Hello, hello everybody, and welcome to the Rev Up Health Podcast. Today we're going to do things a little differently. We're going to look at the women's hormone journey from a personalized perspective — specifically Tandy's story.
A lot of women struggle with hormone shifts and trying to understand why they feel the way they do and what can be done. We want to get a little more personal and let everyone know that yes, you have troubles and problems, and Tandy did too. She's going to open her heart and tell us the details. Over 80% of women will go through some type of hormone imbalance — it's pretty significant and can take many forms.
I also want to recognize that this is just my story. As we say all the time, each person is unique. Some things may be similar and relatable, but my story won't apply to everyone.
Growing Up Without the Conversation
Hearing another person's perspective is comforting, because it lets you know you're not alone. As a young person, there wasn't a lot of talk — like there is today — about what to expect from the onset of cycles through menopause. There wasn't much conversation in my household with my mom, either; it was pretty much figuring it out on my own. And my cycle history wasn't similar to my mom's. It's not a dinner-table topic that comes up at family meals.
Your menstrual cycle is like another vital sign, and it really is — it tells a story. A big part of my story around hormones and hormone replacement is depression, which I struggled with starting around age 16, maybe even a little before, and that went on my entire adult life.
What were your cycles like growing up? Honestly, I didn't pay a lot of attention — I feel like they were pretty regular, but I had a lot of PMS symptoms: bloating, gas, mood changes, fatigue — the whole laundry list. My cycles hit me pretty hard, and that's where my mom and I differed. There wasn't a lot of talk about it, even though there are plenty of signs and symptoms — well over 70 different ones related to hormone changes from perimenopause into menopause.
Fatigue, Sleep, and Thyroid
When I first headed down the hormone replacement path, I was feeling fatigued and having trouble sleeping. I was talking with a functional nutritionist to find out what I was getting wrong, and I actually started more on thyroid than sex-hormone replacement.
Do you feel your thyroid concerns were ignored by primary care? Definitely. I asked my primary care on more than one occasion to check my thyroid because I felt fatigued and had weight gain — those were the two things that prompted me to ask. And I'm pretty certain all they were looking at was my TSH. It honestly didn't even occur to me to talk about mood or depression — you hear about depression being a chemical thing, but I never put together that it could be hormonal.
Unfortunately, a lot of women who go to their provider are offered an antidepressant or SSRI to control their mood, but it's so obvious when you see it from the other side of the fence.
The other thing I'll mention before hormone replacement is that I had terrible postpartum depression after my first daughter was born. It was a very dark time, and we didn't really talk about it — my family and I just lived it as part of life. That was my first big hormonal experience, though even then I didn't put the hormonal piece together. Not long after I got over that, I got pregnant again, and immediately after my second daughter was born I was put on antidepressants in the hospital to prevent going through that same cycle of depression — probably before my progesterone even dropped. I didn't have the postpartum depression that time, so it did help, and I was able to wean off it later while raising two kids.
Starting Hormone Replacement
My hormone journey initiated from seeing that nutritionist. She looked at my lab values and noticed my thyroid was on the low end of normal — but still normal. I remember asking if you'd be willing to talk about thyroid replacement. In my traditional Western medicine understanding, I was taught that if your TSH and other thyroid levels are normal, it's not your thyroid. But you were open to me exploring other avenues, and that's when I found Dr. Ann Morgan and started down that path.
When I first started hormone replacement therapy, I was about 40, fatigued, still struggling with depression, and having a hard time sleeping. At the time we had a dog who would wake up and roam the house during the night, and as soon as he woke me I'd struggle to get back to sleep and lie in bed for an hour listening to everyone else sleep. It was terrible.
I started with thyroid replacement, progesterone, and testosterone. Those were real lifesaving medications, and it was life-changing — though not instant. The sleep came pretty quickly, which was fantastic. They all work together, but for me the thyroid really helped with energy and also with the depression. That's something we've learned a lot more about through continuing education — we're not just treating a low number, we're treating signs and symptoms of thyroid deficiency, and there's a big difference. There can be issues with receptors and cellular activities that create the signs and symptoms of low thyroid function, and it makes a difference to treat the patient that way.
From Perimenopause Toward Menopause
How did the signs and symptoms change over time? For the first five to six years it was pretty smooth sailing. I was sleeping well, my energy and workouts were better, and I didn't have a ton of symptoms — I was feeling better than I probably had in my entire life, because the depression wasn't as much of a struggle. Cycles were very light.
Then within the past year, I started having what seemed like regular cycles again, which was different but not unbearable. I noticed itchy ears — one of my big symptoms — along with vaginal dryness and a bit more irritability. I did labs in June and all my numbers still looked like perimenopause, but I kept having these feelings of being more irritable with lots of dryness — still no hot sweats or the big mood changes I'd experienced in the past — even though I was already on progesterone, testosterone, and thyroid.
