How “My Way or the Highway” Thinking is Limiting Midlife Care for Women

There’s a better way to heal women in midlife and it starts with learning from them.

I don’t know about you, but it feels like every day my social media and inbox are flooded with conversations about menopause. One debate that keeps resurfacing—without much change—is the discussion around hormone replacement therapy. And frankly, I’m growing more concerned.

Most medical providers follow the guidelines set by The Menopause Society, which focus on a cautious approach to hormone therapy—primarily recommending it for hot flashes and osteoporosis risk within the first ten years of menopause. These guidelines are important, but they don’t always address the full range of symptoms that women experience during perimenopause and menopause.

As someone who has spent years treating women in midlife, I’ve found that the best care happens when we blend the latest guidelines with clinical intuition, lived experience, and collaboration with peers. This approach opens up new possibilities—helping women feel like themselves again after years of struggling.

But what does that look like in practice? And why does it matter so much?

“My Way or the Highway” Hormone Therapy in Medicine

The Menopause Society (formerly the North American Menopause Society) and other mainstream medical organizations continue to define the role of hormone therapy in somewhat restrictive way. Their stance is that the risks of hormone therapy outweigh the benefits for anything beyond the most severe menopausal symptoms. In both their 2017 and 2024 position statements they do not address the use of hormones for the many other debilitating symptoms of hormone decline—insomnia, anxiety, depression, brain fog, joint pain, and rising cholesterol levels, to name a few.

Essentially, the primary US-based organization whose role is to make recommendations and guidelines for the care of women with hormone decline, is saying that we should tolerate the side effects of hormone loss in every circumstance except hot flashes, genito-urianary symptoms, and bone loss. 

And yet, the internet is exploding with medical providers openly discussing the numerous benefits of hormone replacement therapy. And they are generally speaking from real, lived experience as medical providers. 

I wrote two weeks ago about how the meno-platforms of some doctor-influencers are upsetting medical organizations who prefer to be the final word on what women should be doing in perimenopause and menopause. You can read that article here. 

The Need for a More Individualized Approach

By keeping hormone therapy limited to only the most basic and widely accepted uses, traditional medical circles may miss an opportunity to acknowledge the full spectrum of ways in which hormone decline affects women. There are a range of solutions for women who don’t respond to the standard “low dose estradiol and oral progesterone” treatment and those solutions deserve attention, too. I’ve seen many of these women in my practice—frustrated, exhausted, and desperate for relief—who have been told by other providers that they simply have to tolerate their symptoms.

One-size-fits-all thinking can prevent real progress in perimenopause and menopause care. The reality is that hormone therapy isn’t just about replacing what’s missing—it’s about understanding the body’s natural rhythms and working to restore them in a way that aligns with each woman’s unique needs.

The Role of Intuition and Experience in Medicine

This reminds me of my early days in midwifery. There were countless times when I instinctively knew exactly what a laboring mother needed to hear, even when there wasn’t a study or guideline to back it up. That knowledge came from experience—from being in the room, witnessing patterns, and learning what truly worked for my patients.

Clinical expertise has always been a part of evidence-based medicine. And the best providers—those with years of hands-on experience—understand that medicine isn’t just about following rigid guidelines. It’s about knowing when to adapt, when to listen to the patient, and when to trust that experience matters just as much as published data.

The Power of Physiologic Hormone Therapy

When I first started prescribing hormone therapy, I followed the guidelines: low-dose estradiol and oral progesterone. For some women, it worked. But for many, it wasn’t enough. I would see the frustration in their eyes when they asked, “Is this really all there is?”

So I started looking beyond the standard approach. I studied the work of providers across the country who were using physiologic hormone therapy—an approach that restores both hormone levels and the body’s natural rhythms with changing daily doses of estradiol, rather than delivering  static, low-dose amounts.

As a midwife, I have always appreciated the normal, healthy and physiologic actions of the body. Perimenopause is a period of time during which not only our levels of hormones fluctuate and wane, but the rhythms fall apart too. 

Restoring both rhythm and levels produces the best results. 

I have a whole article about this methodology here.

When I started implementing a physiologic approach to HRT, the results were remarkable. Women who hadn’t slept through the night in years were finally getting restful sleep. Some saw their autoimmune symptoms improve. Others were able to come off their antidepressants.

Physiologic HRT was a revelation for me. It was the perfect example of what happens when we apply traditional treatments, recognize their limitations, and lean on lived experience to find better solutions. It allowed me to take my knowledge of how the body naturally functions and align it with the best, forward-thinking treatments—leading to truly personalized care.

A New Approach to Perimenopause and Menopause Care

There is so much dogma in the hormone space that it can feel overwhelming for women trying to make informed decisions about their health. The key is to work with a provider who understands the guidelines, the science, and the reality of treating patients in the real world—someone who doesn’t take a “my way or the highway” approach but instead listens, adapts, and personalizes treatment based on each woman’s unique experience.

Terminology and rigid guidelines mean nothing if you’re still suffering. What truly matters is finding a treatment approach that helps you feel like yourself again.