Episode 9: Menopause and hormone therapy – Myths, facts and choices
In this episode, we’re exploring a topic that sparks a lot of curiosity and confusion – Menopausal Hormone Therapy (MHT), formerly known as Hormone Replacement Therapy (HRT).
If you’ve ever wondered whether it’s the right option for you, this conversation will help you cut through the noise.
Dr Peta Wright, Dr Thea Bowler, and Sam Lindsay-German dive into the history and evolution of hormone treatments, from early synthetic versions to today’s more advanced bioidentical options.
They explain what these terms really mean, how the treatments work, and the potential benefits and risks associated with them.
Along with breaking down the science, they also provide thoughtful advice on navigating the overwhelming amount of information out there, so you can feel empowered to make choices that align with your body and lifestyle.
🎧 Tune in now to hear…
🌿 The fascinating history of menopause treatments: Discover how menopause was viewed in different cultures, why synthetic hormones were first developed, and how we’ve progressed to the more personalised hormone therapy options available today.
🌿 The difference between bioidentical and synthetic hormones: Understand the science behind these treatments and why bioidentical hormones are now considered a safer and more effective option for many women.
🌿 How to make the best choice for your body: Dr Peta and Dr Thea explain why hormone therapy isn’t a one-size-fits-all solution, and how you can work with your doctor to find a treatment plan that’s tailored to your unique needs.
🌿 A fresh perspective on menopause: Far from being a “decline,” menopause can be an empowering stage of life. This episode helps you rethink the societal narratives around menopause, offering practical advice on how to manage symptoms and embrace this new chapter.
Whether you’re curious about hormone therapy, already on MHT, or exploring natural ways to support your health during menopause, this episode offers thoughtful, evidence-based insights from experienced gynaecologists who are passionate about helping women feel confident in their choices.
And we would love to hear from you.
If you have any questions about MHT or menopause that you’d like us to answer on a future episode of the podcast, please email them to hello@verawellness.com.au or contact us on Instagram @verawellness.com.au.
Resources mentioned in this episode:
Episode 7 of Women of the Well – Demystifying perimenopause and menopause.
Feminine Forever by Robert Wilson – A highly controversial book that played a big role in popularising early hormone treatments for menopause.
The XX Brain by Dr. Lisa Mosconi – A great resource on the neuroendocrine changes that occur during menopause.
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Episode transcript:
Ep 9: Menopausal Hormone Therapy Explained
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Welcome [00:01:00] to another wonderful episode of Women of the Well. We are today going to be talking about HRT. The terminology is now menopausal hormone therapy. Oh, thank you. So we're going to be talking about that. And we're going to hopefully be able to, in this episode, answer some of those questions that you've wanted to ask, but feel very unable to ask anyone and get any clear answers or perhaps questions that you actually just don't even know where to ask into which field you can ask those actual questions.
And then the third thing is in and amongst all the confusion that I find on social media, how do you actually know what is true and where there is evidence to back it up? And I should say that it would be worth listening to your previous podcast about demystifying metaphors, talking about. what menopause is, what the physiology of it is, and I guess what mental and spiritual approach to it might look like.
[00:02:00] Yeah. So, as we begin, I would love for you both to first of all, just explain how HRT or MHRT or whatever it's called now. Sorry, I will get that. I'm never very good at getting these things. So how it actually first came about, why it came about and who came up with the concept. I think historically and culturally in lots of societies around the world, particularly indigenous cultures, menopause hasn't really been a thing.
Symptomatically, not particularly problematic for people and on a spiritual level, um, to be aging and to be coming into your elderly years was seen as gaining wisdom, becoming the tribal elder. You know, people had reverence for that transition of midlife into adulthood. Um, older age, like that native [00:03:00] American proverb that I love, which is at a woman's first period.
She meets her power in her reproductive years. She practices her power and it menopause. She becomes her power. And I love that. And it's like, um, yeah, especially in that culture, women who were menopausal had reached that age, were really revered and respected. And I think some of the problems with menopausal symptoms probably came later with capitalism, workforce, also the Western ideals of beauty.
Definitely. And the youth obsession. Yes. The value of fertility, beauty and youth above all else. And the. In a patriarchal society. Yes. And the really inherent fear that we have of aging because it signifies it. Because in a patriarchal society, if you're not beautiful, young, fertile as a woman, what is your value?
That's [00:04:00] right. So. It was earlier in the 19th century, or the 1900s, I'm really bad at knowing centuries, but in the 1900s, where Freud had a lot to say about menopause, noticing that women became more argumentative, um, less easy to deal with in their years post midlife . They didn't slot into the patriarchy in quite the, No, that's right.
Right. They rebel. Yes. How awesome. And then a man called Robert Wilson wrote a book called Feminine Forever, which I think was in the 1940s, which again elaborated on Freud's ideas that essentially menopause was the end of a woman's life. She entered a period of decay and decline after that. She became uninterested in sex.
She became argumentative and that really the only way of, remaining relevant and youthful was to take estrogen. And around that time, [00:05:00] the synthetic estrogen was developed that was taken from the urine of pregnant horses, pregnant mares. That was used up until like the 2000s. Very recently. Yeah. Yeah.
