13 Oct The Rx Pad of Misogyny: Why Doctors Still Get Menopause Wrong with Esther Blum
Have you ever walked into your doctor’s office with a list of symptoms, feeling hopeful that you’d finally get answers, and walked out with a prescription that didn’t fix a single thing?
Maybe your weight stopped budging. Your sleep fell apart. Anxiety showed up out of nowhere, and your libido quietly left the building. You did what you were supposed to do. You made the appointment. And then you were offered a birth control pill, an antidepressant, and a gentle suggestion to relax, breathe, and maybe try meditating.
I know that experience personally. Before I ever started this podcast, I was deep in perimenopause and sitting across from the gynecologist I had trusted for years. Her practice delivered my daughter. I told her about the anxiety, the depression that felt eerily similar to postpartum, and the back pain that flared in a pattern every month. Her first suggestion was birth control pills. When I said no, she suggested antidepressants. What she never mentioned was hormone replacement therapy, nutrition, or anything that addressed what was actually happening in my body.
I’m 55 now, post-menopause, and I wear an estradiol patch that I would honestly fight you for. But I had to become my own health detective to get here. And I know so many of you are still stuck in that exam room.
That is exactly why I wanted to bring Esther Blum onto Midlife Conversations. Esther has spent nearly 30 years building what she calls a gaslight-free zone for midlife women. She’s a menopause expert, a five-time bestselling author, and a TEDx speaker whose talk tackled what she calls the prescription pad of misogyny. Whether you’re curious about HRT, can’t take hormones, or simply want to understand your options, this conversation is for you. There’s no judgment here about which path you choose. There’s only better information.
What Is the Prescription Pad of Misogyny?
According to Esther, the term describes what medical schools still teach about menopause treatment today: when a midlife woman comes in with symptoms, the default options are birth control pills or antidepressants. That’s it.
There’s often no conversation about hormone replacement therapy. No conversation about diet and lifestyle. And no effort to normalize or explain the massive neuroendocrine shift a woman’s body is going through.
Here’s the part that surprises most women. Birth control pills are not FDA approved for the treatment of menopause. Esther is clear that there’s real clinical research supporting certain antidepressants and non-hormonal medications like Veozah for hot flashes, and those can be a great route for women who can’t take hormones. The problem is when those are the only tools offered, and when they’re offered for symptoms they weren’t designed to address.
Why Birth Control Pills Aren’t Menopause Care
Esther frames it simply: menopause is not a birth control deficiency.
Birth control pills contain synthetic estrogens and synthetic progestins designed to suppress ovulation. That’s useful if pregnancy prevention is the goal, and yes, you can still get pregnant in perimenopause. But in midlife, progesterone is typically the first hormone to decline. Continuing to suppress it can contribute to anxiety, mood changes, and heavy, unpredictable bleeding.
Doctors aren’t prescribing birth control out of bad intentions. It’s what they were trained to do, and it can calm heavy bleeding. But Esther points out that synthetic progestins don’t offer the same mood, memory, and cognitive benefits that oral micronized bioidentical progesterone can.
If you want to stay on birth control for contraception, Esther suggests asking your provider about adding oral progesterone alongside it. The same goes for women with an IUD. And for women who don’t tolerate oral progesterone well, a progestin IUD can still provide uterine protection.
Crime Scene Periods and Unopposed Estrogen in Perimenopause
If you’ve ever had a period so heavy it soaked through your clothes, you are far from alone. I experienced it myself every other month and never even thought to bring it up.
Esther explains that these “crime scene periods” are often driven by unopposed estrogen. As progesterone declines, estrogen in perimenopause can swing dramatically from day to day, surging and dipping with nothing to balance it. The result can be flooding, clotting, cramping, and even anemia.
Even women already on progesterone can experience this if their dose isn’t high enough. Fibroids can also contribute to heavy bleeding. If this is happening to you, it’s worth tracking and bringing to your provider, because it affects far more than your wardrobe. It affects your iron, your energy, and your quality of life.
Medical Gaslighting in Menopause Is More Common Than You Think
Esther’s own story is one of the most jaw-dropping I’ve heard. During perimenopause, she was dealing with severe insomnia, sleeping just two to four broken hours a night, while also battling undiagnosed Lyme disease and mold exposure. She was raising her son, running a business, and in a very dark place emotionally.
She went to a doctor hoping for answers. He told her to take Xanax, assured her it wasn’t addictive, and then handed her a book on Jewish mysticism to put under her pillow. It took Esther about five months to come off the Xanax, with rebound insomnia and panic attacks along the way.
And her story isn’t an outlier. Esther has heard from women whose doctors told them to change sex positions to fix low libido, take Benadryl every night for insomnia, or simply have a glass of wine. Many women have been told that menopause is a social media phenomenon.
