The New Menopause: Navigating Your Path Through Hormonal Change with Purpose, Power, and Facts

Dr. Haver sheds light on the pervasive issue of women’s menopausal symptoms being dismissed or downplayed by the medical community. Through testimonials from women who were told their symptoms were “all in their head” or simply part of “getting older” (16), she highlights the widespread lack of support and understanding women face during perimenopause and menopause. Many women have been denied proper care, with doctors attributing their symptoms to mood changes or refusing to recognize perimenopause unless typical symptoms like hot flashes were present.

Dr. Haver emphasizes the critical role estrogen plays not only in reproductive health but also in protecting various body systems, including the heart, brain, bones, and blood sugar regulation. As estrogen levels decline during menopause, women face increased risks for serious health conditions like heart disease, stroke, osteoporosis, and dementia. These hormonal changes, though natural, should not be ignored or minimized, as they have life-threatening consequences if left untreated.

She also points out the lack of education among healthcare providers, noting that many doctors are inadequately trained to recognize and treat menopause symptoms. This gap in medical knowledge leaves women feeling unsupported and struggling to find relief. Dr. Haver advocates for better education and awareness in the medical community and calls for breaking down gender bias, which has historically led to the dismissal of women’s health concerns.

Dr. Haver also refers to how the medical community’s definition of aging tends to focus solely on chronological age, often overlooking the concept of endocrine aging. She explains that while most of the body’s organs age at a steady pace, the ovaries age much faster, leading to significant hormonal shifts. This gap in understanding results in missed opportunities for early interventions, such as hormone replacement therapy (HRT), which could help alleviate symptoms and reduce the risk of long-term health issues.

In addition, she discusses the lack of standardized diagnostic criteria or routine screenings for perimenopause, which makes it harder for doctors to recognize and treat the early stages of menopause. Dr. Haver encourages women to seek out informed discussions about hormone therapy and other strategies to manage their health, emphasizing that menopause is a significant phase in life that deserves attention and proactive care.

Dr. Haver delves into the complex history and often confusing nature of menopause treatment. She opens with a real-life account of a woman whose joint pain and high cholesterol went untreated because her doctors failed to connect these issues with menopause. Dr. Haver explains that estrogen is crucial for more than just reproduction, playing a vital role in maintaining the health of the heart, brain, bones, and more. As women enter menopause, estrogen levels drop, leading to various symptoms like hot flashes, joint pain, and increased health risks such as osteoporosis, heart disease, and cognitive decline. Despite this, the medical community has historically overlooked these effects.

The chapter also explores the evolution of understanding menopause, from early misconceptions—like the belief that menopause drove women mad because toxins weren’t being purged from their bodies through menstruation—to more scientific breakthroughs. The term menopause was first coined in the 19th century, but it wasn’t until the early 20th century that researchers began to understand the role of hormones like estrogen in the process.

However, HRT has had a turbulent history. Early hormone treatments were crude and derived from animal sources, but as estrogen was better understood, more refined treatments like Premarin became widely used. In the mid-20th century, books like Feminine Forever promoted estrogen therapy to maintain femininity and youthfulness. However, by the mid-1970s, concerns about the increased risk of endometrial cancer in women using estrogen without progesterone caused many to abandon the therapy. This led to the development of combined hormone therapy, using both estrogen and progestin, which helped reduce cancer risks and gained widespread use by the 1990s.

Dr. Haver also discusses the rise and fall of hormone therapy's popularity, noting that while early research pointed to its benefits—such as reducing heart disease and preventing bone loss—there was a lack of randomized controlled trials (RCTs) to confirm these findings. The chapter ends by introducing the Women’s Health Initiative (WHI), a massive study launched in 1998 to test the effects of menopausal hormone therapy on heart disease and cancer, which would significantly alter the course of HRT’s use. Dr. Haver hints that the upcoming chapter will explore this pivotal moment in menopause treatment history.

Dr. Haver discusses the significant shift in the use of HRT after the 2002 WHI study, which linked HRT to increased risks of breast cancer and stroke. She recalls how, overnight, 70 to 80 percent of women stopped using HRT, as the media’s alarming coverage of the findings caused fear and confusion among both patients and healthcare providers.

The chapter explains the study’s design, which divided participants into two groups: one receiving a combination of estrogen and progestin to protect against endometrial cancer and the other taking estrogen alone. While some benefits of HRT were noted, such as reduced risks of osteoporosis and colon cancer, the reported increase in breast cancer risk caused the study to be halted early. However, Dr. Haver explains that the study's results were often reported in terms of relative risk, which overemphasized the findings. For instance, while the relative risk of breast cancer was reported as a 25 percent increase, the absolute risk increase was only 0.08 percent.

Another key point Dr. Haver highlights is the significance of the age at which hormone therapy is started. The WHI study participants had an average age of 63, much older than the typical age of menopause onset, which is around 51. This skewed the results, as younger women closer to menopause are more likely to benefit from HRT, particularly in terms of cardiovascular and bone health.

Dr. Haver also touches on the different formulations of hormone therapy used in the study, noting that the combination of conjugated equine estrogen (CEE) and synthetic progestin (medroxyprogesterone acetate) might have contributed to the reported cancer risk. Modern bioidentical hormone therapies, which are more commonly used today, may offer a safer alternative.

The chapter concludes by discussing the fallout from the WHI study, which left many women searching for alternative treatments, some of which were ineffective or even harmful. Dr. Haver emphasizes the need for better ongoing education for healthcare providers on menopause and hormone therapy to ensure that women receive accurate information and proper care. She encourages people to be proactive in discussing HRT with their doctors, stressing that modern research supports the safety and benefits of hormone therapy when used appropriately.

Dr. Haver emphasizes the lack of education and research on menopause by sharing the story of a nurse who suffered from severe symptoms without receiving adequate medical support. She highlights that in 2021, only $15 million—just 0.003 percent of the $5 billion allocated to women’s health research—was dedicated to menopause.

Dr. Haver then highlights positive developments in menopause care, noting increased corporate investment in research and product development. She mentions groundbreaking studies, including those by Dr. Lisa Mosconi, which link the drop in estrogen during menopause to accelerated brain aging and a higher risk of Alzheimer’s in postmenopausal women. However, there is hope, as HRT may help protect cognitive health.

In terms of access to care, Dr. Haver explains how telemedicine platforms like Midi Health and Alloy Health are improving access to menopause care. She notes the growing availability of products for menopause symptoms but urges women to choose evidence-based treatments despite the variety of options.

Moving forward, Dr. Haver addresses the financial burden many women face in seeking proper diagnosis and care, often going through costly and ineffective treatments before identifying menopause as the root cause of their symptoms. She highlights studies showing that women treated with hormone therapy often have reduced long-term healthcare costs compared to untreated women. Workplace support is another major area of concern, with Dr. Haver citing surveys showing that menopause symptoms significantly affect job performance, leading to mistakes, missed promotions, and even women quitting their jobs. She suggests employers offer flexibility, including work-from-home options and better resources for menopausal employees.

The chapter ends on a positive note, with Dr. Haver emphasizing the role of social media, celebrities like Naomi Watts and Oprah Winfrey, and medical experts in breaking the silence around menopause. She stresses that while much progress has been made, there is still a long way to go in improving menopause care, research, and societal attitudes.