Yeah. And it was really marketed on the back of Robert Wilson's book as, you know, something that helped women to retain their femininity and their youthfulness, but also their health, you know, it was marketed as, you know, this will prevent. Long term diseases. And also some of the, in the context of those societies, uh, and you know, how we know how hormones affect the brain, potentially depression, anxiety, mental health issues that might come up at that point.
And so it was. So this was all, um, we had to think about it in terms of, you said the 1940s, so this is post war. Yeah. I'm just sort of just thinking about what was happening in the world at that time or certainly. Yeah. Yeah. In this is America, um, [00:06:00] just thinking about how women would have been so involved in helping with the war and doing things behind the scenes and actually having purpose.
To then, once we made that shift, um, that would have been a big change and I'm, I'm just, I just suddenly went, Oh, this is great. A light bulb was going off for me too, because that was the same time. Yeah. When the men came back, then the women, then those jobs out of the home were back in the hands of the men.
Because the women went back into the home and that's when they developed all of the appliances. Remember that? That was like when they started marketing all the appliances to be like, so make doing the washing easier. This will, this wonderful vacuum will clean your floors. Like trying to keep. Women at home, and this was at the same time.
It was also the time when Valium prescriptions went up for all the housewives. Yes. Like, it's interesting, isn't it? A way of subduing, somewhat. Subduing. Yes. And so then, for many years, sort of 50s, [00:07:00] 60s, 70s, What was the W. H. I. study? Well, firstly, they get, used to give dust to oestrogen, which was problematic because you need progesterone as well to protect the lining of the uterus, so they discovered like in the, maybe the 60s or something, 50s or 60s, I can't remember, that lots of women were getting endometrial uterine cancer because they were all on, unopposed estrogen therapy.
And then someone figured out that, um, we needed to give progesterone back as well. But so synthetic progestin was added. And then the thought was that it was good for osteoporosis or bone protection, helped with symptoms and also cardiovascular disease. There's a huge big study in the 90s that a lot of people will know called the WHI study.
Where they had three groups of women, some on placebo, one on just oestrogen alone. And they were women who'd had a hysterectomy before, so they didn't need the progesterone. And then another group who had oestrogen and progestin. And it was going on for a really long [00:08:00] time. And then all of a sudden, The results were sort of leaked and then the study, the investigators had to sort of make a statement before anyone had really analyzed the data properly.
And they found that in the women who took the estrogen plus progestin, there was an extra eight per dose. Yeah. 1, 000 women who had developed breast cancer. They also found that in the oestrogen alone arm, there was less breast cancers than the placebo group even, but that wasn't publicized at that point, it was, it was just almost overnight on the front page of every single newspaper without even any clinicians having the data or the study.
It everywhere saying everyone has to go off their HRT because there's this increased risk of breast cancer. So women were terrified. Clinicians didn't know what to do. Um, they all went off HRT. And then for probably like 10 years or more, people were afraid of prescribing HRT. And even then, as the data began to be analyzed and the [00:09:00] real Um, truth of that study came to light, the damage had been done in the public psyche.
That's right. I think like, in addition to breast cancer, the things that were reported, the adverse effects of HRT or MHT that were reported from that study were, um, increase in cardiovascular disease and an increase in clotting and strokes. And like you say, when they actually delved into the data. What they found was that for women who used HRT, used MHT within 10 years of their last menstrual period, um, in fact, none of those risks really applied.
And if even using the combination, estrogen, progestin, if it was used for less than five years, there was no increase in breast cancer risk. So actually for women using MHT, the old synthetic form of MHT within 10 years of their last menstrual period and for less than five years, there were no increase.
And the whole group of women, there was large amounts of women who were in their 60s, [00:10:00] 70s, women who didn't even have any symptoms. So you weren't trying to treat any symptoms or help to improve their quality of life. So the benefit is not going to be there. And they often already had comorbidities, like they were smokers, they were obese, they had heart disease already.
Um, so it was a really skewed population. It's not the population of women that we would be talking about helping who have troublesome perimenopausal symptoms today. So it was just, yes, a complete shambles and really, um, badly. Reported. And managed. Yeah. Yeah. And that was, I was going to say, so it's really that the women that were taking it within the bracket of 10 years post menopause, they were all fine and it's just if they carried on beyond that time, that, but then that was even thrown out as well because they had those.
Hmm. And also it's not the kind of hormones that we now use as well. Yeah, that's, and yeah, so that's what I was going to ask, but going back to the guy that first came up with it. It was the same HRT. Did something else [00:11:00] happen around his study? Well, Robert Wilson, the man who wrote the book, Feminine Forever, which really advocated hormones for all women to retain their youthfulness and stop their decay, stop their decline and decay, which was really a very, very popular book.
It eventually, became apparent that he was being paid by the pharmaceutical companies who made the hormones to write the book. Have we come much further since then? One of my next questions. I feel like, so, after that WHI study came. And then women went off it and like there probably was a lot of women who had, did have really debilitating symptoms for whom MHT would have been beneficial and they didn't have access to it because of that perception.
Uh, I think now the pendulum has swung, it needed to come back towards the middle, and I think it's now swung back almost to the feminine forever days, I think, [00:12:00] since the 2000s to now, there's been a lot more research on HIT, but still, I think that the promises is. of HRT that we hear about on social media through influences, et cetera, are overblown and overplayed.
