There is no wisdom in menopause, only heat.

For many women there is also sleep disturbance brought on by a relentless cycle of waking in a drenching sweat, reigning fury on the sheets, then falling back asleep only to waken shivering as the perspiration evaporates while discarded pajamas silently torment from the corner of the bedroom.

And then there is dryness. Skin, hair, but especially vagina. It is like a desert storm, think shock and ow! not shock and awe.

Some women like to call their hot flashes power surges, but they leave me with no sense of strength. Maybe no one else sees the river of sweat on my top lip, appreciates the porcelain gripping nausea, or understands the gesture of grasping for something, anything, to fan my face, but I know and that is enough.

I don’t resent the aging, I resent the break in stride.

Hot flashes and other symptoms of menopause, such as vaginal dryness, are due to a drop in estrogen and progesterone. This can be a meandering descent over years or a precipitous crash. Women also have individual sensitivities to hormones so when and even if symptoms develop varies greatly. Some women are plagued for years before and after their periods stop and others don’t understand any of the fuss.

The biology of the hot flash has not been well elucidated. While this is due in part to society’s lack of interest in women of a certain age, they are also stunningly unpredictable and hence hard to study. Not knowing when they will strike adds to the imbalance.

Hot flashes are biologically complex. Science suggests they are a narrowing of the thermoregulatory zone, basically a wonky inner thermostat that renders one victim to environmental whims. The smallest change in temperature, even the essence of heat, can stoke the furnace. In a way it is like a fairy tale curse because I feel as if I have been transformed into a poikilotherm.

In the United States there are approximately 64 million women who are post menopausal and about 50% of them are suffering with symptoms, just like me. Many are also at risk for osteoporosis. We are constantly losing and building bone. Without estrogen the building mechanism for women can become perilously slow resulting in a net loss and an increased risk for fractures.

In the 1990s our approach to hormones for menopause could best be described as “A round of estrogen for all my friends!” Hormones, we were told, not only stopped hot flashes, reversed vaginal dryness, and protected bones, but might also prevent many diseases and even dementia. It was almost like the fountain of youth.

The Women’s Health Initiative or WHI was a large study designed to test the hypotheses that hormone replacement therapy could prevent chronic disease and then all of a sudden it was halted. We doctors were told this was due to an increased risk of breast cancer and heart attacks and so hormone prescriptions plummeted.

We offered non hormonal options, but dressing in layers often doesn’t cut it or isn’t possible. For example, when I’m in the operating room wearing a surgical gown and a lead apron it’s not as if I can take something off. Even out of the operating room I find it grating to be constantly obsessing about having the right clothing so I don’t feel like I am going to spontaneously combust.

Many women do not like the side effects or the idea of the non hormonal options for hot flashes, antidepressants and anti-seizure medications. And so the price of longevity for many appeared to be running the gauntlet of heat and sleep disturbance. This is no sprint, the average duration of hot flashes is four years, but some women can suffer for ten years.

A fresh look at the WHI data and how it was presented to the public paints a different safety picture, although I felt the burden of the harmful legacy when making my own decisions. Even though I believed the revised data that tells us estrogen is safe and effective therapy for hot flashes for women my age and is excellent preventative therapy for osteoporosis, a condition for which I am at risk, I waffled. My two medical fears, hormones and fractures, felt like Scylla and Charybdis. The indecision of standing still artificially felt like the safest ground.

And then my 85-year-old mother had another fracture and prolonged hospitalization. I’ve lost count of the number of fractures, but she has lost over six inches in height, is immobile, and has spent much of her last 10 years in extreme pain because of severe osteoporosis. Disease is often a lottery of both genetics and environment, but by the time I know my fate osteoporosis wise it will be too late for preventative therapy.

After reviewing all the literature the science told me I was only facing only one monster, osteoporosis, and so I took the plunge.

Overall, the data suggests no increased risk of death with hormones for women younger than 60 years who are within 10 years of menopause and there may even be a net benefit. There is an increased, though still very rare, risk of stoke and blood clots. The increased risk of breast cancer is 1 woman out of 1,000 per year. For perspective this is also the risk of breast cancer from drinking one glass of wine a day. There is a definitive decrease in osteoporosis and possibly a reduction in heart attacks. One analysis suggests in the 10 years after hormone therapy became tainted with risk between 18,000-91,000 women may have died prematurely because either they or their doctors feared estrogen.

