Beyond Hormones: Two Ways of Looking at Menopause and Whole-Body Health

Menopause is often framed as a hormonal milestone — the end of reproduction and the beginning of a new phase of life. But what if we’re only seeing part of the picture?

A recent Nature Reviews Gastroenterology & Hepatology article explores how menopause affects gastrointestinal and liver health, bone density, and more. It paints a clear and comprehensive picture: menopause doesn’t just change reproductive hormones — it ripples through the whole body.

But there's another way to understand what's happening — one that sees these changes not as isolated effects, but as part of a larger energy management strategy gone awry. This view comes from the emerging framework of Exposure-Related Malnutrition (ERM), which interprets menopause through the lens of bioenergetic stress and system-wide adaptation.

Here’s how the two perspectives differ — and what they both have to teach us.

🧪 Perspective 1: The Clinical View — Hormones Affect Everything

The Nature Reviews article offers a well-documented summary of menopause’s broad effects:

• Gastrointestinal changes: altered motility, increased GERD, gut microbiome shifts.

• Liver metabolism: faster progression of fatty liver disease post-menopause.

• Bone and muscle: higher risk of osteoporosis and sarcopenia due to loss of estrogen.

• Immune and gut health: increased risk of IBS, coeliac symptoms, and inflammatory flares.

• Hormone Replacement Therapy (HRT) is explored as a tool to counteract some of these changes — with mixed results depending on the system, formulation, and timing.

This view is rooted in classical physiology: hormones regulate tissues, and when those hormones decline, systems shift. Logical, measurable, and largely supported by observational and clinical data.

But it leaves some deeper questions open:

• Why do some women transition through menopause smoothly, while others spiral into multi-system dysfunction?

• Why does hormone replacement help in some cases and harm in others?

• Are these changes reversible — or signs of something more systemic?

🔁 Perspective 2: The ERM View — The Cost of Chronic Adaptation

The ERM framework flips the lens.

Instead of asking “What does menopause do to the body?”, it asks: “What does the loss of reproductive signaling reveal about the body’s ability to adapt?”

In this view, menopause is not just the absence of hormones — it’s a shift in the body’s energy priorities. When estrogen and progesterone fall, the body faces new decisions:

• Should it keep supporting high-energy tissues like bone and muscle?

• Can it maintain immune tolerance and gut integrity?

• Or must it cut costs, sacrificing repair, balance, and resilience to protect vital functions?

In a well-resourced body, this transition is smooth — symptoms are mild, and systems adjust.But in a body already overstressed, undernourished, or chronically inflamed, menopause becomes a tipping point. That’s when you see:

• Accelerated bone loss and muscle wasting (energy diverted from repair)

• Worsening gut function and immune sensitivity (barrier dysfunction, microbiota shifts)

• Liver fat accumulation and insulin resistance (metabolic compromise)

• Mood and sleep disturbances (neuroendocrine exhaustion)

These aren’t just “side effects” of low hormones — they’re signs of a trade-off: the body is spending energy where it must and cutting support where it can.

This is Exposure-Related Malnutrition — not due to starvation, but due to chronic stress, low-grade inflammation, poor nutrient availability, and the body’s attempts to adapt over time.

🧠 Why These Views Matter Together

Both perspectives are valid — and together, they tell a more complete story.

The clinical view reminds us that hormones shape every major body system.The ERM view reminds us that how we adapt to those hormonal changes depends on the body’s total stress burden and energy availability.

That’s why one woman might develop severe osteoporosis after menopause, while another stays strong.Why gut issues flare for some, while others feel better.Why hormone replacement helps — or hurts — depending on context.

Menopause is not just a hormonal event. It’s a whole-body checkpoint in our lifelong energy economy.

🌿 What Can We Do?

This understanding calls for a new kind of prevention:

• Not just replacing hormones, but supporting resilience across systems.

• Ensuring nutrient sufficiency, especially protein, calcium, magnesium, and antioxidants.

• Reducing hidden stressors — inflammation, sleep deprivation, poor metabolic control.

• Using HRT wisely, in the right body, at the right time.

Because you’re not broken. You’re just adapting.

And with the right support, you can adapt well.

📝 References

• Ley, D., & Saha, S. (2025). Menopause and gastrointestinal health and disease. Nature Reviews Gastroenterology & Hepatology. https://doi.org/10.1038/s41575-025-01075-7

#Menopause, #Exposure-Related Malnutrition (ERM), #Stress Adaptation, #Bioenergetic Trade-Offs, #Hormone Replacement Therapy (HRT)