Hormones were always tricky for me.
I was often prescribed birth control—not just for pregnancy prevention, but solely to “manage my moods.” I never felt quite right on it. But back then, there weren’t other options—except antidepressants, which doctors offered freely and without question. No thanks. Every time I brought it up, I was brushed off with the usual advice: Just manage stress. Exercise more.
I doubt the Pill was doing me any favors, but there was no real guidance. No conversation. Maybe those symptoms were my body’s way of saying: slow down, stop pushing so hard. But I didn’t have that option. Life was busy.
In my late 30s, I worked a demanding global career—yet somehow, I got into the best shape of my life. I made time to work out, ate well, and felt strong and resilient.
Then my routine began to shift.
In my mid-40s, I met my now-husband. Life got full—fast. There were more social events, travel, dinners, and drinks. Over time, I exercised less, ate out more, and work stress was steady.
Looking back, I realize my body still had enough of a buffer — enough estrogen to get away with it.
For a while, I could still rebound. I’d clean up my eating, get back to the gym, and feel a little more functional. But underneath, it was starting to wear on me.
In time, I noticed more anxiety creeping in, sleep was not the best — and the weight no longer stayed off like it once did.
I also started to dread crowds, noise, even the busy social events I used to enjoy. My body was whispering — I didn’t listen.
I remember flying from a work gig on the East Coast to meet him for a music festival. We did a road trip down to New Orleans.
One night, while getting ready to go out, I caught a glimpse of myself in the mirror and was stunned. It was like my body had changed overnight. Had I not been paying attention?
My doctor kept me on birth control well into my late 40s, even as my symptoms worsened. My energy was off, anxiety was climbing, sleep felt nonexistent, and I was always bloated. I leaned into wine to take the edge off — more than I used to.
And who picks up social smoking again in their 40s? I was grasping for anything that could take the edge off. I felt completely off.
I eventually saw a functional medicine doctor and transitioned from birth control to HRT.
I tried to get back into a routine — exercise, home-cooked meals, doing all the right things. But the pace of work, the late nights, social events, and travel was wearing on me. I was a bit better — until I wasn’t.
I remember exactly when it hit me. It was November 2019, on a work trip — right before the pandemic. We were at a team dinner, something I usually enjoyed. But that night, I felt unusually unwell. I had to excuse myself and head back to my hotel room.
At the time, I chalked it up to stress and poor sleep. But something was different this time. The usual after-work celebration wasn’t landing at all. Something deeper was happening.
I was losing my buffer.
My workouts became hit or miss. A far cry from the 6-day regimen I once had. Emotionally, I was carrying more than I could process — family dynamics I had no space to face.
Then came COVID.
Work demands intensified, but the travel stopped. I always loved work travel, but I remember thinking—this was the silver lining.
My mother’s health was declining, and I took a leave of absence for a few months in 2020. By late 2021, I left my career entirely to care for her full-time. She encouraged me to go on leave—but as she said, “Do it for yourself.”
And she was right.
There was no way to do both. The old me would have believed I could.
The signals in my body were getting louder.
But it wasn’t until after she passed in February 2022 that the dam broke. That’s when my own health completely tanked.
My labs were off. A comment I just happened to notice in my chart about fatty liver was brushed off as “common” — no big deal. Four abnormal EKGs. Crippling GI distress. Prescription after prescription — none of it helping.
The truth is, I didn’t stand a chance. Not with the way perimenopause and menopause are handled here. I wasn’t given information. I wasn’t given options. I was left to figure it out alone — and pay for it out of pocket.
In the U.S., it’s still treated like a private burden — something to manage quietly or medicate superficially, but not a life stage worth real investment. Most doctors still receive little to no menopause training. Hormone therapy is framed with outdated fear, often withheld unless you fight for it. Part of that fear stems from the early days of HRT, when women — like my mother — were prescribed horse urine-derived estrogen (Premarin), with little understanding of the risks, or awareness of better options. Even when it’s prescribed, HRT can be wildly expensive — and in my experience, even with insurance, nothing was covered.
