and progesterone is low. Our testosterone has fallen for years. There are too many symptoms to count – although we all keep trying to. And there is a shocking dearth of research on this stage, with most of the discourse extrapolated from studies on menopause. Also, people use ‘perimenopause’ and ‘menopause’ interchangeably, and that makes everything more confusing.
What to (maybe) call it: perimenopause hormone therapy (PHT)
Hormone therapy in menopause
Menopause is a moment in time when you haven’t had a menstrual period for a full 12 months. But increasingly, it’s also replacing ‘post-menopausal’ in the menopause lexicon. There are two reasons this would be a positive shift. One is because some of the symptoms and vulnerabilities that happen after menopause is ‘over’ continue on for years. Genitourinary syndrome of menopause (aka vul-vag stuff), for example. But also, as menopause is defined as the cessation of our fertile life, this phase never really ends.
What to call it: menopause hormone therapy (MHT)
Science stuff
ALCOHOL + HORMONE THERAPY: Consuming alcohol while taking estrogen as part of hormone therapy may worsen heart health for perimenopausal women, according to a study presented at the American Heart Association’s Basic Cardiovascular Sciences Scientific Sessions this summer.
LIVER + HORMONE THERAPY: Women who have moderate-to-severe hot flashes are three times more likely to develop metabolic-dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD). This according to the results of a small study out of Greece presented at the ENDO 2024 meeting in Boston this summer.
DEMENTIA PREVENTION: The Lancet standing commission on dementia looked at hormone therapy for the first time in its 2024 report, Dementia prevention, intervention and care, and does not recommend hormone therapy to prevent dementia. In a meta-analysis of about two dozen studies, members actually found a small but statistically significant increase in dementia risk associated with hormone therapy, both in combined and estrogen-only therapy.
3 books worth knowing about
ANTHOLOGY: First off, we have a release date for feminist author and commentator Mona Eltahawy’s anthology Bloody Hell! And Other Stories: Adventures in Menopause from Across the Personal and Political Spectrum – I am one of 17 contributing essay writers – and it’s March 2025. I’ve seen a proof, complete with Sheyam Ghieth’s gorgeous illustrations, and it took my breath away. Inclusive, representative – so much of what is lacking in the current discussion. If you pre-order before August 27 (Tuesday) you can get your name in the book:
CELEBRITY: Menopreneur and actress Naomi Watts will tell her personal story – early menopause in her mid-30s, just as she was planning to start a family – in Dare I Say It: Everything I Wish I'd Known about Menopause. The book, complete with a flaming megaphone on the cover, is out January 21, 2025.
FOOD: Dietitian Dr Linia Patel on September 12 will try to answer what everyone wants to know: what should we eat? Food in Menopause aims to examine the role of nutrition across the various stages of the menopause transition. In her paradigm, food one of four pillars rounded out by sleep, movement and stress management.
Hotflash hot tip: Energy
One of the most helpful takeaways from more than 100 podcast episodes so far came from Dr Annice Mukherjee. The British endocrinologist and author of The Complete Guide to the Menopause told me that we need to treat our energy like a bank account, balancing deposits and withdrawals. That’s hard though, isn’t it? I forget all the time. I was reminded this week of her words as I read the beautiful book Your Radiant Soul, by energy worker Prune Harris. She built on the energy bank concept by bringing in the aspect of kindness as a different kind of ‘deposit’. Anytime we feel kindness, compassion or gratitude, our energetic fields expand. The kicker? “Being kind to yourself is the biggest and most vital part of living your life to the fullest and is the foundation of all the other kindnesses you engage in.”
It’s only the second time in Hotflash inc podcast history that I’ve done a two-part episode. Part 1 of my interview with Rebecca Rotstein is live now; part 2 drops next week. Rebekah is the founder of Buff Bones, a medically endorsed exercise method for bone and joint health with on-demand classes and trained instructors in more than 30 countries. Part 1 of this conversation delves into into the intricacies of bone and joint health, sharing evidence-based studies that emphasize the need for high-intensity exercise to increase bone density after menopause. In Part 2, we talk about what to do to keep your bones, muscles, tendons and fascia strong. This episode was recorded late last year.
Click, read, listen, watch
While I love to see menopause elevated to a level where it’s not only a focus on huge podcasts, but on huge bro podcasts, it’s nerve-racking knowing the people doing the interviewing don’t have the insight, knowledge or background to challenge anything that is being said The Mel Robbins Podcast / Huberman Lab Podcast
What causes a UTI? 7 triggers in menopause to look out for Woman & Home
Primary Ovarian Insufficiency goes undiagnosed in teenagers. A leading researcher calls for more awareness ABC
From autism to learning disabilities: More accessible menopause support needed, experts say BBC
Tiktokers can’t make claims about wild yam cream anymore Cosmetics Business
Editor’s note
I made a video this week about a doctor calling out some other doctors for way overselling the prevention aspects of hormone therapy.
Some people liked it. Others did not.
And that is the way it goes.
I am a journalist. Not a cheerleader. I take no sides and I look only for the true truth. Narratives are stories and they always benefit someone. You usually only have to follow the money (or the power).
If I had to weigh how my coverage would land every time I published something, I never would have written my first word.
As the American actor and libertarian Vince Vaughn patiently told a reporter from the New York Times (who was the worst by the way) recently: “I like stuff that’s provocative and challenging and committed to a point of view. You should hear different ideas.”
Also, I highly recommend Bad Monkey on Apple TV.
F—-nuts.
AMx
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"I am a journalist. Not a cheerleader. I take no sides and I look only for the true truth." the more I read from you, the more this reigns true. This is a skill that I find less and less people have, thank you Ann Marie for the way in which you present the information and then allow the readers, us, to take it and make our own decisions. THIS is journalism ❤️