I went with FDA approved pharmaceuticals eschewing so-called compounded “bioidentical” hormones“, a quasi-medical term of varying definitions. This is not medicine, it is marketing. Despite the claims of some self-styled anti-aging gurus and compounding pharmacies the raw hormones in these products are not one step away from ground up yams, they are synthesized in a lab. Also, the exact “bioidentical” estrogen the ovaries produce is why women who start their periods early or have later menopause are at increased risk of beast cancer.

There are also serious safety concerns with compounded hormones. Many women are duped into using transdermal progesterone cream, except progesterone is poorly absorbed though the skin. There are also concerns that compounded estrogen may have more hormone than advertised. This matters because high doses of estrogen that have not been studied may have unknown risks and women with a uterus who are exposed to either too much estrogen or an insufficient dose of progesterone or progestin (a hormone modified to function like progesterone) are at increased risk for cancer of the lining of the uterus (endometrial cancer). Accuracy matters.

A woman’s decision to start hormones should be based on bothersome symptoms, her risk of osteoporosis, her risk of breast cancer and any medical conditions that impact her risk of heart attack, stoke, and blood clots. The North American Menopause Society has a fantastic app (MenoPro) to help women get started. Assessing an individual risk benefit ratio will take a conversation with a medical professional, a blood pressure measurement, up to date breast cancer screening, and possibly a physical exam.

Anyone who claims hormone levels are needed to start or monitor therapy is way off base. Hormone levels offer an illusion of customization and safety and additional billing opportunities, but are impossible to interpret as values can fluctuate day to day. They are also not necessary as the dose of estrogen required to prevent osteoporosis is known and we treat the symptoms of menopause not levels.

Based on the revised data, my risk factors, and my previous experience with hormonal contraception I chose transdermal estradiol and an oral progesterone. Other women may make difference choices. Pharmaceutical grade estrogen comes in a patch, a pill, a cream, and a vaginal ring and they all have advantages and disadvantages. A progestin can be taken orally or transdermally and there is also a progestin containing IUD. Progesterone can only be taken orally, but there is some limited data to suggest it may be the safest option.

I am very grateful to the physicians and researchers who took the time to revisit the WHI data and to produce clear guidelines for me and other women like me to follow. Without their work I would probably be sweating away worrying that I was losing bone. Instead, I am sleeping soundly, which may not make me any wiser but is probably still very good for my brain.

Visiting a glacier, an effective but sadly temporary management strategy of hot flashes 

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  1. Thanks Dr J for a great post. I’m talking with my friends and learning everyone’s menopause is different. For me, I was pushed into menopause via chemo for breast cancer. The hot flashes were so bad, just as you described. One night my husband laid next to me in bed (he was a pillow length away from me) and he said you’re too hot to sleep next to. I’m like HOW DO YOU THINK I FEEL? He finally understood. My oncologist recommended a shot in my neck – sympathetic nerve with anesthesia. It was being tested at Northwestern in Chicago. It worked. My hot flashes went from a 10/10 to a 3/10 which was manageable. I recommend this to anyone who is suffering because it is safe and lasts about 6 months.

  2. This is very informative and concise. I am a Nurse Practitioner and give talks on menopause; raising its awareness and explaining the benefits of HRT.
    I will share to my menopause support groups. Thank you.

  3. This was a great article as I am debating hormone therapy.
    I wake up between midnight and 6:00am every night every hour on the hour and I am bloated- 5 pounds on and off.
    Wondering if hormones would help both?

  4. I’m so glad I found this blog last night (come for the hilarious, but scientifically rigorous takedowns of GOOP, stay for the education about women’s health!). I’m in the unenviable position of having gone through premature ovarian failure at age 27 due to a rare autoimmune condition. My “menopause” (not a true menopause, as I still have my eggs, but effectively menopause, as my body is unable to produce steroid hormones) was a precipitous crash, and it was one of the most difficult health issues I’ve had to endure — and I have a few chronic conditions, so there was plenty of competition!

    I’m also in the strange position of being a 30-year-old giving her mom menopause advice, since she’s going through it now. Her side effect risk is greater than mine, obviously, due to her age (particularly blood clots), but the title of this post is basically the message I’ve tried to convey: there is no wisdom in suffering more than you need to.

    Transdermal estradiol is my miracle drug! I still get occasional hot flashes, but prior to HRT, they were far more frequent. My mood was cataclysmic, prone to uncontrollable feelings of rage, and I had a ton of joint pain and even some neurological symptoms. HRT made all of those horrible symptoms much better, and gave me back my sex drive, which I was not willing to lay to rest in my 20s 😛

    Plus, I also have Sjogren’s Syndrome, so the whole dryness-of-the-everything aspect of menopause was particularly unbearable for me.

