#268 Should I use Hormone Replacement Therapy in Menopause? The Shocking Truth About Breast Cancer vs. Dementia Risk

The information provided in this podcast is educational and not intended to diagnose or treat medical conditions.

Dr. Donnie Wilson struggled for decades to solve her numerous health issues and heal her body. But with focused determination, she healed herself and in doing so, she discovered the Dr. Donnie stress recovery Protocol. On this show, you're going to hear from doctors, nutritionists and Experts along with Dr. Donnie who will give practical advice and wisdom to help heal your body. This is how humans heal.

In this video, I'm going to be helping you to answer the question, should I be starting hormone replacement therapy during peri or post menopause? I'm Dr. Donnie Wilson. I'm a naturopathic doctor, certified professional midwife and clinical nutritionist. I've been practicing as a women's health expert for over 25 years. I graduated and did my residency at Basser University in the Seattle area which is the leading institution for naturopathic education. So I was trained in bioidentical hormone replacement therapy in the 90s and I've actually been helping women with hormone replacement therapy throughout the years since then. And so I want to share that information and experience with you as well as the latest research because in my continuing education I I continue to update my training through educational seminars and reviewing the research so that I can give you the latest information to be able to be making this important decision for your life. I actually think this is the most important decision women are making in their 40s and 50s because this has not only the ability to influence how you feel now, but it also has the ability to influence how you feel and your health for the rest of your life. So I'm so glad you found this video and I'm very excited to share this information with you. I'm going to be going into understanding the decision making process about whether choosing hormone replacement therapy makes sense for you. It's a very individualized decision and something you want to understand and think through your history, your risk factors in before making this decision decision. And you really want to be communicating with a practitioner who understands all of this as well, who can guide you every step of the way. So before we go into that decision making, I want to make sure that you understand what I mean by hormone replacement therapy and also to mention that I if you're wanting to know more about the symptoms of menopause to be sure and go look for others of my videos on this topic where I go into detail about understanding menopause and the symptoms of menopause. So hormone replacement therapy, when we say that we're Referring usually mainly to estrogen and progesterone as hormones to replace. If you think about it, the ovaries, right, during peri and postmenopause, they're decreasing their function. And what happens in that time frame is the ovaries decrease their production of estrogen. They also decrease their production of progesterone, which is usually produced when we ovulate. Right. So if we're not ovulating, we're not going to be making much progesterone. And then also the ovaries can produce testosterone and dhea. So all of these hormones can be impacted by peri and postmenopause. And it can vary slightly from each person. Exactly when it decreases and how that influences you, the way you feel and your health going forward. So it's always important to think through this from your body's perspective and to have a practitioner who can help you to do that. So hormone replacement therapy, you, you might hear a lot of different terms and ways of referring to it. Um, sometimes we call it hrt, which is hormone replacement therapy. Sometimes it's shortened to simply HT hormone therapy, or sometimes estrogen therapy or progesterone therapy or testosterone therapy separately. Right. Or, or sometimes it's referred to as bioidentical hormone replacement therapy. So I want to help you to understand that whenever we're talking about hormones, there's these various different options to consider. But usually if we're referring to hormone replacement, that we're talking about estrogen, progesterone. And I will also, in this video I'm going to focus on estrogen and progesterone. In another video, I will go into more detail about the DHEA and testosterone. So when we say synthetic versus bioidentical or natural hormones, what we're referring to is the difference between hormones that are produced in a lab. Right. They're human made hormones that are synthetic. Right. They, they're chemical based and they look similar to what our bodies make, but slightly different in the chemistry. And so they can provide some of the same effects as our hormones, but they also are more likely to cause side effects and maybe not have as much of the positive benefits as hormones that look the same as what our body makes. Right. That makes sense. Right. If it looks exactly the same as what our body makes, then our body thinks it came from our body. So when we refer to bioidentical hormones, that means that the hormone looks, it's identical to our biological hormones, or sometimes it's referred to as natural hormones, but that means it could be Estrogen, that's bioidentical, progesterone, that's bioidentical. And so you might be hearing about the difference between a synthetic, even progesterone. A synthetic progesterone is called a progestin. And the synthetic estrogen and progestin are found in birth control pills. And oftentimes if you see a gynecologist during perimenopause, that's what they might prescribe is a birth control pill. Um, and then once you go into menopause where your period stops happening, then usually this transition will be to an estrogen and progesterone. And in that case, some practitioners are still using a progestin and potentially equine estrogen like Premarin, which is, is still considered a, you know, human made estrogen, versus using a natural or bioidentical estrogen, which would be estradiol, which is the same as it's referred to as E2. Estradiol is one of our natural estrogens on progesterone, which is our natural progesterone, can also be used. And they, what the research shows is that there's just as much potential benefit to helping with symptoms and, and preventing health issues and, and actually less side effects and more benefit when using natural or bioidentical hormones. So from me, as a naturopathic doctor, I'm going to be, when I'm talking about hormone replacement therapy, I'm really more often going to be supportive or encouraging or suggesting the use of bioidentical or natural hormones over the synthetic hormones. Although there are scenarios and cases where we need to use synthetic hormones. So just know that there's always a decision making between the synthetic and natural hormones. And whenever possible, I suggest to choose natural or bioidentical hormones based on the research. Okay, so let's talk about this decision, this big decision. So when you're thinking about hormone replacement therapy, the first thing we're going to be asking your practitioner, any practitioner you talk to is going to ask you is when was your last period? Because that really helps us understand where are you in this window of Perry to post menopause. If your last period was within the past year, that's still considered perimenopause. And we may