You don’t need to boost your estrogen as you move through perimenopause and menopause.
You really don’t.
If your body needed more estrogen as it concluded your reproductive years, it wouldn’t spend all that time diligently depleting it to the levels found in prepubescent girls.
Side note: have you ever noticed how prepubescent girls don’t experience the symptoms that we attribute to a lack of estrogen?
For decades, doctors, researchers, and the media have been convincing women that come midlife, their bodies start getting it wrong – miscalculating the hormones needed for good health. An influential collection of estrogen pushers has emerged, keeping the dominant estrogen theory alive.
There are doctors who will tell a perimenopausal patient that despite her inner knowing that the time has come for her to quit hormone-based birth control, she should not quit (and perhaps instead, come 50-something, “upgrade” to HRT). These doctors argue that the estrogen (in birth control and then in HRT) will protect her against cancer. This is a myth and a disservice to women. Women should be encouraged to trust their instincts!
Then there are the researchers who following the disastrous results of the Women’s Health Initiative in 2002 (which revealed that post-menopausal women taking estrogen and progestin hormone therapy had an increased risk for breast cancer, heart disease, stroke, blood clots, and urinary incontinence) have been scrambling ever since to declare “safe estrogen windows” for certain age groups and patient profiles. The researchers argue that in these “safe windows” estrogen should be freely prescribed, even though common side effects of replacing estrogen in these "safe windows" still include weight gain, bloating, mood swings, depression, breast tenderness, headaches, digestive problems, nausea and/or vaginal bleeding – nothing that perhaps another medication can't help with, if a woman can't take it in her stride.
There are the health correspondents and media personalities who source their information from medical organizations and associations without questioning what those “objective” bodies with their big-pharma backers might be interested in them reporting.
There are people in the more “alternative-leaning” world who talk about bioidentical hormones, which in many cases are under-researched and still work on the premise that a woman needs to up her estrogen – going against the grain of what hundreds of thousands of years of evolution worked out for us instead.
And then there are women in their 40s and 50s, who in a desperation to find a quick exit from their sweaty and exhausting midlife rollercoaster ride, have swallowed this whole “women naturally malfunction during perimenopause and menopause” narrative and encourage each other to try HRT or bioidentitcal HRT because: “Honey, we're in new terrain! Once women never lived through menopause [another myth]! You just need estrogen!”
If the estrogen theory was reliable (low estrogen always equals symptoms; an estrogen boost always equals the end of symptoms, with no undesirable side-effects) there would be no need for this blog post. But the estrogen theory, just as so many theories throughout history, is unreliable because it is grounded in a confusion between correlation and causation.
A drop in estrogen does not cause perimenopause and menopause symptoms to arise. A drop in estrogen creates the conditions that allow symptoms to arise IF a woman is pushing her life away from her innate well-being, through elevated levels of stress (first and foremost), and other unhealthy life-style choices.
So why not change the conditions that allow the symptoms to arise? Well firstly, as we have seen with over half a century of experimenting with hormone therapies, when you change the body’s brilliantly balanced ecosystem, results are unpredictable and women remain burdened by symptoms and even dangerous side-effects. And secondly, because doesn’t it make sense that if we happen to move away from our innate well-being, we keep in place the naturally occurring warning systems that let us know we need to move back into balance?
Women will only start feeling better at midlife when there is a paradigm shift in the understanding of perimenopause and menopause. This will happen when society as a whole starts understanding the confusion that it created in the relationship between estrogen and perimenopause and menopause symptoms.
What is needed is a change in thinking about midlife women’s health to clear up the confusion between correlation and causation.
As Yuval Noah Harari points out in his fascinating book Sapiens: A Brief History of Humankind, imagining new realities and convincing populations to believe them, lies at the heart of our success as a species. Sometimes the realities we create do not best serve populations but the potential to change that reality remains, always.
Confusions between correlation and causation played out with other theories that were held true for centuries, only to be debunked by a change in thinking about what had, until a certain time, appeared to be true.
Dominant narratives can and do change, and to get inspired as to how this might happen, we need look no further than my garden…and we need to talk a little bit about moths.
Moths? Yes, moths! Stay with me!
In my garden, when a long dry weather spell is followed by one day of rain and then another dry day, as if by magic, small brown moths fill the air.
With some basic knowledge of zoology, I can assume that a dry spell followed by short burst of rain creates the perfect conditions for moths to take flight from their cocoon. A little bit of internet research confirms this to be true. However, if I had lived in the 4th century BCE and was at that time a student of Aristotle (which of course is impossible, since I am a woman and Aristotle said of women that we are inferior and incomplete), I would argue that the moths in my garden were created out of rain and earth. I would point to their sudden appearance as further evidence to back up the theory of spontaneous generation.
