Peri & Pause The Podcast

Jamie, founder of Peri & Pause—the Menopause Center—and a board-certified nurse practitioner, explores why many women feel dismissed during perimenopause and menopause, emphasizing it’s often rooted in history and training rather than lack of care. She explains how menopause was long framed as a “normal” transition not requiring intervention, despite wide-ranging effects on brain, sleep, mood, metabolism, and cardiovascular health. Jamie highlights limited menopause education in medical training and how normal lab results can lead clinicians to default to stress or mood explanations. She details how the 2002 Women’s Health Initiative study—often misinterpreted, focused on older women and specific hormone formulations—drove widespread fear of hormone therapy, shaping practice for decades. She notes newer, more nuanced evidence is slowly changing care and previews upcoming episodes introducing the clinic’s nurse practitioners.

00:00 Why Women Feel Dismissed
02:14 Menopause Is Natural Not Simple
05:40 Training Gaps In Menopause Care
07:43 Defaulting To Stress And Labs
09:46 WHI Study Changed Everything
10:50 Who WHI Actually Studied
12:24 Hormone Types And Nuance Lost
14:05 Breast Cancer Risk Explained
15:31 Aftermath And Reassessment
19:23 Where Menopause Care Is Now
20:24 Next Series Meet The NPs



Creators and Guests

Host
Jamie Gallagher DNP, FNP-C, MSCP
Jamie is a doctoral-prepared, board certified family nurse practitioner and a Menopause Society Certified Practitioner. She is the owner and founder of Peri & Pause. She has served as a nurse practitioner in the Triangle area of North Carolina since 2009 in family medicine, urgent care and women's health. She is an active member of The Menopause Society, the HERmedicine Provider Alliance, the National Association of Nurse Practitioners in Women's Health, and the International Society for the Study of Women's Sexual Health. She is also a proud military spouse, mother of four and grandmother of three.

What is Peri & Pause The Podcast?

The Peri & Pause Podcast is for women in midlife who know something in their body has changed—but haven’t been given real answers, or have been left overwhelmed by conflicting information.

Hosted by Jamie Gallagher, DNP, FNP-C, MSCP, a nurse practitioner specializing in perimenopause and menopause care, the show explores hormones, metabolism, mental health, sleep, sex, weight changes, and chronic conditions through an evidence-based, deeply practical lens. We unpack the physiology of midlife alongside the lived experience of women navigating careers, relationships, finances, and identity during this transition.

Every woman deserves this conversation—and the clarity, language, and confidence to advocate for better care.

Because “Your Labs Are Normal” Is Not the Whole Story.

[00:00:18] Default_2026-03-04_3: Welcome back. I'm Jamie, the owner and founder of Perion Puse, the Menopause Center. I'm a board certified nurse practitioner and a Menopause Society certified practitioner. And I'm so glad you're here today.

. Today I wanna talk about something that many midlife women experience, but rarely talk about openly.

It's that feeling you sometimes have after a healthcare visit. You walk out to the parking lot, get into your car and sit there for a minute thinking, did they actually hear me? Or maybe you think maybe I didn't explain that well. Or even maybe this really is just stress and I'm making too much of it. If you've ever felt dismissed during a healthcare visit and midlife, I wanna talk about that today.

Not in the way you might expect, because this episode isn't about blaming clinicians. It's not about telling you the system is broken or that people don't care. We can all have differing thoughts about that. I do wanna say that clinicians care deeply about their patients. We went into healthcare because we wanted to help people.

Healthcare to me, has to be a calling. If it's not, I cannot imagine how difficult it would be to practice in an ever-changing arena like this. But there are moments in practice in medicine where the science, the history, the training environment, and the current state of our health system all collide in ways that create confusion and midlife women's health is absolutely one of those moments.

So today we're gonna talk about why this gap exists, why so many women feel dismissed during perimenopause and menopause, and why in many cases that experience isn't about someone not caring. It's about the reality that this transition has historically been misunderstood, under-taught, and shaped by one of the most influential studies in modern women's health.

So this first piece, menopause is natural. , Let's start with that basic idea. Menopause is a natural life transition. Every woman who lives long enough will go through it and varying symptoms will be experienced. They'll be different among and between women. Some temp symptoms will be severe, some will be mild. So if something is natural and universal, the assumption for many years was that it didn't necessarily need intervention.

