Why Stacy London Believes in Education and Hormonal Health

Stacy London's Path from Fashion to Hormonal Health Advocacy

Stacy London spent two decades in front of cameras, co-hosting TLC's What Not to Wear and building a career around helping people feel confident. Then perimenopause arrived. She has described the experience as blindsiding, marked by anxiety, insomnia, brain fog, and joint pain that no one had warned her about.

A Personal Reckoning with Perimenopause

London has spoken publicly about the confusion she felt when symptoms started in her late 40s. "I didn't know what was happening to me," she told interviewers, describing months of doctor visits before anyone connected her symptoms to shifting hormone levels. Her experience mirrors a pattern documented in the medical literature: a 2019 survey published in Menopause found that only 31.8% of women felt "well prepared" or "very well prepared" for the menopausal transition [1]. The gap between lived experience and medical education became the foundation of her advocacy.

From Personal Experience to Public Mission

London founded State Of, a menopause wellness and education brand, in 2022. The company sells supplements and topical products, but London has consistently framed education as the core mission. She has argued that the taboo around menopause leaves women isolated and that silence carries real health consequences. Research supports this framing. A 2023 Mayo Clinic study estimated that menopause-related productivity losses cost the U.S. Economy approximately $1.8 billion per year, driven by missed workdays and reduced on-the-job performance among symptomatic women [2].

The Education Gap London Keeps Highlighting

London's central argument is straightforward: women cannot make informed decisions about their hormonal health if neither they nor their doctors have been adequately educated. The data on medical training deficits is stark.

Medical School and Residency Shortfalls

A 2017 survey published in Menopause found that the median number of hours dedicated to menopause education in U.S. Medical school curricula was zero [3]. Among OB-GYN residency programs, only about 20% offered a formal menopause medicine curriculum. Dr. Stephanie Faubion, director of the Mayo Clinic Center for Women's Health and medical director of The Menopause Society, has stated: "We have a workforce that is largely unprepared to manage menopausal women. The result is that women are either undertreated or not treated at all" [4].

Patient-Level Knowledge Gaps

The downstream effect is predictable. Women who don't receive proactive counseling about perimenopause often misattribute their symptoms to aging, stress, or mental health conditions. A 2021 study in JAMA Network Open found that among women aged 40 to 55 reporting depressive symptoms, hormonal contributors were evaluated in fewer than half of cases [5]. London has pointed to exactly this dynamic, noting that she was prescribed antidepressants before anyone tested her estradiol levels.

The WHI Legacy and Lingering Fear

Much of the education gap London describes traces back to the 2002 Women's Health Initiative (WHI) findings. The initial WHI press release reported increased breast cancer and cardiovascular risk with combined hormone therapy, triggering a mass abandonment of HRT by both patients and providers [6]. Prescriptions for menopausal hormone therapy dropped by more than 70% in the years following. Subsequent reanalysis of WHI data, including the 2017 18-year follow-up published in JAMA, showed that the risks were concentrated in women who started therapy well past menopause onset (age 63 on average in the original trial) and that younger, recently menopausal women actually showed reduced all-cause mortality [7]. London has repeatedly cited this course correction, arguing that outdated fear still drives clinical decisions two decades later.

What the Science Says About Hormone Therapy in Menopause

London's advocacy aligns with current evidence-based guidelines. She is not a clinician, but the positions she promotes reflect mainstream endocrinology and gynecology consensus.

Efficacy for Vasomotor Symptoms

Systemic estrogen therapy remains the most effective treatment for hot flashes and night sweats. A Cochrane systematic review of 24 randomized controlled trials (N=3,329) found that oral estrogen reduced hot flash frequency by approximately 75% and severity by 87% compared to placebo [8]. The 2022 position statement from The Menopause Society (formerly NAMS) affirms that hormone therapy is "the most effective treatment for vasomotor symptoms and the genitourinary syndrome of menopause" for symptomatic women under age 60 or within 10 years of menopause onset [9].

The Timing Hypothesis

The "timing hypothesis" or "window of opportunity" concept is central to London's messaging. Hormone therapy initiated within 10 years of menopause onset or before age 60 carries a different risk-benefit profile than therapy started later. The ELITE trial (N=643), published in The New England Journal of Medicine, demonstrated that early-initiation estradiol slowed progression of subclinical atherosclerosis (measured by carotid artery intima-media thickness), while late-initiation estradiol did not [10]. This distinction is the reason current guidelines support individualized therapy for symptomatic women in the early postmenopausal window.

Bone and Cardiovascular Considerations

Estrogen therapy also reduces fracture risk. The WHI itself demonstrated a 34% reduction in hip fractures among women taking combined estrogen-progestin therapy [6]. For cardiovascular outcomes, the Danish Osteoporosis Prevention Study (DOPS, N=1,006) showed that women randomized to hormone therapy shortly after menopause had a significantly lower composite risk of death, heart failure, and myocardial infarction after 10 years, with benefits persisting at the 16-year follow-up [11].

