Aging is an inevitable part of life. Every day that we are fortunate enough to wake up and face the world, time continues to march on, leaving its mark on our bodies and minds. Despite the many claims and promises we see in the media, no one has found a way to turn back the clock on aging—not really, at least not yet. Each stage of life presents us with unique challenges and opportunities to learn, adapt, and grow in our own unique ways. Some stages are more difficult than others, and for women, the transition into midlife and beyond can be particularly challenging, both physically and emotionally.
This period, often referred to as perimenopause and menopause, is a time when hormonal changes can have a profound impact on a woman’s well-being. Unfortunately, this phase of life has often been marginalized and misunderstood within the broader landscape of healthcare, both in the United States and around the world. As a physician specializing in health optimization, I am driven by a passion to educate and empower individuals to take control of their health and well-being. Through extensive research and the work my team and I have done for our YouTube channels and podcasts, I have witnessed firsthand the power of knowledge and the tremendous impact it can have on people’s lives. This blog post is an extension of that mission, aimed at arming women with the information they need to make informed decisions about their hormonal health.
Before we dive into the reasons why your hormone replacement therapy (HRT) may be failing you, it’s important to address the root causes of the confusion surrounding hormones. Why is it so difficult to talk about hormones? There are many factors at play, but in my opinion, the root cause goes back to the deep-seated misogyny that has permeated patriarchal societies for centuries. This bias has extended into the field of medicine, where women’s unique physiology and health needs have often been overlooked or underrepresented.
Historically, medical research and treatment have been heavily skewed toward men, with women often treated as smaller versions of men—an approach that is not only misguided but also harmful. This bias has had far-reaching consequences, leaving women grappling with unanswered questions, misdiagnoses, and suboptimal care. It is imperative that we address this disparity head-on and advocate for a more inclusive and equitable approach to women’s health. Women are not small men, and they should not be treated as such.
As women approach midlife, typically around the age of 40, natural shifts in hormone balance begin to occur. Most women go through menopause around the age of 51, defined by the point at which 12 months have passed without a menstrual cycle. However, the reality is that hormonal changes can begin a decade or more before this final definition rings true. During this season, known as perimenopause, symptoms such as anxiety, depression, weight gain, changes in body composition, fatigue, and sexual dysfunction are common. Yet, these symptoms are often dismissed or treated with pharmaceuticals like antidepressants or anti-anxiety drugs, while hormone dysfunction is rarely considered or even tested for.
This lack of consideration for hormone-related issues leaves many women to suffer in silence. What’s particularly insidious about this approach is that the vast majority of doctors may not even realize they are causing harm. The medical training they receive and the established medical model they follow often push what can only be described as oppression for women. This is passed along to patients without a true understanding of the root cause of the problem and without the knowledge or tools to address it effectively.
In today’s society, the experience of perimenopause and menopause seems more challenging than ever before. While some may argue that we are simply hearing more open discussion about these issues, I see this as a sign of a larger problem. Women in their 30s, 40s, and 50s are often dealing with the stresses of raising children, managing careers, supporting spouses, and caring for aging parents—all at the same time. This unique combination of responsibilities can create an immense burden, leading to significant stress and, ultimately, negative health consequences.
Modern women often take on tremendous and often unrealistic roles within their families and careers, and by midlife, the impact of these roles begins to show. Even in households where traditional masculine and feminine roles are still prevalent, women are often working outside the home to help make ends meet financially while also pursuing demanding careers. The added stress of maintaining the home and raising children can create an imbalance that negatively impacts a woman’s hormonal health.
This is a challenging conversation for many men, especially those who were raised with clear expectations of marriage and family roles. I often hear stories of women who continue to shoulder the burden of childcare and household management despite having careers that are just as challenging as their spouses’. In addition to these responsibilities, many women also find themselves caring for aging parents, further compounding the stress and strain on their health.
Despite these challenges, there are tools available that can help women not only survive but thrive during this phase of life. It’s important to understand that stress impacts female sex hormones differently than it does men’s. Recognizing this difference and learning how to manage stress effectively is crucial for maintaining hormonal health.
My own experience, both personally and professionally, has shown me the power of hormone optimization in helping women navigate midlife with greater ease and confidence. My wife, Dr. Ashley Lucas, is a shining example of this. She has learned to manage the many roles she plays in life—partner, mother, daughter, entrepreneur, and leader—by respecting her natural rhythm and seeking hormonal support where necessary. Through this approach, she has been able to continue her mission and purpose with strength and vitality.
The benefits of hormone optimization don’t stop with menopause. In fact, hormone therapy often becomes simpler once the ovaries stop producing their own estrogen. Hormone optimization can look different for different women, but understanding your options is the first step toward success. One of the main reasons your hormones may not be working for you is that you were never offered them in the first place. The traditional medical system has largely failed to recognize the importance of hormone replacement and optimization for women as they approach midlife, but this can change now.
To better understand the discussions that follow in this blog and the broader landscape of hormone optimization, it’s important to clarify some basic terminology. Women have three primary sex hormones: estrogen, progesterone, and testosterone. Throughout this blog, we will focus primarily on estradiol, the most important form of estrogen. Progesterone can be replaced in two primary forms: synthetic progestins and bioidentical micronized progesterone, with the latter being the natural form of the hormone.
It’s also worth noting the distinction between various terms used in hormone replacement therapy. “Hormone Replacement Therapy” (HRT) is a commonly used term in the medical community, but recent discussions have highlighted that it may not fully capture the goal of hormone optimization, particularly before or after menopause. Some prefer the term “Menopausal Hormone Therapy” (MHT) to describe the treatment of menopause symptoms with hormones. However, I prefer to use the term HRT to encompass the broader goal of optimizing health through hormone therapy.
The journey of hormone optimization and replacement is complex, but my goal is to empower you with the knowledge and tools you need to make informed decisions about your health. We will explore the often overstated risks and many misconceptions surrounding hormone therapy, as well as the unique roles that estrogen, progesterone, and testosterone play in women’s health.
This blog is a testament to my belief that every woman deserves access to the information and care necessary to thrive during this transformative season of life. While the landscape of hormones can be challenging for both patients and doctors, I see a revolution stirring in women’s healthcare. Women deserve to know the truth and to be treated with equality. Conversations about hormones may seem difficult, but with the right perspective, knowledge, and the removal of bias, they don’t have to be.
As we move forward, remember that the first reason your hormones may not be working for you is that the system has prevented you from pursuing your optimal self. But with the right information and support, you can take control of your health and well-being, and embrace the power of hormone optimization to live better, longer.
.jpg)
Access to proper care and personalized hormone replacement therapy (HRT) is crucial for women to fully benefit from its potential in optimizing health and relieving menopausal symptoms.
.svg){kind=icon}
.jpg)
Optimizing hormone replacement therapy (HRT) requires personalized care, regular monitoring, and the right combination of hormones, doses, and delivery methods to achieve the best health outcomes.
.jpg)
Rhythmic hormone replacement therapy, which mimics natural hormonal cycles, may offer greater health benefits than traditional static dosing, potentially improving outcomes for bone, breast, and cardiovascular health in postmenopausal women.
