https://www.listennotes.com/e/2653ee01c71f4f43b19f0663b047122c

Did you know that starting hormone replacement therapy actually has an ideal window? And starting it at the wrong time can actually impact your brain, your bones and your heart? In the next few minutes, I'm going to break down the science, the research, and the ideal age range to implement hormone replacement therapy and practical insights that you can find that's not just generic advice. So I'm Dr. Betty Murray, I'm a certified nutritionist, PhD, researcher, and I've owned a clinic for over 20 years where we have helped tens of thousands of women for over 20 years with bioidentical hormone replacement therapy for perimenopause and menopause. And here's the real thing that we know from the research and also our clinical practice with tens of thousands of women over 20 years is there's never a one size fits, fit all answer. However, there are critical factors that you need to know to maximize the window of hormone replacement, to feel better, and to actually have a better health span. So stick with me because I'm on a mission to really empower women to live their best next season in this perimenopause through menopause and beyond transition. So let's dive in. So there's a theory called the critical window theory of hormone replacement placement therapy. And I'm going to go through the exact science and where your doctors may be getting this information wrong. So the reality is we have to start with the Women's Health Initiative. So prior to the Women's Health Initiative, which was issued in 2002, hormone replacement therapy for women in menopause was standard of care. We're talking from the 50s, 60s, 70s, 80s and 90s. And in fact, in most westernized countries, depending on the country you look at, between 40 and 70% of women were given hormone replacement therapy as standard of care through the menopause transition. Now, the Women's Health Initiative was a very poorly constructed study. The average age of the woman was 63. They were looking at long term cardiovascular risk and wanted to identify if hormone replacement therapy would reduce the risk of heart attack and stroke. So here's the thing, in order to do that, they must have enough time to show women going through a heart attack and stroke. So when they constructed this study, they picked women who were older. On average, the average age was almost 63 years old. These women were also smokers and ex smokers already had several cardiovascular risk factors that indicated they already had cardiovascular disease. They had high blood pressure, they had obesity, metabolic syndrome and diabetes. They actually went out and excluded healthy women from the study. Now, this is important to know. If you're looking at hormone replacement therapy and the only people in the study already have cardiovascular disease, it is hard to pull apart how much the hormones had actions within the study and, and the actual participants themselves. So here's what the data really showed is they had three arms to the study. One group did nothing at all, no hormones. Another group actually did estrogen therapy only with a form of estrogen called Premarin. And the other group did a form of hormone replacement therapy called Premarin and medroxyprogesterone, which is a synthetic progestin. That's really important because it's the synthetic progestin that increased the stroke and heart attack risk in women over 65 or average age of around 63 that already had cardiovascular disease. And what they found was the women in the group that were taking medroxyprogesterone and the premarin had a slight increased risk of stroke. That stopped the study. Now, what was true is the women that were actually on hormone replacement therapy showed a reduced risk of breast cancer, particularly in the group that was the women that were taking estrogen alone. Now, in the group that were on the medroxyprogesterone and the estrogen actually showed a slight but not statistically significant increased risk of breast cancer. So here's the stats. What did it come to? All women at that age group have a 4 in 1,000 people chance of getting breast cancer. That's just the facts. Now, in that group that was on the medroxyprogesterone, they showed a 5 in 1,000 risk, not really statistically significant and could have easily been to chance. However, that's what happened in the media. That's what women were told. And overnight women were told that hormones were going to cause cancer or give them a stroke and stop hormone therapy, despite the fact that every single study prior to that showed hormone therapy to be protective and that it was standard of care for decades. And it was also considered treatment for things like osteoporosis. So one study, poorly done, ripped hormone therapy away from women. Now then we started looking at things therapeutic window. And it's because we use the data in the Women's Health Initiative that we have a lot of confusion here. So the therapeutic window of hormone replacement ideology and theory was born. Now, the reality is there are some real true science about starting hormone therapy earlier in the process. And actually it's better to start