Content warning: This story includes references to suicidal thoughts.
Lisa Schlenk didn’t know it yet. As she walked along a dirt trail last August, her life was about to change—and a new understanding of perimenopause and hormone therapy would play a major role.
Schlenk had left late the night before with a hiking group to climb Old Rag Mountain in Virginia. After reaching the summit before sunrise, the group watched the Blue Ridge Mountains emerge in the morning light and stopped to take photos. In one image, Schlenk looks out over the horizon, her long black hair pulled into a ponytail. The photo appears triumphant. In reality, she was contemplating suicide. The longtime federal IT specialist had begun setting aside belongings for friends and family, organizing her finances and cleaning out her office.
Her turning point did not come at the summit. It began on the descent, when she overheard another hiker discussing hormone therapy. The woman described experiencing intense anger, anxiety and extreme fatigue before treatment—symptoms that improved after she began hormone therapy, which is commonly prescribed for menopause-related symptoms. “I thought, oh my God,” Schlenk recalled. “She was describing some of the symptoms I was experiencing. Could hormone therapy help me, too?”
Schlenk had already asked her doctor whether her treatment-resistant depression and mood changes could be connected to hormonal fluctuations. In her early 40s, she was approaching—or possibly already experiencing—perimenopause, the transitional stage before menopause when the ovaries gradually produce less reproductive hormone and estrogen levels can fluctuate unpredictably. The treatment was once commonly called hormone replacement therapy, or HRT.
At the time, Schlenk was taking birth control pills containing synthetic forms of estrogen and progesterone, a common treatment for some perimenopause symptoms. Her doctors dismissed her request to try hormone therapy, which uses bioidentical forms of these hormones and may be prescribed in different doses or through different delivery methods. Schlenk consulted two gynecologists, but says both initially rejected the idea. One agreed to change the brand of her contraceptive, but it made no difference. Her depression continued to worsen.
After hearing the hiker’s experience, Schlenk searched online for “HRT-friendly doctors near me.” She found Midi, a telemedicine company focused on women’s midlife health, and scheduled a virtual consultation. “During my first appointment, I sobbed with a runny nose and tears running down my face,” Schlenk says. Her nurse listened, lowered her estrogen and progesterone doses, and helped her transition from birth control to hormone therapy. The provider also explained that different hormone formulations and delivery methods can affect people differently. For the first time, Schlenk felt heard.
Over the next five months, Schlenk and her care team met regularly to adjust the medication dosage and delivery method while reducing side effects. She credits hormone therapy with transforming her mental health. “I’m not planning my own funeral anymore,” she says. Instead, she spends time with her beloved dog, hikes regularly and says she feels genuinely happy—even while sitting in Washington, D.C., traffic.
As Schlenk was learning how perimenopause affected her mental health, attitudes toward menopause treatment were also changing. Hormone therapy fell out of favor after a widely publicized 2002 study raised concerns about potential health risks, including cancer, and doctors began prescribing it less often. In recent years, however, medical professionals, feminist advocates and the Make America Healthy Again movement have helped renew interest in menopause care. Prescription patterns are shifting. Millions of people experiencing menopause symptoms—including mood changes, hot flashes and night sweats—may now have more treatment options to discuss with a qualified health care provider.
Source: www.wired.com