The real danger here is that when we hear these messages often enough, we start gaslighting ourselves. We stop trusting what our bodies are telling us.
One more thing I want to say gently. If you’re one of the lucky women who sailed through menopause, that’s wonderful. But telling someone who is struggling that you had no problems can feel incredibly invalidating. And as Esther points out, many women who say they had no symptoms later realize that things like hot flashes or a frozen shoulder were part of the picture all along.
The Women’s Health Initiative Study That Changed Everything
So why is menopause still barely taught in medical school? Esther points directly to the 2002 Women’s Health Initiative study.
The women in that study were, on average, in their 60s, with many already a decade or more past menopause. Many already had or were predisposed to cardiovascular disease and type 2 diabetes. They were given conjugated equine estrogen, derived from the urine of pregnant horses, along with a synthetic progestin.
The headlines that followed sent millions of women off hormones almost overnight. Since then, the data has been reexamined many times and medical position statements have been updated. And one finding that rarely made the headlines: in the estrogen-only arm of the study, women actually had a lower risk of breast cancer. In Esther’s view, the synthetic progestins were the real problem, not estrogen itself.
Do Bioidentical Hormones Cause Breast Cancer? A More Nuanced Conversation
This is the question I get every single time we talk about hormones, so I asked Esther to walk through it.
Her position is that the research does not show bioidentical hormones cause cancer in healthy women. She also explains that transdermal estrogen (patches, gels, and creams) doesn’t pass through the liver the way oral estrogen does, which is why it isn’t associated with the same clotting concerns.
At the same time, Esther is clear that this isn’t black and white. There are situations, such as active treatment for hormone receptor positive breast cancer, where a careful conversation with your oncologist is essential. For women who have had a double mastectomy or a full hysterectomy with ovaries removed, she believes there is a strong case for starting hormones promptly to avoid an abrupt surgical menopause.
For women with a cancer history, Esther recommends going into your oncologist appointment with specific questions about relative risk. How many women out of 100 have a recurrence on a given treatment, and how many without it? What does the treatment mean for your bones, brain, heart, and quality of life? Every woman deserves an individualized conversation, and every woman deserves respect for the informed decision she makes, whether that includes hormones or not.
The Black Box Warning Is Gone (Even If Your Box Still Has It)
Here’s a piece of news many women still haven’t heard. In late 2025, the FDA moved to remove the black box warning labels from estrogen products.
If your box still carries the old warning, Esther explains that it’s likely older inventory still working its way through the supply chain. New packaging should reflect the updated labeling.
What If You Can’t Take Hormones?
This is so important. If HRT isn’t an option for you, for any reason, it is absolutely not doomsday. Esther lays out a powerful foundation that works with or without hormones.
Start with your diet. Esther calls diet ground zero. A protein-rich breakfast of 30 to 40 grams can support focus, help prevent the afternoon crash, and steady blood sugar so you’re less likely to wake at night. Fiber helps your body clear excess estrogen, and having a bowel movement every day matters for hormone detox. She also likes a modest serving of starch at dinner, like sweet potato, rice, or legumes, to help calm cortisol and support sleep. Keto may quiet hot flashes for some women, but she often sees sleep issues develop over time.
Lift something. You know this is my zone. Esther has seen women raise their testosterone levels through consistent strength training, especially upper body work. If you’re rebuilding from illness or exhaustion, start gently. Esther herself began with one-on-one barre and Pilates sessions after Lyme and mold, and even hanging from a bar to build grip strength counts.
Get outside. Morning sunlight supports mood and energy in ways indoor lighting simply can’t.
Consider targeted support. Esther mentions rhapontic rhubarb for hot flashes, magnesium glycinate for anxiety, sleep, and regularity, and glutathione for liver and detox support. She also notes that FDA-approved non-hormonal medications like Veozah and Lynkuet are options for hot flashes. Always discuss any new supplement or medication with your provider.
GLP-1s, thoughtfully. We also talked about GLP-1 medications. Esther’s clients who use them tend to be on the smallest possible doses. My own opinion is that low doses, along with tools like metformin or berberine for some women, may help calm the blood sugar swings that drive cravings in midlife, which can make healthier choices feel possible again. But Esther and I agree on one thing: if you’re already undereating, fuel your body and start strength training first.
The Estrogen Patch Shortage: Workarounds That Can Help
If you’ve had trouble filling your estradiol patch prescription, you’re not imagining it. Esther explains that a manufacturer stopped producing patches, and demand rose after the black box warnings came off. She also raises a point that stopped me in my tracks: hormones simply aren’t as profitable for pharmacies as products like Viagra, and she can’t imagine a Viagra shortage being tolerated the same way.
