The Women We Left Behind
- Jun 15
- 7 min read
Written by Nelum Dharmapriya, Doctor & Health Coach
Dr. Nelum Dharmapriya is a Brisbane-based GP with a special interest in metabolic health, menopause, and lifestyle medicine. She combines 30 years of clinical experience with a personal passion for helping women thrive in midlife and beyond.
A few months ago, a woman in her late sixties came to see me. Let's call her Margaret. Margaret wasn't there to talk about menopause. In fact, she was convinced that chapter of her life had closed decades ago. She had come because she no longer felt like herself.
She told me she was tired all the time. Her sleep wasn't what it used to be. She struggled to find words during conversations and often walked into a room only to forget why she was there. Her joints ached. Her confidence had diminished. She felt more anxious than she used to and less resilient when life threw challenges her way.
"I don't feel sick," she told me. "I just don't feel like me anymore." It is a sentence I hear surprisingly often. Many women in their sixties and seventies describe a similar experience. They don't necessarily have a single symptom that sends them rushing to the doctor. Instead, they describe a gradual erosion of vitality. The woman they once were seems to have slipped quietly away, replaced by someone who is more tired, more forgetful, more anxious, and less physically capable.
Most have come to accept it as ageing. When I asked Margaret whether anyone had ever spoken to her about menopause hormone therapy, she laughed.
"That ship sailed years ago," she said. "I missed that opportunity." Her response stayed with me because it reflects what millions of women have been led to believe over the past two decades and for much of my medical career, I believed it too.
Like many doctors, I trained in the shadow of the Women's Health Initiative study. Published in the early 2000s, it generated headlines around the world linking menopause hormone therapy to breast cancer, heart disease, stroke, and blood clots. Women stopped taking hormones in huge numbers. Doctors stopped prescribing them. Fear became deeply embedded in both the medical profession and the wider community.
Looking back, it is difficult to overstate the impact that study had. An entire generation of women became frightened of menopause hormone therapy. An entire generation of doctors became cautious about prescribing it. Many women who may have benefited from treatment either stopped it abruptly or never considered it at all.
The greatest misunderstanding was not that the Women's Health Initiative existed. It was that its findings were applied to all women, all hormones, and all stages of menopause.
What has emerged over the following two decades is a far more nuanced picture. Many of the women in the original study were older and well beyond the menopausal transition. The hormone formulations used were different from the body-identical hormones increasingly prescribed today. Yet while the science evolved, the fear remained.
As a result, many women now in their sixties and seventies simply assumed the conversation was over. I think that is a tragedy.
What makes this topic deeply personal for me is that I, too, believed many of these myths. As a Clinician with more than thirty years of experience, I was taught the same things many women were told. It wasn't until I experienced my own menopausal transition, with symptoms that affected my health, confidence, sleep, metabolism and overall wellbeing, that I began questioning what I thought I knew.
The more I learned, the more I realised that menopause medicine had changed dramatically, while many of us were still practising based on information from decades ago.
One of the most important things I have come to appreciate is that menopause today is very different from menopause throughout most of human history.
For most of human existence, women did not spend decades living beyond menopause. Today, many women can expect to live into their late eighties or nineties. A woman who reaches menopause at fifty may have another thirty or forty years ahead of her.
That changes everything. Menopause is no longer a brief transition towards the end of life. For many women, it marks the beginning of a life stage that may last longer than the years spent raising children or building a career.
The question is no longer whether women survive menopause. The question is how well they live afterward. Once I began looking at menopause through the lens of healthspan rather than simply symptom management, I started to see the bigger picture.
For many years, I viewed menopause primarily through the lens of hot flushes and night sweats. If those symptoms settled, I assumed the menopause story was largely over.
I now realise how incomplete that view was. What I have come to appreciate is that menopause is not simply about the ovaries, nor is it just about oestrogen.
The receptors for the major female hormones, oestrogen, progesterone and testosterone are found throughout the body, including the brain, bones, muscles, blood vessels, bladder, skin, connective tissues and the immune system. These hormones are not simply reproductive hormones, they are whole-body hormones that influence how we think, feel, move, sleep and function.
As levels decline during and after menopause, the effects can be felt far beyond the reproductive system. They may influence cognition, mood, sleep, muscle strength, bone health, cardiovascular health, libido, urinary function and overall well-being.
This helps explain why so many women in their sixties tell me they no longer feel like themselves.
Many have simply accepted these changes as normal ageing.