And there's not really a comparison to what other things can help women during this time. And there's no sort of, it's very simplistic to be just like, we'll replace the hormones. And also almost it's gotten to the point where, again, it's like, it almost is. Um, very identical, like the concept of menopause being a deficiency and a disease and that in order for a woman to feel well and to function, their hormones must be replaced because it's a hormone deficiency.
And I actually think that is a flawed way of looking at a natural process in our body. And I think that's often where many people are coming from in this current landscape. Yes. Because there are so many vocal people out there who. Paint it that way, that, that hormones have to be [00:13:00] replaced for the remainder of a woman's life.
And I completely reject that. I think, you know, menopause, and you talked about this in your last podcast, like menopause is a transition. It's a transition point in life where we go from ovulating regularly to having no more eggs and that Lisa Mosconi calls it a neuroendocrine transition, which it is.
It's just the changes that occur from the hormonal shifts that impact on our brain, but it's not a permanent state. I would say that it's a permanent shift in the way our brain and our body and our metabolism work into a new state. But I don't, I reject that that is a wrong state or is a disease state.
Absolutely. And sorry, when I say it's a temporary state, I mean the symptoms. The symptoms are temporary. Or it's a lesser state. It's not a lesser state of being. Yes. Uh, which is what we're sold, that we're moving towards a lesser state of living, that we are going to struggle during, we're told we're going to struggle.
It's going to be [00:14:00] awful. It's horrible. Much like we were told that about our periods. So it's just part of that same rhetoric of, yeah, this is what it is, poor you, being a woman rather than, wow, go you. And we should say that like, it's, it's the minority of women who have symptoms that are going You know, really, really problematic.
Some women, probably 20 percent of women have symptoms that are really troublesome and the remainder of women, some symptoms, but they're manageable. So let's, um, let's go back to talking about the actual, um, MHT and what it is now, because One of the things that you were saying earlier was that originally this came from horse urine.
Fascinating. So do we still use horse urine or what do we now use? Which is totally fine, but I'm now, I've got all these questions about are the horses okay? And I mean awful. Anyway, but so what are we using now? And what, So, because I know that we have bioidentical, I [00:15:00] don't know much about this. I would like to know a bit more about the difference between if I came to see someone because I was having symptoms that I really felt needed HRT.
How would I choose between synthetic and bioidentical? And also a few of my friends have traveled to see certain people, um, you know, in certain spaces who can figure them out bioidentical hormones based on their bloods and things like that. And I don't really under, I mean, it sounds amazing, like, Oh, I've got everything checked out and then I've had a special thing written up just for me.
Can you tell me, is that what we should be doing? Is that a, is that, does that work? Is that actually the right thing to do? I think in terms of the type of hormones that are used now, yes, in the older studies, it was a synthetic. Um, estrogen and a synthetic progestin, so not the same molecular structure as our own estradiol and progesterone that we make, um, in the process of ovulation.
And therefore, being a different molecular structure, those [00:16:00] drugs had varying effects within the, within the body. So impacts on heart, blood vessels, brain, um, and those sorts of things. Sorry, are you talking about synthetic? Made in a lab or? They're all made in a lab. It's just that the bioidentical or body identical, it's the same thing.
They are just the exact same molecular structure as the hormones that our ovaries make. Bioidentical estradiol is what our ovaries make and progesterone is what our ovaries make and the other ones are a slightly different structure. They're having different effects in the body. Whereas the body identical hormones that we.
Use now. I was going to say, I also found it interesting that when bioidenticals were a thing before they have, you know, a pharmaceutical company has made them, it was all very much like, oh, you know, we've frowned upon the medical fraternity, was we frowned upon bioidenticals because they're compounded and like, [00:17:00] we're not entirely sure what's in them.
Until the, um, and they were obviously born out of the fact that women and people who know about hormones were like, well, these hormones aren't particularly great for women, produced them. But then when the pharmaceutical companies had a, had developed some that is the same, then that's what we use now because they are shown to be safer.
It's just interesting. It's very interesting. I often think about that now that it's. regulated by the government and the pharmaceutical companies. Yes. But though the body identical, bio identical hormones are the same molecular structure as the hormones that we make, eustradiol and progesterone, and don't cause a lot of the side effects and risks that the older formulations of hormones So no one uses the synthetic anymore?
Some people do. But some doctors would prescribe them if someone prefers a oral tablet, but there are, there are bio identical, body identical versions in both tablet form, [00:18:00] in transdermal form. And I think that if you're considering going on HRT, generally speaking, the bio identical ones are the safest, most effective ways to go.
Yes. There are like, some. individualized circumstances where you might use the older ones, but ultimately, when you're starting someone on hormones, you would typically use transdermal estrogen, which means estrogen delivered through the skin, either in a patch or a gel, and micronized progesterone taken in a capsule.
That's really the safest way of taking hormones. MHT now, because we know that transdermal use has no increased risk of clotting or strokes. And it was the progestin component of the old, uh, menopausal hormone therapy that increased the risk of breast cancer. And what we know about a micronized progesterone is that it doesn't do that.
It's probably neutral or slightly beneficial in terms of breast cancer risk. Mm. What were the other questions? I was asking about where, you know, when you. The sort of clinics that [00:19:00] provide you with this, um, go and get everything checked and then you get something that's drawn up for your body. Is that the right way to do it?