    I’ll be on hormones for at least the next couple of decades. My patron saint is Percy Julian, the black chemist who persevered the racism of the Jim Crow era and went on to discover synthetic steroid hormones. I owe my health and happiness to him!

    Thank you so much for helping to demystify and defang the negative perceptions of HRT. Obviously there are risks with any drug, but I think the suffering that often comes with menopause is downplayed, like many sources of female pain. I’m so sick of reading articles that say that menopause is some wonderful blessing in disguise, a font of matronly wisdom, not so bad after all — what’s a few hot flashes, really? As though menopause doesn’t also cause unbearable pain, insomnia, and mood swings in a lot of women, myself included!

    Good luck with your HRT, doc! I hope your change of life is as smooth and medically managed as possible :-). And again, thank you for sharing your wisdom. I shared this blog post with my mom!

  5. What a well written article. As someone with an advanced degree in human physiology and suffering from the worst of the worst symptoms it was nice to read an article by an educated female who understands! When so many MDs don’t seem to get it and add to frustration, it’s nice to find women who can relate to this journey. Support and finding others who don’t act like you’re crazy had helped so much!

  6. Laura: I haven’t heard anything about it specifically. You could research the two individual ingredients. You could probably come up with the same type of combination using estradiol and a separate drug, but it wouldn’t have been studied.

    1. personally i would stay away from conjugated estrogens and stick to the bio-identical estradiol, for my own health as well as the lives of the horses, but I am not an expert.

  7. I really appreciate this article! I am 56 and started HRT (prometrium and estradiol) at age 54. I stopped last year due to significant swelling in both breasts, one more than the other, that was scary. Once I stopped, I had a massive bleed. Even though I was taking the prometrium, I still had built up a lining. I would like to consider going back on, for all the reasons you state. I am wondering, do I need a higher dosage of prometrium? Would that stop the breast swelling and the uterine lining? Also, are you recommending that women stop at age 60? Thanks for all the great and science-based information.

  8. Thanks for the info. I’m still a ways away yet and sometimes find myself wishing for it. My PMDD is not much fun, either.

  9. And then there are the joint pains, the utter lack of energy, deterioration in spatial ability which affects driving skills, strange ones like nominal dysphasia which are uncommon but documented, migraines, increase in chance of prolapse and more, and for some of us it never ends. And yet I have been told many times by doctors that I should “Tough it out because you’ll be over it in a few months” and even more offensively, “You can’t try to stay young forever”. I don’t want to stay young, I just want quality of life and yet medics tell me that they won’t allow me to take the hormones that I know work for me because of a small risk that I have looked at and decided that I am happy to take. (I have a degree in biology and a post-grad certificate in statistical analysis). I am 15 years past my last period and still get hot flushes and all the rest. Instead they are happy to tell me that I am depressed so they prescribe a cocktail of other drugs each with their own problems and potential side effects which are nothing like as effective. It’s not just male doctors either, I’ve had the same from young female doctors, who in my less generous moments I wish a horrible, never-ending menopause.

  10. Honestly i feel like I’m afraid to breathe. My dr (who i love) prescribed Duavee. After reading the potential side effects, I’m afraid to take it. No I don’t want bone loss,and yes, I haven’t slept welll in a year because I’m drenched 2-3 times a night, but increased stroke/breast cancer/heart attack risks aren’t encouraging either. Do i suck it up and ride out the sweats for who knows how long or take the pills? This sucks

    1. I don’t know about your general health and I’m not a doc, so I wouldn’t presume to give an opinion about your situation. I can only share my own experience. I had terrible night sweats to the point of being completely exhausted during the day (btw, read up on the health effects of being chronically tired – it puts any HRT risks into perspective). I finally asked to be referred to the women’s health clinic in our city and only then was HRT mentioned. My male GP never even asked about my symptoms. But I digress. The OB GYN at the clinic took my history, shrugged and said “here’s your prescription, it’s a no brainer.” She put me on Estradiol (transdermal gel) and teva-progesterone. It’s no exaggeration that I now have my life back. Totally worth it.

  11. A lighter side to hot flashes: a friend suffered terribly from hot flashes. She was at work, talking to two young male lawyers. She was wearing a suit jacket, a vest, a blouse and a bra. I could tell when the hot flash started. She was peeling off her clothes as fast as she could with no regard for the young men. They looked at me in horror and bewilderment! It was hilarious. They had NO idea what was happening. When she started on the top two buttons of her blouse, I reassured them she would stop soon!

