Episode 99: Upgrading the menopause conversation with Clarissa Kristjansson

Clarissa Kristjansson is a Mindfulness and Menopause expert, author of The Mindful Menopause, and host of the brilliant Thriving Thru Menopause podcast. She’s on a mission to change the way women approach menopause and aging. The last time we got together, we had such a brilliant conversation, on her podcast, I just had to share her with you. We both get quite hot under the collar about a lot of the same issues.

We talk about:

  • How Clarissa got so passionate about menopause
  • Why it’s so important to take a holistic approach to menopause
  • The importance of mindfulness when it comes to a good menopause experience
  • What annoys Clarissa about the prevailing narratives surrounding menopause
  • The myths around menopause
  • How women can be proactive and not just reactive about their menopause experience
  • The use of data when it comes to menopause
  • Understanding and contextualizing data presented
  • Menopause at work
  • Sexism and ageism and their insidious intersection
  • The female brain drain in midlife
  • Making work work better for women, especially older ones
  • Clarissa’s top tips for thriving through menopause

And more!

Find more about Clarissa:

Clarissa’s website: clarissakristjansson.com

Instagram | Twitter

Clarissa’s book: The Mindful Menopause: The Secret to Balance, Vitality and Clarity Through The Change

Listen to her podcast: Thriving Thru Menopause

Organizations which have lists of produce most susceptible to hazardous pesticides mentioned on the podcast:

Environmental Working Group

Pesticide Action Network UK

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Menopause, HRT And The Importance Of Staying Curious

I want to share some thoughts on menopause, HRT (hormone replacement therapy) and a new narrative in the UK that most if not all women should be on HRT for menopause issues and long term health, because of HRT’s potential preventative impact on heart disease, osteoporosis and Alzheimer’s.

It’s evident that systemic and localized (vaginal) HRT can be enormously helpful for many women in managing their menopause, but I don’t believe, unless absolutely necessary, most women need to be on systemic HRT long term.

Davina McCall presented a ground-breaking documentary about menopause. In it she talked of having two episodes of shame around menopause, the first when she was initially diagnosed and the second when she took HRT. It’s tragic that she felt shame over either of these and I commend the program for exposing this as something which simply shouldn’t happen anymore. There is nothing shameful about menopause nor taking HRT to help with it!

menopause hrt Rachel Lankester
Author, Rachel Lankester

I too experienced these kinds of shame.  After failing to conceive a long hoped for second child, I was told I had gone through early menopause at 41. It was crushing.  I gave in to taking HRT at 44, because I was found to have borderline osteopenia in my hip. I felt I was succumbing to a narrative of downhill to the end.

At the time, menopause specialist, Dr Nick Panay, and his early menopause team were looking after me and had been advising me to go on HRT until average menopause age of 51, to give my bones and heart the extra 10 years of estrogen protection they’d missed out on because of early menopause. It took me three years to accept their advice.

I chose to come off systemic HRT as advised and at 53, another bone density scan showed no worsening in my bones. Now I occasionally take localized vaginal estrogen to help with vaginal dryness. I use a cream as vaginal pessaries come with individual plastic dispensers which I consider unnecessary plastic waste.

Women are rightly indignant they’re not getting the care they need from our National Health Service (NHS).  The documentary was a powerful reminder of the sad state of play and lack of awareness both within the medical profession and for women themselves. 

One thing about the documentary I do struggle with though, is that it failed to mention the obvious, that menopause is a natural and transformative life stage. To not highlight this reality underpins the emerging narrative that menopause is a bad thing and that HRT is the answer.

Peddling HRT as the ‘must have’ for all women in menopause, such are its life-saving properties, protecting against heart disease, osteoporosis and Alzheimer’s, AND that most women should be on it well beyond menopause, smacks of snake oil sales with bells on. Women are now even asking if they need to be on HRT to protect themselves from dementia!

This narrative is taken up by some leading menopause professionals who, to my mind seem to be as damaging as the doctors who prescribe anti-depressants for menopausal women. 

The narrative needs balance. Diet and life changes are probably more important for menopause issues and long-term health than defaulting to synthetic drugs. Sadly, the documentary was void of any discussion regarding the impact of diet or lifestyle on hormonal balance and only passing comment on lifestyle in terms of fitness.