Because some people go to, I've got friends who go to the doctor and then I've got friends who go and see these, I don't know really what they are, but I'm going to say sort of specialists. I don't know in what field they are. Some of them might even be, um, slightly holistic and alternative. So if you just talk to me about how you, how do you figure out what to take and is it guessing or is it scientific formula?
You know, what, what do you do? I think that. It has to be really individualized because someone who comes when their periods have completely stopped is different to someone who is say 45 and they're still getting their cycle, so they still have their natural cycle and it's in that kind of erratic phase where there might be some months where there's high oestrogen and other months where there's low oestrogen and overall generally lower progesterone because that's a very different situation to deal with than someone who has not got a cycle anymore.
Someone who has not [00:20:00] got a cycle anymore, there's kind of like no magic, like bespoke treatment. It's whatever suits them and their symptoms because to test their hormones, they don't have those hormones to test at that time. They're low, right? So after you've gone through that, you've had your final period 12 months ago, your estrogen, your progesterone levels are low.
So I would say for those people, It's very safe to be just using standard bioidentical therapy, mostly in continuous. I know there are some physicians, like there's an American integrative gynecologist who sort of talks about replacing hormones in a more physiological way, where they're still getting a cycle or they're not getting a cycle because they don't have a cycle, but it mimics that cycle.
So they're having estrogen all the time and progesterone for the last two weeks. And then of course that will bring a bleed on. Most women don't wanna do that, that, so most women, after they've finished having periods, are on continuous HRT, so it's some estrogen and some progesterone. So then they would [00:21:00] have no fluctuation.
They would just basically be at a level and that would maintain them at that level through a whole 28 day cycle. Yeah, because they won't have a cycle. So it's like being, I'm changing, it's like a little bit like the pill. in terms of those flat hormone levels, but they're much smaller doses of hormone.
So if you were the person who was 45 and you're having that erratic cycle, it depends a little bit on what you're trying to achieve. So if they, if they aren't that worried about heavy periods and they don't really want to stop their cycle, you might use again, say they didn't have any, it has to be really guided by the symptoms.
So say if they didn't have low estrogen symptoms, which would be like hot flushes, brain fog, muscle aches and pains, potentially mood, and they were just having heavier periods and maybe some sleeplessness or anxiety, sometimes just using progesterone for those women might be good. Other times, if they do have some of those lower estrogen symptoms, adding some estrogen in can be good too.
I think that when we have times where we do have higher estrogen, [00:22:00] sometimes, Simplistically, people think if we add estrogen to them, we just make a person's estrogen go up higher. But the way the brain and the ovary work is that when the ovary is making low amounts of estrogen, the brain is pushing. So it's really trying to get the last bit of estrogen of oestrogen out. So if you do have high oestrogen, the brain's signal to the ovaries actually goes down, right? So if you add a little bit of oestrogen in someone who does have those fluctuating, you actually probably will lower the overall effects. So it's not like you're just adding on top of the oestrogen, so it can help to prevent that.
Yeah. Even out of that fluctuation. It helps it to level out. Yeah. Yeah. So. And also provides almost like a little buffer. Yeah. So that the highs aren't as high and the lows aren't as low. Exactly. But also in that scenario, doing blood tests in that scenario, also. pretty unhelpful. And I think women feel like the more tests we have and the more complicated and the more expensive the tests are and the more number of supplements, that's got to be better.
But basically, because if you think about [00:23:00] our ovaries are like sputtering along at that time, right? So again, some months they are getting that signal from the brain, which is saying, for God's sake, make the estrogen, right? And then the brain is like, okay, fine. And it just does like a big spurt. And so you have a high level.
And in those months, you might have, if I did a blood test, you might have a high level of estrogen and you might have more breast tenderness. You might have heavier periods and more bloating and things like that. And if I did a blood test at that cycle, and then I'd say, oh, you've got estrogen dominance.
Then in the next cycle, because you're ovaries are like, I'm tired from having to do that. Cause you shouted at me last month and now I've got nothing to give. Your estrogen could be low. So where you're taking the blood test from kind of has a point in time and it isn't really relevant over a long period of time and then prescribing a treatment that is supposedly bespoke for that basically one point in time doesn't make any sense.
It doesn't make any sense and it really overcomplicates the whole entire thing. Yeah, that was [00:24:00] exactly what I, in my brain, I was like, this must be the case because it's much the same when we have blood tests there at the pin point of a moment. Sometimes they're going to show a bigger picture, but you know, we, Yeah, we change.
And so yeah, if you're relying on that for that's going to change and that's very confusing because I Feel personally there was a stage when I was probably around 45 where I actually felt I should go and get my hormones tested I didn't really know why but everyone was getting their hormones tested and I felt like I should see what my levels were And, you know, I'm just saying this because I felt like that's what I should be doing.
But it's the zeitgeist because everything that is a problem or you're finding is difficult, it's got to be the hormones. That's what it is. I had a lady, as an aside, who came to see me today and one of her problems was, I think I have a hormonal imbalance, who was on the pill and even worse, okay, she'd just been to an integrative doctor.
Who had tested her hormones whilst on the pill. Okay, and the pill [00:25:00] obviously turns off your hormones. And then told her she was estrogen dominant. Because she was being given the pill. Anyway, but I don't know how they would have tested for that. Because her hormones would have been incredibly low. Because they're shutting her hormones.