be less likely to add estrogen at that point. If you're still having a period, we might start by using natural progesterone to help regulate your cycle and help with symptoms, but we're less likely to add an estrogen until your period is becoming farther and further apart. So if you start having more symptoms and it's been longer between your period, that's when your practitioner is more likely to start adding estrogen. And the reason is because estrogen can stimulate the growth of the uterine lining. Right? So if we have estrogen, we're more likely to have another period. And so, and also whenever we start adding estrogen into the body and you, if you have your uterus, if you have not had a hysterectomy, then we need to also add progesterone. So here's the key is to know you can use progesterone by itself without estrogen, but you really cannot use estrogen by itself unless you've had a hysterectomy. If your uterus has been removed, then you can use estrogen without progesterone. Some practitioners even then would still question whether we may want to still add progesterone even if you had a hysterectomy. But the key is to understand that if you have your uterus and you want to use estrogen, we're going to need to balance it with some progesterone. Because we know from research that if we only use estrogen, we could develop a uterine lining and that could then lead to uterine bleeding or even hyperplasia or increased risk of uterine cancer. So we need to have a progesterone to counterbalance the estrogen. So that's one thing to know is that anytime we talk about estrogen use, we're likely going to be knowing that there's some progesterone right there with it, unless you've had a hysterectomy. Okay, so we asked this question, when was your last period? If it's been more than a year, you're now postmenopausal and we could use estrogen and progesterone together. And if it's been more than five years, or if it's been more than 10 years, that can also influence the decision making about around hormone use. Many practitioners are going by the research from the Women's Health Initiative that showed that if women were more than 10 years since their last period, if it's been a decade since your last period, then according to one study, or some studies at least, the Women's Health Initiative study, there's some concern about whether if you wait longer to start hormone therapy, are you going to get as many of the benefits or are there going to be even some downsides? So the really key is to know that there's this 10 year window from the last period to the first 10 years of your life. After that, that's really the best time to be making a decision about adding in estrogen, estradiol, est, and then that progesterone that comes with it. Now there's other studies that show that we don't, we don't need to be so strict about that 10 year window. But I want to mention it because likely your practitioner will be thinking about that because of the research. And now there's even more research coming out saying, hey, there can be benefit. Like if you're past 10 years, right? So let's say you're over 60 years old and you never used hormone replacement or estrogen or progesterone, and now you've come to this and you're thinking, maybe I would like to try it, then you're going to want to talk to your practitioner about how it's been more than 10 years, but you would still, based on your body, your symptoms and your health risk, you would still like to consider adding in hormone replacement therapy. And there are some things we can think through and decide whether that makes sense for your case. Okay, so that's the first thing is we think in terms of where are you in this time frame. And then as I started to mention, we want to think about what are your symptoms, right? So if you're having a lot of symptoms related to menopause and maybe you've tried a lot of other things, maybe you've tried herbs and nutrients and, and other approaches, and still you're having all these symptoms, that's a reason to definitely be thinking, hey, maybe some estrogen in particular, especially estrogen with progesterone may be helpful for those symptoms. And we're going to talk about that a little bit more here in a second. I also have a whole, I'm going to do another video, separate video, where I talk about the natural ways to address these symptoms, right? Because there are a lot of studies on nutrients and herbs you can use for home for menopause related symptoms. So but if you've had a lot of symptoms and they're not getting better, like let's say you have disrupted sleep, you're getting hot flashes or night sweats all the time, you're having a change in your libido, change in your mood, change in your, you know, so many other things, joint pain, bone loss, right. You start to get all these different symptoms and number two is your disease risk. So that's the other factor we want to take into consideration if you want to be Preventing bone loss, preventing osteoporosis, preventing fracture risk. Right. Or if you want to be preventing cardiovascular disease and risk and also potentially decreasing dementia risk as well as other health issues like diabetes, then that's another reason for thinking about choosing hormone replacement therapy. Okay, so you want to be thinking, what are my symptoms? First of all, when was my last period? Second, what are my current symptoms that could be menopause related? Third, what are my disease risks for the rest of my life? What is my family history of health issues? What are my genetics related to health issues? And so you can weigh all of this into the equation and your personal history of health issues. Right. If you know you have history of breast cancer, that's going to be a different discussion than if you don't have a history of breast cancer. Right. So we need to be thinking about all of this when we take into account this decision about whether to start hormone replacement therapy. And now some things I want to help you understand in terms of the, how these hormones work in terms of symptoms. For example, with what are referred to as vasomotor symptoms, that's the hot flashes and night sweats, using estrogen or estrogen with progesterone can decrease the hot flashes of vasomotor symptoms by 75 to 95% based on research studies. So absolutely, if you're experiencing severe hot flashes and night sweats, even, I would say to the extent of, even to intel migraines, this is something we want to be considering using hormone replacement therapy to help you because these night sweats can keep you up and then you're not sleeping and then that leads to other health issues. Right. So this is a actual reason. I know sometimes women feel like, oh, this is just something I have to deal with. No, it's not something you just have to deal with there. If you, and especially if you've tried all the natural approaches and you're still getting these night hot flashes and night sweats, that's the time to think about using hormone replacement therapy to help you. Okay? Now there's also the sleep issues that can be helped by using hormone replacement therapy. And the studies have shown that it can help with your sleep, especially estradiol. But also progesterone can be helpful for sleep issues because sometimes women are not getting good sleep even without having night sweats. Right. If you have a hard time going to sleep or staying asleep, you're waking up. This is definitely something to consider. Now also.

