As an Independent Prescribing Pharmacist specialising in women’s hormones, it’s perhaps no surprise that one of the most common questions I’m asked is, “Are my hormones causing this?’
Whether it’s fatigue, brain fog, anxiety, painful periods, fertility challenges or the symptoms of perimenopause and menopause, hormones are often at the centre of the conversation. And rightly so. They influence almost every aspect of a woman’s health, from our reproductive years through to menopause and beyond.
Prescribing hormones is a key part of my clinical practice. Every week I support women through perimenopause and menopause with hormone replacement therapy, help optimise thyroid function, investigate menstrual irregularities and work with couples preparing for pregnancy, including those undergoing IVF. When used appropriately, medical treatment can be transformative.
But after years of working in women’s health, I’ve learnt something equally important.
Treating hormones isn’t simply about prescribing hormones.
One of the greatest privileges of my work is having the time to look beyond the immediate symptom and ask a different question—not just *what* is happening, but *why*.
Two women may arrive at my clinic with almost identical symptoms. Both may be exhausted, struggling with low mood and finding it difficult to think clearly. On paper, they appear to have the same problem, yet the reasons behind those symptoms can be completely different.
One may benefit enormously from hormone replacement therapy because falling oestrogen levels are driving her symptoms. Another may have an undiagnosed thyroid disorder. A third may have significant iron deficiency following years of heavy menstrual bleeding. Someone else may be experiencing the effects of insulin resistance, chronic inflammation or poor sleep. The symptoms may look remarkably similar, but the treatment shouldn’t be.
This is why I believe women’s healthcare should never become a process of simply matching a symptom to a prescription.
Hormones don’t function in isolation. They are influenced by the health of almost every other system in the body.
Take oestrogen, for example. We often focus on whether levels are high or low, yet the body also needs to produce, metabolise and eliminate oestrogen effectively. The gut microbiome and the liver play a very important role in this process, reminding us that digestive health and hormonal health are closely connected.
The same is true for ovulation and progesterone. Chronic stress, inadequate nutrition, disrupted sleep and metabolic health can all influence the intricate communication between the brain and the ovaries. In women with PCOS, insulin resistance is often one of the key drivers of hormonal imbalance. In fertility care, inflammation, nutrient status and sperm health are just as important as hormone levels themselves.
This is why my consultations rarely focus on hormones alone.
As both a prescribing pharmacist and a nutritional therapist, I have the opportunity to combine evidence-based medicine with nutrition and lifestyle interventions in a way that reflects the complexity of women’s health. Sometimes that means prescribing hormone replacement therapy or thyroid medication. Sometimes it means identifying nutritional deficiencies, supporting metabolic health, improving gut function or addressing lifestyle factors that may be contributing to symptoms. Often, it’s a combination of approaches that helps women achieve the best outcomes.
For me, this isn’t about choosing between conventional medicine and a more holistic approach. It’s about recognising that they work best when they work together.
I often think that women have been encouraged to see their health in separate chapters. We talk about periods in adolescence, fertility in our thirties and menopause later in life, as though they’re disconnected experiences. In reality, they are all part of the same story. Hormones influence our health throughout our lives, interacting with every system in the body, and understanding those connections allows us to provide more personalised, effective care.
Women’s Health Month is a timely reminder that women deserve more than reassurance that their symptoms are simply “part of getting older” or “just hormonal.” They deserve to be listened to, investigated thoughtfully and treated as individuals.
Hormones will always be a central part of that conversation. They are fascinating, powerful and capable of transforming how a woman feels when managed well. But perhaps the most important lesson they’ve taught me is that they are only one part of a much bigger picture.
When we stop treating hormones in isolation and start understanding the woman sitting in front of us as a whole, we don’t just improve hormone health—we improve women’s health.
And this is an actual patient journey of a patient I saw:
“I just don’t feel like me anymore.” The sentence I hear from so many women in their 40s.
One of the things that strikes me most in clinic isn’t just the symptoms women describe—it’s the way they describe themselves.
“I don’t recognise myself anymore.”
“I used to cope with everything.”
“I’ve lost my confidence.”
“I feel like I’m falling apart.”
Recently, a woman in her late forties came to see me. She had a successful career in a demanding profession and, by anyone looking from the outside, appeared to have everything under control. She had always been capable, resilient and energetic. She managed long days, travelled for work and balanced a busy life without thinking twice.