So just to clarify what you're saying there is that. You can't be tested for your hormones when you're on the oral contraceptive? Because your hormones are turned off? Yes. And if you're in that perimenopausal flux, the only blood test that would be vague was two times where it might be helpful. One, if you had a blood test on like day two and it showed that you had a slightly high FSH, which just shows, yeah, your brain is like telling you lazy ovaries to try and make more hystrogen.
And yes, you're probably in that phase. Transition, but you probably don't really need you know that you're in the transition because you feel that you're in the transition. And then the only other time that sometimes for some people can be helpful is if they're having heavy periods and they might want to know am I ovulating still and like doing like a test in their luteal phase of their progesterone, but it has to be timed with when that is.[00:26:00]
So again, not amazingly helpful as an overall rule. No. And certainly like titrating a dose of hormones to be specific for one particular blood test is not helpful.
It can change over the course of the time because symptoms can change throughout that transition. That's right. And the amount of oestrogen that you make eventually ends, so that will become, becoming lower over time.
And so one of the things I was just thinking was, the only time that I've, this is quite personal, but I don't really mind sharing it. The only time I've tried anything like this was when I tried something to help with vagina dryness, because I was like, I don't know what to do. And I generally use natural things, which actually I've now gone back to, but I did try it because I spoke to you guys and you were saying it's, it's okay to try. So I gave that a go, but that's different to MHT or is it the same as MHT? Yeah. So the vaginal estrogen, and we should say that like genitourinary symptoms of [00:27:00] menopause are probably the most common symptoms.
And that's vaginal dryness, often a little bit of incontinence, pain with sex with vaginal dryness. Less lubrication, yes, and some bladder symptoms. And the estrogen that we use for vaginal symptoms is, a different type of estrogen that's better absorbed by the vaginal tissues.
It really doesn't enter the systemic circulation or the bloodstream to any significant degree. And the reverse is also true, that the estradiol that we give systemically doesn't penetrate the vaginal tissues very well, which is why sometimes if people are on hormone replacement therapy, they might be on both.
And it's a really safe form of, and it can really make a big difference to probably 90 percent of women who are struggling with that and where other things haven't worked. Absolutely. And even women who've had breast cancer are totally fine to be on it as well. I think just overall symptoms are the most important thing.
Blood tests don't really matter. And you know, that might be a woman who's in [00:28:00] for early 40s who's having symptoms, who, you know, might want to look at treatment. As well as a 54 year old woman who might be having symptoms who might be wanting to look for treatment. And really the blood tests for both of those women are irrelevant if they're really struggling with symptoms.
Okay. So one of the questions I came to Thea with, um, a while ago, it was probably a couple of months, it was quite a while ago now actually, um, was at the end of yoga one day. I said, I just need to talk to you. It wasn't a big, it was a big conversation you didn't have very long. And I said, I'm totally overwhelmed.
I feel like I know as much as I could possibly know about menopause. I feel like I understand how to look after myself holistically. I feel like I'm okay, but I really wonder if I should be on HRT because everything keeps telling me that I should be in order to protect myself from, you know, um, getting bad bone density, getting cardiovascular disease, not really going crazy.
And I felt like at the time, maybe my, um, social media feed was just overwhelmed by lots of these, um, people telling me [00:29:00] that, I should be on something to help me because otherwise I was going to struggle with, um, these. These problems later on in life. And I was beginning to think I was doing myself a disservice being, I was, wasn't 50 at the time, being 49 and not actually being on MHT and, and I was genuinely confused and I'm now not confused.
I'm now happy because you spoke to me, but I feel like that's a conversation that is important. And I wonder if you could answer to anyone who feels like me, that's just going, I don't know why, but I feel I should be on it. Hmm. Should I? There are, there's lots and lots, as you say, in the media at the moment about hormones, almost like hormones to prevent aging, hormones to prevent disease.
And really, there's not enough evidence to, um, suggest that we should be doing that. So none of the sort of national menopause bodies recommend doing that. Um, hormones or menopausal hormone therapy for primary [00:30:00] prevention, other than for osteoporosis. Yes, for people who have a significant family history or have low bone density.
But really, I think there is, uh, I guess a deeper question, which is the lifestyle factors that actually help to prevent all of those chronic diseases, cardiovascular disease, Alzheimer's disease. Osteoporosis are far more effective. And so, that's simple things like. Doing exercise that you enjoy, perhaps doing a little bit of resistance training, weights training, um, having a diet of whole foods, more on the Mediterranean style of eating, getting enough sleep, limiting stress, you know, having joy, all of those things actually are far more effective at preventing chronic disease than taking a hormone. And I guess we always want to look for the quick fix. We don't always want to reach for the quick, easy thing, but I think no drug, [00:31:00] no hormone is ever as effective in improving wellbeing than doing those lifestyle changes. But some people will say it's not a drug. It's a natural hormone that's in your body That's just being replaced because it's a deficiency.
Yeah, what do you say to that? Well, I would say that you know There are actually lots of studies to show that doing exercise and doing resistance training Helps to reduce a lot of the symptoms of menopause and that the Hormone shift is a temporary deficiency. The symptoms are a temporary deficiency, which if we can sit in that and make our way through that, whether it's with the support of additional hormonal treatments or not, we will eventually come out the other side and the symptoms will resolve and
overwhelmingly, studies show that women who've come through the menopause transition and are in their post menopausal years feel a greater sense of contentment, feel a greater sense of happiness. [00:32:00] Actually, studies that compare their happiness within themselves to their pre menopausal years, they report being far happier than they were.
