I Don’t Want What Everyone Else Is Getting” - Estrogen, Resistance, and the Myth of the Menopause ‘Trend’

In Episode 2 of On the ’Mones, Kate starts with a moment many midlife women will recognise: a close friend, a few glasses of wine, a forgotten word, and the immediate dismissal of perimenopause as something “everyone else is doing.”

That moment opens the door to a much bigger conversation.

This episode explores why many women resist menopause care (even informed, health-literate women) and why perimenopause is often misunderstood as a “trend” rather than what it really is: a long-overdue correction to decades of silence, stigma, and medical neglect.

Kate unpacks:

• Why perimenopause is being talked about more, and why that doesn’t mean it’s overdiagnosed
• How menopause mirrors the cultural unmasking we’ve already seen with ADHD in women
• Why HRT is no longer just about hot flushes, but long-term brain, bone, and heart health
• The three types of estrogen (E1, E2, E3) and how oral, transdermal, and vaginal forms differ
• How to think about estrogen as a toolkit, not a one-size-fits-all prescription
• And why resistance to “what everyone else is getting” is often about fear, identity, and agency - not medicine

The episode also features a deep dive into Wellness Woo of the Week, tackling wild yam cream: what it claims to do, why it doesn’t work biochemically, and why women are so often targeted by hormone misinformation in the first place.

This is an episode about hormones, but it’s also about psychology, culture, gender bias, and what happens when women finally have language for what they’ve been experiencing all along.

Smart, evidence-based, occasionally sweary, and deeply validating, this one is for anyone who’s ever wondered whether midlife medicine is a fad… or long-overdue progress.

Whether you are in perimenopause, approaching menopause, or simply trying to understand your hormones, I've got you. 

Read more about this episode at Medication Clarity Clinic - Kate's own medication education and telehealth consulting site: https://medicationclarity.com.au