So just think about that. Along the same line, pregnancy can require an intervention. Cancer requires intervention. Heart disease requires intervention too, but perimenopause and menopause, for decades, it was framed more like aging, something that simply happens, something women are expected to move through or push through or just power through.

And while the fact that menopause is a natural biological transition, the experience of it can be anything but simple. It can cause such distress that women leave relationships, leave careers, try drastic measures to help themselves because we feel so different and don't know what to do oftentimes, and we don't understand what's happening.

Our mothers may not have mentioned this change. It was in some ways taboo to discuss in generations past plus a hundred or so years ago, we didn't live too much past this transition. So there's that. Um, perimenopause and menopause involve dramatic changes in hormone signaling that affect. Far more than reproductive organs.

Perimenopause is not a decline in estrogen, like you hear about. It really is a chaos of highs and lows of estrogen and inconsistent progesterone and other hormones. But we're not gonna get into the molecular detail of that right now. These changes affect the brain, sleep, mood, regulation, metabolism, muscle mass, cardiovascular health and cognitive function.

But for a long time that complexity was not emphasized in medical training. It was often framed simply as a normal stage of life.

And when something is labeled normal, the instinct in medicine and healthcare is often not to intervene unless symptoms are severe.

. If we're even cognizant enough to associate those symptoms with something, something naturally occurring. So from the very beginning, menopause care started from a different conceptual place than many other areas of medicine.

The second piece is limited education. Another important factor is the education. Menopause education historically has not been a focus of major or, or medical training or healthcare training. In many programs, only a small number of hours are dedicated specifically to menopause, physiology and treatment options.

Research shows that only about 31% of medical residency programs provide a formal menopause curriculum. About 20% of respondents in one survey reported no menopause specific in instruction, and less than 7% felt they were prepared to treat menopause. There was also a study that founders practitioners receive an average of two hours of menopause education.

The focus in reproductive medicine is usually on fertility, pregnancy contraception, gynecologic disease, and cancer screening. They're all critically important topics, but perimenopause, the years leading up to the menopause is complex, variable, and harder to teach in a straightforward kind of way. And while fertility and pregnancy and cancer, they're important, it may not be a part of every woman's life, or those may not be a part of every woman's life.

Perimenopause and menopause definitely are, this is not a single event. It's not like thyroid disease, for example, where you, you find symptoms and you have an associated abnormal lab or imaging and you treat it, you get the lab in a certain range and the symptoms go away. That's not it. It's a shifting hormonal landscape.

Chaos. At times, estrogen levels fluctuate. Progesterone begins declining earlier, so that's why in our late thirties, early forties. It's the middle of the night waking the mood changes and feeling more irritable, increased anxiety, um, all that around that time, and progesterone was helping us with that.

The brain responds to those changes not only to progesterone. But to estrogen in ways that affect sleep, anxiety, focus, and energy. And unless someone seeks additional education or specializes in midlife women's health, they may not receive deep training in recognizing these patterns. That's why this is so important, pattern recognition.

So when women walk into appointments describing sudden anxiety, broken sleep, brain fog, mood shifts, fatigue, that is not matching effort. A clinician may be trying to make sense of symptoms that weren't heavily emphasized. In training, labs are checked a couple. The standards like blood count, blood sugar TSH, usually not necessarily the actual thyroid hormones that are free T four.

Free T three, for example. Um, maybe some iron studies, but most clinicians have a hunch these will be normal and most of the time they are. So that's very reassuring for ruling out the bad things. That's great, but it still leaves us feeling dismissed, like the symptoms we know we are experiencing are all in our head or something that just hasn't been found out yet.

I said it in earlier podcasts, we feel like we're dying of something that just hasn't been found yet. I have early dementia, or I have a brain tumor, or I have multiple sclerosis, or I have a heart condition. You know, these palpitations. But it's important to work those up and rule out true health conditions.

Absolutely. That are, you know, can be threatening, but pattern recognition and appropriate care cannot be excluded. And when that happens, medicine often defaults to explanations that feel more familiar. Stress. Oh, it's your job, your teens, your marriage, your, your parents mood disorders. Oh, it's. A DD that wasn't discovered before.

