🌿 This Is My Happy Space – The “Complex” Patients

I hate that word—complex.
But I use it here with care, because what it really means to me is time.
A patient I can sit with for an hour or two (yes, I know that’s a luxury), go deep, ask the right questions, and actually understand.

Over time, I’ve realised that many of these so-called “complex” cases—the ones other clinicians might quietly call “heart sink” patients—are actually special hormonal stories. Not always obvious. Not always linear. But always worth it.

Because when we consider hormones as part of the picture, something shifts.
People feel seen. Patterns emerge. And sometimes—yes, really—symptoms improve.

These are the patients who have taught me more than I could ever have imagined.
And they’ve reminded me that dreams do come true.
Especially when we stop assuming and start listening.

But, this is where I learnt how I practice.
Where I’ve been challenged.
Where the science finally makes sense.
Where I’ve seen textbook theory replaced with real human lives—and why that matters more than anything.

It’s in the validation of an autistic woman who felt like she was losing her mind every three weeks—until she removed her estrogen patch and suddenly felt relief. (It turns out those patches peak and reach steady state at around three weeks.)

It’s in the post-surgical menopause patient who was on high-dose estrogen, feeling better—but not quite right. And we realised: patches can bring big peaks and troughs.

It’s in the 20-year-old with POI who bled continuously and couldn’t tolerate progestins but was desperate for anything that might stop the bleeding. Or the other 20-year-old who just wanted to feel like her friends, and the pill gave her that.

It’s in the woman with a history of breast cancer, spiralling into suicidal depression, who had tried everything else. Starting MHT gave her life back. Her husband said he had her back. She became a present, vibrant grandmother again, spending summers with her moko.

It’s in the 35-year-old who’d been on Depot Provera for a decade—hypoestrogenic, with chronic dry eyes, vaginal dryness, multiple specialists involved—and no one had considered low estrogen.

It’s in the 24-year-old with endometriosis on 9-weekly Depo injections. Her estradiol levels seemed “fine,” but symptoms told a different story: vulval fissures, thin red vaginal walls, signs of atrophy. She needed local estrogen and topical steroids—not just disease suppression, but restoration.

It’s in the 59-year-old grandma who started HRT for “typical” symptoms, felt amazing for 6 months, and then stopped. But now, she still gets up and down off the floor to play with her grandchildren. That’s her win.

Every patient teaches me something. And what every one of them has shown me is that when I go back to the foundations—listen to the person, understand the whānau, and map the hormonal timeline—we find solutions. We make educated guesses that aren’t stabs in the dark, but deeply informed starting points. Sometimes it’s surprising. Like the women who become more anxious or develop insomnia with progesterone, even though 98% of others feel calm and sleepy. Hormones are complicated—and that’s okay.

Because patients know their bodies. My role as a doctor is to ask the right questions, hear what you already know, and bring science and skill into the room so we can figure it out—together. Especially in perimenopause, we’re working with a shifting baseline. The target moves. And sometimes we go back to the drawing board. That’s not failure—it’s part of the process.

One of the patterns I often see: someone starts MHT and feels incredible. Then, it fades. Maybe there’s receptor saturation. But when the hormones drop again, it hits harder. That fall feels further because you remember what it was like to feel well. But here’s the thing: now you have reference points. You know what better felt like. And that makes it easier to recover, adjust, and bounce back. Eventually, when you stumble, you’ll recognise the signs earlier. You’ll advocate for yourself. And if you fall again—because sometimes life makes sure we do—you’ll know it’s not forever.

And most importantly, you’ll know it’s not just hormones.
But when it is?
We’ll figure it out. Together.