Beyond HRT: The Full Scope of London's Hormonal Health Message

London does not limit her advocacy to prescription hormone therapy. She speaks about the broader system of menopause management, including lifestyle interventions, mental health support, and body literacy.

Lifestyle Factors and Symptom Management

Resistance training, for example, has evidence supporting its role in mitigating menopause-related bone density loss and metabolic changes. A 2020 meta-analysis in Sports Medicine (13 RCTs, N=868) found that resistance exercise significantly improved lumbar spine bone mineral density in postmenopausal women [12]. London has spoken about how strength training became part of her own perimenopause management, a recommendation consistent with the American College of Sports Medicine guidelines for older adults.

Mental Health and Cognitive Symptoms

Perimenopause is associated with a 2- to 4-fold increase in the risk of major depressive episodes, according to data from the Penn Ovarian Aging Study published in Archives of General Psychiatry [13]. Cognitive complaints, particularly difficulties with verbal memory, are also well-documented during the menopausal transition. The SWAN (Study of Women's Health Across the Nation) cohort found measurable declines in processing speed and verbal memory during perimenopause, with partial recovery in the postmenopausal years [14]. London's openness about her own anxiety and brain fog normalizes these symptoms and, more importantly, prompts women to seek evaluation rather than dismissing their experiences.

Body Literacy as a Foundation

London frequently uses the term "body literacy," the idea that women should understand their own hormonal patterns, cycle changes, and symptom trajectories before they reach crisis points. Dr. Jen Gunter, OB-GYN and author of The Menopause Manifesto, has echoed this concept: "Women deserve to know what is coming hormonally the same way they learn about puberty. Menopause should not be a medical surprise" [15]. This philosophy of proactive education, rather than reactive treatment, is the thread connecting London's public statements.

Why Celebrity Advocacy Matters for Menopause

Whether or not celebrity health advocacy is ideal, it fills a vacuum that the medical system has left open.

Reach and Destigmatization

London's platform reaches audiences that medical journals do not. Her Instagram following and media appearances translate complex clinical information into accessible language. Research on health communication suggests that celebrity disclosure of health conditions increases public awareness and health-seeking behavior. A 2014 study in BMJ documented the "Angelina Jolie effect," showing that Jolie's public disclosure of her BRCA1 status and prophylactic mastectomy led to a 64% increase in BRCA testing referrals in the U.K. Within two weeks [16]. Menopause advocacy from visible public figures may produce similar downstream effects on screening and treatment uptake.

Limitations of Celebrity-Driven Health Messaging

London herself has acknowledged that she is not a physician. The risk with any celebrity health advocacy is oversimplification or the promotion of specific commercial products over evidence-based care. London has been relatively disciplined in deferring clinical specifics to physicians and directing her audience toward The Menopause Society's resources and board-certified menopause practitioners. That distinction matters. The Endocrine Society's 2015 clinical practice guideline on menopause management emphasizes that hormone therapy should be individualized based on symptom severity, personal risk factors, and patient preference [17].

How to Act on London's Core Message

The practical takeaway from London's advocacy is a set of specific, actionable steps grounded in guideline-based care.

Find a Menopause-Trained Clinician

The Menopause Society maintains a searchable directory of NAMS-Certified Menopause Practitioners (NCMPs). As of 2025, there are approximately 2,000 NCMPs nationwide, a small number relative to the 6,000+ women entering menopause daily in the United States [9]. Seeking out a certified provider is the single most impactful step a woman can take to receive evidence-informed menopause care.

Track Symptoms Before Your Appointment

Documenting hot flash frequency, sleep disruptions, mood changes, and menstrual cycle irregularities for at least 4 to 6 weeks before a clinical visit provides data that clinicians can use to guide treatment decisions. Symptom tracking tools validated for menopause include the Menopause Rating Scale (MRS) and the Greene Climacteric Scale.

Discuss the Full Treatment Menu

Hormone therapy is not the only option. FDA-approved non-hormonal alternatives for vasomotor symptoms include fezolinetant (Veozah), a neurokinin 3 receptor antagonist approved in 2023, which reduced moderate-to-severe hot flashes by 60% at 12 weeks in the SKYLIGHT 1 trial (N=502) [18]. Cognitive behavioral therapy for insomnia (CBT-I) and SSRIs such as low-dose paroxetine (Brisdelle, 7.5 mg) also have evidence supporting their use in menopausal symptom management.

Women aged 45 to 55 with new-onset vasomotor symptoms, mood changes, or sleep disruption should request a menopause-focused evaluation that includes serum FSH, estradiol, and TSH testing to differentiate hormonal causes from thyroid or psychiatric conditions.