The limitations of HRT – menopause is not all about oestrogen.

HRT - hormone replacement therapy

When we hear about menopause, we are often hearing of symptoms and issues associated with declining levels of oestrogen. And when we are debating the pro's and cons of Hormone Replacement Therapy (HRT), we are talking about oestrogen and/or progesterone replacement.

The thing is, the symptoms of menopause are not just down to those two hormones.

There are lots of other hormones at play during perimenopause and beyond, and if you have followed me for a while or read my book, you know that I talk a lot about the Feisty Four. These are the four hormones that can be the difference between sailing through menopause with no symptoms or having a really tough time.

These four hormones are interconnected, so if any one of them is out of balance, it can affect the others. Oestrogen is one of them, but if any of the other three are out, then it can not only affect how you feel but also your oestrogen and progesterone levels, so it can really make the difference between having awful symptoms and then having mild symptoms, or none at all.

Will HRT help?

It depends! If you take HRT, you are only replacing your oestrogen and progesterone. If you have an imbalance in cortisol, insulin or thyroid, it won't help that. And if you balance your other hormones first, you may not even need it! It may be one of the other imbalances that is affecting your oestrogen or progesterone.

Your Feisty 4


Cortisol is your stress hormone. Too much or too little of this can really derail your menopausal journey by;

  • suppressing progesterone, which is already declining because you're not ovulating every month, and that can cause sleep issues, anxiety and mood swings.
  • interfering with your brain hormones, so that can cause extra anxiety, extra stress, mood swings, brain fog, memory loss, being overemotional, low motivation and just feeling numb or flat.
  • suppressing your thyroid so that can make you feel sluggish, gain weight, and cause extra PMS, heavy or painful periods, low libido, hair loss, brittle nails. There's a lot of symptoms associated with low thyroid as it affects the whole body.
  • pushing up insulin, encouraging more fat storing especially around the belly area, more mood issues, fatigue, brain fog and inflammation.

So you can see that if you've got too much or too little cortisol being produced, it can have an effect and really interfere with the menopausal oestrogen and progesterone fluctuations.


Insulin is another one of the feisty four, and this is important because if you have too much of it being produced, from either too many carbs in your diet or from too much stress, it can really derail your menopausal journey by increasing symptoms of fatigue, weight gain, insomnia, mood swings and PMS.


It's very common to have thyroid issues past the age of 45 due to ageing, stress, genetics, nutrient deficiencies or gut issues. Not enough thyroid hormone production can increase feelings of exhaustion, anxiety, depression, low libido, digestive issues, hair thinning, feeling cold, and of course that dreaded weight gain.


Oestrogen and progesterone start declining on average from the age of 35. The symptoms of declining and fluctuating sex hormones can mimic many of the symptoms we have mentioned for other hormone imbalances.

Other important hormones

Testosterone declines during menopause naturally but if it goes too low, it can affect your bone health, your brain health, and your heart as well as your sex drive. DHEA is another stress hormone from your adrenals, and it can decline with extra stress, and as you age. Low DHEA can result in fatigue, low libido, mood swings, depression, weight gain, joint pain, and it can weaken your immune system.

So you can see that a lot of the symptoms put down to menopause can actually be caused by all sorts of different hormone imbalances that are not necessarily due to oestrogen or progesterone.

Whether you're taking HRT or not, if you don't feel as good as you should, then it may well be worth getting these other hormones checked out.

Message me or comment below if you'd like to get help with that.

Comments 1

  1. Thanks. Nikki… You know what this is the best blog post regarding the menopause and limitations of HRT to address the problems associated with the menopause. Menopause is a natural phenomenon that influences the physiological process of a woman in a very adverse way and suitable precautionary measures should be taken into consideration to make it deal with such situations, but HRT is not the best option. In my point of view, undergoing bio-identical hormonal replacement therapy is more useful and effective as compared to HRT.

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