HeraSphere #35: Estrogen Runs Your Clock

Hi friends,

This week, I went to Dr. Mary Claire Haver’s book talk at 6th & I with some friends. I’d seen her speak in January. I write this newsletter. I’ve followed her on social media. I wasn’t sure how much new ground there would be.

Then she started talking about her mother and her grandmother. Both frail by the end. Both with dementia. She paused and said: they didn't have to end up that way. We just didn't know then what we know now.

Those personal stakes make it more real for me. She was a daughter who became an OB/GYN and watched two women she loved decline without anyone knowing how to stop it. She's teaching the world about menopause because she's furious it took this long, and determined it won't take this long for the rest of us.

This is is about what I learned, and what landed differently the second time around.

The TL;DR

• The menopause transition doesn't begin with hot flashes — it begins in your brain, your mood, your sleep, and your joints, often years before any doctor connects the dots.

• Estrogen is a whole-body regulatory system with receptors in your heart, bones, brain, gut, and skin.

• The medical establishment has chronically underfunded and undertaught this transition, leaving most women to figure it out themselves.

• Here's what Dr. Haver actually does for her own menopause — and what I'm changing because of it.

• Check out my 30 day plant challenge: see how many plants you are eating per week and how it compares to the HeraSphere community

Your Doctor Probably Doesn't Know

• Most healthcare providers genuinely weren't taught about menopause. Less than 1% of NIH funding goes to menopause and non-reproductive women's health. Medical schools give perimenopause about one hour of curriculum — for a transition that can last a decade. Dr. Haver is clear on this point: the system failed to prioritize it, which means your OB/GYN came up without the tools on their own.

• The numbers are worth sitting with. $50 billion NIH budget. 10% to women's health. Less than 1% to menopause. That is a century of priorities resulting in your unanswered symptoms.

• You have to advocate for yourself. This is an n of one experiment. You need to find the right provider, bring a list to your appointment and be persistent. Because sadly, the burden and consequences are yours alone.

The First Symptoms Aren't What You Think

• Dr. Haver calls the perimenopause years "the zone of chaos" — symptoms that are real, measurable, and hormonally driven, but rarely recognized in a standard clinical visit. Vertigo. Tinnitus. Frozen shoulder. Migraines. They vary by the individual and the playbook isn’t clear.

• Most women — and most doctors — are waiting for hot flashes as confirmation that perimenopause has arrived. Hot flashes are often the last symptom, not the first.

• The transition begins in the brain. Anxiety that spikes out of nowhere, mood shifts that don't match your circumstances, cognitive fog, sleep disruption — these are frequently the opening signs, arriving years before a missed period. Most women get treated for anxiety or depression without ever being told estrogen is involved.

• Rates of anxiety and depression roughly double during the menopause transition. Women with no prior psychiatric history develop symptoms during this window at striking rates. Many women report signs of ADHD - the mental health impact is not widely known.

• The bottom line: If you've been treated for anxiety, depression, or insomnia in recent years and no one has mentioned hormones, ask the question yourself — whether you're in perimenopause or well past it. These symptoms often won’t resolve on their own, and the root cause of estrogen decline won’t go change.

Every System in Your Body Has an Estrogen Receptor

• The reason symptoms across the menopause transition are so varied is that estrogen is a systemic hormone across the entire body. When levels become erratic, the effects show up everywhere at once: joints, skin, brain, cardiovascular system, gut.

• Your LDL and Lpa are likely going up — and it's not your diet. Estrogen plays a direct role in how the liver processes cholesterol. As levels drop, LDL rises and so does Lpa (lipoprotein(a) — a cardiovascular risk marker most standard panels don't include). I've been watching my own numbers creep up for two years assuming it was something I was eating. It's the estrogen transition. That changes the conversation I'm having with my doctor.

• You lose roughly 30% of your collagen in the first five years after menopause — which is why skin changes feel so sudden.

• The bottom line: When symptoms seem unrelated — cholesterol creeping up, skin changing fast, joints aching, brain misfiring — stop treating them as separate problems. Ask your doctor to look at the whole picture through the lens of the estrogen transition.

Protect Sleep As the Non-Negotiable Foundation

• The estrogen-sleep connection runs deeper than most women realize. Estrogen helps regulate the hypothalamus — the part of the brain that controls body temperature. When estrogen drops, the hypothalamus loses its calibration and starts misfiring. That's what causes the 3am wake-ups, the sudden heat, the racing heart, the mind that won't quiet down. It’s due to a hormonal signal gone missing. And because these episodes fragment your sleep — pulling you out of the deep, restorative stages your brain needs to consolidate memory, clear waste, and regulate mood — the effects compound. Poor sleep from hormonal disruption over time raises cardiovascular risk, accelerates cognitive decline, and makes every other symptom on this list harder to manage. This is treatable and it absolutely should be treated.

• Progesterone has a natural calming, sleep-promoting effect on the brain. Dr. Haver times her progesterone dose to bedtime. If you're on progesterone and still not sleeping well, look further — don’t assume sleep disruption is just part of the transition.