Then, almost without warning, things began to change.
Over a matter of months she found herself waking in the middle of the night feeling unbearably hot. She was exhausted despite sleeping for longer than she ever had before. Walking downstairs left her joints aching. She felt emotional in a way that was completely unlike her, and her confidence slowly disappeared. She found herself questioning decisions she would once have made instinctively.
She assumed she was simply burnt out.
After all, work had been stressful.
Like so many women, she put her symptoms down to getting older, working too hard or simply needing a holiday.
But as we started talking, another story emerged.
Her periods, which had always been predictable, had gradually become lighter before disappearing altogether for several months. She’d begun experiencing vaginal dryness and recurrent urinary tract infections. Her energy fluctuated wildly—some days she felt like herself, while on others she struggled just to get through the day. Even simple things such as exercising felt impossible because she felt so depleted.
None of these symptoms existed in isolation.
They were all pieces of the same puzzle.
One of the biggest misconceptions about perimenopause is that it’s simply about hot flushes. In reality, changing hormone levels influence almost every system in the body. Oestrogen, progesterone and testosterone don’t just regulate reproduction—they influence the brain, muscles, bones, urinary tract, metabolism, sleep, mood and even how resilient we feel under stress.
As an Independent Prescribing Pharmacist and Functional Medicine Practitioner, my role isn’t simply to prescribe hormones. It’s to understand why someone feels the way they do and make sure we’re not missing anything else that could be contributing. Fatigue, for example, might be hormonal, but it can also be related to iron status, thyroid function, blood sugar regulation, nutritional deficiencies or chronic inflammation. The same is true of recurrent urinary symptoms or digestive issues, both of which she was also experiencing.
Her blood tests eventually confirmed what her story had already suggested.
She was transitioning into menopause.
For the first time in months, she felt relieved.
Not because there was an easy fix, but because she finally had an explanation. She wasn’t imagining her symptoms, and she certainly wasn’t “just stressed.”
Together we created a personalised treatment plan. Hormone therapy formed part of that plan, but it wasn’t the whole plan. We also focused on improving her nutrition, increasing her protein intake to preserve muscle mass, supporting her nervous system, addressing vaginal health, improving sleep and discussing further investigation into her gut and urinary microbiome because recurrent antibiotic use had become part of her story too.
Like many women, the first few weeks weren’t completely straightforward. Hormones sometimes need adjusting, and this is why ongoing support matters so much. Medicine is rarely about finding the perfect prescription on day one; it’s about listening, reviewing and tailoring treatment as someone’s body responds.
Several months later, she walked back into clinic looking like a different person.
Her energy had returned. She felt mentally stronger, more confident and more resilient. Her hot flushes had improved, the aching in her body had settled and she finally felt like she had herself back. She was sleeping better, her urinary symptoms had become much more manageable and, perhaps most importantly, she no longer questioned whether what she had been experiencing was “all in her head.”
Stories like hers are the reason I believe Women’s Health Month matters so much.
Too many women spend years believing they simply have to put up with feeling exhausted, anxious or unlike themselves. They normalise symptoms because they’re told it’s part of getting older, or because their blood tests don’t tell the whole story.
Menopause and perimenopause are natural transitions, but suffering through them shouldn’t be.
If there’s one message I’d like every woman to take away this Women’s Health Month, it’s this: if you don’t feel like yourself, don’t ignore it. Your symptoms deserve to be heard, understood and properly investigated. Sometimes the answer is hormones. Sometimes it’s something else. More often than not, it’s a combination of factors that requires a personalised approach.
Because feeling like yourself again isn’t a luxury. It’s something every woman deserves.
Richa Puri is a Nutritional Therapist & Independent Prescriber located in Gerrards Cross, Buckinghamshire and Central London. with specialist interest in Women’s Health and Fertility, dipION, mBANT, CNHC, MPharm, IP
For more information about Richa, visit https://seedwellness.co.uk/richapuri
Online and Knightsbridge Clinic:
Clinic Hours:
Online : Monday & Tuesday 9.30am to 4.30pm; Thursday & Friday 9.30am to 5.00pm.
Knightsbridge: Wednesday 11.30am to 6pm
IG: https://www.instagram.com/richapuri_hormonesandfertility/