One-sided narratives from the evangelical can have darker sides. ‘Champions’ and ‘goddesses’ deserve scrutiny and the simplest and probably the clearest form of scrutiny is the financial trail. HRT and hormonal insecurity is lucrative business. We are in a culture of wanting our cake and eating it. Excess without consequence. We will pay anything for a panacea.

How many of us swallowed the lies of the cosmetic industry and have felt reduced by body image, hair type, greying hair, wrinkles, spots, skin colour or felt guilt for eating the wrong things, drinking too much or being the weaker, fairer softer sex? 

Billions have been made by creating insecurities and ‘needs’, then exploiting them. We have been crushed, silenced, side-lined and lied to. Sadly, we do have a tendency to be shaped by the nonsense we are told.  I was.

From puberty women live on a hormonal and societal roller coaster. By our 50s many of us have had and raised children, tried to make safe homes, we’ve been undervalued, objectified, underpaid. We’ve juggled, loved, strived and known fear. Menopause is a gift that takes us off the rollercoaster. Perhaps HRT keeps us its slave?  

Menopause is a transition as major as puberty. It is not to be feared. It is not a permanent state. It is a gateway that takes us into deep calm waters where we can thrive in new ways.

Why am I passionate about diet and lifestyle changes? After my early menopause, I went to see a nutritional therapist who put me on a special diet. I was to have no alcohol, sugar, caffeine, dairy, processed foods, eat as organic as possible and eat a healthy source of protein every three hours to make sure my blood sugar levels were balanced.

Within five weeks of changing the way I ate and what I ate, I had a menstrual bleed, and a further hormone test showed I was back to being pre-menopausal. This only lasted another nine months, but it was a wake-up call that showed me the impact of diet.

I did not conceive and the effects didn’t last, I was just too late. Eventually I slipped back to a less healthy diet, although I’m still caffeine free, I eat better and exercise more. I don’t live an abstemious life! It was similar dietary and lifestyle changes that allowed me to transition off systemic HRT at 51 with no adverse side effects. I’m now post-menopausal and celebrating the liberation it brings. 

Hippocrates (460-370 BCE) is perhaps a thorn in the flesh for ‘modern medicine’ and the HRT industry, as his wisdom regarding health tends to mindfulness, which is free, as opposed to intervention, which is costly and profitable. If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” “Let food be your medicine and medicine be your food.”

Food for thought?

On reflection, my resistance to HRT was bound to resisting the negative sexist and ageist narratives about women and ageing.  Like most women, I was never taught about health, perimenopause, menopause and being post menopause. As a consequence, my work has now become sharing what I’m learning, being alongside other women experiencing menopause and living life beyond, and to help challenge the narratives that enslave us.

With HRT it is women with money who pay to go private and keep paying, if that is the only way they can access HRT. The more women can be persuaded HRT is the golden ticket, the more money can be made.

What about UK women who can’t afford to see a private doctor to get their (long term) supply of HRT? Why is menopause so difficult that many women need HRT to get through it? Why don’t we ask more questions about why British women reported having the worst experience of menopause?

HRT clearly has a crucial role in menopause care and should be more readily accessible in the UK, but why are we now told most women would benefit from taking it to keep us healthy into older age? We can do other things to keep ourselves healthy. What about women in countries without money for basic medical care let alone hormone therapy? Will women worldwide be lead to believe HRT is crucial for their long term health? That will lead to a lot of insecurity but also new untapped markets…

In her 2020 book, The XX Brain, The Groundbreaking Science Empowering Women to Prevent Dementia, Dr Laura Mosconi, PhD, Director of the Women’s Brain Initiative and Associate Director of the Alzheimer’s Prevention Clinic at Weill Cornell Medical College (WCMC)/NewYork-Presbyterian Hospital, says:

“Let me underline that the primary indication for MHT (HRT) remains relief of hot flashes, night sweats, and vaginal dryness. MHT is not recommended for prevention of heart disease, Alzheimer’s, cognitive decline, or any other conditions.”