Transcript

SPEAKER_00 0:00

You're listening to On the Moans, where we have conversations about hormones, midlife, and the moments that make us wonder, is it just me? I'm Kate. I'm a 48-year-old pharmacist and newly minted perimenopausal oversharer. This is where we talk openly about the changes we aren't prepared for, so we never have to feel alone in them again. I acknowledge the Camaragle people of the Iora Nation, the traditional custodians of the land which I am recording today. I pay my respects to elders past and present, and I extend that respect to all Aboriginal and Torres Strait Islander peoples listening. Always was, always will be, Aboriginal land. Last night I was sitting with one of my friends, we've been in each other's lives for about 35 years, and after a few whines, because of course we had, we were being our usual loud, chaotic selves. She's mid-story trying to remember the word or name of something or someone, and suddenly she goes, Oh my god, my memory is getting so bad. And without even thinking, I just shoot back, it's your estrogen. Totally glib, totally on brand for me at this stage of life. And she groans and goes, Oh, not you too. At the school gate, it's all brain fog, this and perimenopause that. And I'm like, Well, you are 48, we're all doing it. Perimenopause is the new black. Then I ask if she's had her 45 to 49-year-old health check. And of course she hasn't, because she's a mum of four, full-time working, permanently running on coffee and chaos. Her own healthcare gets shoved to the bottom of the list. Totally relatable. But then she says something that really stops me. I don't want anyone pushing HRT on me. I don't want to walk in and get what everyone else is getting. And honestly, I'm baffled. This is a woman who's married to a doctor. This is a woman who is a healthcare professional herself. A woman who absolutely knows how to have a nuanced conversation with her GP. And yet suddenly she's acting like she'll be marched into the clinic and forced fed estrogen like Foi Gras. Why doesn't she want what everyone else is getting? Why does she think she's somehow exempt from human biology? Why is she imagining herself as the one woman whose ovaries have achieved enlightenment and no longer follow the rules? I gently remind her that not everyone needs HRT. Truly. But the evidence is getting stronger and stronger that for many women, estrogen earlier and for longer can be protective, particularly against osteoporosis. This one is basically a given. Cardiovascular disease and reducing the risk of dementia. So HRT isn't just hot flash juice anymore. It's preventative medicine for long-term health. It's not some fad people are jumping on. It's the correction of a decades-long gap in women's health research. And then she hits me with this classic line, but I don't have hot flashes. As if hot flashes are the only symptom. As if menopause is basically a personal sauna you either have or you don't. So I'm like, hot flushes are like one tile in a very large mosaic. How about brain fog, irritability, anxiety, mood swings, sleep problems, night sweats, heart palpitations, joint aches, low libido, vaginal dryness, recurrent UTIs, heavy periods, irregular periods, migraines, weight redistribution, dry skin, hair changes, bloating, fatigue, overwhelm, and feeling like you've lost your personality somewhere between woolies in the car park. But just because she's not waking up drenched in sweat, she thinks she's not there yet. Made me realize how deeply this misconception runs that perimenopause equals hot flushes, HRT is trendy, and midlife symptoms are something women are meant to power through. Even among health literate women. And it left me pondering, what sits underneath this resistance? Is it fear of aging, fear of losing agency, fear of being medicalized, fear of being lumped into the same category as everyone else? Because the reality is that every woman, if she lives long enough, will go through menopause. Common things happen commonly. But the resistance is real and it's emotional and it's cultural. If she's hesitant, this confident, educated, medically connected woman, imagine the women who don't have that background. It was such an interesting moment of realizing that the gap in menopause care isn't just clinical, it's psychological. We've spent decades not talking about it, so now women don't know how to approach it without feeling like they're signing up for some sort of midlife club against their will. And the more I thought about her reaction, especially the I don't want what everyone else is getting part, the more it reminded me of something we've been seeing in a completely different area of healthcare. The explosion in ADHD awareness and diagnosis. For years, ADHD, especially in women, was badly understood, rarely recognized, and almost never discussed. If you struggled with focus, executive function, emotional regulation, forgetfulness, or overwhelm, you were told you were lazy, dramatic, disorganized, or just not trying hard enough. Then the research caught up, the language shifted, people started describing their actual lived experience, and suddenly a huge number of women went, hang on, that sounds just like me. And the diagnosis jumped, not because it became trendy, because it became visible. And it it didn't create ADHD, it just revealed it. Perimenopause is going through the same cultural unmasking. For decades we didn't talk about it, women didn't understand it, some doctors weren't aren't well trained in it. There was stigma around aging, stigma around hormones, stigma around being difficult or emotional. So of course women internalized their symptoms. Of course they powered through. Of course they minimized what was happening. Now with better research, stronger evidence, massive public conversations, thousands of women sharing relatable symptoms online, and clinicians finally learning how to recognize the signs, we're seeing this wave of awareness. And with that wave comes a familiar backlash. It's overdiagnosed. Everyone thinks they have it. People just want the meds. It's a fad. And it's the exact same criticism ADHD faced and still faces. But visibility doesn't mean overdiagnosis. It means people can finally see themselves in the picture. So when my friend says, I don't want what everyone else is getting, what she's actually reacting to isn't the treatment itself, it's the cultural shift. She's seeing this flood of women talking about perimenopause the way people suddenly started talking about ADHD, and she's interpreting that as trend or groupthink rather than a massive correlation of decades of medical invisibility. The irony, of course, is that in both