GOING MENOPOSTAL: An excerpt
What you (and your doctor) need to know about the real science of menopause and perimenopause
Today I’m delighted to be sharing with you an exclusive excerpt from Going Menopostal, the new book from Amy Alkon, an American independent investigative science writer specializing in applied science. I’m extra-delighted because Amy is that rare person in this space who understands what we’ve been yelling about over here, something most journalists and many mainstream menopause white coats do not appear to: in perimenopause, low estrogen is probably not your problem, and progesterone and progestin are not at all the same thing. I don’t think it will come as a surprise that I don’t agree the evidence supports everything in this excerpt, particularly this line: “In fact, taking estrogen immediately upon going into menopause is the single best protection we have against the biggest killer of women: heart disease.” But that’s the beauty of the landscape: these things are open to interpretation and we do not all have to agree. I hope some day soon Amy and I can have a conversation about all the things. For now, I thank her for sharing this with me and issue a huge congratulations on a massive undertaking. I hope you enjoy it.
But first! Check out this ONLINE event I’m going to be part of Saturday (tomorrow). There may be tears, but it’s a worthy subject – and the pain of not having children is something I’ve never really spoken about publicly. I’m speaking about it on my IG stories just now. You can register here.
And now…
GOING MENOPOSTAL: What you (and your doctor) need to know about the real science of menopause and perimenopause
by Amy Alkon
Foreword by Robert Lufkin, MD
(BenBella Books, 2025)
THE MEDICAL NEGLECT AND MIS-TREATMENT
OF WOMEN IN MENOPAUSE AND PERIMENOPAUSE
The single most patient-betraying area of our medical care
Many women in their 40s start feeling mysteriously unwell. “Mysteriously” because their symptoms sneak up on them, little by little, and seem unrelated since they don’t trace to a single identifiable cause.
At first, a woman might mistake some symptoms for mean ole PMS—until it occurs to her that premenstrual syndrome isn’t supposed to be endless. She’s bloated and achy—not just at tampon time, but throughout the month. Every day, her boobs feel like overfilled water balloons, and they hurt every time she takes a step. And whoa! Is that her period or a test run for bleeding to death?
Eventually, sleeping through the night becomes a battle—one she usually loses. Then there’s the bottomless hunger. No matter how much she eats, she remains monstrously hungry—like a starving wild animal—and she’s got the depressing rapid weight gain to show for it. And while we all have the occasional “I HATE EVERYONE AND EVERYTHING!” bad day, hers start coming daily. She’s wired and angry—for no apparent reason—and spends much of her time wishing a gory death on people who commit horrific crimes, such as humming while in line at the hardware store.
Notice something? No one symptom stands out as frighteningly worrisome. (Nobody dies of sore boobs.) It is important to note that some lucky women experience few symptoms or none at all—or fewer and less intense symptoms. However, for those of us who do get slammed, the collective mystery is the problem: the sudden “new normal” of feeling like something the dog threw up on the rug—without a clue as to why.
We can come to terms with facts we know—even devastating facts like “It’s cancer.” The medical unknown, on the other hand, dumps us and our imagination into a bottomless pit of worry about all the terrifying things that could be wrong with us.
Take me, for example. Until the summer of 2016, when I got my first hot flash (at age 52), I’d spent six to eight years not noticing I was slowly but increasingly feeling pretty terrible. Eventually, it hit me, and I got really scared. After a lifetime of barely going to the doctor, I seemed to be falling apart in a disturbing variety of ways—but why? Do you get, like, 40-some years of good health, and then some dark figure checks their watch and says: “Happy birthday! Welcome to ‘Feel Like Total Crap Till You Die!’”?
If only I’d known that my menstrual cycle hormones—estrogen and progesterone—were the perps behind my mental and physical symphony of suck. Many women suffer hormone-driven symptoms not just after their periods stop—the phase called “menopause”—but in the three to 10 years leading up to it: the phase I’d been in, called “perimenopause.” These symptoms can show up as early as age 35, but they usually rear their nasty little heads in a woman’s 40s.
Some women do bring their symptoms to their doctor. Unfortunately, their reward is seldom relief. Perimenopausal symptoms are consistently dismissed, misdiagnosed, and mis-treated—by well-meaning doctors who have every intention of helping their patients.
The problem is this: Treatment guidelines for women in perimenopause are based on a major error—the long-held, unquestioned assumption that estrogen levels in perimenopause are low, as they are in menopause.
They aren’t.
In perimenopause, estrogen levels can actually soar, making many women sick and putting them at increased risk for breast and endometrial cancer. Yet, women in perimenopause are prescribed estrogen—potentially overdosing them on the hormone causing their suffering—when the actual problem is not that they are low on estrogen, but that their bodies have stopped producing enough of its vital counterbalancing partner hormone, progesterone.