    1. I honestly don’t see that as funny. It’s kind of awful. I’d be mortified.

      I’ve just gotten good at riding the heat wave and hoping I don’t turn too red.

    2. Thank you for this 🙂 I regularly make light of my symptoms because I know I’m not the only one and I firmly believe that if I don’t laugh about it I will cry about it

  12. HRT has been a real blessing for my mother. Since she has always had a tendency to blood clots, she has used really small doses but it was enough to help her to sleep. And sleep deprivation always made her really miserable. So when my time comes, I will opt for HRT, too (especially as I have no problem with blood clots, on the contrary, with prolonged bleeding).

  13. Great article! I am 52 and am not on hormone replacement. I do have hot flashes and am afraid of muscle and bone loss. I am very active. Is hormone replacement not indicated after 60 years old? Also, is testerone replacement ever indicated in menopause? Also, how would I know the doses to start on? Thank you! I love your articles and rants!

  14. Thank you for this! I’m 71 and I had a complete hysterectomy when I was 50 because of heavy non-stop periods caused by fibroids. I started taking Premarin and was on that until the cost skyrocketed up to $85 a month and Medicare Part D insurance moved it to the Tier 3 category (basically–we ain’t paying for this.) A friend of mine told me about her estradiol and I switched to that. Costs about $6, even without Part D. Works great.

    Whenever my friend (who’s 76) would see her doctor, she would get asked if she wanted to stop taking the estradiol. She always replies “Only if I want to be a crazy bitch.”

    1. Walmart has the estradiol for $10/90 day supply. And for those who are intact the medoxyprogesterone to go with it is likewise $10/90 day (but check before filling, that price only applies if they get it from their usual source.) I don’t mind Medicare making the Premarin expensive–the generic works fine, why pay out the nose for the brand name?

      1. Premarin and estradiol are not the same thing. Estradiol is the generic to Estrace. They are both types of estrogen, but different “flavors” and one may work better than the other for an individual. As a very frugal family doc, I started with estradiol but that did not work well for me. Premarin is definitely worth the cost for me! And for many of my patients. My analogy– Coke and Pepsi, some people like one, some the other and some can’t tell the difference.

  15. Yes, thank you! My last period was in 2008 – my hot flashes are finally abating. I went w/o hormones save a bit of estrogen cream at the worst of it. There may not be wisdom – but there IS an end to anemia!

  16. Thank you! I am 49 and although I still have regular cycles and don’t have hot flashes, I started having really bad insomnia in the last year, usually during my menstrual cycle. I also started having mild anxiety issues. I mentionned this to my primary care physician and she prescribed oral progesterone for part of the month. It has been tremendously helpful and now I sleep really well most of the time.
    Has anyone else become a really warm sleeper during perimenopause? I’m not sensitive to heat during the day and no hot flashes or night sweats but when I sleep I usually only need a sheet or no covering. My husband keeps wanting to tuck the blanket over me but I have to remind him that I don’t need it. I live in upstate NY so it’s actually a good side effect in the winter.

    1. Yes! I finally had to go sleep in our guest bedroom, with the ceiling fan on high and two large windows open for cross ventilation. We used to get really cool night time breezes off the ocean. I’d be lying there buck naked and spread eagle on the bed in the morning and my husband would come in and comment that it was so cold you could hang meat in there. It was wonderful.

  17. What you said! I agree 1000%! Also started hormones because of QoL deteriorated so much with insomnia and night sweats. The hot flushes ( as we call them in South Africa) were embarrassing – no one likes their OBGYN to mop sweat off their brow while doing their PAP smear!

  18. Interesting – thanks so much! I am pre-menopausal at nearly 47 and I had my hormone levels checked to see if I needed a IUD (nephrologists want me to have one). So I found out that I have hypothyroidism and now take thyroid hormone. I guess hormone level tests do have a good side? Only if you have had head and neck radiotherapy though. But hot flushes – I’m having them! Mysterious as they come and go – some months I don’t have them and other months I have one after another….

  19. Thanks for this article. I’m one of the lucky gals who get wicked menopause symptoms- at one point I was clocking between 20 and 30 serious flashes a day, sleeping less than an hour at a time. I have never been so exhausted in my life – even when I had small babies. Hormone treatment was a gift.