Now it's your anxiety. You had years ago rearing its head, it's it's depression, um, lifestyle factors. It, it, it's your crappy diet. And if it's not your crappy diet you need to exercise more and eat differently or sleep more as if we can just will ourselves to sleep eight solid hours. 'cause that'd be nice.

I digress. , I. Stand by. It is not because someone doesn't care, but because those frameworks are what clinicians were taught to reach for first then came the Women's Health Initiative.

So now we need to talk about something that dramatically shaped menopause care. In 2002, a large study called the Women's Health Initiative, often referred to as the WHI released results from one of its hormone therapy trials. This was a very large, very expensive, very influential study funded by the National Institutes of Health.

Its goal was to evaluate the long-term health effects of hormone therapy. We were seeing benefits of hormone therapy and treatments on women that took these as compared to women who didn't. And in medicine, we want data to make relationships between things through evidence. So this study was intended to do just that.

But when the initial and misinterpreted results were released, the impact was immediate. . Headlines appeared across the world suggesting that hormone therapy increases the risk of breast cancer, heart disease and stroke. Prescribing dropped rapidly. Women stopped their medications overnight, and clinicians became extremely cautious about hormone therapy.

To understand what happened and why the story is much more complicated than those headlines. We need to look more closely at the details of the study itself. So let's talk about who was actually studied. One of the most important things to understand about the WHI is the population of women who participated.

The average age of persist participants was about 63. Many of these women were more than 10 years post menopause. They could actually not have hot flashes because the, um, researchers and the women would know if they were taking the placebo or a sugar pill or the actual, um, hormone itself.

. And all this matters because starting hormone therapy many years after menopause may have different effects than starting at around the time of the menopausal transition. The study also included women with a range of cardiovascular risk factors or heart con concerns. About half of participants were overweight or obese, which is consistent with the general population, but also important when evaluating cardiovascular risk.

Some participants were smokers. Other had underlying metabolic risk factors like obesity, overweight blood sugar issues, and others. These factors influence outcomes like heart disease and stroke, but in the headlines that followed the study's release, these nuances were rarely discussed. Instead, the message most people heard was simply, hormones are dangerous, hard stop.

Another important detail is a specific hormone therapy used in the study. The WHI primarily evaluated one formulation, conjugated equine estrogen, often abbreviated CEE, combined with hydroxy progesterone acetate, which is a synthetic or um, progestin.

The current brand name for this is Prempro. This combination was one of the common prescribed hormone therapies at the time. But it's not the only type of hormone therapy that exists today. We have multiple formulation, routes of delivery and dosing strategies, transdermal estrogen or estrogen patches as they're commonly called or transdermal means on the skin.

These are bioidentical, meaning they're like our body's own type of estrogen called estradiol, or one of the estrogens that we have. Um, oral micronized, progesterone, same bioidentical, not synthetic, like the component in prempro or birth control or synthetic hormones. Not to say these are bad, just different and maybe not the best treatment for management and prevention that we want.

As midlife women, we have lower doses. Not that lower is better, but it's easy to start with and to change up the dosing based on outcomes, symptoms, benefits, and side effects. We have different delivery systems, like I mentioned, the patches, gels, sprays, injections, and still oral tablets or capsules. Those options were not what the WHI trial was designed to study, but when the results were released, the interpretation often extended beyond specific therapies that were evaluated.

For example, oral estrogens can increase the risk of blood clot due to the fact that they go through our liver patches deliver the estradiol. That goes through our skin and it does not go through our liver. So we can reduce that risk by simply using a patch rather than a pill. Again, nuanced was lost in this study.

So for the breast cancer finding, one of the most widely reported findings from the WHI was the association with breast cancer. Here's where the language matters in the combined estrogen progestin arm of the trial. So they're taking estrogen and a progestin. Researchers observed a slightly increased risk of breast cancer in the estrogen only arm.

They noticed a lower risk of breast cancer by about 20%, . The statistical, the statistical term, often used to discuss the analysis of this study was the finding that was approaching statistical significance or borderline significant. So let's explain that phrase In research.

Statistical significance means that the results are unlikely to be just due to chance. Researchers usually set a threshold called a P value. To determine whether something meets that standard. When a finding is almost statistically significant, it means the result was very close to that threshold that did not necessarily meet the strict cutoff researchers typically use.