Genital, what's called gsm, which is genital urinary symptoms, of menopause. So now genital urinary symptoms are going to be things like vaginal dryness pain, pain with sex, pain with getting a pap smear. And it also can lead to increased likelihood of bladder infections, vaginal infections, including high risk HPV virus. So when we're talking about these symptoms that are vaginal or in the bladder and the vagina, this is because of the reduction of estrogen vaginally. The estrogen really helps keep those cells happy and healthy and prevent infections and prevent discomfort. So when we go through menopause and the estrogen drops vaginally, that's what creates these symptoms. And so what's well established in the research is using estrogen. Now, usually when we're doing hormone replacement therapy, we're talking about, you know, either swallowing estrogen and progesterone as an oral dose or putting it on your skin as either a cream or a patch so that hormones are circulating around your body. When we're thinking about vaginal estrogen, we're taught we often are talking about also adding estrogen specifically vaginally, as a cream or a tablet or a suppository. So, so we're actually putting estrogen directly in the vagina. Now, I wanna make sure to clarify because a lot of women will say to me, okay, you know, I'm confused. Is this one or the other or both? And so I wanna emphasize that in some cases, we might only be using vaginal estrogen. But the key is to know that when we use estrogen vaginally, it doesn't, not very much of it circulates around your body, so it mostly stays vaginally. In fact, when you use vaginal estrogen, you, you are not required to use progesterone because so little of it circulates around your body. It really stays right there in the vagina. For the most part, less than 10 to 15% gets out of the vagina. So when we, we, when you have symptoms vaginally, your doctor is likely to recommend one of these forms of estrogen to use vaginally. But that's not going to help you with the rest of your body. It's very unlikely to help with the symptoms other places, and it's not going to be helping you to prevent disease risk. So when we're talking about hormone replacement therapy, we're talking about something you swallow or you put on your skin and it circulates around your body. That's hormone replacement therapy. But we also might use estrogen vaginally additionally or separately. And that you know, so it goes together, right? So a lot of times women would be using a systemic estrogen and progesterone and also a vaginal estrogen. Having optimal cortisol and adrenaline levels is essential for health and longevity. And yet the stress in the present and in the past can affect our cortisol and adrenaline levels, causing them to be too high or too low. The thing is that we're not all affected by stress in the same way. So over the past two decades, I've been researching and discovering how to help my patients recover from stress. And I've identified the five stress types which are the five common patterns of disruption in cortisol and adrenaline levels. The reason why this is so important is because the treatment is different when cortisol is too high. We use different herbs, nutrients and other modalities to bring levels back to optimal than if the levels are too low. So that's why I, through research, developed the stress type quiz, which allows you in under two minutes to discover what likely your cortisol and adrenaline levels are. So then you can make decisions about which herbs, nutrients and other healing activities to choose to help optimize your cortisol and adrenaline again and improve your health now and into the future. Just go to stresstypequiz.com where you can take the quiz and take it from there. And I want to point out that really now the research is showing that use of vaginal estrogen is considered to be so protective that it's considered to be a healthy decision for most all women. Of course you always need to check with your practitioner and your case because there are some scenarios. Let's say if you're currently have breast cancer, treating breast cancer, then it may not be used, but you have to check with your practitioner. But other than that, most women who don't have, who are not currently being treated for breast cancer, very often it's recommended to use a vaginal estrogen because it is so protective to the vaginal area, the bladder, preventing infections, also in preventing hpv, preventing cervical cancer. So this is something to really know is that at the very least, if you're postmenopausal, to definitely think about and talk to your doctor about use of vaginal estrogen at the minimum. And then on top of that, then you would think about the systemic oral or transdermal, we call it transdermal. When you put it on your skin, either a cream or a patch is transdermal estrogen and then oral progesterone. Or in that case you could use vaginal Progesterone to counter the estrogen. Okay, so that's that. That's the thing is that the estrogen can definitely help with the. The vaginal symptoms and that bladder's susceptibility to infections. It can also be used to help with.

