Jackie's Take: What's on My Mind in Women's Wellness ✍️ 🤔 📰 

Why I’ve Been Starting Estrogen in Early Perimenopause ⏱️ 

(And Why the New Data on Risk Reduction Proves It’s Time to Rethink the Rules) 📏 

Every fall I follow the new research coming out of The Menopause Society’s annual meeting. It’s where the next decade of women’s health starts to take shape, and this year one study stood out.

Researchers reviewed more than 120 million health records and found that women who started estrogen therapy during perimenopause, roughly a decade before menopause, and continued for at least ten years had about a 60 percent lower risk of breast cancer, stroke, and cardiovascular disease compared with women who started later or never used hormones.

The study, led by Case Western Reserve University, is observational and not perfect, but it points toward something we have long suspected: timing matters. It also happens to align with what I’ve been doing in my practice for years.

A Shift From Relief to Prevention

For decades, hormone therapy has been framed as symptom management. You wait until your periods stop, the hot flashes start, and then you qualify for treatment.

This new research reframes estrogen as more than symptom control. It suggests that early initiation may actually lower disease risk.

When estrogen is started while the ovaries are still cycling, it appears to protect the heart, brain, and blood vessels. Women who began therapy after menopause still saw some benefit for breast cancer and stroke, but they had a small increase in heart attack risk. The earlier group consistently did better.

As the researchers explained, the goal was to see whether estrogen could do more than relieve discomfort. The findings suggest it can reduce disease burden and start a larger conversation about prevention in women’s health.

What I See in My Practice

The women I see in their early 40s rarely fit the stereotype of menopause. Their periods are regular and their lab work looks “fine,” yet they feel off.

They describe lying awake at 3 a.m. with a racing heart, crying without reason, snapping at their families, or forgetting words mid-sentence.

This is what I call estrogen volatility. Hormone levels aren’t declining smoothly. They are spiking and crashing. Those fluctuations disrupt serotonin, dopamine, and GABA, the neurotransmitters that regulate mood, focus, and stress. The result is irritability, anxiety, and a feeling of losing control.

Starting low-dose estradiol early helps stabilize the system. It doesn’t shut down ovarian function as was previously thought. It does provides consistency that reduces hormonal swings and the neurologic chaos that follows. When combined with micronized progesterone and targeted lifestyle work, the results are often transformative.

Why Timing Changes Everything

The “timing hypothesis” in menopause care proposes that the cardiovascular benefits of estrogen depend on when it is started. This new data extends that idea into perimenopause itself. Beginning therapy before estrogen collapses seems to offer the greatest protective effect.

Stable estrogen levels improve blood vessel elasticity, reduce inflammation, and support favorable lipid profiles. Estrogen also influences how the brain uses glucose and oxygen, which means it plays a role in cognition, mood, and memory.

Keeping that signaling steady during the transition years may prevent the physiologic wear and tear that later contributes to disease. The implications are huge.

What the Evidence Can and Cannot Tell Us

Because the study used retrospective electronic health record data, it cannot prove cause and effect. We do not know the exact type or dose of estrogen used, and factors like lifestyle and genetics were not controlled.

Even so, the size of the dataset (and it’s large sample size) gives it weight. More research is needed, but the trends are a clear signal it is time to start changing how we think about timing.

Prevention As the New Standard

Perimenopause is not only a reproductive transition. It is a neurologic and cardiovascular one. Waiting until after menopause to act ignores the decade when prevention could be most effective.

We need to start viewing hormone therapy as a potential preventive tool, not just a rescue medication. That means educating both clinicians and patients about the early warning signs of hormonal instability and intervening before full ovarian shutdown.

The women who thrive through midlife will be the ones who act early, who pay attention when their bodies whisper, and who advocate for hormone therapy as part of a larger prevention strategy.

The Tea: What's Trending in Women's Wellness & Culture 🍵 📰 

💊🔥 Testosterone Is Having a Moment (But Let’s Get Real About It)
More reporting (hot off the press!) about what women have been whispering to each other for years: testosterone therapy works. From libido to muscle tone to mood, midlife women are calling it their secret weapon, but without FDA approval or insurance coverage, most are paying cash and flying blind. It’s validation and caution wrapped in one very hormonal headline. (New York Times)

💊😵‍💫 Antidepressants Are the New Lifestyle Accessory…?
SSRIs have gone viral on TikTok, turning anxiety meds into aesthetic. The WSJ article unpacks what happens when #livelaughLexapro meets real life: emotional flatness, low libido, and withdrawal symptoms influencers forget to mention. A must-read if your algorithm is making serotonin look chic. (Wall Street Journal)

💍📊 Oura Just Got a Nervous System Upgrade
Oura’s new Cumulative Stress feature might be its smartest move yet. It tracks how your body stores stress through sleep, HRV, and temperature data, then reveals how recovery, or lack of it, is shaping your resilience. Add in 12-month menstrual insights and upcoming blood pressure tracking, and Oura is officially moving from wellness toy to health tech. (TechCrunch)

🧬💕 Your Social Life Is Literally Slowing Down Your Biological Aging
Here is a new study out this week that caught my eye (and confirms what your group chat already knows) — connection is longevity. Women with strong social ties show slower biological aging, better stress resilience, and less inflammation, which means your weekly catch-up might be the most medicinal thing you do all week. (Brain, Behavior, & Immunity – Health)

The Group Chat Edit 📲 👯‍♂️ 

🌀 To Try:
Retro walking is exactly as it sounds: literally walking backward. Trainers call it a secret weapon for balance, coordination, and brain longevity. Studies show it strengthens often-ignored muscles and lights up neural pathways in ways traditional walking doesn’t. Read more about why it works here.🚶‍♀️↩️

🎥 To Watch:
This Today Show segment breaks down why ovary health and muscle mass are the ultimate longevity duo for women. It’s a concise reminder that our hormones and muscle fibers are in constant dialogue, and that lifting weights might just be the best hormone therapy you’re not prescribed. Watch it here. 💪🧬

🧴 To Buy:
My current obsession: this hand cream that feels like cashmere for your skin. It’s loaded with glycerin and niacinamide (hello barrier repair) but absorbs instantly — no greasy keyboard fingers. ✨🙌