it before you're completely in menopause. And here's the reason why estrogen Affects the entire body. It is a full body effect. Every single cell but two have estrogen receptors. So when we go through menopause and lose all of our estrogen, we actually see an increase in vascular, so this is your blood vessel inflammation, overall inflammation, metabolic changes that increase your risk for obesity and diabetes. We also see the loss of bone mineral density and bone bone strength because estrogen actually stimulates your bones to build. And probably even more importantly, we also see a radical change in the brain at this time. When we go through menopause, our brain actually increases the receptors for estrogen. So think of that as keyholes for the hormone estrogen to click into and think of that as the key. So that means the brain is so looking for estrogen. That actually increases the number of, of estrogen receptors. So the brain is actually looking for that. But when you don't have estrogen on board, what happens is the brain starts to shrink. And the very important highways that go to the frontal lobe, which is where we have our deepest thought and also memory and critical thinking, those highways start to pull away from the frontal lobe. That's why you can't remember where your keys are. You can't remember the girl that you worked with for 20 years and, and you sat next to each other in the cubicles, but now you can't remember her name. You know what I'm talking about, right? It's because the brain remodels. And so it is because of this process that we came up with a critical window theory. And like I said, it's not all theory. So the idea is, is the earlier you start hormone replacement therapy, particularly with estrogen. But I'm going to give you in the next segment why progesterone is so very important when we start that hormone therapy to support where your ovaries are no longer making enough. What we do is we stop the loss of bones by continuing to support your bone building efforts and reducing the bone reabsorption efforts, which are controlled significantly by estrogen. It also supports the brain to not shrink and lose some of those very important pathways to the memory and attention and focus centers of the brain. And it helps reduce inflammation and support the arteries and blood vessels which make us protected against cardiovascular disease. And actually, women, until we go through menopause, are protected against heart disease compared to men. But within five to ten years of menopause, we actually age match men. So our risk actually exponentially, exponentially goes up when we lose our hormones. So the critical window of best opportunity, this is really important, is going to be in that window of perimenopause to menopause or within a few years because we get the best, most important benefits from it. However, that doesn't mean you can't start it later. Now I would be totally remiss if I didn't mention progesterone and actually go a little bit into the science. So estrogen is, you know, the big harbinger of doom of menopause, right? That's the big hormone everybody thinks about. However, progesterone, which is the other hormone that's made by our ovaries when we're actually cycling, is on a steady decline from our, you know, late 20s, 30s and is on a massive decline in our 40s. And by mid-40s usually it is almost non existent, right? That's why we have a hard time getting pregnant and in our 40s because progesterone is no longer available. Now progesterone is really important. It helps the receptors. So the keyholes in your brain for a, a neurotransmitter called gaba. So it is our natural anti anxiety neurotransmitter. So it's really important. So it helps keep you relaxed, it helps you sleep and get better, deep sleep. So progesterone is also really important to the brain and the body and even helps other parts of the body because it affects your cortisol and adrenaline as well. It is somewhat of the same pathway. And so progesterone is also equally important. So the next most important thing to understand is when do you start these? How do you know the biological impact and the actual timing for you individually? Because it's not one size fits all. So here is where it really gets interesting. And many women make critical mistakes about when to start hormone replacement therapy. And there are specific biomarkers that we can look at to really help you optimize your personal timing. And these are, think of these as your personal timing indicators, right? So your body gives clear signals often that hormone replacement therapy might be the most beneficial. And the first one that I like to think about is sleep interruption. This, you know, you're exhausted, you fall asleep, you pass out on the couch at 8:30, only to get up, go to bed and wake up at, oh, I don't know, somewhere between 1 and 3am and stay up for hours. Now there's a critical hormone called progesterone that affects a very important neurotransmitter called gaba. So think of GABA as your body's kind of natural Xanax, right? It Helps you relax, it helps you sleep more deeply. It helps you go into REM sleep. When we lose progesterone, we often don't