The Impact of HRT on Sensitive Nervous Systems

Paula Rastrick, Creator of the Sensitive Women framework & Founder of The Brain Body Method Talks about The Impact of HRT on Sensitive Nervous Systems

During perimenopause, most women are told the symptoms they are suffering from are simply down to falling oestrogen levels. But what if the real issue lies deeper within the nervous system itself?

As an embodied, trauma-informed practitioner with a background in sports science and decades of experience working in professional football as a rehab and performance coach working with some of the country’s top performing minds and bodies in sport, I have long understood the intricate and deeply intertwined relationship between the mind, brain, and body. 

Yet even with my knowledge, qualifications and training, at the age of 45, whilst running a successful business, I found myself unravelling during perimenopause. My symptoms were overwhelming and all-consuming; Increasing anxiety, brain fog, emotional volatility and the feeling that I was drowning and no longer able to keep my head above water. My usual coping tools stopped working and my resilience was disappearing under a haze of stress. 

The typical response from the medical field is simple: take antidepressants or, increasingly, women are offered HRT (Hormone Replacement Therapy). If all else fails, you may be offered to have your womb removed, which is a hugely drastic move with its own cocktail of issues. All these options follow a “one size fits all” approach that doesn’t consider the complexity of individual nervous systems. From my perspective, experience and research of the latest science available to us, this model is defunct and is failing many women. 

My work is grounded in the Hormonal Sensitivity Hypothesis, which explores how hormonal transitions intersect with trauma, stress, sensitivity and neurodivergence. Research is beginning to support what many women already know. Some of us have more sensitive nervous systems than others. This is often true for those with a history of trauma (a word that many of us would say does not relate to us, but on closer inspection does) and for those who are neurodivergent. For women who fit into these categories, HRT is not always the miracle solution it is made out to be. In fact, for some, it can worsen symptoms. Something that is rarely recognised in clinical settings.

I hear this echoed every week in the experiences of the women I work with and across social media communities. Many describe how, after starting HRT, they felt more anxious, emotional, overwhelmed, wired and exhausted. They have increased issues with sleeping, mood swings and focus issues insensify. Some women like myself develop intrusive and suicidal thoughts, panic attacks, or experience unrelenting agitation that not only has an impact on ourselves but also on those we love around us. Yet, when these concerns are raised with prescribers, many women’s symptoms are dismissed or met with advice to increase doses, in what I call “cut and paste prescribing”

The blueprint of women’s nervous systems, stress systems and hormonal systems are not taken into account when conducting research in clinical trials for these drugs. There is no research checking on the sensitivities that this subset of women struggles with. As a result when seeking out help, they are often screened out, ignored and left feeling like their doctors see them as hypochondriacs. These are the women who say “something doesn’t feel right,” even when their bloods come back “normal.” And it’s these women who often get told they’re anxious, dramatic, or “complex”. But in truth, no one’s looking in the right place.

Here’s what’s missing in the menopause conversation. HORMONES DO NOT WORK IN ISOLATION. Oestrogen, progesterone and testosterone are not just reproductive hormones, they are powerful neuromodulators. They affect mood, memory, sensory processing and emotional regulation, and they do not work in isolation; they communicate with and impact the entire brain and nervous system.

Here’s why. 

GABA (short for gamma-aminobutyric acid) is our brain’s main calming neurotransmitter. It helps us feel safe, sleep deeply, and regulate emotions. Progesterone supports GABA, helping release its calming effect in the body. Oestrogen, in contrast, activates glutamate, our main excitatory system. It revs things up. We need both, in balance, just like a car needs both a fully functioning brake and an accelerator. If your GABA system is already struggling, and oestrogen is added without enough progesterone (or without supporting the nervous system first), it can tip everything further out of balance. The result? Heightened anxiety, rage, insomnia, emotional overwhelm and other physical as well as emotional complications.

This isn’t hypothetical, and while many women do find genuine relief through HRT, there is a growing number who have a very different experience, one that is just as real, yet far less acknowledged. In my community, women describe worsening sleep, panic episodes, unpredictable emotional swings, and a deep sense of dysregulation in their bodies and minds after being prescribed high oestrogen and HRT protocols. These are not mild side effects. For some, the consequences have been severe, impacting work, relationships, parenting and mental health. And yet, this reaction is often misread by practitioners as a need for more oestrogen, when in fact the system is already in overload.

The biomedical model describes perimenopause as an “oestrogen deficiency” state, but this isn’t entirely accurate for sensitive women. Many of us already have low GABA, reduced progesterone, and altered nervous system function. These aren’t deficiencies that can be simply patched up with hormones; they are signs of a system that needs deeper regulation and support.

We need a new model. One that is trauma-informed, neurodiversity-aware, and prioritises the nervous system. Before prescribing hormones, clinicians should ask: What is this woman’s nervous system baseline? What’s her trauma history? How does her body handle and metabolise stress?

Because many symptoms currently labelled “hormone related” may in fact be symptoms of underlying nervous system dysregulation or a reaction to underlying or unprocessed trauma.

Perimenopause is actually a significant brain and nervous system recalibration as opposed to simply a stable decline in oestrogen, and these symptoms can’t be addressed with a  “top-up” one-size-fits-all approach. 

When I work with women, I now start here. Regulating the nervous system first, through individualised care using evidence-based nervous system interventions such as HRV training, Heart Rate Variability, Breathwork and yoga, Somatic therapy, Safe-touch practices, EMDR and trauma-informed care. Once we understand the system, these symptoms can often be addressed through non-hormonal interventions. Because if the nervous system isn’t regulated, no Hormone, no matter how “bioidentical” will land well. Some women need HRT. However, many women need nervous system support first, or alongside it.

Hormones are not magic; they are modulators, and if we don’t understand what they are modulating, namely the nervous system, we risk doing harm.

The experiences and the stories of many of the women I now support tell the same story, the current model isn’t working for them. We need a new approach, a model that respects complexity. One that prioritises safety. One that actually listens to women.

Because if we don’t understand the nervous system, we cannot understand the sensitivity and complexity of women and HRT and can end up doing more harm than good. 

DISCOVER: thebrainbodymethod.com