But what if some of them aren't? What if at least part of what we have traditionally labelled as "just getting older" is related to decades of living in a low-hormone state?
Once I began looking at menopause through this broader lens, I became increasingly interested in what happens to women's long-term health after menopause.
The loss of female hormones is associated with far more than symptoms. As women move through the menopausal transition, their risk of chronic disease changes dramatically. The risk of cardiovascular disease approximately doubles. The risk of developing type 2 diabetes rises significantly. Bone loss accelerates, increasing the likelihood of osteopenia, osteoporosis and fractures. Women lose muscle mass, strength and power at a time when maintaining independence becomes increasingly important.
One statistic that particularly struck me was that by the age of 65, women experience around four times the rate of disability seen in men of the same age. Much of this disability is driven by conditions that become more common after menopause, including osteoporosis, fractures, loss of muscle mass and chronic disease.
Perhaps most concerning of all is what happens to brain health. Dementia is now the leading cause of death in Australian women, and women are approximately twice as likely as men to develop Alzheimer's disease. While the reasons are complex and still being investigated, it is becoming increasingly clear that female hormones play important roles in brain function, cognition and neurological health throughout life.
At the same time, I started referring more women for bone mineral density scans. What I found shocked me. Women who appeared healthy, active, and well were returning with diagnoses of osteopenia and osteoporosis. Many had no idea they had already lost substantial amounts of bone. Some had never been told that women can lose up to 25% of their bone mineral density during the years surrounding menopause.
The consequences of that bone loss can be devastating. A fracture is not simply a broken bone. For many women, it marks the beginning of a loss of confidence, independence and mobility.
Recently, I wrote about a woman whose seemingly minor fall became a powerful reminder of what is at stake when bone health is overlooked. Her story highlights why preserving strength, bone density and independence must become a central part of the menopause conversation.
This is why the conversation about menopause hormone therapy matters. Not because it is a fountain of youth. Not because every woman should take it and certainly not because it is the only answer.
It matters because women deserve access to accurate information and the opportunity to make informed choices about their health.
The body-identical hormones we use today are very different from the therapies that generated so much fear twenty years ago. Modern body-identical oestrogen, progesterone and testosterone are chemically identical to the hormones produced by the human body. In particular, transdermal oestradiol, delivered through the skin, bypasses the liver and has a very different risk profile from older oral preparations.
While women who commence therapy closer to menopause appear to derive the greatest cardiovascular benefit, emerging evidence suggests that carefully selected women over sixty may still experience meaningful improvements in symptoms, quality of life, bone health and potentially cognitive health.
For women wanting a deeper understanding of how modern body-identical hormone therapy differs from older treatments, I recently explored the science, benefits and practical considerations in more detail here:
Menopause hormone therapy is not a magic solution, nor is it appropriate for every woman. However, it is increasingly being viewed as one of the tools that may help women maintain health, function and independence as they age.
For many women, the question is no longer, "Can I survive menopause?" The question is, "How can I thrive during the thirty or forty years that come afterward?"
Margaret certainly thought her opportunity had passed. Like so many women, she believed the conversation was over. My message is simple.
If you are in your sixties or seventies and have accepted symptoms that affect your quality of life because you believe they are simply part of ageing, it may be worth revisiting the conversation.
Science has changed. The treatments have changed. Most importantly, your future health matters.
Your next step: If this article has resonated with you and you've found yourself wondering whether some of the changes you've attributed to ageing could be related to menopause, I encourage you to start the conversation.
You don't have to navigate this journey alone. If you'd like to explore this area further and better understand how menopause, hormones, nutrition, lifestyle, and metabolic health may be influencing your wellbeing, I invite you to book a free discovery call with me. Together, we can explore your concerns, discuss your options, and help you identify the next steps on your journey to better health.
You can also join our Whole Food Revolution Community and subscribe to our YouTube channel, where we share evidence-based education, practical strategies, and inspiring stories to help women thrive through midlife and beyond.
Because every woman deserves the opportunity not just to live longer, but to live stronger, healthier, and with confidence in the years ahead.
Visit my website for more info!
Read more from Nelum Dharmapriya
Nelum Dharmapriya, Doctor & Health Coach
Dr. Nelum Dharmapriya is a Brisbane-based GP with 30 years’ experience in women’s health and metabolic wellbeing. Founder of Whole Food Revolution, she empowers women 40+ to reclaim energy and confidence through the three pillars of science, lifestyle, and mindset.
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