ADHD and perimenopause, we didn't suddenly create more cases, we finally started recognizing them. And once you recognize something, you can actually treat it effectively, early, preventatively, individually. That's not a fad. Surely that's progress. When we talk about estrogen, we're actually talking about three different hormones that behave very differently in the body. There's estrone, E1, the weaker background estrogen that becomes more prominent after menopause. There's estradiol E2, the powerhouse estrogen that dominates during our reproductive years and is used in most modern HRT. And then there's estriol E3, the gentle skin-loving estrogen used mainly for dryness and vaginal health. Together they form the estrogen family. Same surname, very different personalities. Because I promise you this, when a doctor says, we'll start you on estrogen, that can mean several completely different things depending on the form, the dose, the delivery method, and the goal. Oral estrogen is a pill you swallow, commonly estradiol or conjugated equine estrogens, premerin. It goes through the gut then to your liver before entering your bloodstream. Some of the pros of oral dosage include it's easy to take, it's familiar to many clinicians and patients, and it's got relatively stable absorption. Some cons include a higher clot risk than transdermal because of first-pass liver metabolism, and not ideal for women with migraine, with aura, clot history, smokers over 35, or women with a raised cardiovascular risk because of the higher clot risk. It suits best women without clotting risk factors, those who don't like gels or patches, and women who prefer the structure of a daily tablet. Transdermal estrogen, patches and gels, these two are the gold standard nowadays for most women. Why? Because they bypass the liver, meaning lower clot risk and more stable delivery of estradiol, that's E2. Estrogen patches, you stick it on your skin, and by a feat of pharmaceutical engineering, it releases estrogen slowly and evenly over a number of days before it needs to be swapped out for a fresh one. The pros include very stable hormonal levels, lowest clot risk, convenient twice weekly for many brands, and great for women with migraines. The cons are adhesive irritation for some, they can fall off if you're sweaty or swimming a lot. Some women just simply hate that sticker feeling, and some of the brands are quite large, so maybe uncomfortable on smaller bodies. It suits women who want consistency, those with higher clot risk, and busy women who don't want daily application. Oestrogen gels are rubbed onto the skin and it's absorbed directly. The pros include very flexible dosing, it absorbs really quickly, has excellent safety profile. It's great for women who want fine-tuning rather than a fixed patch dose. Cons can include you have to remember to apply it daily, it takes a few minutes to dry, so you are doing the walk around naked moment. It can transfer to others if not fully dry. I had a vet friend tell me that they'd seen a few pets present with symptoms of high estrogen, don't ask me what they are, because their owners hadn't washed their hands properly before giving them belly rubs. The gel suits women who want adjustable doses, those who dislike patches for whatever reason. The supply issues around the patch is real and ongoing, so that's the reason I personally chose to go for the gel. Athletes who need something that won't peel off. Vaginal estriol E3 is the sweet, gentle workhorse. It's used in vaginal creams, pessaries, rings, or ovules, and is compounded extemporaneously as face cream. This is local low-strength estrogen. It negligibly enters the bloodstream and stays mostly in the tissue. It's used vaginally for dryness, pain with sex, recurrent UTIs, burning, irritation, loss of elasticity, and skin thinning. And on the face it's used for moisturization, plumping, and wrinkles. The pros are it's extremely safe, works locally only, amazing for skin integrity, can be used with systemic HRT or alone, and is life-changing for vaginal atrophy. Cons, it doesn't actually treat hot flushes or mood swings or any systemic menopause symptoms. It needs consistent early use and then a maintenance dose. And some women don't like the messiness. It suits anyone with vaginal dryness, women who can't take systemic estrogen, breast cancer survivor, ask your oncologist for approval, but often yes. Perimenopausal, postmenopausal women wanting comfort and skin support. The best estrogen is the one that treats your symptoms, fits your lifestyle, matches your health profile, feels comfortable and sustainable, and doesn't increase your risk profile unnecessarily. So for many women, patches or gels are the safest and the most physiologically natural. Oral estrogen is still a solid choice for some. Vaginal estriol is essential for dryness and skin support and should almost be its own category of self-care. This isn't a hierarchy, it's a toolkit, different tools for different jobs. This week's episode of Wellness Woo of the Week is a product that has been sold to women for decades with the sort of confidence usually reserved for dodgy secondhand car dealers. Wild yam cream. You've seen it, you've probably had it recommended to you. Honey, I was a mess and now I'm fixed, it's the wild yam cream. My hormones are finally balanced. Depending on which website or influencer you're listening to, wild yam cream is supposed to balance your hormones, boost progesterone, fix menopause, stop hot flushes, regulate cycles, boost fertility, reduce PMS, detox the endocrine system, which just doesn't exist by the way. It's all marketed as a natural alternative to HRT and heavily implied to be just as good but safer. And none of that, none of it, is backed by evidence. So what does wild yam cream actually do? This part's quick. Nothing. It does nothing. It's the equivalent of rubbing mashed potatoes on your legs and claiming that you're making vodka. Here's why. Wild yams contain diostenine. It's a plant steroid. Great, except your body can't convert diostenine into progesterone or any hormone for that matter. The TGA and FDA both know this and prohibit manufacturers from claiming hormonal effects. Diostogenin can only be converted into progesterone in a lab using chemical processes. Your liver cannot do this, your skin cannot do this, your ovaries cannot do this, your body just doesn't have the enzymes or metabolic pathways. Diostenin looks structurally similar to human sex hormones, estrogen, progesterone, testosterone, and that's why marketers latch onto it. How does diostenine become progesterone or estradiol? Well, this is where the confusion comes from. In