When they were younger in their post menopausal years. Is that women who are on HRT or not disclosed? Like we don't know if it was on HRT, off HRT. I don't know. Hmm. Do you know? No, I don't know. No. Yeah, I think these, yeah, that's the sort of question, isn't it, really, to These are studies, I was thinking as you were talking, there are so many studies that I would like to see, and we know that there aren't many studies done on things like this, so we can always ask for them.
But I was thinking it would be so interesting to do a study on those women that didn't take when, um, in the, you know, after the, what came out in the 90s, to see how they progressed. I was just having, my mind was going to these places of, this is where we need to get the studies on. Women that have been through menopause, some who've been on HRT and some who haven't, and looking at where they are now in their 80s.
And, [00:33:00] and looking at how they feel, looking at how their mood is, and looking at how their health is then. And I feel like there's still limited studies being done that are going to give us those answers. So we're still certainly, I feel me as a 50 year old, I'm still just hoping and praying that I'm doing the right thing, which I feel like I am.
Because like you're saying, I believe many, many women have gone through this natural transition where their hormones have changed because they are no longer bearing children. And those women have gone on to live. To be a hundredth, some of them, but also you have been in a position where you have cultivated a life where you're authentic and you're doing what you want to do and you prioritize looking after yourself.
And I think a lot of women find themselves at this point in their lives, not in A position or not feeling like they're in a position to do that. They're not supported by [00:34:00] society, their community. They're stuck in the energy of go, go, go, go, go, go, go, go, which makes it, if they need to continue in that energy, um, it's almost like they feel they can't have a change in their hormones because they need to continue the physiology to be what it has been in order for them to keep achieving that.
So we're talking about. You know, in order for women to maintain productivity through this stage of life, we may need to medicate ourselves. I think, I feel like we're at a point in society where like people will say, well, the thing is it was all very well and good for people. You know, 200 years ago, because when you were 50, you weren't at the head of the corporation and you didn't have the demands and you, you know, you were able to like, be the wise woman and live on your own clock and all of that sort of stuff.
And now women are definitely not in that position. They might have had children later, they've still got all of the responsibilities and the [00:35:00] burdens of family rearing, as well as their careers and all of the pressures of our modern life. I do think that we can't, so I understand where people say, well, in order for me to keep that up, I will go crazy if I'm having these symptoms and don't have help.
And so I think, fully think anyone who has symptoms that wants to be helped, that, that agent is fantastic, not risky. Definitely good. But I also think it's an opportunity for us to look at, okay, is this the way we want to keep going? And maybe making some changes in our lives in the broader context of our own lives and in the context of society would actually reduce, and I think it would reduce a lot of the symptoms and the angst that women are feeling at this point in time.
Absolutely. And I think like we are in a very privileged state in a way in that we have choice, you know? Right. And if. Somebody wants to take the hormones and keep working, you know, 10 hour days, five days a week, [00:36:00] they can. But, and that's completely fine, like any, any option that any woman chooses is completely fine.
The menopause, I think, provides a tap on the shoulder to go a bit deeper and to think what in my life is not fulfilling me, where am I not aligned and what changes do I need to make to move into the next part of my life. In a way that will make me happy. I was reading something that the red school put out and I can't say exactly as well as, but it made me think about it just now.
It's like, it's the ultimate report card for your health at this stage. So we could say, I was thinking, would it be the high school report card? No, maybe it would be the end of university. You get this report card saying, how did you go at uni, you know, reach 50. And, um, And then you get a choice, you know, uh, actually I have to go back and do it all again.
Or, um, because, you know, you haven't actually learned what you needed to learn, or you actually get take a really big stock of life and go, okay, this is not where I want to go. I [00:37:00] actually chose the wrong degree, you know, I was just thinking that's it. It's a bit like the kicking the can down the road of like when you're in 13 or 14 and might be having some period problems or the ups and downs and the yes, the pill can be really helpful, but we have to think about more than just like.
skipping the stage because eventually, um, we, and, and even if you're someone who chooses to remain on hormones and that's helped you and you want to stay on them forever until you die, which is totally an option completely. And, but I think that, that deeper like opportunity that we were saying menopause may present.
That spiritual growth will be still tapping on your door, on your, like regardless of what's happening with symptoms, and this is just this huge opportunity to get clear on what you want for the rest of your life. But also I think it just makes me so sad to think that it is a concept that it's just so alien to so many women because they don't have time to have their [00:38:00] mm-Hmm.
not midlife crisis, but no, they have time or space to have that awakening because. They have to keep going and like we were talking before about, it's really good that there's this awareness about women's symptoms and women's experiences and helping them to navigate and journey through this time, uh, and that there are all of these options, but it's almost so simplistic when we think about, you know, the workforce and we, this is the quote, the statistic about what percentage of women leave the workforce because of menopause, um, and You really, how many of those women were just like, I'm sick to death of having to do this job that I've headed for the last 10 years, grinding, constantly grinding, and this is their actual up level.
And like, we have to really be conscious about who it is we're serving when we. I'm not given the opportunity to become troublesome. That's right. To disrupt. Because this is the, the, like one of the huge values [00:39:00] of women at this time, our potential to see things as they are and say, no, this is wrong. And maybe disrupt, cause some trouble.
