Is Menopause Really an Illness? Is HRT a Safe Alternative? Lets dive into How Modern Medicine & Ayurveda Differ.

A woman’s life is made up of many beautiful phases, each with its own purpose, significance, and journey.

According to Ayurveda, there are two important preparatory phases in a woman’s life:

Puberty → Pregnancy & Perimenopause → Menopause

Puberty helps prepare the body for the reproductive years, while perimenopause prepares the body for the transition into menopause.

The way you support your body during these transitional phases can influence how smoothly you move into the next stage of life.

Prepare well today to support a healthier tomorrow.

What can go wrong during puberty & perimenopause?

The teenage and young-adult years are an important time for building hormonal and metabolic health.

Conditions such as PCOS, eating disorders, and IBS are relatively common in younger women and can sometimes be associated with challenges later in life, including fertility problems and complications during pregnancy.

For example, women with PCOS may have a higher risk of developing problems such as gestational diabetes, high blood pressure during pregnancy, excessive fatigue, postpartum depression, and difficulty losing weight after pregnancy.

As these women move into their 30s and 40s, some may also experience conditions such as fibroids, heavy or irregular bleeding, ovarian cysts, or endometriosis. Lets not ignore other health issues like hair loss, increased facial hair, infertility and difficulty to conceive and having to choose IVF and other artificial procedures. In certain cases, these problems can eventually lead to surgery, including hysterectomy and ovarian surgeries. Some women may also experience early menopause, which means reaching menopause before the usual age of 40 years.

Then comes the next major transition: perimenopause.

During this stage, underlying metabolic issues can become more noticeable. Weight gain, high cholesterol, high blood pressure, insulin resistance, and fatty liver may become more common, and menopausal symptoms can feel more difficult to manage as the protective hormones like estrogen fades away from our system slowly.

The key message is that these stages of life are inter connected more than you realize.

The health habits and metabolic foundation built earlier in life can influence how the body handles pregnancy, perimenopause, and menopause later on. Preparing the body before each transition can make a meaningful difference.

When women finally enter what can be one of the most beautiful and liberating phases of life — menopause — majority are instead faced with difficult symptoms such as weight gain, hot flashes, fatigue, joint pain, rising blood sugar, mood swings and other metabolic changes.

I am currently in my perimenopausal phase, and based on my irregular periods, I believe I have been in this transition for about a year.

So the pressing question is:

What do I do during perimenopause to prepare my body for a healthier, smoother menopause?

Here is a breakdown of How I Structure my 24 hours:

5:30 AM — Wake up during Brahma Muhurtam as I like to begin my day early. For me, this quiet time helps set the tone for the entire day. I feel more focused, organized, and mentally clear when I start my morning this way. On days when I miss this time, I often feel more scattered and less productive.

6:00–7:00 AM — Prepare breakfast and lunch for my kids. This is my family time in the morning. I prepare breakfast and pack lunch ensuring that they don't need to look out for unhealthy snacks in the cafeteria.

7:00–9:00 AM — Morning wellness sessions. My morning sessions usually include Brahma Namaskar, Pranayama, Trataka and chakra meditation. The movements are not vigorous, but they are enough to gently open the joints, improve circulation, wake up the body, and lift the mind out of its slumber preparing for a productive day. I conduct them at 3 various times Mon to Fri at 7, 8 and 9 am to accommodate clients of various time zones in the US.

10:00 AM onward — ConsultationsI spend close to an hour with each client, listening carefully to their concerns and helping them find solutions that fit their lifestyle, health goals, and individual circumstances.

12:00–1:00 PM — Lunch. This is one of my favorite part of the day. I usually practice intermittent fasting until noon, so I genuinely look forward to lunch and am hungry.

My meal is always fresh, wholesome, and simple. Even though I have help with cleaning and chopping, I prefer to prepare my own lunch so I know exactly what goes into it. I focus on plenty of vegetables, lentils, homemade yogurt, ayurvedic leaves, millets and fresh ingredients, while keeping an eye on the amount of oil and salt I use.

A nourishing lunch like this keeps me satisfied until dinner, and I rarely feel the need to snack in between.

1:00–2:00 PM — Power restI usually take a short afternoon rest or power nap. In some cultures, this is similar to a siesta.

For me, even 20–30 minutes can completely recharge the second half of my day. I try not to sleep for too long because a lengthy nap can interfere with nighttime sleep.

2:00–5:00 PM — Consultations continue. My afternoon is usually filled with back-to-back consultations. Whenever I have cancellations, especially during the fall and winter months, I step outside for a walk. This is also when I often record my reels for Walk with Sahila.

5:00–6:00 PM — Strength training sessions. Strength training is one of the rituals I consider especially important during perimenopause. During these sessions, I train my clients using dumbbells and simple props such as blocks, a wall, towels, and chairs. The goal is to work both large and small muscle groups, maintain strength, and support the body as we age.

