I Sat Quietly and Took Notes

A room full of women in their late 30s and 40s talking about hormones. Here's what nobody said — and what I think more women need to hear.

A few weeks ago I ended up at a neighborhood get-together, sitting with a group of women I mostly didn’t know. We were all late thirties, early forties. And within about ten minutes, the conversation went exactly where you’d expect it to go: perimenopause, hormones, HRT.

I didn’t say anything. A potential character-flaw for analysis at another time.

But I sat there quietly taking mental notes — because what I heard was both completely understandable and a little bit heartbreaking.

So here’s what I heard & I wish I’d gotten to say.

We’ve been here before

One woman in the group had started HRT and felt like a completely different person. The others were asking questions — what kind, what dose, what to ask their doctor for. There was real relief in the room around the idea that there was something they could take to make them feel better in their bodies.

But in the same conversation, these same women were venting about birth control. How they felt crazy on it. How they still don’t understand why it was handed to them as the solution for period problems for years. How it muted their emotions, killed their libido, made them feel like a version of themselves they didn’t recognize. One woman said she felt psychotic on it.

And I just sat with that for a second. Because HRT and birth control aren’t the same thing, obviously. But the underlying logic is similar: hormones are off, so we’re going to put hormones in. What’s causing the problem in the first place? We’ll get to that later. Or we won’t.

I think we’re going to look back on this moment the same way we now look back on how birth control was prescribed and talked about. The same pattern, a different decade.

“Perimenopause” is doing a lot of heavy lifting right now

It is absolutely possible for perimenopause to start in your mid-to-late thirties. But I also think we’re using that word to clinically label a lot of hormone irregularities the second a woman is over 35 — when in reality, a lot of what’s happening has identifiable, addressable causes.

Estrogen metabolism is heavily influenced by gut health. If digestion is sluggish or your microbiome is off, estrogen doesn’t clear properly. Thyroid function affects hormone production directly. Stress — and God knows we’re all carrying a lot right now — depletes progesterone. Not theoretically. Literally. Your body uses progesterone as a precursor to cortisol, and when cortisol demand is high, progesterone loses.

The other thing that comes up constantly when I’m actually looking at labs: nutrient deficiencies. Minerals. Vitamin D. Women in their late thirties and forties who are running on empty nutritionally, whose follicles aren’t developing well, whose estrogen production is low partly because of that. Something as simple as supporting vitamin D in the first half of your cycle can meaningfully support follicular development and help your body produce its own estrogen more effectively.

From what I heard, none of this is being mentioned in doctor’s offices. It’s not even being looked into before hormones get prescribed in most cases.

Our bodies need more inputs as we age. We can’t run the same habits we had at 25 in a body that is more insulin sensitive, more stress-reactive, and less tolerant of nutritional gaps. That’s not perimenopause. That’s biology. And even if a patch or a pill can solve some acute symptoms we’re having, it doesn’t solve the actual problem.

I’m not anti-HRT

I want to be clear about this. If you’re in your late forties, close to menopause, and you’ve addressed everything else — HRT might be exactly the right tool. It can genuinely change quality of life, and I’m glad it exists.

What I take issue with is using it as a replacement for understanding. Because if your hormones are struggling because of a gut issue, or heavy metal burden, or adrenal exhaustion, and you just override that with artificial hormones — those underlying issues don’t go away. They show up somewhere else. A cardiovascular symptom. Worsening anxiety. Digestive problems that come out of nowhere. Your body’s systems are deeply connected. You can’t just patch one output without addressing the inputs.

It’s similar to the GLP-1 conversation that’s finally starting to happen. These medications work. For some people, they work remarkably well. But the people using them without also addressing nutrition and muscle preservation are losing muscle mass at alarming rates and dealing with serious GI problems. We need both sides. The medication and the lifestyle work aren’t either/or.

And there’s one more practical thing worth mentioning: if you’re using progesterone cream and you don’t know where you are in your cycle, you may be applying it before ovulation — which can actually suppress ovulation, reduce your natural hormone production, and not help at all. This is not rare. It’s a really common mistake, and it matters.

What I’d actually go back and say

Everybody’s path looks different. What worked beautifully for one woman at one dose through one delivery method may not work the same way for you. That’s worth knowing before you walk into a doctor’s office and ask for what your neighbor is on.

What I’d want for every woman in that group is someone helping them look under the hood first. Understanding what’s actually driving the imbalance, not just naming it and medicating it. Addressing the things that can be addressed so that if they do choose HRT, it’s working with a healthier system — and less likely to create new problems down the line.

If you want that kind of support

That’s exactly what The Hormone Club is for. Each month we go deep on a different hormone-related topic — live workshop, plus a recording you can listen to on your own time. There’s also monthly office hours where you can ask questions, get pointed toward resources, and actually understand what’s going on in your body.

Right now it’s $39/month, and founding members (members who lock in before June 1st) lock in that rate permanently.

If you’re tired of getting half the story, this is where you get the rest of it. [Join here.]