It's Never Just Hormones

You hit twelve months without a period and somebody says congratulations.

What did you actually just finish?

For most women the symptoms don't stop there — and the bigger thing nobody mentions is that menopause isn't a passage you come out the other side of. It's a permanent state you now live in, and what happens in the first years of it shapes the next thirty.

Dr. Michelle Montville is a gynecologist who spends her days on exactly this. In this episode she explains what actually changes once the ovaries stop — in the heart, the bones, the brain and the metabolism — and why so much of it is happening to women who were told they were fine.

We get into:

- Why a normal lab result in perimenopause isn't evidence that nothing is happening

- The difference between desire and arousal, and the "gas and brakes" model that makes low libido something you can actually work on instead of a personal failure

- Why an easy menopause is not a protective one: the risk profile changes whether or not you had symptoms

- What the evidence on hormone therapy really supports, and exactly where it stops

- Why weight settling around the midsection is a health signal and not a cosmetic one

- And the one thing she'd tell you to fix first if you could only fix one There is also a conversation in here about grief, invisibility, and the particular fierceness that arrives when a woman who has spent twenty years absorbing things stops absorbing them.

Our host, Amy Green, discloses her own hormone therapy in this episode. Nothing here is medical advice or a recommendation about your body — that conversation belongs to you and a clinician who knows your history.

Every episode of It's Never Just Hormones opens with a real woman's story.

Looking for a clinician who works in this area? The Menopause Society has a provider directory at menopause.org.

Guest: Dr. Michelle Montville — Hosted by Amy Green, LCSW, PMH-C, Founder of Mamaya Health. Produced by Emily Siner.

It's Never Just Hormones is a production of Mamaya Health. mamayahealth.com/podcast

She counted. Eight doctors in four years before one asked the question that mattered: “Where are you in your cycle?”

Dr. Sophia Yen, MD, MPH, MSCP, explains why it takes so many doctors. Only 31% of the OB-GYN residency programs that responded to a recent survey said they had any menopause curriculum, and a twenty-year misreading of one major study is still shaping what doctors are willing to offer.

We talk about what perimenopause actually is (a change in your period, not a number on a blood test), why estrogen affects every cell from your head to your toes, when an antidepressant is the right call and why it shouldn’t replace hormone therapy, what the Women’s Health Initiative really found twenty years later, and what to bring, what to ask, and when to walk away from an appointment.

Find a menopause-trained clinician by zip code: menopause.org (practitioner finder) · hermedicine.org
Mentioned: Estrogen Matters, Dr. Avrum Bluming

Have a story about a season nobody warned you about? Share it here: [story form link]. Anonymous is fine, and nothing airs without your okay.

Find care built for your season: mamayahealth.com

Sources: Allen JT, et al. Menopause, 2023 (menopause education in OB-GYN residency). Chlebowski RT, et al. JAMA, 2020;324(4):369–380 (WHI 20-year follow-up).

Disclosure: Dr. Yen is CEO and co-founder of Pandia Health. This episode is not sponsored.

This podcast is education, not medical advice. If you’re in crisis, call or text 988. If you’re pregnant or postpartum, Postpartum Support International can help: 1-800-944-4773 (call or text).

She is 46. She has not slept through the night since February. She forgot the word "invoice" in a meeting, twice. There is a note on her phone she has been adding to since the winter, and it has no title.

She takes it to her doctor. They run her labs. Four days later, one line comes through the portal: your hormone levels are within normal limits.

It is that one word — normal — that does the damage. She decides the problem is her.

A hormone panel is a single moment in time. Perimenopause is defined by fluctuation. Which is why a blood draw on a Tuesday morning can sit comfortably inside a normal range while you are living inside a swing that is taking you apart. The number was accurate. It just wasn't the answer to the question she asked.

My guest is Dr Amy Divaraniya — PhD in biomedical sciences, seven years as a data scientist before founding Oova, an at-home hormone testing platform. She went looking for longitudinal data on perimenopause and found it largely didn't exist, because women in the transition get screened out of women's health research for having irregular cycles. Which is the definition of the thing being studied.

In this episode:

Why the test comes back normal when nothing feels normal, and what clinicians use instead.

