If menopause is not just a hormonal transition but a system-level reprogramming, what else are we still misclassifying and therefore mispricing in women’s health?
I can't take estrogen at all, not even s tiny dose, because it causes migraines for me. I em extremely interested to hear more about this research. I often wonder about our female ancestors who lived long and healthy lives well into their 80s and 90s - how were they able to do that before HRT?!
Same here. I can’t take estrogen at all too. The migraines are unbelievable. And I don’t think this is limited to both of us Kay. Many women cannot take estrogen.
So if estrogen isn’t an option, the whole “just replace it” approach falls apart pretty quickly. Which is why I think this shift in thinking matters because it suggests there might be other pathways to target beyond hormones.. I am following this closely.
Many people (including medical personnel) have suggested to me to "just put up with the migraines" in order to take estrogen... my eyebrows and my hairline can't go up high enough to be incredulous at that horrific suggestion
So interesting to consider this broader more complex hypothesis and provides insights into why the robust HRT studies in post menopausal women have not shown a decrease in cardiovascular morbidity with the treatment.
Absolutely Kate, and that’s where it gets interesting.
If the underlying shift is happening at a systems or gene-regulation level, it may help explain why HRT alone hasn’t consistently moved cardiovascular outcomes. We may have been treating one layer of the problem, not the mechanism driving it. And it raises the question of what we’re missing in how we define the intervention in the first place.
This epigenetic angle is really interesting. I’ve spent a lot of time looking at cardiovascular health in midlife women, and I think the “estrogen deficiency” theory of heart disease is too narrow.
Women are at higher risk for microvascular dysfunction—something that’s still largely overlooked in clinical care despite growing research. Importantly, this doesn’t begin at menopause. We often see early signs during pregnancy, where about 1 in 5 women experience adverse outcomes that are strongly linked to underlying vascular issues.
By the time women reach midlife, more than half of those under 65 who have heart attacks don’t have the typical obstructive blockages. Instead, factors like undiagnosed iron deficiency (huge problem), chronic inflammation, and oxidative stress can impair endothelial function and contribute to disease. I recommend you look into the INOCA International (Ischaemia with Non Obstructed Coronary Arteries). They are doing work to bring more awareness to this type of heart disease more prone in women.
Menopause may accelerate these underlying processes, which helps explain the rise in risk. But based on what I’ve read, it’s more of a revealer than an instigator. And there are many promising ways to help women besides HRT, of which research is mixed especially for older women.
If menopause is not just a hormonal transition but a system-level reprogramming, what else are we still misclassifying and therefore mispricing in women’s health?
I can't take estrogen at all, not even s tiny dose, because it causes migraines for me. I em extremely interested to hear more about this research. I often wonder about our female ancestors who lived long and healthy lives well into their 80s and 90s - how were they able to do that before HRT?!
Same here. I can’t take estrogen at all too. The migraines are unbelievable. And I don’t think this is limited to both of us Kay. Many women cannot take estrogen.
So if estrogen isn’t an option, the whole “just replace it” approach falls apart pretty quickly. Which is why I think this shift in thinking matters because it suggests there might be other pathways to target beyond hormones.. I am following this closely.
Many people (including medical personnel) have suggested to me to "just put up with the migraines" in order to take estrogen... my eyebrows and my hairline can't go up high enough to be incredulous at that horrific suggestion
Shocking 😳 My eyebrows would certainly go up at that suggestion!
So interesting to consider this broader more complex hypothesis and provides insights into why the robust HRT studies in post menopausal women have not shown a decrease in cardiovascular morbidity with the treatment.
Absolutely Kate, and that’s where it gets interesting.
If the underlying shift is happening at a systems or gene-regulation level, it may help explain why HRT alone hasn’t consistently moved cardiovascular outcomes. We may have been treating one layer of the problem, not the mechanism driving it. And it raises the question of what we’re missing in how we define the intervention in the first place.
This epigenetic angle is really interesting. I’ve spent a lot of time looking at cardiovascular health in midlife women, and I think the “estrogen deficiency” theory of heart disease is too narrow.
Women are at higher risk for microvascular dysfunction—something that’s still largely overlooked in clinical care despite growing research. Importantly, this doesn’t begin at menopause. We often see early signs during pregnancy, where about 1 in 5 women experience adverse outcomes that are strongly linked to underlying vascular issues.
By the time women reach midlife, more than half of those under 65 who have heart attacks don’t have the typical obstructive blockages. Instead, factors like undiagnosed iron deficiency (huge problem), chronic inflammation, and oxidative stress can impair endothelial function and contribute to disease. I recommend you look into the INOCA International (Ischaemia with Non Obstructed Coronary Arteries). They are doing work to bring more awareness to this type of heart disease more prone in women.
Menopause may accelerate these underlying processes, which helps explain the rise in risk. But based on what I’ve read, it’s more of a revealer than an instigator. And there are many promising ways to help women besides HRT, of which research is mixed especially for older women.