The Menopause Mindset

214 Beyond Hormonal Determinism: Hormones Influence the System, They Don't Build It

• Sally Garozzo • Season 1 • Episode 214

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Most menopause conversations focus almost entirely on hormones. But what if that’s only part of the story? In this episode, Sally Garozzo explores emerging neuroscience on estradiol, fear circuitry, and trauma exposure, including a 2025 study suggesting that estrogen interacts differently with the brain’s threat regulation system depending on prior stress and trauma history. We unpack why HRT helps many women but isn’t always the whole answer, how the nervous system shapes our menopausal experience, and why understanding the intersection of menopause, trauma, and nervous system regulation can offer a more complete picture of midlife wellbeing.


Research referenced in this episode

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Sallygarozzo@hotmail.com (00:01.336)
There's a sentence I hear a lot. Heck, I've even said it myself. And it goes like this. It's my hormones. It must be my hormones. For some people, it's said with a kind of relief. For some, there's a frustration underneath it. And for others, there is a complete resignation. I feel anxious. It must be my estrogen. I'm snappy. Definitely hormonal. I really don't feel like myself. My levels must be off.

And I totally get it. For so long, women were dismissed, told we were too sensitive, told we were overreacting, too emotional. So when science finally turns around and says, no, actually, your hormones really do influence your brain and your mood, no wonder it feels like a win for us. Finally, something measurable, something medical explaining things. And I want to say this clearly right at the start.

Hormones matter. Estradiol is not just decorative. It's a really important hormone for fertility and for our brains. It shapes and influences our circuitry. It influences how we process the threat that we perceive, how we regulate emotion, how we sleep, how we formulate thoughts. And HRT can be transformative. I take it. I am not.

anti-HRT and this is not an anti-HRT episode. But here's what I've been noticing. There's a group of women, really thoughtful, intelligent, smart women who say...

who start HRT and say, this really helped, but something in me still feels wonky, still feels unsettled. And they don't always shout it from the rooftops, but it's like this underground murmur. It was definitely like this for me. And it says, why do I still feel weird? Why does my nervous system still react so fast? Why do I still feel tender? And often instead of sitting with that

Sallygarozzo@hotmail.com (02:14.03)
question we reach for the familiar explanation. It must be the dose. Maybe I need more. Maybe I need less. Maybe I need a different brand or a different type. And sometimes, yes, that's absolutely right. But sometimes I wonder whether we're reducing something much more complex into a single biological variable. We've become really fluent in hormonal language over the years.

We can talk about estrogen and progesterone and cortisol and insulin and thyroxine. But are we equally fluent in talking about our environment, about childhood, about attachment, about the climate we grew up in? Because here's the thing, hormones don't exist in isolation. They exist in a system, inside a nervous system that has been shaped for decades.

a system that's been shaped by tone of voice, by unpredictability, by whether our stress was met or minimised, by whether our feelings were held or hurried along. And I think something really significant has happened in the menosphere. In trying to legitimise women biologically, which was absolutely necessary, I think we might have drifted into something called

hormonal determinism. And hormonal determinism is the belief that human behavior, emotions and personality are directly controlled by hormone levels rather than being anything to do with the complex systems that they exist in. And this feeds into the notion that if we can just get estrogen right, everything will fall into place. It's neat.

It's medical, it's reassuring, of course, but it might be incomplete. Because what if estradiol isn't the author of absolutely everything we're feeling? What if it's more like a highlighter pen, illuminating patterns that were already there? What if menopause doesn't create the chaos? What if it reveals it? And that's what I want to explore with you today.

Sallygarozzo@hotmail.com (04:35.35)
not to undermine medicine, not to throw hormones under the bus, but to widen the lens. Because sometimes when we say, it's just my hormones, what we might actually be saying is, I don't quite have the language for the deeper story yet. And I think we're ready for that language now. So before we decide whether estrogen is the problem or the solution, let's take a quick look.

at what estradiol actually does. Because from a stress and threat perspective, it's actually quite interesting. We often think of estradiol as being about periods or fertility or bone density, which of course it is, but it's so much more than that. It's a psychoactive hormone that affects brain function. It moves through our neural circuits. It influences how neurons talk to one another.

