What is your body actually asking for?

I'm going to start with an observation that has made me ponder a lot, this is not a position that I am holding. So many woman I know are taking HRT. Every Instagram feed I scroll is full of it. Women who suffered in silence for years — misdiagnosed with depression, anxiety, chronic fatigue — are finally getting answers and feeling better. This is genuinely good news.

And yet. I'm curious. When something becomes this unanimous, this fast, I find myself asking questions. Not against HRT. But around it. What do we not know?

I was curious to the history of HRT

The first estrogen drug was approved in 1942. The hormones came from pregnant mare urine. By the 1960s, a bestselling book claimed menopause was "a hormone deficiency disease, curable and totally preventable." Not a life transition. A deficiency. Something to be fixed.

By the 1990s, it was the most prescribed medication in the United States. Then in 2002, a major clinical trial linked it to breast cancer and heart disease. Use collapsed overnight. Women were left without support and told to manage. That was also wrong. Then the study was found to be seriously flawed. The pendulum swung back.

Davina McCall made two documentaries. HRT went into national shortage in the UK. The rehabilitation was real and largely deserved. But medicine has been certain about women's bodies before.

What else is worth considering?

In Japan, only 9% of women report hot flashes. Osteoporosis rates are half those of North American white women — despite far lower HRT use. Japanese women have the longest life expectancy in the world. Is it the diet? The community structures? The different relationship to ageing? The absence of a medical framework that calls it a disease? Probably all of it, yet we're barely looking.

What the research says

HRT is the most effective treatment for hot flashes and night sweats. When zooming out, and the picture shifts. A controlled study found resistance training — squats and deadlifts, twice a week — was more effective than HRT alone for spinal bone density. The main reason most women stay on HRT long-term is bone protection. So why isn't this finding everywhere?

A meta-analysis of 3,500 women found CBT and mindfulness reduced anxiety, depression, and symptom severity with medium to large effect sizes. One four-session programme cut symptom severity by 50%. Group formats outperformed individual ones — the relational container itself appears to be part of the medicine.

And a population cohort study found that women using plant-based compounds had 40% lower all-cause mortality and 60% lower cancer risk than those on conventional HRT. One study. Handle with care. But still — are we comparing HRT against nothing, or against genuinely effective alternatives?

My own research - early stages and I am simply open

I work with women navigating chronic health. The pattern repeats: a body in threat-mode for years, a nervous system that never returned to rest, a relationship to symptoms that is fundamentally adversarial, a backdrop of society based on slavery, war and genocide.

The HRT conversation on social media seems to stay inside a framework - the body is deficient, the solution is external.

What if the symptom is a signal? What if the severity of the transition has something to do with how depleted the system already was — adrenally, nutritionally, socially? What if the explosion of HRT use is partly a measure of how unsustainably so many women have been living? I'm not asking that judgementally. I've lived it and am exploring it myself.

What this isn't.

This is not a case against HRT. Women who are suffering deserve relief. This is a case for asking better questions alongside the pharmaceutical ones. For staying curious about what the system needs to regulate itself — not just what it's missing.

Because here's what I keep coming back to: the body and the soil operate through the same intelligence. Both are adaptive systems that, given the right conditions, tend toward health. We don't fix a degraded ecosystem by pumping it full of synthetic inputs and leaving everything else the same.

Why would the human body be different?

Part 1 of 4.. to be continued. Curious to what people think?

Deborah Richmond works with women navigating chronic health through Systemic Constellation work. She is based at Quinta das Abelhas, a regenerative land project in the Serra da Estrela mountains of Portugal.