By Amely Greeven
If you’re a woman in her mid-to-late 40s or early 50s, chances are you’ve asked friends, What are you taking? The topic of course, is hormones, and whether to use them during the yearslong passage toward menopause known as perimenopause.
The answer isn’t one-size-fits-all. The benefits of menopause hormone therapy (MHT) for smoothing the edges of midlife hormone change come at us fast and thick on social media and podcast episodes. It’s exciting to get more information than ever, but it can also induce anxiety. If you don’t start replacing declining estrogen and progesterone—the two hormones that change in ratio and lower significantly in this life phase and that also have important protective effects bodywide—are you screwed later in life?
There’s so much content—and so many claims—about MHT that it’s easy to get confused and miss some fundamentals, says integrative women’s health doctor Aviva Romm, M.D., currently completing a book on empowered menopause called Force of Nature. Hormone therapies, which she says should always be prescribed by a provider specially trained in menopause care, and may be essential for some women, can work brilliantly for certain challenging symptoms. Estrogen in pill or patch form can help with hot flashes and night sweats, and also help prevent bone loss that can lead to osteoporosis. Vaginal estrogen can be life-changing for women struggling with challenging genitourinary symptoms.
When women find relief for these issues, a cascade of other improvements in how they feel, or sleep, or perform can follow in their wake. But these are currently the only four areas for which MHT is proven effective. Progesterone, typically prescribed alongside estrogen pills or patches, is famously calming—yet, surprisingly, not proven as a sleep therapy. As for the widely held belief that MHT in your 40s protects against dementia in your 70s—research suggests the possibility, but there’s no conclusive data to support this yet.
None of this means that MHT doesn’t help women feel better in a host of crucial ways. But it’s empowering to achieve future-proofing benefits through lifestyle choices too.
Strength and jump training can build bones’ longevity and develop muscle mass that naturally ebbing estrogen can erode. Exercise physiologist and nutrition scientist Stacy Sims, M.Sc., Ph.D., advises lifting heavy weight—give yourself months to develop proper form, gradually increasing the load. This delivers more than we think: solid sleep, mood improvements and resilience against dementia; metabolic health and body composition improvements; even neurotransmitter support that can help with hot flashes. It may reverse bone loss, which hormone therapy alone cannot. (Sims recommends the Osteo-Gains app for jump training and short high-intensity interval training too.)
Circadian habits may be even more fundamental, and require zero sweat or grit. Dr. Azra Bertrand, a medical doctor who teaches the “sacred science of body wisdom,” explains, “Your circadian coherence, or your predictable exposure to light and dark, is not a side issue in hormonal health; it is the most important issue—every cell in the body has a biological clock, including the ovaries, and the master hormone melatonin regulates all the other hormones including estrogen and progesterone, which is why melatonin is a proven treatment for peri- and menopause symptoms.” He adds, “What is already a sensitive hormonal system gets even more sensitive in this transition stage.”
The medicine that Bertrand recommends to support smooth passage is simple, and ancient. Not just shielding blue light at night, sleeping in pitch dark and getting out first thing, as all biohackers know, but also cultivating a relationship with the sun and the stars, as our ancestors did, through a personal circadian ritual. Whether through yogic sun salutations, qi gong or the Sola-Terra practices he teaches through his Biomancy University, “Try to take it beyond the mechanical. Open your sense of devotion to the sun, understand you are in connection with a living intelligent field.” Women who restore circadian harmony can be surprised by the regulation of cycles and even relief of some symptoms. Whether this practice ends up adjunct to prescribed hormone therapy or standing on its own, reveling in morning sun and immersing in melatonin-enriching darkness is a natural remedy that soothes a changing body, mind and spirit.