And it increases something called synaptic plasticity. You've probably heard of neuroplasticity, which is essentially the brain's capacity to learn, to adapt, to rewire and update. And that sounds wonderful, right? Plasticity is good. Adaptability is good. We want that. But it's important to remember that plasticity is neutral in and of itself. It's simply

amplifies what you're learning. So whatever is being learned and absorbed, it amplifies it, even fear. Now there's a part of the brain, which I'm sure you know, called the amygdala. It's right in the center of our brain and it's our internal smoke alarm. It's constantly scanning the threat to protect us. It doesn't care whether the threat is a tiger,

or just a raised eyebrow. So you've got that. Then you've got the ventromedial prefrontal cortex, which I'll just call the regulator. This part of the brain is the adult in the room is the part of the brain that says it's okay. That's not danger. It's just someone else's tone of voice. That's just them, not you. Now estradiol influences the conversation.

Sallygarozzo@hotmail.com (07:01.09)
between those two regions, that conversation between the threat system and the regulator. Now research shows that in many women, higher estradiol levels are associated with stronger connectivity between the ability to regulate and the alarm system in our brain. So in reality, that means when our estradiol levels are good, we have much better top down

calming of fear response. Etrodiol, when it's present, can support the extinction of that fear. The brain's ability to learn that something which once felt dangerous is now safe. So that's really powerful, isn't it? And if we stopped there with our insight, we might say, see, estrogen is brain protective. It helps calm down anxiety and fear.

However, there's actually way more nuance than is being spoken about. In recent studies looking at women with trauma exposure, that buffering effect between the threat regions and the risk

That buffering effect between the threat regions and the regulation regions wasn't the same. And I'll put that link in the show notes to that study. Estradial didn't in fact... Right, I'm going to start again.

Sallygarozzo@hotmail.com (08:34.528)
In recent studies, looking at women with trauma exposure, that buffering effect between the threat regions and the regulation regions wasn't the same. Estradiol didn't in fact strengthen that regulation, that regulatory connection. Estradiol didn't strengthen that regulatory connection in the same way as non traumatized women. The alarm and the regulator

were not communicating more effectively just because estradiol was higher. So that's a real mic drop moment. That basically means the estrogen won't override the environment. Estrogen won't override your internal architecture. So hormones have an influence on the circuits, but they don't build them in the first place.

because our circuits are built from our experiences.

Sallygarozzo@hotmail.com (09:46.347)
If a nervous system has learned over the years that the world is unpredictable, if the amygdala has been sensitized early and if regulation had to develop in a climate of chronic stress, then estradiol is entering a very different landscape. It's not entering a pristine system. It's entering one that has already been shaped. And here's the piece I find the most interesting. Estradiol increases salience.

which basically means it increases what we notice. It increases responsiveness. It makes signals louder. So if the signal underneath is already turned towards vigilance, what does that amplification feel like? It's going to feel like anxiety, intensity, emotional sharpness, noticing patterns before anyone else does.

And so suddenly the narrative shifts. Instead of asking, is my estrogen low? It might be more helpful to ask, what has my nervous system been trained to tune into? Because estradiol doesn't create your history, it interacts with it. And that's a really different story.

And so if we're talking about all of that, we have to talk about trauma because if estradiol interacts with that fear circuitry, we have to understand how that fear circuitry gets shaped in the first place. And that really depends entirely on how we define trauma. When most research studies talk about PTSD, they're using very specific criteria. They are using exposure to actual or threatened death,

They're using criteria around serious injury, around sexual violence, around neglect. Big, bad, ugly events is very much event-based. Something happened, there was a before and an after, and that absolutely matters. Those experiences can profoundly affect the nervous system. But here's what I'm finding myself wondering. What about the slower things?