And of course the powers that be don't want that to happen, but I think we have to always remember who, who are we serving when we're not being able to tap into that. Absolutely. Also, is that not exactly the same as what happens to teenage girls? Yes. So I was, as you were saying that I was thinking. We, and I know we talk about this, but it's exactly the same.
We're going through another shift period, much the same as when we started this whole process with puberty. And now we're going through this next shift cycle, um, at the end of our mothering journey, um, for those of us that had children or mothering just in terms of who we are as a woman going through those years of life.
And it's so interesting because I think one of the things is that you were saying that was about. You know, not being able to do all these things for everyone. And this is the point that the the decline in estrogen means we come back to thinking about [00:40:00] ourselves And that is actually what it's designed to do It's designed for us to actually suddenly not need to be So needed by everyone or have to feel that we should serve everyone and stay home bound, but that now we can actually go and find ourselves.
Yes. And the big thing is like, you know, yes. Um, although like menopausal hormone therapy is still off label for treatment of mood issues, it does work. It does help a lot for, um, you know, Anxiety, depression, brain fog, energy does help because we know about those serotonin receptors. But we were saying like, if you do arrive at this time and you are angry or irritable or enraged at the injustices of the world, how much you have to do, the fact that you haven't thought about yourself for 25 years, or that you've secretly never loved your job and you've just been churning out.
Or you've never loved your husband. Or you've never loved your husband. Then that anger is valuable. And I think [00:41:00] that, yes, I'm very happy to write a prescription for oestrogen, but I will also probe about like, feel your anger. What is it trying to tell you? What desires? beneath it because that anger is there for a reason and it isn't like an inbuilt part of the disease of menopause it is like part of the power of menopause and part of the power of that perimenopause transition to go there.
Absolutely because without that anger we can't take You know, we're not going to take action. We're going to stay exactly as we were, and if we want to stay exactly as we were, that's totally fine. But I think we need to be cautious about perhaps medicating it away when actually it might serve a purpose.
And the other thing I always think is like, yes, the, the hormonal symptoms are one aspect of a person's life, but in fact, just treating a lot of the hormonal symptoms doesn't take away that extreme stress. That feeling of being unfulfilled, it might mean you can cope with those feelings now. [00:42:00] Wouldn't it be far better to address those feelings and make a change that means you can go forward in the life that you want to be living?
And I was going to say, yeah, I agree a hundred percent. And also, You know, if we leave anger unresolved, we leave all those other, those symptoms could very well result in a dis ease in the body where the body actually has to respond to that. And there's, um, maybe in a different episode, we can talk about, um, some of what Gabor Marte has discussed with those, um, diseases that come about from, you know, suppressed anger and how that shows up in the body, because I feel this is what isn't talked about.
But I did wonder as I was listening to you that one of the things that made me pause for a moment was sometimes maybe a woman might need the HRT to take a little bit of a pause and be able to be able to cope better with what she's going through to then make the change. 100%. Much the [00:43:00] same as we do if we sometimes need antidepressants.
We just need to have that. Yeah. Sometimes that, that place. Yeah. And sometimes it can, it can give them that foothold, that clarity to actually not feel completely overwhelmed and to be able to see. the steps that they need to take to make, to make changes. Plus I also think like we've come from women's experiences like going through menopause kind of very shamefully and behind the scenes and not being able to talk about what they're feeling and not really having any options for treatment to now we talk about it.
We have all these options for treatment, but almost to take away the symptoms. But I think there's also a third option where we're in a society where we acknowledge this time in a woman's life and allow and provide space and support for her to heal. Go through whatever it is she needs to go through with or without hormones, but like to be like [00:44:00] saying, I'm feeling rageful because of this.
I have to take a weekend away in a gypsy caravan to like, not, not see anyone. I'm going to go do some crazy things to explore this. I'm going to go on an ayahuasca, whatever it is like, right. And actually support that awakening of women. What an incredible society that would be, be rather than just, let's like, Talk about the horrible, horrible, horrible symptoms and then how we can like medicate it, but actually make space for it all.
Absolutely. The whole experience. Which goes for the menstrual cycle as well. You know, it goes for all of these transitions that we have. But it's just like it's a painful, it can be, it's a binary. Yes, but it's, but society is like it's a painful inconvenience that interferes with the status quo of capitalist patriarchy.
Hence, we will talk about it, but we'll just, Like, stop it. We'll stop it. But it's almost like, you know, yes, it's inconvenient for women to go through menopause. So let's make everyone be so fearful of it that everyone wants to take the hormones. I think as well, what I found fascinating was, um, just speaking to a few of my friends [00:45:00] similar age, is they Even though there's all this stuff in social media and in the news and in other places, they're still not actually talking to each other about it.
They actually, someone said to me, I just, you know, actually I was surprised to talk to some other people in here that they were feeling similar things. It's still, yes, it is out there, but women are still Shameful of actually saying what they're actually feeling like I'm enraged or I'm not happy in my work or I don't have as much energy or, you know, because we have been taught in our society and in our culture to keep performing and to put on a brave face and to walk out of our door with a full face of makeup and present as if everything is okay.
