Whose menopause is it anyway?

The case for menopause without HRT, grounded in evolutionary biology and the Adaptation Model

Less than a decade ago, most of us — me included — had barely heard the word menopause said out loud, let alone in public. Then suddenly it was everywhere. TV documentaries. Celebrity confessions. Campaigns. Podcasts. Supplement ads. Shining a light on menopause is, in principle, a good thing. But the framing of that light is the problem. And the message, however it is dressed, has been loud and clear: menopause is a horror show, caused by a deficiency built into our biology.

You can’t sleep. You can’t think. Weight piles on if you so much as look at a biscuit. You swing from rage to despair in a heartbeat. Confidence evaporates. Skin thins. Sex drive disappears. Women describe it as losing themselves. If that is your life right now, you do not need anyone to tell you that something feels very, very wrong.

Something is very wrong. Medicine has, for the best part of a century, defined menopause as an oestrogen deficiency state — and almost every account, from clinical guidelines to wellness influencers, is still built around that single definition. What mattered most about you — and defined your whole life — has now gone. This is the Deficiency Model, born in the laboratories of the twentieth century. It treats post-fertile life as a chronic disease in need of lifelong management. But what about a post-menopausal woman without a single symptom? Does she have an oestrogen deficiency if she has no symptoms? The question messes with the definition. I know, because I am her: eight years post-menopause, and I have never had any symptoms. Women struggle to believe me, because the cultural script has made a menopause-without-suffering – menopause without HRT – almost unthinkable. That is the depth of the story we are inside. Even a woman embodying the alternative is read as an impossibility.

I offer the alternative as a direct contrast — the Adaptation Model, grounded in evolutionary biology, anthropology, and decades of clinical observation, which says menopause is not a mistake but a designed transition into a different biological configuration. The high-oestrogen state of fertile years was designed for fertile years — not for life. After that, the body moves into a different configuration, by design. A post-menopausal woman is not a faulty younger woman. She is a different biological design, doing what she was always coded to do.

Evolution does not preserve biology that leads to half the population being too sick to function. The long post-reproductive years exist because women living well past menopause are part of the reason humans are still here — feeding grandchildren, shaping communities, holding knowledge, preserving and shaping culture, freeing daughters to raise more children at shorter intervals. We are not a glitch in the system. We are part of the system’s success.

So what about the symptoms? They are an ancient hard-wired code trying to run in a modern environment that does not fit it — relentless stress, broken sleep, ultra-processed food, chronic sugar and starch overload, chemical loads, invisible caregiving, social isolation. Menopause is not the problem, but the context is. Which means that the misery is optional, because when you change the conditions, the symptoms resolve. Menopause without HRT should be our default position, not a suspicious alternative.

And so we arrive at the question the dominant narrative avoids.

Whose menopause is it anyway?

Does your menopause belong to doctors and pharmaceutical corporations? To the supplement and beauty companies who have turned a life stage into billion-dollar industries? To the influencers and media celebrities who have made themselves the face and voice of all of menopause?

Or can we take it back? Can we dismantle the “broken woman” myth — the century-old story that says a woman past fertility is, by definition, a diminished woman? Can we stop deferring to people who do not live inside our bodies, telling us what our bodies are – or should – be doing?

Who gets to tell the story of your menopause? The answer you choose is not abstract. It will shape how you understand your symptoms. It will shape the decisions you make about treatment. It will shape the kind of health you build in the decades ahead.