have that sustained sleep overnight, despite being exhausted. And so we often get interrupted sleep. We're up for a really long time. Insomnia, where you can't fall asleep, can often be ruminating thoughts and other things. But progesterone is very, very important to that nighttime window. And so often your timing signal may very well be sleep interruption or poor sleep quality. The other thing we see that actually is really important is the intersection of sleep apnea and upper airway resistance in women. You're probably like, Betty, what the heck does that mean? So sleep apnea is where you stop breathing at night, right? You have moments, maybe you're snoring, where you have a cessation of breathing. Your oxygen saturations drop, and then your body figures this out and wakes you up a little bit to actually get a little bit of air. You're not aware of the awakening. But what it does is it screws up your sleep cycle and keeps you from going into deep sleep. And REM sleep, which starts to affect the brain, it increases weight loss, or, I mean, sorry, weight gain. So it increases weight gain, it reduces your metabolic strength and. And it is its own independent risk factor for dying and shortens your life as much as smoking. So what's interesting about progesterone is progesterone actually affects the tone of the windpipe or the air pipe. Thinking of it coming from the nasal passages all the way down into your lungs. And when women lose progesterone levels, we see a decrease of tone in those in that windpipe. So essentially what happens is you go from breathing from a big straw into a tiny little cocktail straw. So what does that mean? You could be getting less oxygen to the brain. Apnea is an extreme version of that. Upper airway resistance is actually a milder version, but is equally damaging, particularly to women. You may not snore, you may not make noise, and you may not be aware, but your brain is constantly being alarmed. So basically, you know, it might be arousing your brain multiple times a minute. So it keeps you out of those very restorative REM sleep, where your brain is actually doing memory right? So progesterone is also really important to the brain. So that's one of the earliest reminders and notices that you might need hormone replacement therapy. And for some women, that can start in your late 30s, but definitely in your 40s to. So that's one of the first alarms. But what are some of the other really important alarms you need to pay attention to, ladies? If you're noticing more fine lines and wrinkles, it's not just about aging. It's about the loss of estrogen and that affects our skin structure, making it drier, thinner, less firm. But here's the great news. I've created Biased Mastery Cream to help. This luxurious bioidentical estrogen cream support supports your natural hydration and elasticity. It's packed with nourishing oils like olive jojoba, aloe and coconut. So it feels amazing and helps soften those lines and bring back that healthy glow. I've been using it and let me tell you, my skin has never looked or felt better. It's smoother, more radiant, and those little cracks and creases are way less noticeable. If you're ready to give your skin some extra love, check out by Est Mastery on the Metabolic Blueprint website. And that's metabolicblueprint.com BiestMastery that's B I E S T Mastery M A S T E R Y and your face will thank you. Vasomotor Symptoms It's a mouthful, isn't it? So vasomotor symptoms are the most common symptoms in menopause and however, not all women have them. That's the dreaded night sweats and hot flashes that show your body's thermostat is no longer working properly. So the thermostat is controlled by the hypothalamus in the brain and estrogen is the controller of the thermostat. When we get the estrogen levels ping ponging up and down during perimenopause, we often get thermostat control that is all over the place. And that's where we start getting hot flashes and night sweats and also sleeping hot at night. However, not every woman has those symptoms, right? And then when we completely flatline with estrogen at menopause, which is the cessation of all your periods and the loss of estrogen, we often see continued hot flashes because the thermostat never recontrols. So that is a clear indication of loss of estrogen. However, there are a ton of other symptoms that could be your signal, right? And there's well over a hundred symptoms that have been associated with menopause. But some of the big ones are going to be things like brain fog, fatigue, anxiety, depression, sleep problems, even if you're on progesterone. So if you're currently taking progesterone and you're not sleeping well, it may be a sign that it's time for estrogen. And even if you're still cycling. Now, some of the other more insidious symptoms that we may also experience are things like itchy ears, dry skin, poor skin quality, loss of collagen, joint pain, frozen shoulder gerd, which is, you know, heartburn and palpitations and racing heart. Those are all other signs. And so for many women, we get those long before we stop cycling. So the loss of your period for one full year is the official day of menopause. However, most