By Morgan Rose, CNM, WHNP-BC, and Dr Kudesia, triple board-certified in Reproductive Endocrinology & Infertility (REI), Obstetrics & Gynecology, and Lifestyle Medicine

The timing of when women start hormone replacement therapy (HRT) may matter more than we ever understood.

The “critical window” for starting HRT isn’t just relevant to brain health; timing has also been shown to shape cardiovascular outcomes.

Early analyses of the landmark WHI trial missed this nuance, including women long past menopause and obscuring benefits seen in those who begin therapy sooner.

Recent research presented at the American Neurological Association Annual Meeting found that women who began HRT within five years of menopause had a 32 per cent lower risk of developing Alzheimer’s disease.

Yet those who started HRT more than five years after menopause showed higher levels of tau proteins, a hallmark of Alzheimer’s, in their brains.

This “critical window” concept challenges the one-size-fits-all model of menopause care. It suggests that when we start HRT, it can be just as important as whether we start it.

Researchers at Mass General Brigham found similar patterns: women who began HRT near the onset of menopause did not show increased Alzheimer’s risk, while those who experienced early menopause with longer lifetime estrogen deprivation faced a higher risk overall.

Why Timing Matters

Women face roughly a 1 in 5 lifetime risk of Alzheimer’s disease, compared to 1 in 10 for men of the same age. The sharp drop in estrogen during menopause may help explain that gap.

Estrogen supports energy production, blood flow, and inflammation control in the brain functions that wane as levels decline.

The data suggest that initiating HRT earlier (around perimenopause or early menopause) may preserve some of these neuroprotective effects, while starting too late could heighten risk once neurodegenerative changes have already begun.

One meta-analysis showed that HRT begun soon after menopause reduced Alzheimer’s risk by over 40 per cent compared to non-users, while starting after age 60 doubled the risk.

These findings don’t make HRT a blanket prescription; they make it a precision intervention.

The Clinical Nuances AI Must Understand

If AI is going to support menopause care safely and intelligently, it needs to understand the reasons behind the actions.

1. Timing Is a Risk Modifier

“Time since menopause” is not just a demographic; it’s a clinical determinant.

AI systems must understand that the same therapy can carry opposite implications depending on when it’s initiated. 

2. HRT Is Not Monolithic

There are multiple formulations, routes, and combinations.

For women who still have a uterus, adding progesterone helps protect the uterine lining and lowers the risk of endometrial cancer that can occur with estrogen-only therapy.

Topical estrogen, which has much lower absorption into the bloodstream, may be appropriate for perimenopausal women who are still having periods or postmenopausal women with a uterus who need targeted relief of vaginal or urinary symptoms.

For example:

• • Estrogen-alone therapy can raise the risk of endometrial cancer and is typically not recommended for women with a uterus.
  • Topical estrogen, with much lower systemic absorption, may be appropriate for perimenopausal women still having periods.
    These distinctions must be explicitly encoded into AI frameworks to avoid oversimplified or unsafe recommendations.

3. Safety Requires Scope and Referral

Complex topics like HRT timing and neuroprotection should always prompt an automatic follow-up:

“Please consult a menopause specialist or clinician (such as one credentialed through the North American Menopause Society) to discuss the risks, benefits, and best options for you.”

AI logic must mirror how clinicians practice by inviting deeper discussion, not replacing it.

From Symptoms to Systems Thinking

We need to move beyond viewing menopause as a set of symptoms to manage, and instead see it as a neurological and metabolic inflection point in women’s lives.

That means:

• Bringing conversations about HRT earlier, during perimenopause, when neuroprotective benefits may still be possible.
• Designing AI systems that recognise context and chronology, not just keywords.
• Making personalised, evidence-based menopause guidance accessible to every woman by cutting through misinformation and connecting her to trusted care.
  

The Bigger Picture

For too long, women’s midlife health has been under-researched and under-resourced. The result is a data gap, which can quickly become a bias when encoded into AI.

If we want women’s health AI to truly care, it must be trained on data that understands the complexity of hormonal transitions, not just the vocabulary of them.