Dr Mosconi goes on to say:

“I must reiterate that prescription medicines come with many potentially dangerous side effects of their own, and the last thing any of us needs is to accidentally exchange one negative side effect for another. Another reason to look beyond estrogen replacement is the fact that estrogen is not always a friendly and helpful substance—especially when it’s not your own. It doesn’t cost much to start with the safer strategies that focus on ameliorating hormonal levels by means of diet, exercise, and other natural therapies. These methods are known to boost hormonal production in the brain as well as in the body, while improving memory, sharpening our minds, and supporting resilience, all the while reducing risk of dementia for all women, no matter what stage of the game they’re at.”

After doing some research, I found evidence that HRT may help prevent and treat osteoporosis, for example, but even that research says:

“Therefore, in postmenopausal women at risk of fracture and younger than 60 years, or within 10 years of menopause, HRT can be considered as one of the first-line therapies for the prevention and treatment of osteoporosis-related fractures. Conversely, the initiation of standard HRT after the age of 60 years for the exclusive reason for fracture prevention is not recommended since the potential risk of long-term complications, namely breast cancer, can outweigh the benefits [24]. Thus, the extension of HRT after the age of 60 years must take into account potential long-term benefits and risks of the specific dose and route of administration, compared to other proven non-hormonal therapies [24].”

Marco Gambacciani and Marco Levancini  2014 Hormone replacement therapy and the prevention of postmenopausal osteoporosis

We now know the breast cancer risk is much less than previously reported and current forms of HRT are safer than early versions, but are still not without risk. Some practitioners say HRT breast cancer risk is no more than drinking alcohol or being overweight. But what if you’re on HRT, drinking too much and overweight? Your risk load could get quite high.

Some say women need HRT now because we didn’t live long past menopause in the past. In parts of the world, some women have lived past menopause for hundreds of years. In 1680, life expectancy for a woman at age 15 (having survived childhood) in England and Wales was 56.6 years, rising to 64.6 years by 1780.

Women in the Blue Zones, where people live the longest, don’t rely on HRT for their long healthspan. I believe it pays to be wary of big bold claims, stay curious and continue to ask questions. We are all guinea pigs when it comes to long term use of HRT. No one knows.  

Random guinea pig.

I’m increasingly skeptical about studies that make big claims about drugs and menopause. I want to know who conducted the research, who paid for it, was it published and peer-reviewed, and even whether it actually happened.

My recent research found a 2016 survey attributed to British broadcasting entity ITV, who claimed to have worked with women’s research charity Wellbeing of Women. The latter told me that survey never took place. There’s an article on the ITV website claiming that one in four women considered leaving work because of menopause symptoms, based on a non-existent survey.

That statistic has become fact and even been quoted by a member of the UK parliament. Why is that false fact still on the ITV website? Probably because it helped get viewers to their program then and helps bring advertising revenue now. They don’t care about setting the record straight. I’ve asked for this to be looked at but no response. I’ve asked to see the source of the statistics in the latest Channel 4 documentary too, but no one has responded on that yet either.

In her book, The New Hot, Meg Matthews includes the menopause experience of Buck Angel, a transgender man. He talks about how taking testosterone for 10 years atrophied his reproductive system…

“…causing my uterus to fuse with my cervix, creating an infection in my uterus. That was the cramping I had been experiencing all these years… After three months on intensive antibiotics to get rid of the infection, I then had a full laparoscopic vaginal hysterectomy… All of this could have been prevented if any one of my endocrinologist would have given me an estrogen supplement… How can doctors be giving a very powerful hormone like testosterone without understanding the need to balance this out… I almost died because of the lack of medical knowledge, yet the doctors give testosterone out with little concern about the long-term effects.”

I’m not suggesting that long-term use of systemic HRT for women could cause similar issues. Of course not. I am suggesting there’s not enough knowledge about the long term effects of any hormone therapy, for practitioners to be so confident telling women it’s okay to be on it long term or even forever. We won’t know whether that’s true, until I probably turn at least 75, in another 20 years.

The narrative that most, if not all women, will benefit from being on HRT long term, also presupposes that life with our pre-menopause hormonal profile is universally better than being off the estrogen rollercoaster as an older woman. I don’t want older women to be split into those who believe good health into older age can best be achieved if we have the same hormonal profile we had pre menopause, and those who don’t.

Some people believe we should be able to replace the hormones we’ve lost through menopause. But that suggests menopause is a disease that needs to be fixed (some want it rebranded as Female Hormone Deficiency) not embraced for the powerful changes it naturally brings.