Spontaneous generation was a theory that lasted thousands of years based on the belief that certain species, such as moths, flies, and other insects would spontaneously come into being from inanimate matter. Aristotle would be comfortable arguing that dust creates fleas, maggots arise from rotting meat, and caterpillars are born from cabbages.
It’s remarkable that today I would not be able to convince my 10-year old daughter that any creature in our garden arose from the elements rather than from an identical parent organism. All the more remarkable when one considers that Aristotle is still believed to be one of the greatest thinkers of all time.
Indeed, while Aristotle held on to the misunderstanding of spontaneous generation, he was disproving another misunderstanding: that the earth is flat.
Through observations such as travelers going south see southern constellations rise higher above the horizon; and the shadow of the earth on the moon during a lunar eclipse is round, Aristotle was building the case for a spherical earth long before humans successfully navigated the first journey around the earth in the 16th century.
The theory of spontaneous generation only began to crumble in 1668, when Francesco Redi published a set of experiments which demonstrated that maggots arise from the eggs of flies rather than directly from rotting meat. Redi’s experiment involved placing meat in several jars, half of which were left open to the environment, while the other half were covered with gauze.
Around the same time, 17th century naturalist, Maria Sibylla Merian (hey, Aristotle, a woman!) studied, painted and published her observations of creatures such as the silkworm moth, depicting (with exquisite detail) its metamorphosis from eggs, hatching larvae, molts, cocoons, all the way to the adult moth.
Neither Merian’s observations nor Redi’s experiments were too complicated a task for Aristotle had he been inclined to spend time looking under leaves or playing around in his kitchen. But he wasn’t inclined and neither were a multitude of great thinkers who followed him, and thus spontaneous generation stuck until it became unstuck.
Today not an inkling of spontaneous generation lies in our understanding of the natural world because a paradigm shift occurred. No-one would be taken seriously if they were to argue that rain falling to earth actually created moths, rather than the conditions for moths to take flight.
I predict that with time a paradigm shift will occur with the estrogen theory. Doctors, researchers, the media and the majority of society currently have a blind spot when it comes to midlife women’s health because they are not inclined to look in new directions, just as Aristotle had a blind spot when considering the origins of certain species (and the nature of women!).
One day, it will be common knowledge that a drop in estrogen creates the sensitive conditions for symptoms to arise rather than the symptoms themselves.
And happily a shift in understanding has already begun – we didn’t have to wait two millennia for that!
As I pointed out in this blog post about recent research, medical organizations that focus on perimenopause and menopause currently only feel comfortable recommending estrogen-based therapies for three categories of symptoms/conditions – vasomotor symptoms (night sweats and hot flashes); genitourinary syndromes of menopause (changes to the labia, vagina, urethra, and bladder); and preventing bone loss and fractures. This is down from the approximately 20 categories of symptoms/conditions that estrogen was once thought to cure, mid last century.
There are still women who swear by HRT or bioidentical HRT and sometimes desensitizing midlife (by changing the hormonal conditions) can be a lifeline when a woman’s symptoms appear so devastating. But desensitizing women should not be considered a long-term strategy for wellbeing, when one considers an individual or the species!
Sometimes, we just need to accept that by journeying through our most sensitive times, we will learn something new. It appears part of the design: at midlife we are supposed to wise-up and learn how good health and happiness are created and maintained. This will serve us and those around us for decades to come.
Slowly but surely and despite the backing of a multi-billion dollar hormone industry, the estrogen theory is crumbling. Every woman who wakes up to her innate wisdom and discovers the true purpose of midlife change helps it crumble some more.
Women must be at the center of reimagining the narrative that lies at the heart of what society believes about midlife women’s health. In the past, this narrative has been left to a world of doctors and pharmaceutical companies who still held on to misogynistic theories of the inferior, malfunctioning woman.
Sister, it’s time we break free! For our own health and for the health of generations of women who will journey through midlife after us. A new reality is being imagined and you can play your part.
If you'd like to transform your own experience of midlife change, find out ways that I can help you here.
If you have ideas of how we could cooperate in myth busting to help change the dominant narrative around perimenopause and menopause to one that will better serve women; or if you'd like to connect me with someone who has a platform and passion for women's health, please be in touch.
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Ready to debunk the next myth? READ:
We are supposed to live this long! Debunking the second biggest myth surrounding perimenopause and menopause.