If you scroll through social media these days, you’ll see a common message: menopause is to blame for everything from belly fat to brain fog, frozen shoulder to mood swings. And the solution? Just add hormones — problem solved.
I wish it were that simple.
I’ve prescribed bioidentical hormone replacement therapy (BHRT) for years. Sometimes it helps — especially with milder hot flashes, sleep disruption, or vaginal dryness. But when symptoms are severe and life-altering, hormones alone rarely deliver the dramatic relief that’s promised. More often than not, I was left wondering: Why isn’t this working?
The Protective Role of Hormones
Estrogen and progesterone do much more than regulate reproductive cycles. They’re powerful immune modulators with anti-inflammatory effects throughout the body. Estrogen, for example, enhances mitochondrial function, calms overactive immune signaling, and supports healthy blood vessels. Progesterone helps stabilize the nervous system and also has direct anti-inflammatory activity.
When hormone levels fall during menopause, those protective effects disappear. For many women, this creates an “unmasking effect.” The inflammation that was quietly smoldering in the background suddenly has free rein.
Menopause Doesn’t Cause the Storm — It Reveals It
Here’s the key point: menopause itself isn’t the root cause of crushing fatigue, unrelenting brain fog, body-wide pain, or exaggerated mood swings. Those symptoms often point to deeper immune dysfunction — what I call IACIRS (Infection-Associated Chronic Inflammatory Response Syndrome).
For years, microbes, toxins, and chronic stress may have been fueling low-grade inflammation beneath the surface. While estrogen and progesterone were still present, their anti-inflammatory buffer kept those problems partially contained. But once hormone levels dropped, the underlying issues were exposed.
That’s why hormone therapy often disappoints when symptoms are severe. It’s not that BHRT is “bad” — it’s that the real problem is upstream, and hormones alone can’t fix it.
Why This Matters
The mainstream narrative says menopause itself is a disease, and the only way to “survive” it is by taking hormones. My clinical experience — and the science — suggest a different story.
- If symptoms are mild, BHRT can be incredibly helpful.
- If symptoms are severe and life-disrupting, that’s a clue: the root cause is not simply “low hormones.”
In those cases, digging deeper into inflammation, immune function, and hidden stressors is where real healing begins.
The Bottom Line
Hormones play an important role, but they aren’t the whole story. Menopause symptoms that feel unbearable are often signals from the body that something else has been simmering for years. By identifying and treating those root causes, you can move beyond simply “managing menopause” and instead move toward genuine, lasting recovery.
References
- Straub RH. The complex role of estrogens in inflammation. Endocr Rev. 2007;28(5):521–574. doi:10.1210/er.2007-0001
- Vegeto E, Belcredito S, Etteri S, et al. Estrogen anti-inflammatory activity in brain: a therapeutic opportunity for menopause and neurodegenerative diseases. Front Neuroendocrinol. 2006;27(4):477–491. doi:10.1016/j.yfrne.2006.07.003
- Simoncini T, Genazzani AR. Non-genomic actions of sex steroid hormones. Eur J Endocrinol. 2003;148(3):281–292.
- Cherrier MM, Asthana S, Plymate S, et al. Progesterone and estrogen reduce cytokine-induced neuroinflammation in vitro. Brain Res. 2005;1049(1):9–17. doi:10.1016/j.brainres.2005.05.007
- Maki PM, Henderson VW. Hormone therapy, dementia, and cognition: the Women's Health Initiative ten years on. Climacteric. 2012;15(3):256–262.
- Gillies GE, McArthur S. Estrogen actions in the brain and the basis for differential action in men and women: a case for sex-specific medicines. Pharmacol Rev. 2010;62(2):155–198. doi:10.1124/pr.109.002071
- Fardoun MM, El-Yazbi AF, Choucair S, et al. Estrogen replacement therapy and inflammation: a novel insight into the missing link between menopause and cardiovascular disease. Front Cardiovasc Med. 2019;6:19. doi:10.3389/fcvm.2019.00019