Menopause, HRT, and Becoming Your Own Advocate: Labs, Symptoms, and What to Ask For
If You Feel “Off” in Perimenopause or Menopause, You’re Not Imagining It
There are so many women in perimenopause, menopause, and beyond who know something has shifted, but keep getting told it’s “normal for your age.”
And yes, your body changes in this season. But that doesn’t mean you’re supposed to quietly accept feeling exhausted, foggy, anxious, inflamed, or like a stranger in your own skin.
When your energy shifts, your sleep gets weird, your mood feels unfamiliar, your weight changes, and you can’t get clear answers, it’s easy to start doubting yourself. But this season doesn’t have to be something you simply survive.
It can be a season of understanding your body more deeply, asking better questions, getting more informed support, and making empowered decisions about what your body may actually need.
In this episode of Healing Her Feminine, I’m joined by Cindy Dupuie, functional medicine nutritionist and founder of A Living Balance, to talk about menopause and beyond, how to think about reading labs, and what women should consider when it comes to hormone replacement therapy.
Why Women Have to Advocate for Themselves (Even Though It Shouldn’t Be This Way)
One of the most important truths Cindy names is this: many doctors are not adequately educated in menopause care.
Because of the fallout from the Women’s Health Initiative study, menopause and hormone education largely disappeared from medical training for years. Unless a provider has pursued additional education on their own, they may be working from outdated information or shutting down the conversation entirely.
That’s why advocacy matters so much here.
Not because you should have to become an expert overnight, but because your quality of life matters too much to accept dismissal.
Cindy’s take is clear: you may need at least one or two people in your corner, a practitioner, a coach, a functional provider, who can help you interpret what’s happening and guide you toward real options.
Menopause Symptoms That Get Dismissed (But Deserve Attention)
Most women know the “classic” symptoms that are associated with perimenopause and menopause. Hot flashes. Night sweats. Insomnia. Mood swings. Loss of libido. Vaginal dryness. Brain fog.
But Cindy also highlights symptoms that are common and overlooked. Weight changes. Cholesterol shifts. Joint pain and stiffness. Digestive changes. Dry eyes. Tinnitus. Skin changes.
The bigger point is this: estrogen, progesterone, and testosterone are not only “fertility hormones.” They affect your brain, bones, cardiovascular system, metabolism, inflammation, digestion, mood, and more.
So when women are told, “That’s just aging,” it can keep them from investigating what’s actually happening beneath the surface.
Are Women Entering Perimenopause Earlier Now?
More women in their late 30s and early 40s are reporting symptoms that feel like perimenopause.
Cindy agrees there may be a shift, but she adds an important caution. Sometimes what looks like perimenopause symptoms can actually be hypothyroidism, low iron or low ferritin, nutrient depletion, and chronic stress physiology.
Meaning, before you assume it’s “just perimenopause,” you deserve thorough lab work.
The Lab Work Conversation: What to Test (and Why It Matters)
This is one of the most practical parts of the episode. Cindy shares what she believes women need to request, especially in the “pause years.”
She also makes a distinction that can change everything. Normal ranges are not the same as optimal ranges. And even “optimal” isn’t one size fits all. Your patterns, history, and symptoms matter.
A complete thyroid panel (not just TSH)
Cindy is direct. TSH alone is not enough.
She recommends a complete thyroid workup that includes Free T3 and thyroid antibodies to screen for autoimmune patterns like Hashimoto’s or Graves. She also recommends reverse T3 when possible, because chronic stress and inflammation can shift conversion patterns in ways that impact how you feel.
Nutrient markers that matter in this season
Cindy recommends testing key nutrients that impact energy, mood, metabolism, and hormone resilience.
That includes vitamin D, an iron panel plus ferritin, homocysteine as a functional marker related to B12 and folate status, and RBC magnesium rather than serum magnesium.
Metabolic markers (including insulin)
Cindy emphasizes that insulin can rise years before A1C changes. So if you’re only checking glucose and A1C, you may miss early metabolic dysfunction.
