Traci McCormick, MD

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Have you ever felt like your body changed almost overnight somewhere in your 40s or 50s?

Well, it turns out there may actually be some science behind that feeling.

A fascinating new study published October 12 in Nature Medicine looked at nearly 300 million routine blood and urine test results to see what happens to different systems in the body around menopause.

Here’s what researchers found.

We already know that hormone changes don’t happen overnight. In fact, they can begin 12 to 15 years before a woman’s final menstrual period.

But what’s interesting is that several lab markers, including those related to cholesterol, bone metabolism, liver function, and kidney function, showed more abrupt changes right around that final period.

In other words, while the menopause transition happens over years, some of the changes happening throughout the body may be much less gradual than we previously thought.

And food for thought... Those changes tended to be smaller in women who were using menopausal hormone therapy.

Now, before anyone interprets that to mean hormone therapy prevents all of these changes, there’s an important distinction we need to make.

This was an observational study. Researchers looked at what happened to women who did and didn’t use hormone therapy. They didn’t randomly assign women to treatment.

That’s important because women who choose hormone therapy may differ in other ways from women who don’t. So the study shows an association, but it doesn’t prove that hormone therapy caused those smaller changes. And changes in lab results don’t necessarily mean someone is developing a disease.

Still, I think this study is important.

We spend an awful lot of time talking about hot flashes, night sweats, irregular periods, and weight gain during menopause.

But menopause involves much more than reproductive hormones and bothersome symptoms. Changes during this time can affect multiple systems throughout the body, including systems involved in our cardiovascular, bone, and metabolic health.

My takeaway?

We need to stop thinking about menopause as something we only need to address when symptoms become unbearable.

That doesn’t mean every woman needs hormone therapy. It means women deserve to understand what’s happening in their bodies, what their individual risks are, and what options are available.

And ideally, those conversations should begin well before the final menstrual period, not years afterward.

Because menopause isn’t just about getting through hot flashes. It’s also an opportunity to think seriously about how we protect our health for the next 20, 30, or even 40 years.

Making the same decisions every day can wear you out. By the time dinner rolls around, choosing a meal or fitting in a workout may feel like one more thing to manage.

Try deciding a few things while you have the time and energy: your workout days, two or three easy dinners, and a bedtime that gives you enough sleep. Leave room for your schedule to change.

What’s one decision you could make today that would make the rest of your week easier? Tell us below.

Pumpkin and cottage cheese make a quick, cozy breakfast with protein. If you prefer a smoother texture, blend the ingredients instead of stirring them.

Pumpkin Cottage Cheese Bowl

Serves 1

1 cup low-fat cottage cheese

¼ cup canned pure pumpkin, not pumpkin pie filling

½ tsp cinnamon

¼ tsp vanilla extract

1–2 tsp maple syrup or honey, to taste

Stir or blend until smooth. Add granola or chopped pecans or walnuts if you like.

Save this for a morning when you want something easy. Nutrition varies with the cottage cheese, sweetener, and toppings you choose.

A routine needs room for real life. Work runs late, dinner plans change, and some nights you barely sleep.

Have a smaller version of your plan ready: a shorter workout, an easy dinner with protein, or a quick breakfast before you leave the house.

Doing the smaller version still counts. Consistency is easier when you know what to do when Plan A falls apart.

What’s one backup plan you could put in place this week? Save this for the next day that goes sideways, and follow Traci McCormick MD for practical ways to build muscle, lose fat, and feel better.

There’s a new study pertaining to testosterone replacement for women that is making headlines in the news.

It raises a concern about heart disease. And if you’re taking testosterone, considering it, or have a friend who uses it, that is probably going to stop your scroll.

A headline connecting a popular hormone treatment to heart disease will attract plenty of views and clicks. So I expect we’ll see it shared widely, sometimes with much less explanation than it deserves.

Let’s slow down and unpack it together. Because the interesting part is what happens when we look underneath the headline.

Researchers looked back through medical records and compared women after menopause who started testosterone with women who did not. Over an average follow-up of nearly three years, cardiovascular problems were recorded in 3.8% of the testosterone group and 0.5% of the comparison group. This included several conditions, such as heart attack, stroke, and heart failure.

Picture two groups of 1,000 women. Those percentages would mean about 38 women with a cardiovascular problem in one group, compared with about 5 in the other.

That difference deserves attention.

But now comes the question that makes this a scientific investigation: **What explains the difference?**

Our brains immediately want to connect the dots. More heart problems in the testosterone group? Testosterone must be the reason.

Maybe it contributed. But seeing two things together does not automatically tell us that one caused the other.

Here’s an everyday example. People carrying umbrellas are more likely to have wet shoes. You could collect thousands of records and find a very strong connection between umbrellas and wet feet.

But taking away their umbrellas would not solve the problem. You would need to account for the rain.

In medical research, the “rain” is any other factor that could help explain the result.

Were the women who received testosterone different before treatment began? What prompted them to seek care? Were there health problems, other medications, or differences in their care that also affected their heart risk?

The researchers did try to make the groups comparable. They matched women using recorded information, including smoking, obesity, diabetes, and high blood pressure. That is an important strength of the study.

But medical records are not a complete recording of someone’s life. If something wasn’t measured or documented, researchers cannot fully account for it.

That is one reason this study’s design matters. It was retrospective, which simply means looking backward at what had already happened.