When the estrogen levels began to drop and FSH began to rise, we started considering a menopause factor. We did labs again in October, and sure enough, estradiol was 10, FSH was 76, and I've now gone 60-some days without a cycle.
Every woman, if she lives long enough, will experience menopause symptoms. One of the biggest ones women talk about is just feeling "off" — that apathy of "why do I feel like this? What's the matter?" You can't pinpoint it, but something's not right. I knew for at least the last six months that I was feeling off.
You also had one of the classic signs of perimenopause and menopause — frozen shoulder — and underwent physical therapy for it, which worked great. A lot of women wonder, "Why do I have a frozen shoulder?" Well, hormonal imbalance is a factor. Over the last year or so, I've also had more joint pain and stiffness — aches and pains in the back, knees, and feet.
A Partner's Perspective
HRT was life-changing for you. As the person who lives with me, what was your experience of the transition? I've got to be careful here — I don't want to get myself in trouble — but I definitely noticed a difference before and after hormone replacement therapy in mood, mood swings, and irritability. There are certain times of the month where I just have to be careful and supportive. Men go through these things too, but not to the extent women do. I tell women all the time: women are more complicated. Men's transition is slow; women's is faster and more abrupt, and women seem to pay a lot of attention to how it goes, while men are a little more stoic.
You've also had symptoms of andropause. I know women joke about "man-opause," but your open-mindedness to watch me go down this path and then pursue your own education around it says something huge. From both a husband's and a healthcare provider's perspective, no matter what hat you wear, we have to be more sensitive to the fact that we don't know everything and have to continually update our thinking — myself and everyone. The old cognitive-dissonance attitude of "this is the way I was taught, this is the way it is, and always will be" is farthest from the truth. Half of what we know now will change in five years.
The Biggest Surprises
What surprised you most about hormone replacement therapy? Two things. First, it was life-changing. And starting thyroid replacement — my experience has been that my depression was related to a poorly functioning thyroid and to progesterone. That's a piece I never knew until I continued my education: that a progesterone crash is the actual cause of postpartum depression. When your progesterone is in the 200s while you're pregnant and then tanks after delivery, that's why women instantly suffer from postpartum depression. Learning later in life that this was part of the chemistry and hormone imbalance I'd been struggling with was the most surprising thing.
Something else I've learned is that normal is not optimal — optimal is a whole different ballgame. Our hormone levels fade and decline as we age, and midlife is when it starts and things begin to feel off. The nice thing is we don't have to feel this way — you don't have to feel cold, tired, and fatigued.
A New Beginning
As you go through this current phase, do you see it as a new beginning or an end? Definitely not an end. This time of life is empowering, because we have an opportunity to listen closer to our bodies and make adjustments to get to optimal health — to do the things we want, in the manner we want, hopefully for as long as we live.
There are a lot of misconceptions about hormone replacement therapy, but what we're talking about is bioidentical, not synthetic. The old WHI trial back in 2000 is when those misconceptions became a wildfire, and women went from one in four using hormone replacement therapy to one in 25 almost instantly. I remember talking to my gynecologist about that study — it was all over the news. I wasn't on birth control much of my adult life because I had terrible side effects to different types, which are synthetic forms.
Spoiler alert: even though I don't technically meet the clinical definition of menopause — which requires 365 days without a cycle — I have little to no estradiol and an FSH of 76. So why suffer for a whole year and wait around for those symptoms to linger? I've started estradiol replacement at this point. The benefits for the brain, bone, heart, vascular system, and breast — cancer protection — that hormone replacement provides are incredible, and that really needs to be emphasized.
Advice: Advocate for Yourself
Again, this is my experience and my story, and there are lots of others out there. Sometimes people don't tolerate certain replacements, so you have to get creative and tweak things — there are a lot of pages in the book of life, and we all have a different one. For women going through perimenopause or into menopause, it's never too late to initiate hormone replacement therapy. Studies suggest it's safe with a lot of benefits at any age.
What would you say to women going through this now and feeling that something's off? The biggest thing is to advocate for yourself — that's what I'd tell my younger self. It's okay to make a little noise, it's okay to not be okay and ask for help, and women don't need to suffer in silence. Let people know where you're at and what you need, whether it's your provider or your family. And men — if you think you're not going through your own version of this, you are, so support the women in your family.
Tandy, I appreciate you being so honest today about something that's difficult to talk about. It was a pleasure, and I'm happy to help anytime. I just want to reiterate: midlife is not the end of vitality — it's the beginning of intentional living. You don't need to go it alone. We hope everyone gained some insight from our discussion today. Have a healthy day.