Content warning: This story includes references to suicidal ideation.
Lisa Schrenk didn’t know it yet, as she trudged down a dirt trail last August, but her life was about to change.
She’d set out late the night before with her hiking group, scrambling up Virginia’s Old Rag Mountain in darkness. They reached the peak in time to watch the sun rise over the Blue Ridge range. Afterward, the women snapped photos. In one, Schrenk gazes out over the horizon, her long dark hair pulled into a ponytail. The image is deceptively triumphant. In reality, she had been contemplating suicide. Schrenk, a longtime IT specialist for the federal government, had started setting aside belongings for friends and family, organizing her financial affairs, and clearing out her office.
Her hallelujah moment didn’t happen at the summit. It started on the way back down, when she overheard her fellow hikers talking about hormone therapy. One described how she’d suffered from intense anger, anxiety, and exhaustion until she’d started a course of hormones typically offered to people in menopause. Now, she was thriving. “I was like, oh my God,” Schrenk remembers. She was hearing some of her own symptoms listed out. Could this be the answer to her problems, too?
Schrenk had already tried to persuade her primary care physician to consider hormone therapy because she suspected that her treatment-resistant mood issues might be linked to a hormone imbalance. As someone in her early forties, she was potentially approaching or in perimenopause, when the ovaries gradually stop making reproductive hormones, with estrogen levels often fluctuating erratically along the way. (Until recently, hormone therapy was widely referred to as hormone replacement therapy, or HRT.)
But Schrenk was already taking one of the most common treatments for perimenopause symptoms—an oral contraceptive containing synthetic versions of the hormones progesterone and estrogen. Her doctor dismissed the idea of switching her to hormone therapy, which sometimes delivers “bioidentical” versions of the same hormones, often in lower dosages. Undeterred, Schrenk had then gone to two different gynecologists. “Automatic no,” she says. One had acceded to switching Schrenk’s birth control brand. It made no difference. The depression deepened.
After hearing about her hiking pal’s experience, though, Schrenk started searching online for “HRT-friendly doctors near me.” She found Midi, a telehealth startup focused on women’s midlife care, and signed up for a video consultation. “I cried through my first appointment, sobbing with snot and tears falling from my face,” Schrenk says. Her nurse practitioner was willing to switch her birth control to hormone therapy, recognizing that the lower dosages and different styles of estrogen and progesterone might have a different effect than the pill. Schrenk finally felt heard.
Over the next five months, they met regularly, fine-tuning the dosages and delivery of the meds to minimize side effects. Schrenk credits the treatment with a radical turnaround in her mental health. “I’m no longer planning my own funeral,” she says. Instead, she’s spending time with her beloved dog, going for lots of hikes, and feeling noticeably happier even when she’s stuck in DC traffic.
Around the time Schrenk was having her personal perimenopause revelation, huge changes were taking place in how the general ovary-having public accessed this kind of medication. Hormone therapy had been out of favor for years, after a 2002 study led women who might have otherwise asked for the treatment to overestimate potential cancer risks and doctors to prescribe it less frequently. But by the end of the Biden administration, pretty much everyone—medical professionals, liberal feminists, the Make America Healthy Again movement—regarded that prescribing trend as a disaster. Potentially millions of menopausal people were living with mood swings, hot flashes, and night sweats, and they didn’t need to be.