03/19/2026
MENOPAUSE:
I have often said that women have been underserved and often overlooked in the medical space. You only need to look at how many Vi**ra ads there are vs prescriptions for women’s s*xual enhancement drugs.
But if I have to pick and choose one segment that’s really missed out on the help they deserve, it’s menopausal women in the past 25 years.
Even FDA Commissioner Marty Makary, who devoted a chapter to HRT in his 2024 book, "Blind Spots: When Medicine Gets It Wrong, and What It Means for Our Health." agrees when he said “Women deserve an apology.”
The truth is so many women suffered unnecessarily and weren’t given the information, support and care they needed – at a time they needed it most. And that’s why so many have said that during menopause, they just don’t feel like themselves anymore.
Or they feel like themselves – but they’re exhausted. They have unexpected weight gain. Their s*x drive has left the building. They’re just irritable all the time. They can’t remember the last time they had a good night’s sleep.
During menopause, we experience so many changes caused by hormonal shifts. And the sad part is if you’ve ever felt unheard or dismissed by medical professionals, it’s because all of this was not in their training.
My good friend and menopause expert Dr. Janice Wright says only 20% of doctors are trained on this. And that’s why so many women still don’t have the very information that could change their lives in menopause and beyond.
Dr. Wright also showed this graph on how women’s hormones decline in midlife. The thing is, our hormones work in concert. We need to think holistically. You can imagine your hormones are like different instruments in an orchestra – they need to work together to create a beautiful symphony.
See how estrogen, progesterone and melatonin can crash in menopause? Testosterone gradually declines – which explains why many women struggle with low libido in peri/menopause and postmenopause.
Of course there are other hormones but here are the key ones. And here’s what they do:
Estrogen: Estrogen does far more than run your cycle—it helps regulate your brain (mood, memory, mental clarity), your sleep and temperature control, your blood vessels and cholesterol patterns, your bones/joints/muscles, and the tissues of the va**na and bladder.
In perimenopause it often spikes and dips unpredictably, and after menopause it becomes consistently low. That swing-then-drop can show up as hot flashes/night sweats, sleep disruption, anxiety or mood changes, brain fog, migraines (for some), joint aches, and later more tissue-based symptoms like va**nal dryness, painful s*x, recurrent UTIs/urgency, plus longer-term bone loss and easier midsection/visceral fat gain for many.
Progesterone: Progesterone is often the first hormone to really become inconsistent in perimenopause because it’s mainly produced after ovulation—and ovulation becomes less reliable.
Many people experience it as a “calming” hormone that supports sleep quality and steadier mood, and it also helps keep uterine lining growth and bleeding patterns more controlled (especially if you still have periods).
When progesterone is low or erratic, you may notice insomnia or night waking, feeling wired/anxious, irritability, and heavier, longer, or unpredictable periods (sometimes with worse PMS-type symptoms).
Testosterone (androgens): Testosterone in women supports libido and s*xual response, but also broader “drive”—energy, motivation, confidence—and helps with muscle maintenance and strength (and contributes to bone health).
Unlike estrogen, it usually declines gradually with age, and people vary a lot in how sensitive they are to that drop. When it’s low (or your body isn’t responding well), it can look like lower desire/arousal, lower stamina and motivation, and a tougher time building or keeping muscle even with consistent training.
Like I said above, hormones need to work together like an orchestra. When one or two’s out of sync, you FEEL it. So don’t worry. It’s not just in your head.
And Dr. Wright says it best: “Going through the menopause is stressful … but also it's a physiologic stress. There's so much change. It's like you're under renovation. There's a big change going on in your system… They're very real physiologic changes. It's not something that we should beat ourselves up about. ”