women experience this transition for an average of seven years. Some people, like me, were lucky enough to have it for well over 10. And so it depends on the woman. So the reality is those other, those other signs can be symptoms of a need for hormone replacement therapy in the form of estrogen to balance your body out. Now, some of the other ones that women don't think of is the, what they call the genital urinary syndrome of menopause. So that's a fancy, fancy way of talking about bladder leakage and batter control problems and urinary incontinence. It is also part of the UTI and, and vaginal yeast infection sort of paradigm that we see ramp up significantly with the loss of estrogen. Because when we lose estrogen, the PH of the vaginal canal and also everything else around, it starts to change, and we get a change in the microbiome, which makes us at a greater risk for yeast infections and UTI vaginal dryness. So, yes, the girly parts down there become the Sahara Desert. And so we'll get painful sex. Lack of arousal, lack of orgasm can also be your own critical sign that things are going south downstairs and that the hormones are taking a nosedive while we are speaking, even while you're cycling. So you can have other signs of hormone loss that are plaguing you, that might be signing that you need hormone replacement therapy. Now, the last hormone I want to talk about, because it doesn't get the actual credit it needs, is testosterone. Testosterone is an important hormone to women, and we make four to five times the amount of testosterone at any given time than we do estrogen, right? So we make a lot of testosterone in our body. However, it's on a steady decline from our 20s all the way through our 40s and beyond. And by the time we're in our 40s and it's less than half of what it was in our 20s. Now, testosterone, when it's appropriate and at the right level for women, we have great memory, great focus, we are motivated, and we have a libido. Now, the FDA has only approved testosterone therapy for libido. And that is not because it's not necessary. It is because it is a patriarchal system. The reality is we need testosterone and that often occurs, occurs long before your period stops. We also need it for muscle mass growth and the brain. It is as much a brain hormone as it is a body wide hormone that helps you hold on to muscle mass and through a proxy bone mass. So testosterone is really important too. So if those symptoms are true for you, then that may also be a sign you need hormone replacement long before you actually go through the a full year without a period. So now that you got some symptoms to watch for, let's talk about the mystery and the myths around hormone replacement to make sure that we're all clear. Okay, so you may have heard and you may have been thinking, hey, Dr. Murray, I've heard that hormone therapy is dangerous. Let's address that myth really, really quickly. So I already told you that hormone replacement therapy with estrogen therapy had been used in women for decades. And if a woman had a uterus, we also supported progesterone to help protect the uterus from hyperplasia. What does that mean? So when you give estrogen alone, what happens is it feeds the uterine lining blood supply for a fetus to implant. Right. You don't have one, there's no eggs left in the carton. And if I don't put progesterone in to support the balancing of that, we can get cells that start to grow abnormally. Because progesterone's job in a natural human is to balance out the action of estrogen in the uterus, but it also has extraordinary impact on the brain and other parts. So it is not just there to balance estrogen. Right. So the idea that you can't do hormone replacement therapy is completely false. Now, one of the things that we have heard that actually has some true science behind it is is that oral estrogen therapy in the form of Premarin and particularly synthetic medroxyprogesterone are dangerous, particularly in older women. They are. And here's the thing. The rule is we never take synthetic hormones and we don't take estrogen hormones orally. Especially if it's premarin that has 13 hormones made from horse pee. Yeah, horse pee. You don't want to take that. Right. We have much more elegant ways to do that. The reason why you don't want to take oral Premarin, made from horse pee and oral synthetic progestins is they go to the liver first and go through what we call first pass liver metabolism. When that happens, the liver breaks it apart and makes a bunch of other toxins. And those toxins then are excreted into the bloodstream and used in the body. Right. That was what we did decades ago. It's old school, we no longer use it. Now today we use bioidentical, which means it's the exact same chemical structure as the hormone you made. So think of it as the key. The estrogen key is identical to what you made. So when you have that hormone key, it does exactly what the body expects it to do. The other thing is estrogen today is never given orally. Yes, there is an estradiol pill. I'm not a fan of it, but most instances women are using estrogen therapy in topical forms, either as a cream, a patch, a pellet