A landmark study based on data from the largest ever survey of menopausal and peri-menopausal women in the UK stated that for 46% of women who took HRT their symptoms haven’t been resolved.[1]
So, why is that? Maybe the exogenous hormones in the form of HRT didn’t work since the symptoms they were supposed to cure were not a direct result of menopause? There are, of course, other possibilities such as an incorrect dosage, the application or timing. Still 46% is quite a big number.
In a way I fear we are trapped in a never-ending cycle of karma like in the 1899 Netflix series with the main characters being trapped in the computer game ALWAYS ending up in the same place. I’m obviously talking here about the return of the narrative that heavily influenced women’s health from the 1966 book Feminine Forever by Robert A. Wilson. He was a gynaecologist heavily paid by Big Pharma to brainwash women into believing that menopause is not only a deficiency but a disease and therefore without (buying) estrogen we’re going to end up shrivelled up and die prematurely and bitter.
And yet… AND YET! This narrative is back. That’s almost 60 years later! Have we not learned anything since then?
Well, looking at the study done by Professor Joyce Harper for the UCL EGA Institute of Women’s Health in May 2021 – I don’t think so. It revealed that more than 90% of postmenopausal women were never taught about the menopause at school and over 60% only started looking for information about it once their symptoms had started.[2] Coupled with the onslaught of conflicting information, most of which these days is acquired via social media, where bold statements and overdramatisation prevail - are we surprised?
Perimenopause is for a lot of us the busiest time of our lives with bringing up children, often looking after elderly parents, promotions or career changes, on top of everything else that modern womanhood requires us to be. And then our bodies start to fail us with a plenitude of symptoms never felt before. Just think about it, on top of all the things that I just mentioned, do we even have the time to educate ourselves by then? I doubt it.
So, when you hear from some sources cataloguing a list of 50 symptoms directly linked to menopause,
then surely, HRT must be the solution to it. One pill or patch and all the symptoms will go away: ‘Pow!’ Magic.
Sounds too good to be true? Well, it is.
So, really, the issue here is that we assign way too many symptoms to menopause when there are only a handful that are a direct cause of it.
A lot of other symptoms are a the result of some previously unresolved issues combined with menopause.
Different phases of perimenopausal transition into menopause might have slightly different symptoms. Without delving into it for now, let’s just make it clear what the symptoms are that are directly linked to menopause transition:
Menstrual changes
Vasomotor symptoms (hot flashes & night sweats)
Vaginal symptoms[3]
Meaning - these are the symptoms for which HRT might be the most efficacious for.
However, as mentioned at the very beginning of this blog, there are a lot of symptoms that are exacerbated by menopause and not specific to it. They are often multifactoral, linked with lifestyle and other medical problems.
These are:
Fatigue
Sleep disturbances
Cognitive changes (e.g., ‘brain fog’)
Overwhelm / anxiety / heart palpitations
Joint aches
Weight gain
Let’s have a look at a symptom that is often attributed directly to perimenopause: such as hair loss.
§ If you have heavy periods and are losing a lot of blood, you’re more likely to have iron deficiency and this can cause hair loss.
§ If your thyroid condition is flaring up, that could cause hair loss.
§ If you’ve been tending towards PCOS and elevated androgen levels - that can flare up more during perimenopause (because we’re losing progesterone and progesterone has anti-androgen properties) so this could cause that male-pattern hair loss.
§ Inflammation hyper-sensitises hair follicles to androgens, which is why chronic inflammation can cause androgen hypersensitivity or androgenetic alopecia. If you have gut problems or a food sensitivity such as to wheat or dairy, then addressing[4] that underlying problem is a must.
So, once again, it is often really a combination of an existing condition and perimenopause, not perimenopause in itself.
Therefore, before we jump to the conclusion that HRT is going to fix all the problems, let’s be honest with ourselves – is there anything in our life that needs attention? I get it, we are not always able to be as healthy as we would like to be due to time/financial/physical constraints. But if there are any ongoing health issues that have been dragging on and on, they’re more likely to intensify or, like Ann Marie McQueen from the Hotflash inc[5] talks about her untreated gut issues, they explode in perimenopause!
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