Do You Really Need HRT in Menopause?
We’re being told loudly and often by the “Menoposse” doctors, that every woman needs hormone therapy in midlife.
And while HRT can be a powerful tool, there is often more to the menopause story.
What’s being forgotten is what the female body is designed to do when our ovaries stop producing oestrogen.
Yes, ovarian oestrogen production declines as we approach menopause. But that doesn’t mean oestrogen production stops altogether.
In fact, the body has two built-in backup systems that continue producing oestrogen after our reproductive years:
The adrenal glands, which make dehydroepiandrosterone (DHEA), a precursor hormone that can be converted into oestrogen in other tissues
Peripheral fat tissue, which uses an enzyme called aromatase to convert DHEA and other androgens into estrone, a form of oestrogen still active in the body
These systems don’t completely replace ovarian output - but they weren’t meant to. They’re part of an adaptive shift, not a hormonal cliff. And yet, most women are never told about them.
We hear that oestrogen “disappears,” and that the only solution is to replace it externally. What’s missing from that narrative is nuance and physiology.
Here’s what’s happening behind the scenes.
What My Blood Tests Say
I’m nearly 50. I regularly test my sex hormones.
And according to my blood work my follicle stimulating hormone and luteinising hormone levels are sky high!
They are shouting at my ovaries to make more oestrogen.
This is textbook late-stage perimenopause.
But here’s the interesting part: I’m not getting the symptoms that usually come with this stage. No hot flushes, no mood fluctuations, no insomnia, no joint pain, no brain fog and most importantly, no osteoporosis.
Why? For me it comes down to this:
My Adrenals Are Doing Their Job
Alongside my reproductive hormones, I also track my DHEAS and morning cortisol. And they’re in good shape.
That matters.
After menopause (and even in late perimenopause), your ovaries slow down, but your adrenal glands step in.
They produce DHEA to help your body can convert into oestrogen, especially in peripheral tissues like fat and skin.
It’s not the same as the estradiol your ovaries make. But it’s not nothing either.
If your adrenals are resilient and not worn down by chronic stress, under-eating, or over-training there is the possibility they can buffer the hormonal drop.
Fat Tissue Helps Too
Another overlooked source of post-menopausal oestrogen is adipose tissue.
In women, fat cells contain an enzyme called aromatase, which converts DHEA and other androgens into estrone - a weaker, but still active, form of oestrogen.
This is why being too lean or over-restricting food can sometimes make symptoms worse.
Your body needs some metabolic reserve to adapt.
What’s Working for Me
Right now, my symptom-free experience of perimenopause isn’t luck.
Here’s what’s likely helping:
A cortisol rhythm that supports daily energy without burnout
DHEAS levels that indicate good androgen reserves
Regular strength training that's female-friendly
Stable blood sugar, nutrient repletion, and not under-eating
Respecting recovery as much as exertion
Could that change in future? Of course.
HRT might be on the table one day, especially for bone protection or other targeted support.
But I want women to know:
You might not be broken.
You might be adaptive.
You might need different inputs, not just more hormones.
It’s Not Either/Or. It’s Know What You’re Working With.
The dominant narrative says menopause equals deficiency.
But sometimes, we’re not depleted.
We’re dysregulated.
Or unsupported.
Or not tested properly.
Your adrenal health, body composition, stress load, and metabolic flexibility all shape how you experience this transition.
You deserve a conversation that includes all of that.
If You’re Wondering What Your Body Is Already Doing…
I offer clarity calls and personalised programs for women who want to understand their own midlife transition - not just treat the symptoms.
It’s time to shift from fear-based messaging to body literacy.
And from hormone panic to strategic support.
You don’t have to do everything. But you do need to know what matters.