and or an oil. Right. When we give it topically on the skin, it absorbs through the skin very, very easily and then goes into the bloodstream, gets used and what little is left over gets sent to the liver to be detoxified and sent out through the body. So when you use topical estrogen, it doesn't have that concern of making a bunch of excess byproducts in the liver that may increase your risk of stroke and heart attack. And actually a study that was conducted and finished in 2024 of 10 million women looking at all causes of dying showed that estrogen therapy given topically did not have any stroke and heart attack risk even if there was pre existing cardiovascular disease and or known risk because of clotting disorders. This is really important because most doctors have not read this study and they will tell women who are older that they can't do hormone replacement because of the stroke and heart attack risk associated with Premarin and especially in older women. So topical only progesterone, which is bioidentical and it's micronized, which means that it has been processed in a way that increases its absorbability orally, has been approved and is used all the time because it doesn't go through first pass liver metabolism and it goes straight to the body, does what it needs to do and actually has the most impact on the brain and having that sort of Xanax go GABA supporting action. And so oral progesterone in a micronized form works great. What I can tell you is topical forms of progesterone, particularly in cream, do not have the science showing that it improves the brain. Xanax effect on gaba, or actually protecting the uterine lining at the same level. Do not use it. I think oral is the way to go. And if you can't tolerate oil because it makes you too sleepy, you can also do vaginal progesterone and get the protection in the uterine lining without the same systemic effects that might be too relaxing. Although that is a rare, rare side effects. Most women are looking for that. Right? So your rules from this point forward are topical estrogen and oral micronized progesterone and testosterone, also given topically, same thing, bioidentical form, given topically in the form of a cream, an oil or a pellet. No, we don't have a patch yet. That's patriarchy at its best. So when we're looking at hormone replacement therapy, the mechanism and the method matters. Now, let's debunk the last part of this story. The other thing we have to consider is your metabolic hormones, right? It's. If you've ever heard me talk before, our hormones are a symphony and all of our hormones play together. So our adrenal hormones that respond to stress, like cortisol and adrenaline, our metabolic hormones like insulin and glucagon and GLP1, all are affecting what the other hormones are doing. So metabolic health is really, really important and it helps determine how well you actually function when you do hormone replacement therapy and whether it works. Because we know that the loss of these hormones increases inflammation and insulin resistance, cortisol increases and we get more belly fat, and we see basically increased risk of all causes of dying and also reduced health span in all women. And so one of the critical things that we do in both my clinic and my telemedicine company is, is we always address the metabolic hormones and we look at them. We don't just make the assumption. The reality is, is we have to address blood sugar stability, stress management, gut health alongside of your hormones. We need to help with the stress factors alongside your sex hormones. Sex hormones are not a panacea. They're not going to cover up the other stuff that's not right. They're all going to work together to help you feel better. So the next question is, so when do you start? How do you know? So here's my framework for how to get started. Here's the secret to the hormone journey. So if you happen to be a perimenopausal woman, you know you're perimenopausal because you're already experiencing symptoms that's why you've self identified that you're perimenopausal. Chances are there's something going on that has you understanding that you're in the transition. That is an average eight. Yeah, eight years for women. So often we might be experiencing mood changes, fatigue, brain fog, irregular cycles, either heavy cycles and crime scene light bleeding, or maybe they're infrequent or all over the place. Again, you might have frozen shoulder, you know, can't laugh or cough without crossing your legs because you're peeing. Maybe your girly parts are like a dry Sahara desert. All of those things are signs that it's time to actually look at hormone replacement therapy sooner rather than later. And like I said, the earliest signs are going to be particularly the sleep issues and the stress and anxiety and depression issues, which are often assigned for testosterone and progesterone because, remember, they're on the decline. Early estrogen is the last one to fizzle out. So often when hormone or therapy is initiated in that transition cycle, you're going to see low testosterone, low progesterone, particularly in the second half of your cycle, which is where all the hormones