Some options to discuss with your provider:
- Switching formulations to oral estradiol, gels, creams, sprays, or vaginal rings, keeping in mind that each delivers differently
- Using a member pharmacy service like HRT Club, which Esther mentioned as a cost-effective option (she has no financial ties)
- Calling your pharmacy to ask how they’re handling stock
I shared a few of my own workarounds too. I keep a prescribed estradiol cream as a backup and sometimes use it on the last day of a patch cycle when the patch is fading. And if you live somewhere humid and your patch keeps peeling off, a transparent medical film dressing like Tegaderm over the top can help it stay put.
Hormone Testing for Women: The Labs Worth Asking For
Esther is a big fan of the DUTCH test, a dried urine hormone panel. Instead of a single snapshot, it shows how your hormones are metabolized and gives a picture of your cortisol curve across the day and night. She often sees women whose cortisol is rock bottom during the day and high at night, which helps explain why they’re exhausted and wired at the same time. It can also show whether HRT is actually being absorbed.
For blood work, Esther recommends a hormone baseline that includes estradiol, progesterone, DHEA sulfate, free and total testosterone, and pregnenolone. She also emphasizes cardiac risk markers, because heart disease, not cancer, is the leading cause of death for women. Those include lipoprotein(a), C-reactive protein, homocysteine, triglycerides, cholesterol, fasting insulin, fasting glucose, and A1C.
And please don’t settle for a TSH-only thyroid check. Esther recommends a full panel including free T3, free T4, reverse T3, thyroid antibodies, and ferritin, plus vitamin D.
If your doctor won’t order these, many labs now let you order and pay for testing yourself. And remember, “normal” lab ranges aren’t the same as optimal.
How to Ask Your Doctor for HRT (and When to Find a New One)
This is where I want to lovingly push us a little. Blaming our doctors won’t fix our health. We wouldn’t keep an accountant who mishandled our taxes, and we don’t have to keep a provider who won’t partner with us.
Esther’s advice is practical. Schedule a separate appointment specifically to discuss hormones, rather than bringing it up mid-pap smear. Bring a written list of your symptoms, with specifics like how many hot flashes you’re having or how heavy your bleeding has been. Tell your provider you’ve done your research, you believe you’re a candidate for HRT, and you’d like them to partner with you. If speaking up feels hard, bring a friend or partner to advocate alongside you.
Before you even book, call the office and ask whether the provider prescribes hormones, what types, whether they work with insurance, and whether they’ll adjust your dose over time. Getting on hormones is just the start. Optimizing them is where you start to feel like yourself again.
And if you’ve already shown a doctor the research and they won’t budge? It’s okay to say thank you and move on. Your job isn’t to change their mind. Your job is to find the right provider.
Menowashing: How to Avoid Wasting Money on Menopause Products
There’s another side to this conversation. As menopause finally gets attention, a flood of products promising miracle results has followed. Esther calls this menowashing. Even she admits to buying a skin oil from an Instagram ad that did nothing.
A few ways to protect yourself: be cautious of vague “proprietary blends,” look for brands that share full ingredient transparency and cite research, buy supplements from professional dispensaries or directly from the brand rather than unknown third-party sellers, and pay attention to how your own body responds. Esther and I both believe there are genuinely great products out there. The key is staying curious and skeptical at the same time.
Vaginal Estrogen: The Most Underused Tool in Midlife
Vaginal estrogen uses such a small dose that it stays local, which is why Esther considers it safe for most women. It helps rebuild collagen in vaginal and urinary tissue and can reduce the risk of recurrent urinary tract infections.
Estriol is a weaker form and estradiol is FDA approved, and both can work well. Esther recommends applying a pea-sized amount around the full inner vaginal canal, along with the labia, urethra, and clitoris, since all of those tissues can thin with age. Most women use it two to three times a week. If you’re sensitive to ingredients in pharmacy versions, compounded options or vaginal DHEA may be worth asking about.
It’s Never Too Late
When I asked Esther what she most wants women to remember, her answer was clear. She believes bioidentical hormones are safe for healthy women, that vaginal estrogen saves lives, and that it’s never too late to explore HRT, though earlier intervention, ideally within about 10 years of menopause, tends to bring the best outcomes.
Most of all, suffering is not a badge of honor. Menopause can be your second spring, a season where you’ve walked through fire, lost some of your filter, and gained the confidence to choose what and who belongs in your life.
The contents of the Midlife Conversations podcast is for educational and informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider. Some episodes of Midlife Conversations may be sponsored by products or services discussed during the show. The host may receive compensation for such advertisements or if you purchase products through affiliate links mentioned on this podcast.