This harks back to the misogynist book Feminine Forever written in 1966, which affirmed a narrative about women being subpar post menopause and that we need to be on estrogen long term ‘to stay agreeable and attractive for our husbands’. We’re not less anything post menopause and can be healthy without synthetic hormones. I don’t want older women (let alone younger ones) to believe they are in any way less because of menopause, or in danger healthwise without HRT.

There are abundant natural sources of plant hormones, amongst many other things, that we can add to our healthy diets to help achieve hormonal balance and long-term health. These work for many women and are often important traditional components of the diets of women in places like Japan and China, where menopause often appears to be less of an issue than it is for Western women.

And, she whispered… are we not just a little entitled and privileged demanding a drug long term whose effect can often be replicated for a large proportion of women by living a healthier lifestyle? When NHS resources are at their most stretched and we are already so lucky to have free healthcare in the UK.

Did you want to keep on with the 5 cups of coffee a day to keep you going, lots of sugary food, burning the candle at 6 ends, smoking, drinking too much booze to wind you down, using products laden with 100s of potentially hormone-disrupting ingredients, sitting down all day, not sleeping well because of the sugar, caffeine and booze, and not dealing with your stress, but take HRT to stop those your hormones screaming for attention?

I see many midlife women doing that and wondering why their body is rebelling. We’d rather demand a fix-all, than get curious about other ways to feel better, longer.

One too many?

Around 25% of women suffer badly with menopause. That’s bad enough, but you’d think it was more. I talk about that with Jackie Lynch author of The Happy Menopause on my podcast. The ones who suffer shout the loudest and often it’s celebrities in the public gaze, who are living stressful lives that can make menopause worse, who speak up about their experience.

I’m grateful to them for raising awareness, but I’d like a more balance, more discussion about other options and less reliance on HRT to mask symptoms, rather than sorting out underlying issues. I don’t want to terrify women coming up behind so that an awful menopause becomes a self-fulfilling prophecy. Be prepared not scared is my motto.

I think of menopause symptoms as the body’s early warning system, the canary in the coalmine, telling us we need to make changes if we want to live a long healthy life. We can take HRT and it may make us feel better. We may also miss the chance to make the changes our bodies are telling us to make, if we’d just start listening.

What is different about us or the way we live to make our menopause experience different to elsewhere or other women? To what extent does our society’s view of older women impact how we experience midlife and menopause? How is life different now to in the past? We need to talk about menopause more. And much earlier too.

The medical profession is woefully under-resourced for helping menopausal women. We need to increase medical and public education so doctors recognize perimenopause and women aren’t fobbed off with anti-depressants, or fear they have Alzheimer’s when it’s hormonal brain fog. Doctors in the UK need to understand the latest NICE guidelines for prescribing HRT and not withhold it unnecessarily from those in need.

I’d also like doctors to know about the role of diet, lifestyle, environmental toxins and stress when it comes to managing menopause. I want an holistic approach. I’d like women to see menopause as a chance to adopt a healthier lifestyle and embrace the different hormonal profile we’re supposed to have post menopause. Then we will find the true healing power and magic of menopause.

If you liked this post, you’ll probably like my book – Magnificent Midlife: Transform Your Middle Years, Menopause and Beyond.

You may also like: Menopause Matters – Resources To Help

menopause hrt
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Getting Truly Revolutionary About Menopause

I’m full of admiration for the women who’ve shared their experience of menopause, so others can get the support they need. We’ve seen a dramatic change in the UK, culminating in the menopause revolution campaign that took menopause to the heart of government and resulted in big changes which will benefit all women. It’s good that we’re talking more about menopause, that it’s being discussed in the workplace and organisations are embracing menopause policies. I’m delighted menopause is now included in the school curriculum so women’s sex education no longer ends with childbirth. It would be good to see more in the med school curriculum but there is gaining momentum thanks to those campaigning for change. It’s important that women who need HRT have access to it and are not penalised because of where they live or whether they can afford a regular prescription.


There are good things happening. But I question the overwhelmingly negative narratives about menopause, that seem to be getting worse not better, as well as the over-selling of HRT as the panacea to ‘fix’ it. Respected menopause specialists and campaigners are describing menopause as a hormone deficiency and promoting long-term use of HRT as a preventative measure against age-related disease. Women are becoming scared that if they don’t take HRT long-term, they’ll be at risk of Alzheimer’s, osteoporosis, heart disease and even suicide.  

