Not Just for Hot Flushes
Oestrogen and the Aging Body
Note to my male subscribers: While this post is gender-specific, it matters deeply for your partners, mothers, colleagues, and friends.
There are very few things I remember word-for-word from medical school in the 1980s, but one line stuck with me. Professor Franco Guidozzi, the brilliant and much-respected head of OBGYN, said:
“Unless contra-indicated, HRT is mandatory for all women over 50.”
I followed that science and prescribed it with confidence when needed, until the storm of the WHI (Women’s Health Initiative), a large U.S. study in the early 2000s, dramatically altered the landscape. Almost overnight, hormone therapy was abandoned—by doctors and patients alike.
So when I entered perimenopause, I cautiously asked for a low dose of hormones. The response? Use it only very briefly, if at all. Fast forward ten years, with no oestrogen on board—and now, at 60, I’m back on MHT (Menopause Hormone Therapy), and I couldn’t be more grateful.
Yes, I missed out on years of potential protection. But the science is finally catching up with what many of us suspected: oestrogen isn’t just about easing symptoms, it’s a cornerstone of long-term health.
A Personal Choice, An Informed One
Not every woman can take MHT, particularly those with certain medical conditions, including breast cancer. Others may choose not to, or prefer natural approaches. This post isn’t a directive. It’s an invitation: be informed. Know the science. Understand what’s possible. Then make the choice that’s right for you.
This topic is layered and nuanced, and I’m not trying to oversimplify it. I’m simply shining a light on compelling new data—especially the growing evidence around hormone therapy and the aging body and brain.
Falling Off the Cliff
Most of our body systems age very gradually. All but our reproduction. At midlife- the reproductive system doesn’t just decline, it stops. Oestrogen levels drop suddenly and sharply. And while fertility ends, the hormones’ role doesn’t.
Oestrogen has far-reaching effects on everything from brain function and mood to immune regulation, cardiovascular strength, energy production, and bone integrity. It's not just a fertility hormone, it's a vital messenger for balance and repair across many systems.
What Went Wrong With the WHI?
Dr.
, a leading U.S. cardiologist, researcher and author , puts it bluntly:“The medical community and public got hormone replacement therapy all wrong.”
The WHI painted hormone therapy as dangerous, but it had serious design flaws, like including women many years past menopause. For two decades, fear replaced facts. Millions of women lost out.
Beyond the Symptoms
Many people think hormone therapy is just about relieving hot flushes and vaginal dryness. Yes, it certainly helps with those. But the truth is, oestrogen is a master hormone—one that supports energy, metabolism, cognition, vascular health, and more. A recent Nature Medicine article underscores just how crucial it is as a key regulator helping the body maintain equilibrium through aging. The drop in oestrogen at menopause can accelerate biological aging and increase disease risk.
Rethinking Aging: What the Data Says
New insights from the UK Biobank, a massive health database of over 500,000 participants, have reshaped our understanding. Dr. Topol’s review shows that women on hormone therapy show slower biological aging—across multiple systems. It suggests that MHT may not just manage menopause—it may preserve vitality and function into older age.
The Conductor of the Orchestra
The 2024 Nature Medicine article describes oestrogen not as a background hormone, but as the conductor—orchestrating balance across the brain, metabolism, heart, immune system, and bones. Without it, the harmony starts to fall apart. Menopause isn’t just a reproductive transition, it’s a full-body recalibration. And oestrogen is central to that process.
And a note on progesterone: It’s not just there to protect the uterus (unless you've had it removed). It has calming effects on the nervous system, supports sleep, and may positively influence mood, brain health, bone density, and even breast and cardiovascular tissue.
Reframing the Conversation
It’s time to shift the narrative. Menopause doesn’t have to be a period of decline, it can be a transition into a powerful new phase of strength and clarity. When medically appropriate, hormone therapy is more than symptom relief—it’s a potential investment in longevity, vitality, and resilience.
Let’s keep asking questions. Let’s challenge outdated narratives. And most importantly, let’s make informed, confident choices.
Disclaimer: This Substack post is for educational purposes only and does not constitute medical advice. Please speak with your healthcare provider about any treatment decisions.
Warmest blessings for great health,
Linda
Thanks again Linda.... fascinating and sheds light on the info we were fed all those years ago, via 'that' study. BTW so many of my contemporaries (& me) are either osteoporotic or osteopenic. And I've often wondered why bone density testing isn't a standard screening procedure for women 45+ years or at least discussed by GPs alongside breast cancer screening, bowel cancer screening, skin cancer screening etc etc. Is it a government cost-benefit decision based on economics ?