That doesn't mean the finding was meaningless. But it also means it requires careful interpretation. And unfortunately, phrases like borderline significant or almost statistically significant do not translate easily into headlines. So the nuance was simplified and the simplified message became hormones cause breast cancer, which is a much stronger and more absolute statement than one, the what the data actually showed.

And that stuck. So what happened next? The effect of the WHI publication was immediate hormone therapy prescribe prescribing dropped dramatically worldwide. Many clinicians just stopped prescribing hormones altogether. Patients became fearful and medical training programs absorbed that shift.

. . An entire generation of clinicians trained in an environment where a hormone therapy was viewed primarily through a lens of risk, and that caution was understandable. Medicine operates under the principle of first do no harm.

If a therapy appears to carry risk, clinicians will naturally step back. But here's where things become complicated. When we avoid a therapy to prevent pot potential harm, we sometimes create another kind of harm. And in the years following the WHI, many women experienced. Severe menopausal symptoms and had very limited treatment options offered to them.

Sleep disruption went untreated. Vasomotor symptoms or hot flashes were minimized. Mood changes were attributed to stress the overall quality of life for many women suffered. I think as women, we can look at our mothers and grandmothers or aunts and see what impact this had.

That generation potentially lost the benefit of hormone therapy due to fear and risk mitigation. This is what we sometimes refer to as harm in the name of doing no harm. No one intended that outcome, but unintended consequences are part of the history of medicine in general. That's how we learn, that's how we get better and how we grow in this field.

So for the reevaluation over time, researchers began reexamining the WHI. They looked more carefully at age groups at timing relative to menopause at different risk profiles, and gradually a more nuanced picture emerged. The risks and benefits of hormone therapy are not the same for every woman. They vary based on age, the timing of initiation of therapy, the type of hormones used, and individual health factors.

The majority of women can use hormone therapy. That nuance has been slowly reintroduced into clinical conversations, but here's the challenge. Changing medical culture takes time knowledge, it takes an average of 17 years from when evidence is found to get that evidence into practice.

And guidelines, evidence and research that is occurring now will take years to come forth into practice. So think about this, if a clinician has practiced a certain way for 20 years, shifting that approach requires new evidence, new comfort, and new training. So the field has been evolving, but it's been gradual.

So why women feel dismissed all of this history, even though there's much more detail than what I've gone over now, leads us back to the experience that many women have today. A woman in her early or mid forties walks into a clinic describing symptoms that don't feel like her.

She's anxious, exhausted her sleep is disrupted, her focus is unreliable. Her labs are normal. Her clinician may genuinely want to help and may also feel uncertain. So two things can be true. Menopause training was limited if hormone therapy was historically framed as risky. If lab values are normal, the easiest explanation becomes stress.

That doesn't mean the clinician doesn't care. Sometimes it means they don't yet have a framework that explains what the patient is experiencing, and that gap is what feels like being dismissed, but often it's actually just uncertainty. So where are we now? The encouraging news is that menopause care is evolving.

Research is expanding. Education programs are growing. Clinicians are becoming more comfortable revisiting the data and having more nuanced discussions about treatment options. The cultural shifts in medicine do not happen overnight. They unfold over years, sometimes decades. We're in the middle of that evolution right now.

So what I want women to know, if you are navigating midlife and something feels different in your body, you're not imagining it. Your experience matters, and it is real. Your observations matter and they are real. Do not let someone tell you what you are experiencing and understanding the history behind menopause care can help you stop internalizing that dismissal.

. It's not about you failing to explain yourself. It's about a field of medicine and healthcare practice that's still catching up to the complexity of this transition, and we're moving forward slowly but meaningfully, and I hope you found this helpful in your understanding of your own experience.

All right. In the next few episodes we're gonna shift into something I'm really excited about. You're gonna start meeting the other nurse practitioners here at Per and Pause. We're calling the series, meet the Nurse Practitioners. Each of them came into midlife Women's Health through a different path.

Some intentionally chose this work for others. It found them after years of seeing the same patterns in their own patients. We're gonna talk about why they practice in this space, what they see every day, what they wish more women understood about this stage of life. Even share some stories about what they've seen in clinic that might resonate.

You will feel like you're getting to know them and hopefully also feel like you're heard and finally understood. Because midlife care is not just one voice, it's a team, and I cannot wait for you to meet them. I'm really glad you're here and I'll see you in the next episode.