This narrative harks back to the book Feminine Forever published in 1966 which described menopause as a deficiency that could be cured with hormone therapy. In his best-selling book, Robert A Wilson maintained that menopause was a serious, painful, and crippling estrogen-deficiency disease that should be treated with estrogen replacement therapy to prevent the otherwise inevitable “living decay”. He promoted the use of a drug that healthy women would take every day for the rest of their lives, so they could remain feminine forever.

Wilson wrote, “All postmenopausal women are castrates.” With HRT, “a woman’s breasts and genital organs will not shrivel. She will be much more pleasant to live with and will not become dull and unattractive.” It was later found that the book and promotional tours were financed by the drug companies producing HRT. Have we really not moved on from this ageist, misogynistic narrative about menopause and the place in society of post-menopausal women? Are women to be disempowered about how they manage their own health in later life? Is this the menopause revolution?

To add to the gloom, Carolyn Harris MP and Penny Lancaster wrote recently about a correlation they saw between menopause, depression and suicide. They quoted a 16-fold increase in depression in women aged 45-52 and a “staggering” 7-fold increase in suicide in women aged 40-50. They said that around 20% of perimenopausal and menopausal women present to their GP with symptoms of depression. Where did they see this headline grabbing data? Is it from peer-reviewed research? What country or region does it relate to and over what time period?  Or rather, does the use of unqualified data to make a point that needs making, also undermine the very point being raised?

If we assume all women 45-52 (or 55 or later) are either perimenopausal or menopausal, does that mean that 20% of all women in that (undefined) age group are presenting as depressed to their GP? How many women is that? Maybe what was meant is that of the women who go to their doctor with problems when they are perimenopausal or menopausal, 20% of those women present with symptoms of depression. That’s a different number but equally ambiguous.

Where does this unqualified data come from? I tried to find out how many women there are aged 45-52 in the UK, for example, to see how many 20% might represent. There was a census done in 2021 in England and Wales, but the results have not been published. So I can’t even get the total number of women in this potential age range, let alone how many go to the doctor. Is there some public data on what women discuss with their GPs that I’m unaware of? The information is powerful, but it helps to know where it comes from, as well as its context.


I’ve seen similar data about suicide and menopause presented as fact in the past, again without referencing a source. The Office for National Statistics (ONS), reports that women aged 50-54 exhibited the highest rate of suicide in England and Wales (specifically in 2019), but the actual rate was only 7.4 women per 100,000 population. This rate compares with 6.9 women per 100,000 in the 45-49 age range, 6.6 aged 40-44, and 6.1 aged 35-39. From age 55, the suicide rate for women decreases until age 80-84.

Of course, any rate of suicide is awful. But these are tiny increases between age ranges, and the rate of male suicide is far greater than that of women in every age group. The ONS also noted a significant increase in suicide rates in males aged 10-24, 25-44 and 45-64, in England and Wales, since 2017. All data needs context. We should most certainly be asking questions about suicide rate change. But we need the full picture.

Suicide rates are higher for women around menopause, but can we conclude menopause is the cause? Other factors that peak at that time are redundancies, divorce and the death of a parent. Women may also be dealing with children leaving home, looking after elderly parents, and feeling the weight of the insidious combination of ageism and sexism that exists in our society and in the workplace especially. Not to mention the negativity and fear around menopause already mentioned. Big birthdays and their ‘over the hill’ cards can also be painful as we grapple with status anxiety and what we have achieved in life so far. The U-Curve of Happiness states that 47 is the unhappiest age for men and women.  We’re also being told that over a million women could leave work because of menopause but again, is menopause the main culprit? How reliable is that research? Menopause may be hard for some, but no data I know of states it is the predominant cause of this increase in suicide rates for women.

When researching my book, I discovered that how we feel about ageing affects how we age. If we feel good about ageing, we are more likely to look after ourselves and therefore age in a more healthful way. Perhaps the way women feel about menopause and getting older has a direct impact on their experience of the transition too. I’m not saying it’s mind over matter. Far from it. However, a positive attitude towards menopause enables curiosity about what is going on when we start to experience changes.  Menopause may not even be to blame for what’s going on.  It’s not an illness to fix, it’s a transition, much like puberty in reverse, from the monthly hormonal roller coaster to still, deep waters. Menopause expert, Dr Jen Gunter recently said on Twitter, “menopause is no more a state of estrogen deficiency than being a child is.”  