    My doctor and I are still trying to find the optimal dose, but the meds have made such a huge difference. We don’t talk about this enough. Or other women make cute jokes, like “having a personal summer” or “power surge”. I try not to be a jerk about it, but overheated, exhausted doesn’t help the sense of humour.

    I hadn’t even considered the osteoporosis end of it.

  20. 14 years after TAH-BSO and despite estrogen-only HRT, I’m still waiting for a day without a hot flash. The estrogen has certainly been helpful, though; at least now I generally have only one (usually around 3am) or two, rather than the 20–24 I used to have before starting estrogen. But I had to suffer through 7 years of severe sleep deprivation because multiple doctors were terrified of giving estrogen to someone with a BRCA mutation & prophylactic mastectomy, even though estrogen alone was association with a 20% reduction in breast cancer risk. Results of the estrogen-only arm of the WHI were almost completely drowned out by the results of the larger estrogen-plus-progesterone arm.

  21. Thank you for this personal and comprehensive discussion of your decision-making, Dr. Gunter! As always, your facts and opinion are greatly appreciated. I’m almost there, and plan to take the same approach as you to protect my bones, and to get a good night’s sleep again.

  22. What is the difference in the original interpretation of the data, and the new,”reinterpreted” data? How is this difference applied to the data?

  23. What a timely article to land in my inbox! I was up at 3:30 this morning with severe bleeding, clots, and night sweats (my bedroom and en suite looked like a murder scene this morning in the light of day). A male gyno told me not to “worry about” HRT because I am still ovulating (at 51). This is an article I can discuss with my new doctor and have a quality conversation rather than a patronizing response.

    1. And how did he know you were still ovulating? Any kind of work-up to determine that? You are better off without him! But not all male gyns are like that. I attended a professional lecture about 25 yrs ago on menopause (it was great, but it was a long time ago so…) by a male gyn who had spent his fellowship studying hot flashes. So there are good ones out there (as well as bad female ones).

      1. If your bed is like a crime scene, please find a good and sympathetic gynaecologist and have a thorough investigation. I used to wake up in pools of blood. This turned out to be a symptom of endometrial cancer, in my case, fortunately early stages, so I was able to be treated quickly and easily and am now able to get on with my active life with no worries. I don’t want to worry or upset you, but early detection and treatment make a huge difference to a healthy outcome with less suffering. Best wishes.

      2. Thanks for your comments, Susanna and Rosie – the male gyno was at the Mature Women’s Health Clinic, of all places, a place for women in the perimenopausal/menopausal stages of life. he was equally dismissive of my concerns about my changing levels of desire, telling me that I needed to “change it up”. As if my decades of excellent sex were meaningless and my own concerns about physical changes without merit. I have fired him from my care, but Winnipeg is a small city with few menopause specialists.

        I had a hysteroscopy and endometrial biopsy, almost two years ago, which were fine other than one small fibroid, not very vascularized. On the hysteroscopy side, ladies, a warning – they tell you it is painless, but not for everyone!!!! It was worse than labour for me, and I almost passed out due to a vasovagal response. All lovely when you are helpless in a very compromised position, and the physician carries on regardless. If one is recommended, do some research and trust your knowledge of yourself to determine whether you want to ask for anesthesia. And do not drive yourself!

        I am having further investigations done.

  24. Even if the hormones have risk, I’ve seen what the lack of them does to my wife. I can’t believe the symptoms would not have a substantial detrimental effect over the years. Of course that’s non-specific and thus isn’t likely to show up in the statistics other than possibly as all-causes mortality.

  25. I would be interested in hearing your thoughts on hormone replacement therapy in the absence of very bothersome menopausal symptoms — as a general way to protect the bone and heart, keep dryness at bay and keep skin elastic, and smooth out the edges of sleep… you know: stay a bit more youthful?

    1. My close friend took hormones for those very same reasons and died of uterine cancer. A very big price to pay!

      1. Uterine cancer is a risk for women who cannot or are not given a progestin or progesterone. That is called unopposed estrogen and it is only offered in extreme circumstances with close monitoring. The type of cancer that develops in this situation is generally very treatable, so a death would happen if care had not been good or not available. I am very sad to hear about your friend and if it was a mistaken or missed that is a second tragedy. There are also uterine cancers that are aggressive and unrelated to hormones, such as clear cell cancers. Without knowing more it is not possible to know the connection for your friend.