Because the difference between “now” and “five years from now” can determine whether a woman ages with clarity or confusion.

AI should know that.

And soon, it will.

Dr Kudesia is nationally recognised for her expertise in fertility awareness, lifestyle, and culinary approaches to reproductive health, and her advocacy for reproductive rights.

Women with an early precursor to Parkinson’s disease show much less brain shrinkage than men, despite similar disease severity, new research shows.

The discovery could help scientists explore how hormones might one day be used to treat the neurodegenerative condition.

The findings are based on data from nearly 700 participants across nine international research centres.

The study focused on isolated REM sleep behaviour disorder — a condition in which people physically act out their dreams.

It is considered the most reliable early warning sign of diseases caused by toxic protein build-up in the brain.

More than 70 per cent of those affected later develop Parkinson’s disease, Lewy body dementia or multiple system atrophy, which affects several body systems.

Researchers from Université de Montréal analysed 888 brain scans from centres in Canada, the Czech Republic, the UK, France, Australia, Denmark and Italy.

After quality checks, 687 participants were included: 343 patients with the sleep disorder and 344 healthy controls.

The results revealed clear sex-based differences.

While 37 per cent of the cortical areas — the brain’s outer layer responsible for higher functions — showed thinning in men, only one per cent of regions were affected in women.

This difference remained even though participants were of similar age (around 67) and had comparable clinical profiles.

Marie Filiatrault is first author of the study and a doctoral student at Université de Montréal.

The researcher said: “Men show much more extensive and severe cortical thinning — the outer layer of the brain that controls our higher functions — than women, particularly in areas linked to movement, sensation, vision and spatial orientation.”

To understand the protective effect, researchers compared brain images with gene activity in different regions, measured in healthy brains after death.

They found that the less-affected areas in women showed higher expression of genes related to oestrogen function, particularly ESRRG and ESRRA, which produce oestrogen-related hormone receptors.

The ESRRG gene was especially notable, showing greater activity in brain tissue than elsewhere in the body.

These receptors play key roles in mitochondrial function — the cell’s energy production system — and in the survival of dopamine-producing neurons, the cells that die in Parkinson’s disease.

Shady Rahayel is professor at Université de Montréal’s Faculty of Medicine and lead author of the study.

Rahayel said: “This sleep disorder offers a unique window of opportunity to study the mechanisms of neurodegeneration before major motor or cognitive symptoms appear.

“Our results suggest that certain brain areas in women with isolated REM sleep behaviour disorder are better protected than those in men, likely through the action of oestrogens.”

The team chose to study this precursor condition because it allows observation of brain protection mechanisms before major motor symptoms develop.

Although only 25 to 40 per cent of people with Parkinson’s experience REM sleep behaviour disorder, studying this early stage gives insight into how the brain resists damage when it is still limited.

Previous studies have shown that women with established Parkinson’s disease tend to experience slower progression than men, pointing to similar protective effects.

The findings could shape future research and treatment development.

The authors recommend separating men and women in clinical trials, which could improve statistical accuracy and reduce the number of participants required.

The biological mechanisms identified — particularly those linked to the ESRRG gene — could also become potential therapeutic targets.

Early laboratory research suggests that increasing ESRRG activity may protect dopamine-producing neurons from the toxic effects of alpha-synuclein, a protein that builds up abnormally in the brains of people with Parkinson’s.

“This study brings us closer to precision medicine, where treatments could be tailored not only to the disease but also to individual biological characteristics, including sex,” said Rahayel.

By Ruby Raut, founder & CEO, WUKA

It’s Ruby here, founder of WUKA and, like many of you, someone who’s been dismissed, doubted, and left waiting far too long when it comes to menstrual health.

Last week, I spoke at an event hosted by the Menstrual Health Project. It wasn’t just another panel or pitch session; it was a wake-up call.

The room was filled with GPs, pharmacists, educators, innovators, and women who have lived the daily reality of conditions like endometriosis, PCOS, PMDD, and premature ovarian insufficiency.