Sallygarozzo@hotmail.com (12:00.44)
What about the tone of voice that told you your feelings were inconvenient? What about being the emotionally responsible child? What about growing up in a house where stress was minimised? What have you got to be stressed about? What about unpredictability that wasn't dramatic enough to be labelled trauma, but was constant enough to shape you? What about enmeshment, parentification?

That's not always captured in traditional PTSD definitions, but there is a term for it. It's called CPTSD, coined by psychiatrist and Harvard researcher Judith Herman. And CPTSD tends to include things like chronic relational stress, emotional neglect, attachment, misattunement, shame that feels woven into our identity until it becomes deep depression.

hypervigilance that doesn't switch off and a body that reacts way before your mind has had a chance to interpret the events. Think of it as erosion over time, rather than one single explosion. And here's the line I keep coming back to. If we define trauma as explosion only, we will miss the vital consequences of that erosion because erosion

reshapes our inner landscape too, just as much as those big bad events. It just happens more quietly, more insidiously, more in the background. Now imagine a nervous system that developed inside that quiet, but insidious erosion, inside subtle unpredictability, inside that emotional minimization.

That brain circuitry is forming in a very specific way. The amygdala may well become more sensitive. The stress response might well calibrate towards more alertness and readiness, ready to jump on anything and to perceive any kind of wonkiness as a threat. The regulator, that prefrontal calming system,

Sallygarozzo@hotmail.com (14:23.222)
may have to work very hard very early. And here's the thing, that shaping happens long before perimenopause, long before estradiol starts fluctuating wildly, long before HRT ever enters the picture. So when research says women are twice as likely to develop PTSD, I find myself asking, twice as likely

based on what definition of PTSD? Are we measuring only storms or are we measuring the climate? Because if that chronic relational attachment wounding isn't fully accounted for, then we may seriously be underestimating the environmental shaping of women's nervous systems. And that really skews the data.

So let's turn to estradiol. If estradiol influences fear circuitry and fear circuitry has been shaped for decades by environmental and attachment injuries, then estradiol is interacting with architecture that already exists.

Sallygarozzo@hotmail.com (15:45.497)
then estradiol is interacting with a brain architecture that already exists. It's already been shaped. It's not creating it from scratch. And that changes the whole frame. It moves us away from my hormones are making me unstable towards my hormones are interacting with the nervous system and a brain that already has a history. And that history

might not necessarily be dramatic, it might not have headlines, but it may have shaped the wonky wiring just the same. So what exactly is estradiol doing when menopause begins to shift the volume on things? So this is where I want to talk about amplification because estradiol is like a volume dial. It increases plasticity or the brain's capacity to learn.

It increases salience, is what you notice. It increases responsiveness. It makes signals really clear, really sharp. makes them louder and more vivid. And yes, that can be wonderful. It can enhance learning. It can enhance connection and even emotional depth. But remember amplification is neutral. It depends on

It depends entirely on what is being amplified. If your underlying nervous system is relatively well regulated and if your early environment was largely safe and you were emotionally attuned to, if your alarm system learned that the world is mostly predictable, then amplification may feel like clarity, confidence, fluidity. But if what your alarm system learned was something different,

But what if your alarm system learned something different? What if it learned that you had to watch for someone's tone, that moods were unpredictable, that safety can't be assumed and that your emotions are something to avoid and that you're not good enough as you are? What if your system adapted by becoming slightly faster, slightly more watchful, slightly more prepared?

Sallygarozzo@hotmail.com (18:07.404)
Now imagine amplification landing there. If the amygdala is already tuned towards vigilance, amplification might feel like anxiety. If relational sensitivity was activated, amplification might feel like over reactivity or anxious attachment or co-dependence or neediness.