  26. Reblogged this on Addicted to Godric…Eric…Andre…(Sevrin) and commented:
    While I’ve not hit this era of my life yet (thank God – it sounds like the body becomes a freakin’ war zone complete with opposing bodily factions, ammo, and a “take no prisoners” attitude), I have to consider that at least a few of my readers are either approaching it or are there already and might need some backup, so maybe you guys might consider this information relevant.
    (Plus if I reblog this I stand a better chance of actually finding it again however-much later when I might need it… Yeah, my brain’s still trying to track that FLM, y’all.)
    Hope this is helpful to you, your mums, your aunties, your sisters, hell, maybe even your super-grumpy grandad…?


  27. I have endometriosis, and I’ve been on GnRH meditation several times over. Now I’m approaching menopause and eagerly anticipating an end to the endometrios!

    I have read some conflicting advice for women with endo – some say that we shouldn’t take estrogen during menopause, since it can keep the endometrios going, and other say that’s not an issue. If you have any information either way I’d really appreciate it!

  28. Just have to say thank you for this. Being post hysterectomy, mid 50’s with only one Ovary left (apparently doing its job, so far) I know my days are numbered before this information become critical to my happiness. Oddly, post surgery I feel I have lost a degree or two in body temperature and am now almost always cold. So maybe after living and paying a heavy price for that angry uterus, now karma is on my side and I get to wonder what all the fuss was about! Either way, I still have something to book mark that provides reliable information on the subject (and locally a great Gyn, whom you know).

  29. Thank you for this information. I have already had breast cancer, postmenopausal, but still, suffer from hot flashes, not as severe, but they are still there. I am now 70. I have lost bone mass and am shorter than I used to be. I have not been sexually active for years and if that changes I am sure I would be screaming as my GYN told me there is already atrophy and much thinning of the vaginal tissue. I am also concerned about my 44-year-old daughter, who is also a breast cancer survivor. She was diagnosed at 41, had a lumpectomy and is now on Arimidex. She has had her Fallopian tubes and ovaries removed. So for her, it was instant menopause. I am not privy to her sex life (she is married and they have two children). That being said since both of our cancers were estrogen positive, our GYN will not give me or her anything with estrogen in it. I also have no Thyroid, so have to take medication for that. My other daughter has Hashimoto’s Thyroiditis and has been on Synthroid for years already (she will be 41 at the end of August). She is also married, but they chose to not have children. I am aware, as is she, of her higher risk for breast cancer and she started, as did my other daughter having an annual mammogram at 35. I did too, as my mother had breast cancer also. Yes, we have had the genetic testing, and even as Ashkenazi Jews, don’t carry the BRACA genes. All of this leaves me with lots of questions. I have cousins who are struggling with menopause, and all of its side effects along with painful sex. No one seems to have answers. Sigh.

  30. Helpful information, even though I’m one of the ones (at least so far) that wonders what the fuss is all about. I was particularly interested to read about the porcelain-gripping nausea. That was part of the two short-lived hot flashes that I had but no one else I talked to had experienced that. Good to know I wasn’t delusional!

  31. My mother gave me the book The Wisdom of Menopause when I was in my late 40s. Dr. Northrup’s description of uterine cancer saved my life when I noticed symptoms immediately; I’m five+ years past treatment & I’m very grateful for that. And frankly, I found immense wisdom during menopause because as my so-called caregiver hormones abated, I took a long hard look at the ways I had been living my life and I changed many aspects that needed to be changed. I felt a profound difference in how I approached people – perhaps it was metaphorical, perhaps it was literal. I didn’t get my hormone levels measured so I could not tell you if it was due to my “caregiver” hormones trickling away, but I sure felt what she described as the no bullshit era dawn. It’s been fantastic.

  32. Thanks for sharing this important information! Symptoms vary for women and there seem to be a range of choices on what to do about them. Good to understand the common options.

  33. Thank-You so much for such an informative article. As a sleep disturbed, 4 alarm hot flash sufferer, I appreciate this as it validates my own research and decisions in regards to hormones. It is nice to have confirmation from an expert!

  34. Thank you. Thank you. Thank you.

    As a male gynecologist who has tried for years to filter through the conflicting science and pseudoscience for my patients, I appreciate your comments that I can give to my patients and their significant others. It is difficult to evaluate statistics that can be weighted every which way depending on bias and agenda.

    As one patient with a scientific background said: “I’ve looked at the numbers and if I lose two years of my life but have twenty years of quality, I’m taking the meds. They will take them from my cold, dead hands.”

    Keep clarifying

    T.E. Myers MD

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