I believe menopause issues are the body’s early warning system, the canary in the mine, warning us that all may not be right with the way we live our lives. How did I come to this conclusion? When I was 41 I was given a diagnosis of early menopause. I was trying for a second child and had a hormone test. I was told I had the hormonal profile of a postmenopausal woman and no chance of having a child. I did some research, changed my diet and how I live, and within three months of getting that diagnosis, I was menstruating again and had a pre-menopausal hormonal profile back for a while.  I didn’t get the baby, but I did learn that changing my diet and how I lived, had a direct impact on my hormonal balance and general health.  I learnt to be proactive not reactive when it came to my menopause transition.

The diagnosis was made all the worse because of my emotional response to it. I walked out of the doctor’s office feeling like a dried up old prune. No one had told me that my life was over, but I felt like it. On reflection I had succumbed, hook, line and sinker, to the negative narratives about menopause and aging that are fed to women all our lives and relentlessly promoted by the marketing assault of the global ‘beauty’ industry: that youth and looking young are best, that we lose our beauty and value as we age, that we need to cover up signs of ageing, and that midlife and menopause mark the end of meaningful life. We can also add ‘menopause as hormone deficiency’ to that long list of negative narratives. It was only because I discovered and created more positive narratives and different ways of living that I managed to bring myself out of my midlife depression.  If I were going through that now, I could also be feeling terrified of what lay ahead as a hormonally deficient woman.

I took HRT for seven years because of early menopause, but weaned myself off at the average menopause age of 51, as I was advised to do, if I felt OK. I have managed any issues since with diet and lifestyle changes. I want women to have the whole picture about menopause. Especially now, when menopause is again being positioned as a deficiency, to fix with HRT, as opposed to a natural and freeing stage of life where HRT may help. Some women are currently also finding it difficult to get hold of HRT. I want women to know they can make changes that will help with or without it. These include reducing intake of sugar, alcohol and caffeine, eating good food regularly to maintain blood sugar levels, reducing toxins in food and personal products, reducing stress or finding better ways to manage it, increasing intake of natural phytoestrogens that can be found in soy, flax and other seeds, for example, increasing exercise and losing weight if, hand on heart, you know you’re carrying a bit too much.

There’s no doubt HRT can help many women, and some need it, but there are also many other more natural ways to help women through the menopause transition. Some menopause practitioners suggest we need hormone therapy now because we didn’t live long enough to suffer in the past and we’re in more danger of age-related disease as a result. This isn’t based in fact either. The loss of menstruation with age is noted in both ancient Chinese and Greek medical writings. In 1680, life expectancy for a woman at age 15 (in other words, having survived childhood) in England and Wales was 56.6 years, rising to 64.6 years by 1780. Clearly, life expectancy differed depending on location, relative wealth, health, race, and so on, but at least in the British Isles, many women were living longer a lot earlier than some commentators suggest. If age-related disease is increasing, I suspect modern life is to blame.

When I read of women again being advised to take HRT forever for long-term health, I can’t help thinking that Wilson’s book has had a lingering impact on how we as a society and individually view postmenopausal women. No one can claim that long-term use of HRT is completely safe, at least not for another 20 years. The HRT manufacturers must be delighted at the prospect of every woman taking their drug for life. As with global sales of anti-aging creams and hair dye, just imagine how much money that would involve! I always say, follow the money.

menopause revolution fist

A true menopause revolution will happen when menopause moves from being a taboo subject brought to awareness through fear tactics, to being seen in its rightful place as a powerful transition in a woman’s life. When we embrace it as heralding a new and magnificent next chapter, rather than labelling it as a ‘hormone deficiency’ that will blight us to the grave. When we recognise that we don’t need to be reactive to menopause, but can take a proactive and empowered response to our experience of it. When we stop blaming lack of estrogen for every midlife and age-related issue, and instead scrutinize modern life and endemic gendered ageism. When women are not scared into believing they must have HRT to prevent them getting heart disease, osteoporosis, Alzheimer’s, or even suicidal. Maybe it’s a counter-revolution we need! Let’s empower women to feel prepared not scared.

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