Sometimes sexual function, related to helping with increasing lubrication and blood flow. So there could be a lot of help with sexual function as well. But when most times when we're talking about libido, that's when we start talking about testosterone replacement, because testosterone can even have more benefit with when it comes to libido. So we'll come back to that in another video. Okay. There's also benefit to symptoms of the skin, the hair, and so much more. So definitely, if you're having any symptoms in your body related to lack of estrogen, from skin changes to wound healing to itchy skin to sometimes dryness, dry eyes, also joint pain, all a stiffness, all of this can be potentially helped by estrogen therapy also. So those are some of the symptoms. But I, you know, again, symptoms are a reason to be thinking about estrogen and progesterone therapy. Now, also, we want to be thinking about disease risk, right? So let's talk about bones, because we know that over the first two to five years after your period stops is when women have the greatest risk of bone loss. And so we want to be, of course, looking at your diet and your nutrients, making sure you're getting calcium and vitamin D and vitamin K to prevent bone loss and exercise. So we want to take a holistic approach. And also if you want to be preventing bone loss or. Or you've had a DEXA scan and see that you are already experiencing bone loss, that's another reason to be considering adding estrogen and progesterone, because what the studies show is that there's a reduced hip fracture by 34% from the women's Health Initiative. And there have been other studies as well, clinical trials that have shown that actually women can even increase their bone density by using hormone replacement therapy. So definitely, if that's a health concern for you, then that's definitely a reason to be thinking about use of hormone replacement therapy. And then also we want to be thinking about.

