Why do people with hypermobility or dysautonomia crash after feeling better?

Crashes often happen because the nervous system is temporarily supported by adrenaline rather than true energy capacity. When that short-term support fades, symptoms can rebound hours or days later, especially in sensitive or hypermobile bodies.

Is sleep the main cause of low energy in hypermobility or POTS?

Sleep problems are common in hypermobility and autonomic conditions, but sleep alone is rarely the sole cause of low energy. Sleep stability helps reduce nervous system stress and supports recovery, but it does not replace individualized medical care.

Is it safe to rebuild energy with exercise if I have dysautonomia?

For some people with dysautonomia or POTS, carefully paced and consistent activity may help over time. Pushing too hard or changing routines too quickly can worsen symptoms, so gradual, individualized approaches are safer.

Menopause Is in Its Renaissance Era: Debunking Myths About Hormone Therapy

Hormone Therapy

May 2

Written By Vanessa Weiland

Introduction

Menopause, a natural phase of life, has often been shrouded in myths and misconceptions. One area that has sparked considerable debate is the use of menopausal hormone therapy (MHT). Over two decades ago, the Women’s Health Initiative (WHI) study raised concerns about the safety of MHT, leading to widespread fear among both patients and healthcare professionals. However, recent research suggests that these fears may have been largely overblown.

In this article, we delve into the renaissance era of menopause management, focusing on the use of MHT beyond age 65 years and its effects on health outcomes. We are living in a very exciting time for menopause care.

The WHI Legacy

The WHI study, conducted in 2002, sent shockwaves through the medical community. It linked MHT to increased risks of invasive breast cancer, stroke, and coronary heart disease. As a result, many people discontinued MHT, especially after age 65, fearing these potential health hazards. However, subsequent studies have provided a more nuanced perspective.

Can We Continue MHT Past Age 65?

In 2024, the journal Menopause published a large-scale study, based on the records of 10 million senior Medicare women from 2007 to 2020, shedding light on the implications of MHT use beyond age 65. Here are the key findings:

Type Matters: The effects of MHT vary significantly by type. Estrogen monotherapy beyond age 65 was associated with significant risk reductions in several health outcomes, including mortality, breast cancer, lung cancer, colorectal cancer, congestive heart failure, venous thromboembolism, atrial fibrillation, acute myocardial infarction, and dementia.
Combination Therapy: The use of a combination of estrogen and progestogen therapy increased the risk of breast cancer. However, this risk can be mitigated by using low doses of transdermal or vaginal estrogen plus progestin. This increased risk is also lower than the increased risk of breast cancer observed in those who routinely drink two glasses of wine per day.
Individualized Approach: There is no one-size-fits-all rule for stopping MHT based on age alone. For healthy people experiencing persistent hot flashes, continuing MHT beyond age 65 can be a reasonable option with appropriate counseling and regular risk-benefit assessments.
Route of Administration: As we age, choosing low-dose and nonoral routes of administration becomes crucial. Transdermal or genital estrogen may offer benefits while minimizing risks.

Debunking the Fear

Also in 2024, the authors of the WHI published a 20 year follow up to their original study in the Journal of the American Medical Association. They agreed with the conclusion that many menopause specialists have since reached, which is that the interpretation of their original study was deeply flawed. Contrary to the initial alarm, the evidence suggests that MHT can be safe and effective for managing menopause symptoms. Younger menopausal folks, especially those under 60, stand to benefit from MHT. Hot flashes, night sweats, and other bothersome symptoms can be alleviated without undue risks.

Conclusion

Menopause is no longer a time of fear and uncertainty. Armed with evidence-based information, we can confidently navigate this transformative phase. As we embrace the renaissance era of menopause management, let’s dispel myths and prioritize individualized care.

Sources:

Baik SH, Baye F, McDonald CJ. Use of menopausal hormone therapy beyond age 65 years and its effects on women's health outcomes by types, routes, and doses. Menopause. 2024 May 1;31(5):363-371. doi: 10.1097/GME.0000000000002335. Epub 2024 Mar 9. PMID: 38595196.
Manson JE, Crandall CJ, Rossouw JE, Chlebowski RT, Anderson GL, Stefanick ML, Aragaki AK, Cauley JA, Wells GL, LaCroix AZ, Thomson CA, Neuhouser ML, Van Horn L, Kooperberg C, Howard BV, Tinker LF, Wactawski-Wende J, Shumaker SA, Prentice RL. The Women's Health Initiative Randomized Trials and Clinical Practice: A Review. JAMA. 2024 May 1. doi: 10.1001/jama.2024.6542. Epub ahead of print. PMID: 38691368.
Cimons, M. (2024, May 1). No need to fear menopause hormone drugs, finds major women’s health study. The Washington Post

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