I often end the session with Yoga Nidra, allowing the body and mind to shift from effort into deep relaxation quietening down the mind after a days long work and stress.

6:00–7:00 PM — DinnerI I try to finish dinner before 7 PM always. Eating earlier gives my body enough time to digest before I go to sleep. My goal is to go to bed feeling comfortable with a light emptiness rather than overly full, so the body can focus on rest, recovery, and restoration overnight.

7:00–8:00 PM — Evening walk and reels. During spring and summer, this is often when I take my outdoor walk and record content for Walk with Sahila which a popular InstaGram series. It allows me to combine movement, fresh air, reflection, and recharge all at once.

9:00–10:00 PM — Wind-down routineI may watch television for 10–15 minutes and then begin my bedtime rituals. These usually include face yoga, brushing my teeth, taking magnesium supplements, writing my manifestation mantra, and practicing Bhramari pranayama. One of my most important habits is keeping my phone away from the bedroom so notifications, sounds, and alarms do not disturb my sleep.

10:00–10:30 PM — BedtimeI try to be in bed by around 10 PM.

As evening progresses, the body naturally increases melatonin production, which helps regulate the sleep-wake cycle. Bright light and screens late at night can interfere with this natural process, so I avoid phone, computer, and television exposure before sleeping.

Good sleep is one of the foundations of hormonal health, recovery, energy, and a healthy circadian rhythm. Its crucial to get minimum of 7-8 hours sleep.

This routine is not about perfection. It is about creating a rhythm that supports my body, mind, work, family, and health every single day and in essence preparing me for a healthy menopause.

HIRE HELP

Every minute of my life is accountable, and I try not to spend my time doing things that do not require my expertise.

Tasks like chopping vegetables, cleaning, dishes, laundry, and other routine household work can be delegated whenever possible. I believe working women should protect their time this way, because at the end of the day, we all have the same 24 hours.

How we use those hours can shape the quality of our lives? In many ways, success begins with how well we manage our time. This becomes even more important during perimenopause. The choices you make during these years can influence how you experience the decades that follow. Do you want to spend your later years constantly managing health problems and doctor appointments, or do you want the freedom and energy to travel, create, work, and enjoy the things you love?

If your goal is to stay strong and healthy after menopause, start building those habits today. Create a routine that supports your sleep, movement, nutrition, strength, stress management, and recovery — and stay consistent with it.

Your future health is built through the choices you make today.

What is HRT (Hormones Replacement Therapy) & Is this Safe today?

To answer his question, one needs to understand the terms endogenous and exogenous hormones.

Easy way to remember endo = inside, exo = outside.

With estrogen, the difference is mainly where it comes from:

- Endogenous estrogen = estrogen your body produces naturally, mainly in the ovaries before menopause, with smaller amounts from other tissues.

- Exogenous estrogen = estrogen that comes from outside the body, such as estrogen in birth-control pills or menopausal hormone therapy.

For example, estradiol made by your ovaries is endogenous. If you take an estradiol patch or pill, that estradiol is exogenous.

Reason why there is controversy regarding HRT is the key study called the Women’s Health Initiative (WHI) trial in year 2002 https://pubmed.ncbi.nlm.nih.gov/12824205/?utm_source=chatgpt.com . One part of the trial studied postmenopausal women taking combined estrogen + progestin. That arm was stopped early because, after about 5 years, the overall balance of risks was judged unfavorable. Compared with placebo, the study found higher rates of invasive breast cancer, heart disease, stroke, and blood clots. The breast-cancer hazard ratio was about 1.26, meaning roughly a 26% relative increase in that study population.

1-Real breast cancer risk comes from progesterone

• Estrogen + progestin: associated with increased breast-cancer risk with longer use. PubMed

• Estrogen alone: used mainly in women who have had a hysterectomy, did not show the same breast-cancer increase in the WHI.

• The WHI Formulation (MPA): Modern science has traced most of the excess breast cancer risk found in the WHI trial directly to MPA, rather than the estrogen component. Synthetic progestins interact aggressively with multiple types of hormone receptors in the body.

• Today's Gold Standard (Micronized Progesterone): Today, doctors favor bioidentical micronized progesterone (Prometrium). Large-scale observational studies (such as the landmark E3N cohort) have shown that micronized progesterone does not carry the same breast cancer or blood clot risks associated with older synthetic progestins like MPA

2. Transdermal vs. Oral Delivery: The Blood Clot Difference

The WHI trial relied entirely on oral pills.

• The WHI Delivery Method: When estrogen is swallowed as a pill, it passes directly through the digestive system and enters the liver first (known as first-pass metabolism). This process causes the liver to overproduce clotting factors, significantly elevating the risk of deep vein thrombosis (DVT), blood clots, and ischemic strokes.

• Today's Preferred Method: Modern HRT heavily utilizes transdermal delivery via skin patches, topical gels, and sprays. Because transdermal estrogen is absorbed directly through the skin into the bloodstream, it bypasses the liver entirely. Clinical data indicates that transdermal estrogen at standard doses carries a near-zero baseline increase in blood clot or stroke risk.