Doctors will pair the estrogen prescription with what many—wrongly— believe to be progesterone. However, instead of prescribing safe, FDA-approved progesterone—chemically identical to the progesterone produced by our bodies—they often prescribe an el cheapo synthetic knockoff, medroxyprogesterone acetate. This drug not only fails to do the job progesterone does to dial down perimenopausal insomnia and other life-trashing symptoms, but it increases a woman’s risk of breast cancer, heart attacks, and strokes.
In menopause, estrogen levels bottom out, and with the loss of estrogen, many of us get socked with daily misery from hot flashes, vaginal dryness, and other symptoms. Prescription estrogen alleviates these symptoms. In fact, once we hit menopause, it’s the most powerful hot flash relief we’ve got, and it’s near miraculous at rehydrating the parched desert territory formerly known as our naturally lubricated vagina. In addition, research increasingly suggests estrogen protects and preserves the long-term health of our bones and our cardiovascular system.
However, for over 20 years, women were denied these benefits—and continue to be because estrogen continues to be baselessly demonized. This is a lingering effect of the methodologically terrible Women’s Health Initiative study (WHI) and the inexcusably distorted way it was announced to the public in 2002—basically amounting to “Hey, Ladies! ESTROGEN WILL DESTROY YOUR BREASTS AND EAT YOUR BRAIN AND THEN TAKE YOU OUT IN A MASSIVE HEART ATTACK!”
The WHI researchers’ claim was a gross misrepresentation—a finding of harm made out to apply to all menopausal women when it was drawn from a highly atypical and unrepresentative subset: a substantial number of elderly women (up to age 79). These women had no menopausal symptoms and were so old and in such poor health that the estrogen the researchers gave them had no possibility of helping them and likely harmed them, like by increasing the plaque buildup in already-narrowed arteries (the Heart Attack Highway).
Elderly, unhealthy women should never have been treated with hormone therapy appropriate for healthy, just-menopausal, symptomatic women, and would never have been—by any doctor with a medical license generated by the state rather than Photoshop.
These women were falsely described to the public as “healthy” by the WHI researchers—most sickeningly, right in the title of the study: “Risks and benefits of estrogen plus progesterone in healthy postmenopausal women.”
This was criminally misleading. The cardiovascular and other risks to elderly, chronically ill women do not apply to healthy just-menopausal women who are prescribed estrogen. In fact, taking estrogen immediately upon going into menopause is the single best protection we have against the biggest killer of women: heart disease. Unbeknownst to most of us, heart attacks, strokes, and ride-along diseases like diabetes now kill one in five women and will soon kill a whopping one in three.
We also are not told there’s a clock on protecting ourselves; for example, a short window of time after we hit menopause when estrogen is helpful and protective for our cardiovascular system. If we start taking it within that window, we set ourselves up to be helped and protected by it throughout our lives. If, like the older women in the WHI, we miss that window, estrogen can be unhelpful or destructive.
Sadly, while the initial 2002 WHI results leapt onto front pages across the globe with the simple horror story, “ESTROGEN WILL KILL YOU: HERE’S HOW!”, the later corrective studies were complicated to explain: “Estrogen might kill you if you take it as an unhealthy elderly lady, but it’ll probably help you if you take it just after hitting menopause when your arteries aren’t sludged up like a drainage ditch after a mudslide.”
The corrective story’s lack of media “legs” has left women and their doctors trapped in scientific 2002 for two-plus decades—and continues to do so. Back in 2002, in the wake of the deceptive WHI announcement, a sucking riptide of mass panic over hormone therapy blew around the globe—and not just among women. Doctors, understandably, were petrified at the prospect of harming their patients with hormone therapy and being hit with huge malpractice suits.
Newly-menopausal healthy women whom the announced risks did not apply to were frightened into believing they couldn’t do anything stupider than start hormone therapy. Women who had previously been helped by hormone therapy abruptly stopped using it—of their own volition or because their doctors flat-out refused to continue prescribing it.
YOUR EMPOWER TRIP STARTS HERE
My goal in writing this book is to help all women have access to the evidence- based care I fought for and eventually got: the safe, symptom-quashing, health-protecting treatment that every woman deserves.
Not all women will want to take hormones, and the book tells you the most powerful and efficient ways to maintain your health into old age without drugs.
Ultimately, in laying out the science in everyday language, I empower you with knowledge—real understanding—so instead of simply crossing your fingers and hoping for evidence-based care, you’re armed with the information to ask for it.
AMx
Adding this book to my "must read now" pile!
Thank you for continuing to shed lift and masses of information this subject