What this season does to mood and sleep — and the disappearing buffer, that space between your decision and your reaction, which is the thing women describe most and name least.

Why so many women land on an SSRI in midlife, and why that can be exactly the right call rather than a verdict on you.

CBT-I, and what the evidence shows about treating the sleep.

The research gap underneath all of it. It isn't a conspiracy. It is something more ordinary, which is sometimes worse.

Where the science runs out — including what at-home hormone tracking has and hasn't been shown to do. This is a field where a lot of people are selling certainty, and we would rather tell you where the edges are.

And the one step you can take tonight, for free: give the list a title.

MENTIONED

Median duration of hot flashes and night sweats: 7.4 years overall, 10.1 years for Black women. Avis NE et al., JAMA Internal Medicine, 2015 (Study of Women's Health Across the Nation).

CBT-I in postmenopausal women with chronic insomnia: 54% in remission at the end of treatment, 68% at six months. Drake CL et al., Sleep, 2019.

Symptom ranking: Oova's own survey of its users. Not peer-reviewed.

READ THE COMPANION PIECE
Could this be perimenopause if my labs came back normal? mamayahealth.com/blog/perimenopause-labs-came-back-normal

OOVA AND MAMAYA
Oova and Mamaya Health are partners, and we talk about that openly in the episode. Dr Divaraniya is here because of the work she's doing on the perimenopause data gap — but you should know the relationship going in.

Whichever side you're coming from, both offers live in one place, along with what The Shift covers: mamayahealth.com/oova

Worth repeating from the episode: measuring a woman against her own baseline over time is the right design. What hasn't been shown yet is that at-home hormone tracking changes an outcome. We'd rather you knew that before you bought anything.

IF YOU NEED SUPPORT RIGHT NOW
You don't have to wait for a crisis to ask for help. If you are in one, call or text 988. If you are pregnant or postpartum, the National Maternal Mental Health Hotline is 1-833-852-6262, free and confidential, 24/7.

It's Never Just Hormones is from Mamaya Health. Our senior producer is Emily Siner. New episodes twice a month. mamayahealth.com

They weigh you before anyone asks why you came.

In this first episode, Amy Green sits down with dietitian Jenn Fleischer to trace where that came from — the voice in your head narrating what you should look like, the number you've learned to step backwards to avoid, and the slow work of learning to believe your own body again.

If you've ever heard a voice in your head that didn't sound like yours, this one is for you.

THIS EPISODE'S GUEST

Credentials: Jenn Fleischer MS, RDN, LDN, CDCES

Registered Dietitian Nutritionist, Certified Diabetes Care & Education Specialist

Owner, Nashville Nutrition Partners, PLLC

Jenn helps clients move from wanting change to empowered action that leads to lifelong healthy habits, working from a non-diet approach focused on education, self-care skills and introspective awareness — the whole person, not a number.

nashvillenutritionpartners.com
linkedin.com/in/jennifer-fleischer-131232282
Instagram & Facebook: @nashvillenutritionpartners

WHAT WE TALKED ABOUT

Why "distrust" isn't the right word for what happens between a woman and her body. How school teaches us to override hunger and our own signals, and what that costs thirty years later. Naming the inner critic — and why separating it from your identity changes what you can do about it. What a scale actually measures, and the exact words you can use to decline seeing the number. Where body neutrality begins, and why it starts somewhere much smaller than love.

IF YOU NEED SUPPORT

National Alliance for Eating Disorders Helpline — 1-866-662-1235 — allianceforeatingdisorders.com

Postpartum Support International HelpLine — 1-800-944-4773, call or text "Help" (not a crisis line) — postpartum.net

In crisis: 988 Suicide & Crisis Lifeline, call or text, 24/7. National Maternal Mental Health Hotline 1-833-852-6262. Crisis Text Line: text HOME to 741741.

TELL US YOUR STORY

Every episode starts with one woman's story. If there's a story you've never told — about any season nobody warned you about — the form is at mamayahealth.com/podcast. Anonymous is fine. Nothing airs without your ok.

CREDITS

It's Never Just Hormones is from Mamaya Health.
Hosted by Amy Green, LCSW, PMH-C.
Senior producer: Emily Siner.
Music by Blue Dot Sessions — sessions.blue.
New episodes twice a month.