We weren’t there to celebrate solutions. We were there to listen. And what we heard broke us open.

The Stories Behind the Statistics

I walked out of that room with one page of notes — not data, not theory, but pain in ink.

The stories were raw and repetitive. Women told us of:

• 14 years of seeking help and getting none.
• 3 decades of living in pain.
• Being laughed at for wanting to come off contraception.
• Being told to “just go on the pill.”
• Waiting for a laparoscopy since 2015, and still waiting in 2025.
• Being asked to gain weight to get a period or lose weight to manage PCOS.
• Being offered pregnancy as a “solution.”
• Losing jobs because of endometriosis.

This is not an isolated list of frustrations. It’s a mirror reflecting the state of women’s health in the UK today.

Behind every statistic, there’s a woman who has rearranged her life around pain, missed promotions, cancelled plans, and lost trust in her own body.

The System Is Failing Us, and We Know It

Hearing these stories, I couldn’t help but think of it like a leaking roof.

You notice the drip, you report it, but you’re told it’s nothing serious, to just wait it out.

Days turn into months, months into years. By the time someone finally takes a proper look, the ceiling has collapsed.

That’s what living with an untreated women’s health condition feels like, small symptoms dismissed until they become impossible to ignore. That’s what our healthcare system is doing to women.

We don’t have a lack of data, we have a lack of listening.

When women describe pain, the system translates it into exaggeration. When they ask for options, they get the same recycled advice: “Go on the pill.”

The medical model still treats menstruation as a niche, not a vital sign.

And that’s why listening matters. Because until we treat lived experience as evidence, we’ll keep designing systems that ignore reality.

Learning from Lived Experience

As founders, practitioners, and advocates, we often talk about innovation, new tech, better diagnostics, smarter apps. But innovation without empathy is just noise.

Listening to eight women share their stories of endometriosis, PCOS, and PMDD reminded me of something fundamental: we can’t fix what we refuse to feel.

It takes courage to speak about periods, pain, infertility, and loss in a room full of professionals.

Yet these women did, not because they wanted sympathy, but because they wanted change.

Their words carried a collective message: “We don’t need to be fixed, we need to be heard.”

The Change We Need

So, what would change actually look like?

1. Menstrual health education in medical schools.
   Not as a module, but as a mainstream subject. Every GP, nurse, and specialist should understand menstrual health the way they understand blood pressure.
2. Inclusive menopause and menstrual support, for all ages, all bodies.
   Menstrual and menopausal health should not be separate conversations. Hormonal health spans a lifetime.
3. Accessible care at every level.
   Support should start at the local pharmacy, not five years into a diagnosis journey. Pharmacists and primary care teams can be the first line of empathy and intervention.
4. Private and public health insurance that covers menstrual conditions.
   No woman should have to choose between financial stability and pain management.
5. Policy change that protects and respects women’s health.
   We need national recognition that menstrual health is not a luxury — it’s a basic human right.

What Listening Really Means

Listening is not passive. It’s radical.

It means staying in the discomfort of someone else’s pain long enough to see the system that caused it. It means asking, not assuming. It means holding space before we offer solutions.

The Menstrual Health Project event reminded me that we can’t rely on numbers alone. Data gives us proof. Stories give us purpose. And when you combine both, that’s when transformation begins.

Why WUKA Cares

At WUKA, we started with period underwear, but what we’re really building is period equity.

Every conversation, campaign, and product we create is rooted in one belief: women deserve better.

Better care. Better education. Better respect.

Because menstrual health is not a side issue. It’s a social justice issue. It’s about the right to live without shame, without silence, and without suffering that’s dismissed as “normal.”

If you’re someone living with any of this, endometriosis, PCOS, PMDD, or anything that makes you feel unseen, I see you. You are not alone. You deserve better, and we will keep fighting for you.

Let’s listen louder. Let’s care deeper. Let’s make menstrual health mainstream.

With you always,

Ruby x

Founder & CEO, WUKA

P.S. Check out the incredible work of the Menstrual Health Project. They’re not just raising awareness, they’re rebuilding the narrative.