3.The "Window of Opportunity" (The Age Factor)

• Then: The average age of women in the WHI trial was 63 years old. Most were 10 to 12 years past menopause.

• Now: Today, doctors only prescribe systemic Prempro to symptomatic women in their late 40s or early 50s who are just entering menopause. Long-term follow-up data shows that when women under 60 start this therapy, it behaves entirely differently—protecting bones and the heart without the elevated risks seen in elderly participants

If you go to an OB-GYN today, Prempro is no longer your only choice. You have the option to bypass the oral route entirely by using a bioidentical estradiol patch combined with natural micronized progesterone (Prometrium), which avoids the clotting and breast risks associated with the old synthetic progestin (MPA) altogether.

4. The Risk is Real, But Contextualized

If you take Prempro for 5 years, the data from the [Women's Health Initiative (WHI) 20-year follow-up] confirms that the risk does rise. However, the medical community now views this as a low absolute risk

• The Math: Five years on Prempro adds about 4 to 6 extra cases of breast cancer per 10,000 women per year.

• Lifestyle Comparison: For perspective, the [The Menopause Society] and oncologists point out that this mathematical increase is comparable to or lower than the breast cancer risk associated with drinking two glasses of wine a day, being clinically obese, or having a sedentary lifestyle.

Absolute Risk Factors (No Systemic HRT of Any Kind)

A woman should NOT start either Prempro or an estrogen patch if she has any of the following conditions:

• History of Breast Cancer: Known, suspected, or past history of breast cancer or other estrogen-dependent malignancies.

• Active or Past Blood Clots: A history of Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE).

• Active Arterial Vascular Disease: A recent history of stroke, transient ischemic attack (TIA), or myocardial infarction (heart attack).

• Active Liver Disease: Active hepatic impairment or liver dysfunction prevents the body from safely metabolizing hormones.

• Undiagnosed Vaginal Bleeding: Any unexplained uterine or genital bleeding must be fully investigated and cleared before hormones are introduced to ensure it is not a sign of endometrial cancer.

Relative Risk Factors for Prempro (oral combination) and Prometrium (micronized progesterone) include:

Cardiovascular and Metabolic Risks

• Controlled Hypertension: Systemic hormones, particularly oral pills like Prempro, can occasionally elevate blood pressure. Blood pressure must be stable before starting.

• Elevated Triglycerides: Oral estrogens can significantly spike triglyceride levels, increasing pancreatitis risks. A transdermal patch is heavily preferred over Prempro here.

• Diabetes or Insulin Resistance: Hormones can subtly alter glucose metabolism. Women with diabetes require closer monitoring of their A1C levels.

• Obesity: Higher body mass index increases the baseline risk for blood clots. Doctors will heavily lean away from oral Prempro toward a patch combined with Prometrium.

Neurological and Reproductive Risks

• Migraines with Aura: Estrogen fluctuations can trigger severe migraines and raise stroke risks. If HRT is used, low-dose transdermal patches are chosen to keep hormone levels stable, avoiding oral options like Prempro.

• Uterine Fibroids or Endometriosis: Estrogen can stimulate the growth of existing, non-cancerous fibroids or reactivate residual endometriosis tissue.

• Family History of Breast Cancer: While a personal history of breast cancer is an absolute "no," a strong family history is a relative risk. Doctors will typically avoid Prempro's synthetic progestin and opt for Prometrium, which has a safer breast profile.

Organ-Specific and Lifestyle Risks

• Controlled Gallbladder or Liver Disease: Past issues with gallstones or managed liver conditions require avoiding oral medications like Prempro to prevent straining the digestive system.

• Tobacco Smoking: Smoking increases cardiovascular risks. If a smoker requires HRT, transdermal options are utilized because oral Prempro carries an unacceptable clotting risk.

• Peanut or Soy Sensitivity: Prometrium capsules are manufactured using peanut oil. Women with mild sensitivities must be monitored, while those with severe allergies must avoid it entirely.

My Recommendation & Conclusion

The hormones associated with the rise in breast cancer risk in earlier studies (WHI) are still similar to the types used today in menopausal women. Today, HRT is considered safer when it is started earlier, prescribed more carefully, and monitored more closely. While the hormone combinations and dosages may still be similar in many cases, the way these hormones are administered has evolved.

The absolute contraindications to HRT may be limited (5 risks), but the relative risk factors are much broader and can include a long list of metabolic and medical conditions. Unfortunately, by the time many women reach menopause, they may already have one or more of these risk factors, which can make HRT less suitable or require much more careful consideration.

So although HRT is FDA-approved and can be safely used in appropriately selected women, it still comes with important risks and limitations that cannot always be ignored. In some women, these risks may further complicate an already challenging menopausal transition.

For this reason, my recommendation is to focus on the regimen I described above and prepare the body as early as possible for the menopausal years.