If emotional suppression was necessary, amplification might feel like, overwhelm. Estradial doesn't install those patterns, but it does interact with them. And this is where that earlier research by Stevens et al becomes important. Because in women without trauma exposure, estradiol appeared to strengthen regulatory communication.

the calming dialogue between the prefrontal cortex and the amygdala, the alarm system. But in trauma exposed women, that buffering, that buffering effect wasn't the same, which tells us something crucial. Hormones don't override what's already there in terms of our baselines. They operate within our baselines. So when perimenopause begins, an estradiol starts

So when perimenopause begins, an estradiol starts fluctuating, sometimes high, sometimes dropping sharply, sometimes unpredictable, and sometimes without enough progesterone to oppose it. The system may feel way more exposed, more raw, more emotionally immediate. Instead of asking,

And instead of asking what's wrong with my hormones, maybe we should ask what patterns are being revealed here. I wish someone had told me that in the early days, because menopause, especially perimenopause, isn't just a hormonal event. It's a neurological shift. Imagine that we have insulation pre-menopause that protects us. But as our menopausal journey begins, that insulation thins and the wiring

Sallygarozzo@hotmail.com (20:26.094)
becomes more exposed.

Sallygarozzo@hotmail.com (20:31.36)
Imagine that we have insulation around our wiring premenopause that protects us. But as our menopausal journey begins, that insulation thins and the wiring becomes more exposed. Doesn't mean the wiring is faulty. It means you can hear it, see it, feel it. It's more electric. It's more buzzy. And that can be really unsettling, especially if the story we've been told is just get your estrogen right and everything will stabilize.

because actually, fine.

Sallygarozzo@hotmail.com (21:06.722)
because that really doesn't make sense in this paradigm.

And finding that stability isn't always about levels. It's about that inner wiring that's being exposed. And this is where I think many thoughtful women start to sense something deeper going on under the surface. They feel that amplification. They try and adjust the dose.

Sallygarozzo@hotmail.com (21:32.943)
way. They feel the amplification, they adjust the dose, they stabilize physiologically maybe, but still underneath there's a hum, there's a sensitivity that feels like it predates menopause. It's a pattern that they sense feels older than hormones. And if you're tuning into that there's something else to notice. What does this mean for HRT? What does it mean if estrogen

aka amplification is being applied to a body that has trauma history. So let's talk about that. Now, just to be clear, I'm not questioning whether HRT works. For many women, it absolutely does. It can really steady those psychological swings and reduce hot flushes, et cetera, et cetera. I take it myself. So this isn't...

So this isn't a rebellion against medicine, but there is a particular, but there is a particular woman I'm thinking about as I record this. She starts HRT, she feels some improvement and yet there's still a quickness in her nervous system. There's still a sensitivity to other people's energy. There's still a body that goes into high alert before her mind catches up.

and she starts to wonder quietly, why does this feel older than menopause? And this is where the research becomes interesting again. There are studies suggesting that trauma history can absolutely predict greater sensitivity to...

Sallygarozzo@hotmail.com (23:29.55)
And this is where research, and this is where the research becomes interesting again. There are studies suggesting that trauma history can predict greater sensitivity to estradiol shifts. There's research suggesting that when estradiol levels vary, this can heighten emotional sensitivity to psychosocial and relational stress. Rejection sensitivity, anyone?

And there are findings showing that estradiol's regulatory effects on fear circuitry are different depending on trauma exposure. And I'll put all of those links in the show notes. But what does that tell us? Well, it doesn't tell us that estrogen is harmful, that HRT is wrong, but it does tell us that estradiol interacts differently depending on the nervous system it lands in.

If a system has been shaped by chronic relational vigilance, then amplification, which is what estrogen does, may not feel soothing. It might feel exposing, like rubbing more salt in the wound. And if the inner landscape or that inner architecture isn't considered, we risk making HRT carry a burden it was never designed to carry.

because Easter journal, Estradial, I'm using those phrases interchangeably actually, cannot rewrite developmental learning. It can't untangle attachment patterns. It can't recalibrate decades of relational conditioning. And that's not a floor of HRT. It's just outside of the scope of its abilities. It's like asking a chef to be a carpenter. So when a woman says,

HRT helped but something still feels unfinished or when she says HRT didn't work, instead of assuming failure, we might consider, instead of assuming that she's not, instead of assuming that she's beyond help, we might consider that something deeper is asking to be understood, not medicated away, not overridden, but actually understood.