are kind of at their highest if your body's still cycling appropriately. And in those cases, when we look at the blood work or we look at testing, we're going to see that progesterone's already declining, testosterone's in the toilet. We need to restore hormones and progesterone and testosterone are the first ones. Now when we start to see that other set of symptoms, right, irregular cycles, we start seeing hot flashes and night sweats. Definitely more mood swings, more fatigue, more, more brain fog. That can also be a time, particularly as you're entering that last, you know, kind of phase of perimenopause, your estrogen actually may be significantly lower than what it's ever been. But just enough to have a cycle. I know that pissed you off, like just enough to have a cycle. So just because you're cycling doesn't mean you have enough estrogen for your body. This is where we at the Minerva Project and my clinic also identify testing in the second half of the cycle to get a good idea of where it's at. Now, sometimes we use a device called the Mira device that allows us to test through throughout the entire month, because, yes, we're looking at a day and time. And could your estrogen be bungee jumping and staying on the, the rubber band part and constantly bouncing? Yes, but that coupled with your symptoms may indicate when you need to start estrogen because you don't necessarily have to wait for your period to stop to start low dose estrogen therapy. Now, the cool thing is, is I'm a PhD, I research this stuff. But. But I have clinicians that work in my companies that actually do the treatment. So I get to look at the research and just really drill it apart. And the reality is, is women's healthcare gets so understudied and underfunded that much of the paradigm, regardless of the menopause society or any other group, gynecology included, we don't really understand women's hormones enough to give you an exact signal. So a lot of it also depends on your symptoms and the other biological factors that we see. But don't wait for your period to stop to consider estrogen therapy, especially if you're in the lower part of that targeted window and maybe you've started progesterone and testosterone and you're still having symptoms that may be a sign that estrogen is on its decline. And it's different for every woman. Don't use hot flashes and night sweats as your only symptom. I never had them. I still don't. All right, so we've already identified that the best window is to start is before you actually hit no more periods. Right? That's the best window. That's the optimal window. However, anytime. And the closer you get to that time period, the better balance we have. It doesn't mean you can't do it. It just means that if you start hormone therapy close closer to menopause, you have less likelihood of brain remodeling, you have less likelihood of vascular inflammation increasing and better remodeling of the blood vessels. And you also have better bone structure that helps your body hold on to bone. Now that's a whole other conversation about how to hold on to and preserve bone, because diet, lifestyle, exercise, all play into that. But estrogen and hormone therapy absolutely is a primary support to a bone mineral metabolism. So the reality is, the earlier in the window, the better. How, however, what if you're postmenopausal? Maybe you're more than 10 years out, right? If you're more than 10 years out, you don't necessarily have contraindications, except for the fact that you don't take oral progesterone in the form of medroxy progestins, Right? You don't want a synthetic one and you don't do progesterone premarin orally, right? Never, never, never, never, never. However, topical estrogen, based on that 10 million women study and many, many other studies is actually fine for women even if we're 10 years out. The difference is we may not see the same effect in the brain, the heart and the bones that we may have seen if we started it earlier. However, starting estrogen in, in later in life absolutely will help protect bone and increase bone turnover and bone building, which is what we need, and it can be protective to the rest of the body. We just have lost some of that perfectly opportune window. So are, you know, is. Is there a group of women that should never have the conversation about hormones? Absolutely not. The research does not support that. The truth does not support that. The reality is it's. It's an honor to live well into our 50s and 60s and in, even as, as close as 1900. We didn't live that long after menopause. This is unprecedented for us to live 30 more years. So the reality is absolutely, absolutely, every woman has the right to this conversation. We, in our clinic, we've been doing hormone replacement therapy for over 20 years. We have women that started in their 60s, they're in their 80s, 80s, still doing it, and they're doing great. They're watching their friends die. They're watching their friends go into nursing homes, still playing pickleball, still playing bridge, still rocking and rolling. Because the reality is the hormones actually help them stay young across the board. And in that 10 million women study, they