And there's a lot of undoing that needs to happen for us to come back. And I've just, I just feel that, yeah, we could be on the edge of breakthroughs, but equally, we could still have quite a long way to go because it's a lot to be able to [00:46:00] say, I'm not coping publicly rather than actually. Making it to be, I'm going to, I'm doing okay.
I'm all right, which is what we tend to do. I'm okay. I'm fine. Cause it's always like that vision of the CEO or the woman in the boardroom having a hot flash and then saying how it was so debilitating and how it's humiliating and whatever, and having to then, like, And these students to save you. And yes, it totally can be, but also it could be like, goodness, I'm having a really hot flush and taking off my outer layers.
I'm getting a fan. I'm getting someone, please, someone of my lackeys, get me some water and let me, and put it on my, you know, like there's other ways we can experience it where we're like, okay, I'm arriving. Every woman, like you always talk about the red school year long menopause What if every woman got three months off?
Yeah. Well, this is what the government needs to do as part of like, uh, maternity leave and menstrual leave. I mean, not menstrual leave, menopause. The menopause sabbatical. One of the things I just wanted to [00:47:00] just bring up, because I think it is important and I can hear that the way we're talking, we are all talking from a place of huge privilege that we can have these conversations, that we could potentially be in a boardroom saying, go and get me this, do you know what I mean?
But what about, I was wondering, you Is M. H. T. available to everyone? Does it cost a lot of money? Are there a demographic of women or people who could be getting this who aren't? And yeah, because this is the thing. It's kind of like, is this a woman of privilege? A white privileged woman's, Medication? It isn't cheap.
Okay. And I think that for a lot of people it is unaffordable. Yeah, I think that it should be made, you know, it's, it should be made more affordable for everyone to be able to access, because. When the symptoms are debilitating and you're not in a position to change anything [00:48:00] about your life. Like yeah, we live in a world just that's women and we talk about this stuff all day long.
But it definitely needs to be made available and affordable for women who need it at any walk of life. And hopefully, I think one of the good things about the awareness Is that GPs are now increasingly, I think, becoming better and more capable of prescribing HRT so that you're not having to go and see a specialist or wait for ages.
And there is actually a menopause, public menopause clinic, either opening or just opened in Sydney as well in Australia. So I don't know if that will happen in other places here, but it should be something that most GPs, women's health GPs should be able to help with. Yeah. Yeah. Sometimes. Much the same with, um, all medication.
We have this sort of idea that we can just go and get it, but maybe some people can't. Maybe they haven't even thought about the option of getting it. So again, this is where I think about those studies that happen. Who are the women in the studies? Where are they [00:49:00] coming from? What is happening in some of the other, um, areas of our country, of our world?
And could there be more studies done? on that wider population in all, of all aspects, which I know is maybe not going to happen, but I just feel like this is the thing where we always seem to have such narrow viewpoint. So yeah, that, that's, that's going to take a while, isn't it? Yeah. And also the context, I think you have to think about the context.
If anybody does have specific. specific questions, I think we should do a questions episode. So I think what we might do is get you all to write your questions into us at Vera. So it's um, hello at verawellness. com. au. Any questions relating to menopause, HRT, we'll do an episode on that and then we'll do another.
Bye. view for specific things and we're going to do one next week on holistic management of menopause because we talk about HIT being something that sometimes can be inaccessible and unaffordable. I [00:50:00] think sometimes the lifestyle changes as well, not because of the cost of them, but because of the time and space required to deal with it.
Make those changes, think just talking about how you can start to make changes is empowering and helpful. Yeah. And the other thing I was going to say is one of the biggest things that we can take away from this conversation as myself and other women who are listening, who are not doctors is choose who you go and see, we talk about this in many of the episodes in my, you know, Um, my point of view is really go and see a woman, um, and maybe a woman who you can resonate with, who can actually sit down and listen to you and does ask questions as well as about what your hot flushes are or what your other symptoms are and like, are you angry?
You may, if you come to us, you might end up throwing bricks at the brick pile and getting beneath your anger and then we'll write you a prescription for it, if that's what you'd like. Yes. So what I'm saying is if you have that [00:51:00] capacity to find a woman who can actually. Be with you and walk that path with you, that is what you need at this time of life.
What we actually need is women who can be, um, our friends on the journey. You know, and I know you're not friends, you're doctors, but what I mean is by that is, you can be there to smile when we just say we're so lost and we don't know what to do, and signpost us to where we need to go. To walk beside you on the journey.
Yes. That's all that being a doctor is anyway. And it's interior actually, because that is what women need. And, and it's very hard to find because we're so rushed through most of our appointments that we just don't really feel seen or heard, which is why we don't get to ask these questions, which is why you should send these questions in and ask Peta and Pia so that you can get honest answers.
So thank you. I just really thank you for what you do. And I'm sitting here as well, almost like, I'm sitting Having a hot flush at that time, sweating myself away, the energy burning away. So it's all part of that, you know, when the heat is rising because you [00:52:00] feel so passionate about things, there's passion moving through you and that's part of it.
So, so yeah, so thank you for being here with us. Just like and subscribe to the podcast if you're enjoying it and share if you know someone who might benefit from this episode and you can Find us on our socials at VeroWellness. com. au. We will talk next week about holistic treatment of menopause with Sam.
Thank you. Thank you.
DISCLAIMER:
This podcast is for information and educational purposes only and is not intended as a substitute for medical advice, diagnosis, or treatment.