Sallygarozzo@hotmail.com (25:54.723)
And this is where this conversation really needs to become more compassionate. Because when we look through menopause, because when we look at menopause through a purely hormonal deterministic lens, this can imply that the problem lives in chemistry alone. But if we know that biology and biography are intertwined, that our chemistry and our story are interlinked,

Sallygarozzo@hotmail.com (26:24.536)
But if we know that biology and biography are intertwined, then chemistry is actually interacting with story, always. And sometimes the story needs our attention, not just the chemistry, not because you're broken or did anything wrong, but because midlife, as you know, has a way of revealing what earlier life required you to adapt to. And that revelation can feel unsettling, but it can also

be really clarifying. So what if our menopause transition isn't just something to manage hormonally? What if it's something to understand? Maybe it's not a malfunction to fix like the hormonal determinism lens would suggest. But what if it's a period of time that reveals something deeper, a pattern, a way we had to adapt, a kind of circuitry.

that's been quietly running in the background for decades. And when that realization hits, it can feel really confronting because it's way easier to adjust dose than to ask, my God, what actually shaped who I am? What shaped this reactivity that I'm experiencing today? What shaped these moods, this rage, this anger, this insecurity? That question.

takes time to answer and it takes real courage to go there. I know that I understand that. And in fact, my next episode is going to be all about this. But here's what I see time and time again with my clients. When a woman begins to understand her inner world deeply, not just her hormones, something radical changes slowly over time, that sense of being at war with our body,

reduces. You start to see that your nervous system makes absolute sense in the context of what you have been exposed to, that it adapted intelligently. You are not broken. You've just adapted so much you don't even recognise yourself. And what feels like over reactivity might once have been protection. And then menopause becomes

Sallygarozzo@hotmail.com (28:48.896)
less of a breakdown and so much more of a diagnostic window. What a lovely way to look at it. It's so much better to look at menopause like this kind of diagnostic window that we're looking through. It's an invitation not to throw out HRT or to reject chemistry or biology, but to integrate all of it with our story, with our biography. Because remember hormones

influence our circuits. They don't build them.

And if something deeper is stirring in you, if you've adjusted the estrogen and still feel like there's a hum underneath, I just want to let you know you haven't failed, but it might mean you're ready for a deeper layer of understanding. So if this conversation has resonated in any way, there are two ways that you can explore all of this with me. The first is through my one-to-one work. This is where we

That's where we look at your nervous system architecture properly, not just symptom management or hormonal tweaks, but the patterns that have been shaped, the relational imprints, the adaptations that once made sense and maybe ready to be updated now. It's precise work. It's thoughtful. It's intelligent. And we do it using a blend of psychotherapy techniques, coaching, CBT methods and

hypnosis, is wonderful. Hypnosis really is a somatic therapy. It's very much about understanding, not fixing. And if that feels like the next step for you, then I'd love to work with you. Just book in a free 15 minute connection call with me through my website. And the second way is through becoming my membership. Becoming is

Sallygarozzo@hotmail.com (30:50.442)
a deeper group space for women in midlife who are curious, not just about hormones, but about their identity, the way their nervous system regulates or fluctuates, the way their stress response regulates, attachment patterns, and how all of this intersects with their menopausal experience. Now, becoming is definitely not a menopause symptom club, that's for sure.

but it is a space for women who sense they need or want a mindful group to help them understand themselves better. And of course it's okay to talk about symptoms, but it's not a moan fest. It's a space where we can attune to each other because attunement is so healing, especially for women.

Now the waitlist for Becoming is currently open, but it does close on the 27th of March. So if you've been circling on the sidelines for a while, this is your nudge to get yourself on the waitlist before it closes. And people on the waitlist will get a private invitation to join an initial salon style Zoom meeting where we can flesh out

where we can understand who you are and flesh out what we really want this space to be. So if you're ready to step beyond hormonal determinism and into deeper self-attunement, I'd be honored to have you inside my circle. Thank you so much for sharing this episode with me. I hope you've enjoyed it and I'll see you next time.