With hormone health, ‘Nobody is looking at everything as a whole’

What you probably already know: Hormonal shifts for women in all life phases, from fertility to perimenopause to menopause, are linked to fatigue, brain fog, weight gain and poor sleep. Millions of women live with these symptoms, but when they seek help for hormone imbalance symptoms, providers often miss the bigger picture. Ashley Arata, an integrative health practitioner and founder of Ashley Cruz Arata Wellness, said many of her clients report their symptoms being dismissed by doctors or treated based on the results of just one or two lab values. Menopause alone is linked to a well-documented list of downstream health effects, and hormone replacement therapy (HRT) remains one of the most-debated tools for managing them. 

Why it matters: An increasing body of research is starting to validate what many women have long suspected — that hormone health is a whole-body framework. A new study published in the journal Menopause examined how menopause and hormone therapy may influence women’s everyday choices regarding diet, exercise and sleep. A landmark paper published in The Lancet this year argued that the condition “polycystic ovary syndrome,” or PCOS, has an inaccurate name and the condition has since been renamed to more accurately explain its multisystem impacts.  

Arata sees a shift playing out in her clients’ experiences. She points to the gut as an underappreciated driver in hormone regulation. Used estrogen gets circulated in the gut, and sluggish digestion can send it back into circulation in the body, contributing to symptoms like mood swings, insomnia and stalled weight loss, she says. Thyroid hormone conversion also depends on gut function, something that is rarely addressed in standard care.

What it means: Hormone symptoms rarely have a single cause, and treating one marker in isolation often ignores the underlying issue. Arata doesn’t blame health care providers, but says it’s due to a gap in the system. “The system is designed for profit, to be billable by insurance codes, and insurance codes have to give ownership to doctors over certain areas,” she says. Each caregiver looks at separate markers or refers patients who suspect a hormone imbalance to endocrine specialists. 

“Nobody is looking at everything as a whole,” says Arata. The system is “just so siloed that no one is connecting the dots and looking at the actual numbers that we need to tell us what's going on with a woman hormonally because it's not as simple as one or two lab markers.” 

What comes next: Expect hormone health to keep moving from a niche specialty toward mainstream primary care. The 2023 international PCOS guidelines already reclassified the condition as cardiovascular risk-enhancing, rather than purely reproductive, and researchers are now tracing PCOS genetic risk back to childhood. With menopause, new clinical trials — including a German cardiovascular study on current HRT formulations — are underway to answer lingering safety concerns that shaped decades of cautious prescribing. 

— Story by Cambrie Juarez
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