Our Doctor's Most Important Organ Is Their Ears
What a leading doctor and a beloved actress taught me about menopause
*this newsletter is not intended as medical advice, please discuss the medications mentioned below with your doctor before considering them
Hi there,
Last week, I launched a Wellness Conference in Brazil with Iguatemi, where so many important topics on health, beauty and wellness were discussed. Today I want to focus on menopause, not only because it’s an important conversation and a reckoning with how far behind women’s health research remains, but because it’s a subject that stays controversial across every layer of the medical community. I was just reading Dr. Jen Gunter’s post on estradiol, and the flood of comments about how the medical community can’t seem to agree on anything is telling.
I watched a very engaging conversation between Brazilian actress and menopause activist Claudia Raia and Brazilian gynecologist Dr. André Vinícius, one of Brazil’s most important menopause specialists, a speaker at the The Harvard Medical School “Women’s Health and Menopause” (WHAM), and the author of Menopause Without Mysteries. Claudia not only advocates for more information and research on menopause; she also stars in the Brazilian play “Menopause Scenes”. She is committed!
Together, they did exactly what the title of his book promises. They turned the lights on a phase of life that most women navigate in the dark, often times confused, dismissed, and ashamed.
The most radical thing he said had nothing to do with hormones
You’d expect a leading gynecologist to spend his time on the physical aspects of menopause and the hormones, and he did discussed estrogen in depth, how it moves through the body, and why its decline reverberates far beyond the reproductive system.
But the message he kept returning to was almost startling in its simplicity, but so urgent that needs to be repeated: doctors need to listen.
Women are tired of doctors who scan the lab results, recite the statistics, deliver the standard lecture on what hormones do, and then move on. Listen. Because the woman in front of you arrives with her own constellation of symptoms, her own mental health, the specific changes she wants to make in her life — and too often those get waved away by physicians who prefer to go strictly by the book.
Listening and being more flexible doesn’t mean that a doctor doesn’t care about science or research; it means those things become useless, even harmful, if you misdiagnose someone simply because you didn’t spend enough time listening to her.
How many times does a woman in perimenopause walk into a doctor’s office and get prescribed antidepressants because her labs “are fine”? Hormones fluctuate wildly, and just because one test comes back “fine” doesn’t mean you’re not in perimenopause or menopause. Knowing what to ask, how to ask it, and then actually listening would have been far more helpful.
The gut
He also brought the frontier of the research to the stage, including work he presented at Harvard’s menopause conference on the estrobolome — the community of gut bacteria involved in how our bodies metabolize and absorb estrogen. Here’s what that actually means: when your body is done with a dose of estrogen, your liver tags it for disposal and sends it toward the exit — but certain gut bacteria can snip that tag off, reactivate the estrogen, and send it back into circulation. Your microbiome, in other words, helps decide how much estrogen you hold onto.
It’s a beautiful, under-appreciated idea: that the health of your gut shapes your hormonal reality, and that something as unglamorous as eating enough fiber is quietly doing hormonal work on your behalf. Menopause, it turns out, is not only happening in your ovaries. It’s happening in your gut, your brain, your sleep, your mood — everywhere.
And some good news
The Brazilian version of the FDA (called ANVISA) has just approved a non-hormonal medication for hot flashes — fezolinetant, sold as Veozah — which means relief is finally arriving for the women who can’t take hormone replacement therapy. The NY Times just came out with an article about all millions of women left out of the HRT conversation, and they mention this drug. The fact that it’s not widely known in the US when millions suffer from the same issue is a mystery to me.
And this issue is personal to me, and I fel like the women mentioned in the article. As a breast cancer survivor whose doctors won’t even open the conversation about HRT, I’ve spent years being told, in effect, to simply endure. So a hormone-free option isn’t an abstraction to me. It’s a door that had been locked, opening to all the women who cannot have HRT.
For my readers in the US: this same medication is FDA-approved here as well. And as of late 2025, a second non-hormonal drug — elinzanetant (Lynkuet) — has been approved too, with early data suggesting benefits for sleep and mood on top of hot flashes. The toolbox for women who’ve been left out is, at last, getting bigger — and that’s great news.
Dr. Vinicius also mentioned estetrol (E4) as a possible alternative in HRT, and it seems to have less impact on the liver and on breast tissue, which is very interesting and positive. If this is a viable alternative, I will for sure ask my doctor to try it.
Moving forward
I have many take aways from their talk, but the most important ones are:
First, medicine and treatments are moving forward. There are more options this year than there were last year, and the conversations being held — not only in Brazil but worldwide — are themselves a sign of how far we’ve come.
And second, we are all impatient, and for good reason. Because for every advance, you can feel the vastness of what’s still missing: the research not funded, the symptoms not studied, the women not prioritized. That a phase of life every woman on earth will pass through remains this under-examined is not an accident. It’s a choice the world keeps making, and we all need to advicate for ourselves and for more research and resources in women’s health.
In the meantime, the remedy Dr. Vinícius offered is one we can all carry, in the exam room and out of it. Insist on being heard. Turns out, our doctors’ most important organ is their ears. And if they are not using them, find a new doctor that does.
Sending love,
Patricia