• Up to 90% of sleep apnea in women goes undiagnosed. Women present differently than men — fatigue, mood changes, and waking unrefreshed rather than loud snoring — and get screened accordingly less. If you're on progesterone and sleep is still broken, Haver's specific recommendation is to rule out sleep apnea before assuming nothing can be done. The downstream risks of untreated apnea are dementia and cardiovascular disease. It's worth a sleep study, and they are now available at home.

• The bottom line: If your sleep has changed in the last few years — quality, not just quantity — it is not just aging. Ask about progesterone timing, rule out sleep apnea, and treat it as the medical issue it is. Everything else works better when you're sleeping better.

Your Bones Have a Deadline — and Muscle Is the Insurance Policy

• The fastest rate of bone loss begins roughly two years before your final menstrual period. Most women picture post-menopausal osteoporosis as the risk window. The real acceleration starts during perimenopause itself, when estrogen is fluctuating and dropping. By the time most women get a bone density scan, they've already lost significant ground.

• If you had a baby in your late 30s or early 40s, you're likely entering this transition already behind. Pregnancy and breastfeeding can deplete 5–10% of bone mass. Younger women typically recover it. Women who move into perimenopause shortly after don't get that window. I had my daughter at 42 and have probably been in perimenopause for a few years — which means I've been losing bone on two fronts simultaneously and had no idea. I'm booking a DEXA scan. If this is your situation, so should you.

• This is no longer a small subset of women. For the first time in U.S. history, births by women in their 40s exceeded births by teenagers in 2023. A generation of women had children later — by choice, by circumstance, by biology — and almost none have been counseled about what that timeline means for their bones a decade later.

• Bone and muscle decline together — and they're protected together. This is where muscle becomes the insurance policy. Sarcopenia, the age-related loss of muscle mass, accelerates in this same window. And it's not just an aesthetic issue — muscle is what keeps you upright, stable, and independent as you age. Haver's mother and grandmother were thin. They were also frail. Thin is not a health metric. Muscle is. The interventions are the same for both: resistance training, a weighted vest for daily bone loading, and enough protein to actually build and maintain muscle mass.

• The bottom line: Get a DEXA scan — about $99 out of pocket at most imaging centers. Wear a weighted vest on your walks. Lift weights. Eat enough protein. Do it for the 80 year old you to prevent frailty and the fate of Dr. Haver’s mom and grandmother.

Dr. Haver’s Own 7 Step Menopause Protocol

• Estradiol patch — her starting point, with the caveat that patch absorption varies significantly between individuals, which affects dosing.

• Oral estradiol — her cholesterol went down on oral. Most women have been warned off hormones for cardiovascular reasons. Form matters more than you think.

• Progesterone — timed to sleep, for its calming effect on the brain. Bioidentical, not synthetic progestin.

• Testosterone — can help low libido. It is chronically under-prescribed and rarely raised by providers. Bring it up yourself if you have to.

• Vaginal estrogen — Separate from systemic HRT, this is safe for virtually all women, and reduces the risk of urosepsis (a urinary tract infection that reaches the bloodstream) by more than 50%. Dr. Haver says: “don’t wait until your vagina breaks.”

• Compounded vaginal estrogen cream on her face. Standard estradiol can be drying on skin. The compounded cream delivers estrogen to facial tissue without that effect. You won't read that in any skincare guide.

• DHEA — converts locally to both testosterone and estrogen. Dr. Kelly Casperson, urologist and menopause specialist, recommends a topical version.

The LDL thing landed hard. Two years of watching those numbers inch up, assuming it was my diet. It's the estrogen transition — the liver loses its regulatory signal and the numbers climb.

The bone section hit closest to home. I had my daughter at 42, I've probably been in perimenopause for a few years, and I had no idea I walked into this transition already carrying a deficit from pregnancy and breastfeeding — with little time to rebuild before perimenopause accelerated the loss further. I already have a weighted vest — I'm wearing it on my daily walks now instead of letting it sit in the corner. And I'm booking a DEXA scan.

Vaginal estrogen is on the agenda at my next appointment. Don't wait until your vagina breaks. Funny, direct, and exactly the thing no one says until someone finally does.

One thing I want to try with you this month: the 30-plant challenge. Dr. Haver mentioned using a printed chart to track her eating of 30 different plants in a week for gut and cardiovascular health. 30 distinct plants: vegetables, fruits, legumes, nuts, seeds, herbs. I've tried to do this but have never actually tracked this. I built a DIY tracker so we can do it together — track your count today, see what the community is eating, and track again next week to see if you improve.

I can’t wait to see what we are all eating!

Lilly

P.S. — If you have a friend who's been told her anxiety, insomnia, or joint pain is "just stress," forward this to her. She may need a trusted provider and a DEXA scan.

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Note: While I love diving deep into research and sharing what I've learned about women's health and wellness, I want to be crystal clear: I'm a passionate health advocate and researcher, not a medical professional. Think of me as your well-informed friend who does extensive homework – but not your doctor.

Everything I share in HeraSphere comes from careful research and personal experience, but it's meant to inform and inspire, not to diagnose or treat any medical conditions. Your body is uniquely yours, and what works for one person might not work for another. Always consult your healthcare provider before making significant changes to your diet, exercise routine, or wellness practices, especially if you have underlying health conditions or take medications.

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