showed that hormone replacement that was started and continued, never given up, reduced all causes of risk for dying, right, from any cause, including cancers, including heart attack, including stroke, including heart failure, you name it. So hormone replacement therapy is absolutely fantastic for women. And now we're going to just do one last little conversation for those women who might have been put in surgical menopause. So what is surgical menopause? Surgical menopause is the forced loss of your hormones, your ovarian hormones, and that is called. Caused by a hysterectomy, including what they call oorectomy, which is the removal of, of your ovaries. When they do that, they throw you into a medically induced menopause, usually within days. And the biggest travesty we see is that women are often not provided hormone replacement therapy for that. And some women go through this in their 20s and 30s, right? So what the studies show, we've got decades of research now to show this, is that women that are put into early surgical menopause have a greater risk for dementia, osteoporosis, cardiovascular disease, all of it. Right? Because we have lost those hormones at critical time periods where the body was still expecting them. So surgical menopause is serious. Now what if you had your uterus removed and your ovaries stayed put? Or maybe you're like me and you had your tubes tied and and told nothing would happen, huh? That's not true. So the reality is, is when you disrupt the ovaries, the blood supply to it, and the fallopian tubes going to the uterus, whether uterus is there or not, you disrupt the ovaries. And often that will present the body going into an earlier menopause. Now, when the uterus is not there, what does that do? It makes it really effing hard to figure out because you can't watch your cycle so you're constantly looking for symptoms. This is my story. I kept looking for hot flashes and night sweats because that's what I was told by the conventional medical community. Oh, and also functional medicine people. And that I had all the symptoms of estrogen dominance because I was gaining weight, my hair was falling out and all kinds of other stuff so that I couldn't possibly need estrogen yet. But the reality is I had had a tubal in my late 30s, which prompted me to sort of go into early perimenopause. And by the time I was 48, 49, my ovaries, even though I had a uterus, had dried up and been reabsorbed by my body. Yes, that's right. So I had no estrogen left and I was waiting for hot flashes and night sweats to be the early sign that it was time to do estrogen. And it was completely wrong. So surgical removal of the ovaries, the uterus, Absolutely. Hormone replacement removal of the uterus with ovaries intact may put you into menopause. Early tubals and other disruption of ovarian function can actually accelerate this activities. So you deserve the conversation and hormone replacement therapy in this process. Absolutely. So here's the bottom line. Hormone replacement therapy is not a one size fit all. You just heard me go through all the different ways in which hormone therapy can be different, our symptoms can be different, how much hormone you actually needed compared to your friend and sister. Completely different. Right. So the reality is this is why we test and this is why we look for efficacy, we look for symptom improvement and we also test lab work to make sure it's right. Because you can be taking hormone and be under treated and not getting the benefit to the heart, the brains, the bones and all cause mortality and health span. Right. So we need to know that. So now that you understand the critical window of hormone replacement therapy for women in perimenopause, I'm going to go ahead and call it like it is. You should start this stuff before you go through menopause. That's the ideal window. However, if you're like me, I'm 55. That ship sailed over eight years ago. You still have the opportunity to do hormones Even if you're 60, 65. You deserve the conversation because there is indication to use it. We just may not have the most beneficial effects that we might have seen if we had started it before we had gone completely through menopause. Now, now that you know that, there's a specific approach that we use at my company called the Manura Project that helps women individualize hormone replacement therapy for themselves while balancing metabolic hormones and diet and lifestyle and nutrition. And if you're interested in learning more, you can check out our company@gethormonesnow.com and we can help you understand your own personal needs and where we might be able to help you now. Thank you for listening to Menopause Mastery. And if you loved the show, don't forget to subscribe. Click the like and give me, give me some questions. Tell me your menopause journey. Where have you been? Even better. What lies have you been told? Because the reality is, is the science is definitely showing hormone replacement therapy is ideal for women because we're going to live a third of our life without them and our life is better and our health span is better with them. So don't forget, like, subscribe and comment below.