Perimenopause and Menopause: Not Just Science, but Sweat and Stories
Perimenopause and menopause are one chapter in your life journey, not your whole story.
On a Grand Canyon float trip, I learned a new definition of “hot flash.” I spent most of the day in the water, and at night I slept with a wet sarong on top of me — with an extra one stored in my pee bucket, ready for instant use. The beauty of that system was obvious: cool down, then pee, then try to fall back to sleep with the devil’s hot breath blowing on me. That’s the kind of resourcefulness menopause teaches you. And really the hottest trip of my life on the first year of real perimenopausal hot flashes?
Sharing My Real MHT Story
It’s funny, people imagine I’m riding an estrogen wave every day, but really, I’m just deeply curious. I’ve researched MHT to death, I try keep up with new studies and ideas, and this blog even got a tiny assist from AI to help me explain it better to you.
Truth is, I tried it briefly, but I’d get a headache and think, “I’m having a stroke (my younger sis, Janna, actually had a stroke due to estrogen from birth control pills).” Or I’d get belly pain and think, “Fudge (not my real word I swear a lot), I’m going to have a darn gallbladder attack and my husband is out of town and can’t take me to the hospital.” But the longer I take writing this blog, I might end up trying it again for a few years.
What the Science Says
Hot flashes & night sweats: MHT remains the most effective treatment.
Sleep & mood: Often improve when night sweats subside.
Bone health: Estrogen helps protect against bone loss.
Heart & brain health: When started within 10 years of menopause, there’s some evidence for long-term benefits. Waiting on more evidence to say that for sure.
Cancer: Combined estrogen-progestin therapy slightly increases breast cancer risk after ~5 years; estrogen alone may lower risk for those without a uterus.
Stroke & clots: Transdermal estrogen (patches or gels) is safer than oral forms.
Colon cancer: Combined hormone therapy may lower colon cancer risk.
Body composition: While not a weight-loss drug, MHT may help reduce abdominal fat and preserve lean muscle.
Metabolic Health: MHT may improve insulin sensitivity and help preserve lean muscle, supporting a healthy metabolism and body composition.
Libido: It can help, but so many things affect libido- if it doesn’t it is time to talk that through with your provider in an open and matter of fact way!
The Risks
Breast Cancer: There is a slight increase in risk with combined estrogen-progestin therapy after about five years, but estrogen-only therapy may reduce breast cancer risk in people without a uterus. This is about an increase of 4 cases in 1000 people that use MHT for a whole year. Lots of ways to say this statistically and lots of things besides MHT increase breast cancer risk more.
Blood Clots and Stroke: Oral estrogen carries a higher risk; transdermal forms such as patches or gels are safer alternatives!!
Gallbladder Issues: Oral estrogen can increase the risk of gallbladder disease, while transdermal estrogen usually does not.
Urinary Symptoms: Systemic estrogen may worsen stress urinary incontinence, but vaginal estrogen can improve urinary urgency and infections.
Breast growth or pain: This can happen in the first three to six months.
Uterine cancer: Why is progesterone so important? If you have a uterus and have unopposed estrogen, you could get uterus cancer. Some IUDs can prevent this.
My Approach- just one doc approach
As an allopathic MD, I lean into listening, trying, client journaling, and adjusting. I don’t order endless hormone panels unless someone finds them personally useful, because your symptoms and history usually tell us more than a “perfect” lab value. MHT should also be accessible. This journey shouldn’t require a second mortgage or convincing multiple caregivers. MSO does have a lot of amazing people doing this work in all different ways- so see what fits you! (MD, ND, Chiropractor, NP, PA, therapist, hypnosis, coaching, and more)
Starting MHT before age 60 or within 10 years of menopause tends to be safest. My goal is for most people to transition off within 5–10 years. But this isn’t about chasing youth; it’s about improving quality of life now, on your terms.
The Bottom Line
Perimenopause and menopause are one chapter in your life journey, not your whole story. Whether you choose MHT, non-hormonal treatments, or a mix, the real work is listening to yourself. I bet there is more to come about MHT benefits as science catches up with use. Despite the current political landscape, I am hopeful our world will still integrate science and spirit while listening to our patient’s needs.
Peace,
Dr. Joey
PS And when in doubt, remember: a wet sarong, a pee bucket, and a sense of humor can get you through a lot when you have midlife wisdom.
Recommended Podcasts
My new local favorite: I Adore the Hell out of You! https://podcasts.apple.com/us/podcast/i-adore-the-hell-outta-you/id1822874885 big hearts and hugs to these two!! Just laughing with “late young” to “middle-age” women that are wise, funny, and in Missoula.
Recommended Book
The Menopause Manifesto — Dr. Jen Gunter. Science-based guide to menopause myths and facts (especially good if osteoporosis runs in your family).
References
The North American Menopause Society. The 2022 Hormone Therapy Position Statement of The North American Menopause Society. nams-2022-hormone-therapy-position-statement.pdf
National Center for Complementary and Integrative Health. Menopausal Symptoms: In Depth. nccih.nih.gov