the 1950s, clever chemists figured out how to take diostenine from wild yams and chemically transform it into progesterone through a multi-step process called semisynthesis. The key steps involve extraction of diostrogen from the yam root, chemical oxidation, side chain cleavage, isomerization, purification to produce USP grade progesterone. This is industrial level chemistry done with solvents and catalysts, temperature control, not something your body is capable of. Then from the lab-made progesterone, manufacturers can further modify the molecule to make body identical estradiol E2, estrone E1, estriol E3, and various progestins. So yes, wild yam is used as a raw ingredient in the pharmaceutical industry, but the body cannot perform these chemical conversions itself. This is why wild yam cream is natural progesterone is false. It contains diostrogen, the precursor, but without the lab, it remains inert. Are the hormones in natural hormonal supplements made from wild yam? The short answer is yes, but this is not what people think it means. If a supplement contains natural progesterone or bio-identical estrogen, that hormone was manufactured in a lab using diostrogen or stigmasterol from yams or soy, then purified and standardized to make pharmaceutical grade hormones. This is why compounding chemists and pharmaceutical companies can say their hormones are plant-derived, but the hormone itself is not plant-like. It is chemically identical to human hormones. And while yam cream on the shelf contains diostogenin, not progesterone, and therefore has zero hormonal effect. There is no human study ever showing that the gut microbiome can convert diostogen into progesterone, estrogen, or any active human sex hormone. A few rodent and in vitro studies show that bacteria can modify plant steroids, but modification does not equal conversion into a biologically active hormone. For a gut microbiome to convert diestrogen into progesterone, it would need to perform oxidation, cleave side chains, rearrange molecular rings, maintain chirality, create a hormone molecule identical to human progesterone. No bacteria we know of can do this. The bottom line is humans cannot convert diostrogen into hormones. Your microbiome cannot convert diostrogen into hormones, while yam cream does not affect, support, or balance hormones. If it could, diostrogen would be regulated as a hormone and you'd need a prescription. And pharmacies would be selling sweet potatoes. Why is it even allowed on the market? I hear you scream. Because the TGA lists products, that Ost L number, they don't need to provide evidence they work, only evidence that they are safe. Manufacturers can't legally claim hormone effects, so they use vague language like supports women's well-being for balance or traditionally used. It's the same loophole that allows many menopause support formulas to exist without any proof of efficacy. And this leads me to why are some women more susceptible to wellness woo? And this is a bigger, more important story. Not because we're gullible and we're not silly, we're responding to a system that for decades has failed us. Here are the big five reasons, in my opinion, why women are disproportionately targeted by and vulnerable to wellness woo. Medical gaslighting and misogyny. Women routinely report not being believed. Symptoms are dismissed as stress, anxiety, or hysterical. Interestingly, the word hysterical comes from the Greek word hysteria, meaning uterus. Ancient Greek physicians, especially Hippocrates, believed that many symptoms experienced by women, so anxiety, emotional distress, fainting, abdominal pain, wandering thoughts, were caused by a wandering womb. Seriously, they thought that the uterus floated around the body like a rogue balloon, bumping into organs and causing irrational behavior. This became the diagnosis of hysteria. But I digress. Where was I? Oh yes, that's right. Medical gaslighting and misogyny. Being told to lose weight, sleep more, or wait it out. When the mainstream medicine dismisses you, you go looking for someone who does listen. And the wellness industry is very good at listening. Even if the advice is nonsensical, the validation is powerful. The pain gap. Women live with more chronic pain, more autoimmune disease, more complex hormonal transitions, more invisible illnesses, and they wait years longer for diagnosis. When health feels unpredictable or poorly supported, certainty, even false certainty, becomes seductive. The fix yourself culture. Women are conditioned to take responsibility for everybody else, plan, organise, manage the family, micromanage their own bodies, their skin, hair, weight, fertility, mood. So the idea that you can fix yourself naturally at home plays directly into that socialization. Wellness isn't marketed to men the same way because men aren't raised to feel defective unless they're optimizing themselves 24-7. The menopause information desert. Let's be blunt. Women get almost no formal education about perimenopause. Most never hear the word until it hits them like a hormonal truck. So when perimenopause starts, brain fog, anxiety, insomnia, rage, night sweats, many are terrified and confused, and when they Google it, they hit a wall of naturopaths, wellness influencers, supplement companies, and yes, wild yam cream. The scientific medical community left a gap and Woo filled it. And the wellness industry is a multi-billion dollar machine, and its target audience is women aged 30 to 55. Women who are stressed, tired, caring for others, hormonally shifting, and actively looking for answers. They're not just the demographic, they're the business model. This is why the marketing works. Natural, toxin-free, balancing, hormone support, ancient wisdom, bioidentical, clinically proven. So while yam cream doesn't work, not biologically, not clinically, not even theoretically, but the fact that women reach for it makes total sense. We've been underserved by medicine, over-targeted by marking, and socially conditioned to fix everything ourselves. If you want progesterone, there is one evidence based option actual, body identical, micronized, regulated progesterone. And if you want to feel seen, believed, and supported, that should be coming from your GP and the healthcare system, not a cream made from. Yams. If you've learned something, laughed, or felt seen, please share this episode with someone who might need some hormone clarity or a little hormone solidarity. And if you're enjoying the podcast, a quick rating or review helps more women find us and keeps this show dancing in the algorithm. Follow me on TikTok and Instagram at prescribe or pass. Until next time, take care, bye bye.