My only option was seeing a functional medicine doctor out of pocket — and paying for expensive tests and compounded hormone therapy. I spent a fortune over the years, without ever knowing if a standard version could have worked. No one ever explained the difference between FDA-approved options and compounded ones. I’m still not completely clear.
Meanwhile, in much of Europe — the UK, France, Scandinavia — women have access to low-cost prescriptions, topical estrogen considered safe for long-term use, and newer guidelines that encourage menopause education for general practitioners. They treat menopause as a normal, supported phase of life — not a liability, not a taboo, not an afterthought.
We deserve that too.
Admittedly, my lifestyle during caregiving and in the months following her death was far from ideal. I also had no sense of purpose without work or caregiving. And in my mind, I still believed I had a buffer. But it was completely gone.
It took me 2½ years before I finally tuned in and created space for healing. That was October 2024.
I committed to cooking healthy meals, ditched the wine, hit the gym regularly for weight training. I lost weight. My labs improved. I felt well. I felt grounded. I started writing, January 2025.
And I still take HRT. And I wonder, does it help?
The reality is, there’s limited research on long-term HRT use beyond age 65 — and I’m not there yet. So the question of what comes next remains open..
I’ve shown up to appointments fully prepared—symptom logs, articles, lab results, questions—only to be dismissed with:
• “It’s just your hormones at this age.”
• “Exercise more.”
• “Avoid red meat.”
And the kicker? “Would you like an antidepressant with that?”
SSRIs seem to be the panacea for every woman’s ‘random’ symptoms.
And functional medicine isn’t always better. In addition to frequent saliva and urine tests — which always came back abnormal — I once took a GI Map test and was told I had dysbiosis, then sent a link to buy pricey supplements, with no real plan.
You hit midlife and realize no one ever prepared you for this. And worse, your doctors don’t seem to have a clue. Suddenly, you’re on your own to figure it all out.
None of my friends really talked about it. We skirted around it, saying things like “I’m just so tired” or “I’m so stressed out.” I think part of it was fear — fear of naming it. Because we’d been taught to see menopause as the end. A final, faded state. A quiet crossing into invisibility.
Hormone therapy isn’t a cure-all.
HRT is supposed to:
- Ease hot flashes and night sweats
- Improve vaginal and bladder health
- Help with mood stability
- Support bone density
- Provide some cardiovascular and cognitive protection
But it won’t:
- Help burnout
- Heal unresolved stress, trauma, or grief
- Replace strength training or fix your metabolism
- Restore emotional balance
- Rebuild muscle or repair nervous system dysregulation on its own
It’s one piece. Not the whole puzzle.
And when your lifestyle is inconsistent, HRT doesn’t do much at all.
And for many of us in our 50s and beyond, the real question becomes: Is my life better because of HRT—or because I finally made space to live differently? Would I feel just as good if I stopped?
Lifestyle was the game changer.
When you lose your buffer, you don’t get away with what you once did. The supplements — I honestly couldn’t tell a difference.
It was making consistent small choices.
Sleeping. Lifting. Eating well. Saying no. Saying enough. Writing. Resting.
Rebuilding my rhythm. That’s what changed everything.
Why didn’t anyone say it clearly? HRT won’t work if your lifestyle isn’t in check.
I’d pushed the envelope so many times before and recovered. Until I couldn’t.
Just like Menopause Musculoskeletal Syndrome—something that’s been known for years but only recently named—no one explained how strength, muscle loss, and metabolic decline fit together.
Maybe this is part of the same problem.
“We weren’t just under-treated. We were never even seen.”
A few voices worth knowing: Dr. Stacy Sims on female physiology and strength. Dr. Gabrielle Lyon on muscle and longevity. Dr. Mary Claire Haver on menopause nutrition and metabolism. Dr. Avrum Bluming and Carol Tavris on rethinking HRT. These are women and researchers who actually see us.