Imagine trying to understand why a cake turned out badly by looking at a grocery receipt. You can see that someone bought flour, eggs, and butter. But how much did they use? Was the oven too hot? Did they leave out an ingredient?

The receipt gives you clues. You still need the recipe and the details of what happened in the kitchen.

That’s how I feel when I read “testosterone therapy” without enough treatment detail.

**What dose? What formulation? What testosterone levels did these women actually reach?**

Were their levels kept within the usual range for women, or did some reach much higher levels? Were different treatment approaches grouped together?

The public announcement does not answer those questions. Until we have those details, it is difficult to know how closely the findings apply to a particular woman’s treatment.

I also want to understand the timeline.

Were women still taking testosterone when the heart problems occurred? Had they stopped? Changed doses? Developed another illness that caused them to stop?

Think of it as needing the whole movie rather than a few snapshots. Knowing that a prescription came first and a diagnosis came later leaves out what happened in between.

That does not establish that stopping testosterone caused the problem, either. It means we need more information before choosing an explanation.

A randomized trial helps answer these questions differently. Researchers assign treatment by chance, rather than looking back at who happened to receive it. That helps balance differences between the groups, including some differences nobody knew to look for.

Sometimes a connection seen in retrospective research holds up in a randomized trial. Sometimes it gets smaller or disappears. Sometimes we discover that something else was driving it.

Retrospective studies are valuable. They can alert us to a real medication risk. But they generally give us less certainty about cause and effect.

And that uncertainty works both ways. We cannot use the limitations of this study to declare testosterone completely safe.

Earlier randomized trials in women have generally been relatively short and have often excluded women at higher cardiovascular risk. We still have gaps in our understanding of long-term safety.

So where does that leave you if you’re taking testosterone?

With a useful reason to revisit the details of your own care: why you’re taking it, whether it is helping, what blood levels you’re reaching, and how your health history affects the balance of benefits and risks.

My first reaction to this study is curiosity and concern. I want to understand the finding well enough to know what we should do with it.

Because when a headline makes you think, “Wait, could this affect me?” the next step should be a clear explanation that helps you make sense of it.

If you take estrogen, are considering it, or have been afraid to take it because of what you’ve heard about the risks, this new study is worth reading.

A large new study published this week in The BMJ looked at the risks associated with menopausal estrogen therapy. But importantly, the researchers didn’t just ask whether women were taking estrogen. They looked at which estrogen they were taking, the dose, how they were taking it, and how long they had been taking it.

And that distinction is important, because estrogen is not one medication.

There is estradiol, which is bioidentical to the estrogen your ovaries naturally produce. There are also other forms of estrogen, including conjugated estrogens and synthetic estrogens such as ethinyl estradiol.

And then there is how you take it.

A pill.

A patch.

A gel or spray.

A vaginal cream, tablet, insert, or ring.

Different estrogen. Different dose. Different route.

And those differences can matter when we talk about risk.

Researchers used Denmark’s national health records to look at women ages 50–69 over an 18-year period. They looked at the specific hormones women were prescribed, the dose, how they took them, how long they used them, and whether they developed a DVT or pulmonary embolism, ischemic stroke, or heart attack.

Women taking oral estrogen had about a 60% higher relative risk of DVT or pulmonary embolism.

But if you take oral estrogen, don’t panic when you see that 60%.

The absolute risk was still small.

Among women not using hormone therapy, there were about 16 blood clots per 10,000 women per year.

With oral estrogen, that increased to about 25 per 10,000 women per year.

So a 60% increase in relative risk sounds pretty dramatic. In absolute numbers, it was approximately 9 additional blood clots for every 10,000 women treated for a year.

Both numbers are true. Both are important when we’re deciding what a risk actually means for an individual woman.

Transdermal estradiol was different.

Women using estradiol through the skin, with a patch, gel, or spray, did not have an overall increased risk of blood clots.

For stroke and heart attack, the increased risk associated with oral estradiol was concentrated in women taking doses greater than 1 mg per day for longer than a year.

There is an important limitation to all of this.

This was an observational study, not a randomized clinical trial.

In an observational study, researchers don’t decide which treatment someone receives. They look at what is already happening in the real world. In this case, they looked at which estrogen women had been prescribed and what happened to them afterward.

In a randomized clinical trial, researchers would randomly assign women to different treatments and then follow them to see what happened. Randomization helps make the groups more similar from the beginning, which gives us more confidence that differences in outcomes are actually related to the treatment.

That matters because women prescribed oral estrogen may have been different in other ways from women prescribed patches or women who weren’t taking estrogen at all.

Researchers can adjust statistically for many of those differences, but they can’t account for everything. This study, for example, did not have information about two pretty important risk factors: smoking and BMI.

So we can say that oral estrogen was associated with more blood clots.

We cannot say from this study that oral estrogen caused those blood clots.

That doesn’t make the findings unimportant. Large observational studies give us valuable information about what happens to people in the real world, particularly when we’re looking at relatively uncommon events.

And if you take oral estrogen, this study is not a reason to panic or suddenly stop taking it.

The absolute risk was small.

Oral estrogen is not automatically a bad choice, and a patch is not automatically the right choice for every woman.

But this study is another reason I think we need to stop asking:

“Is estrogen safe?”

The better questions are:

Which estrogen?

What dose?

Taken how?

For how long?

And in whom?