She recommends looking at insulin, A1C, and triglycerides to get a clearer picture of metabolic health.
A note on hormone testing in perimenopause
Cindy shares that she generally does not test estrogen or progesterone in perimenopause because levels can fluctuate dramatically day to day. In menopause, especially if on HRT, testing can be more useful.
Why “Googling Your Labs” Can Backfire
A lot of women do what makes sense. They get their results and start searching online, asking friends, or plugging numbers into AI tools.
But Cindy explains the problem. Labs require pattern recognition and context. Symptoms, history, and the relationship between markers matter.
Even when AI gives “optimal” interpretations, it’s still not looking at you.
So if your labs come back “normal” but you still feel off, Cindy’s message is simple. Don’t stop there. Dig deeper. Find someone who will.
HRT: What Cindy Wishes Women Understood Before Making Assumptions
HRT is one of the most emotionally loaded topics in women’s health. Cindy doesn’t minimize that.
But she does want women to understand a few foundational truths.
The Women’s Health Initiative study used non-bioidentical hormones, including oral estrogen and synthetic progestins, which is not what many practitioners use today when they prescribe bioidentical options.
Cindy also shares that many women are still being underdosed, refused HRT, or taken off unnecessarily because of outdated narratives, including the idea that women should only use HRT for a limited number of years.
She’s especially passionate about vaginal estrogen support for tissue health and UTI prevention, because recurrent UTIs can become a serious quality of life and health issue as women age.
And she emphasizes that HRT is not a magic fix. It’s “icing on the cake” alongside lifestyle support. Nutrition, sleep, stress regulation, digestion, and environmental load still matter.
If You’re Not Ready for HRT Yet: What You Can Do Now
If you’re still researching, still deciding, or simply not ready, Cindy encourages women to start with the basics that create real change.
Start with nutrition that supports blood sugar stability. Prioritize sleep and nervous system regulation. Support digestion and detox pathways. Reduce environmental toxic exposure. Get comprehensive lab work and track patterns over time. Consider targeted supplements based on your labs, not trends.
Cindy also mentions maca as a potential adaptogenic support, especially for HPA axis regulation, depending on the woman and her situation.
What Vitality Can Look Like After Menopause
Cindy’s message is hopeful and grounded. Vitality is possible for a long time. But many women need support, guidance, and a plan that’s personalized, not generic.
And if you feel too tired to even know where to begin, that’s not a personal failure. It’s often a sign your body needs more support than it’s currently getting.
A Gentle First Step: Support Your Nervous System in the Morning
If this episode resonated and you want a gentle place to start, especially if you’re feeling overwhelmed, dysregulated, or disconnected, here’s a supportive first step.
Lindsey’s free 7 Day Morning Rituals Blueprint is designed to help you reconnect with your body, support your nervous system, and create a more grounded start to your day without pressure or perfection.
Final Takeaway: Don’t Take “No” as the End of the Conversation
If you take nothing else from this episode, let it be this. You deserve informed support.
You deserve a provider who takes your symptoms seriously. You deserve lab work that actually tells a story. And you deserve the right to make empowered decisions about your body without fear, shame, or dismissal.
This season can be a doorway into deeper self-trust, deeper education, and deeper sovereignty.
Resources Mentioned
Cindy’s free Lab Checklist for the Pause Years
Cindy’s course, Grace In Transition for Women Of A Certain Age [Use code: HHF20]
Connect With Cindy
Website: https://alivingbalance.net/course/
Instagram: @Cindy_Dupuie
YouTube: Cindy DuPuie
If you want to go deeper into the idea that painful cycles are not something you have to normalize, like heavy periods and bad cramps, Listen to Episode 13.
If you feel like your body is off, but your labs keep coming back “normal,” Listen To Episode 11.
If you want to connect this conversation to the deeper reasons weight can shift in midlife, even when you’re eating well, Listen in to Episode 12
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