The diabetes risk, because metabolic syndrome or elevated blood sugar levels and diabetes risk can also increase in women poor postmenopausally. And what they're finding is that estrogen and progesterone can actually show a reduction somewhere between.

15 and 30% of all the different studies.

Reduction in type 2 diabetes. So if this Is something that's in your health history, something you're concerned about, then that could be another reason to consider.

And definitely if you already know you have type 2 diabetes, then you may also want to be con, you know, be considering use of estrogen to help prevent it from getting worse. Also weight gain, which is very common symptom related to post menopause and health issue. Um, the, there's some varying um, studies related to weight gain. It may have a mild effect on that in terms of preventing weight gain. And, and so that's also a reason to consider hormone replacement therapy, although it's not a huge benefit. We definitely have to also think about other factors when it comes to preventing weight gain. But.

The, this is some another reason to potentially consider hormone replacement therapy. A lot of women also experience, experience low mood and anxiety. Now there's some varying studies related to this to show that.

That hormone replacement therapy can help to some degree with these symptoms. So it's something to consider trying. But it's not like the research is not showing a huge benefit when it comes to mood. But I find clinically that oftentimes women do find an improvement in their mood, anxiety and depression and so on when we, when they start in with hormone replacement therapy. So it can definitely be impacted. But it's, you know, you're going to want to also consider other factors like cortisol and neurotransmitters in order to help with mood as well. Now this one, this something I want to emphasize a lot is the research related to cognitive decline and dementia risk because the Women's Health Initiative showed that when women again, when women start estrogen therapy within the first 10 years of menopause, especially within the first five years after menopause, they have even up to 50% reduced risk of Alzheimer's and dementia. So that's a really important thing to know. I think that so often we've been in fear of hormone replacement therapy, increasing risk of cancer, because that's what we were told when the Women's Health Initiative first came out in 2002. And so a lot of the media was scaring us to say, hey, is there an increased risk of breast cancer associated with estrogen? And many women are aware of that information and have fears around hormone replacement because of it. But the fact is now they've reevaluated the study and they come out with new information to say that no, we should not be. Women should not be avoiding estrogen because of fear of breast cancer, because when they reevaluated it, they saw that only after four years of use, there was an increase in one out of a thousand women per year who had increased risk of breast cancer. So it's actually a, you know, much lower risk than they were reporting originally 20 some years ago. So I really want to emphasize that, you know, if you're hearing, oh in your mind, you're thinking, oh my gosh, I'm worried about breast cancer risk. I want to reassure you that the latest information is actually that, that there's so many more potential benefits of using estrogen and the breast cancer risk is way, way, way much less than we ever heard before. So that's really shifting now. This is the different. If you currently have breast cancer or if you have a history of breast cancer, you're going to be working with your oncologist in that scenario. But if you do not already have a history of breast cancer, then then using hormone replacement therapy is an option for you. If you have a, even if you have a family history of breast cancer, hormone replacement is still an option for you. So this is all changed and changing and I want you to know about it. Because on the other hand, this research is also showing such a decreased risk of dementia. So if what's been happening is so many women have been afraid because of what we were told about breast cancer risk and not using hormones, but now we have a huge increase in the number of women who are experiencing dementia. So we have to be weighing this out and re looking at it and say, wait a minute, if the breast cancer risk is really not that significant, but the benefit, the potential benefit for preventing dementia is significant, we need to be changing our decision making, right? We need to be seeking this through and helping women to decide. Now again, some of the studies emphasize this starting estrogen within the first five to 10 years, which is absolutely optimal. So if you, if your period, if your last period was within the last five to 10 years, this is definitely the time to be thinking about hormone replacement therapy. And if you're beyond that, if you're beyond 10 years, still it's worth considering because there's some, also some new research that's coming out that shows that even when women start estrogen and hormone replacement therapy 10 years after their period ends, they are still getting the benefit for preventing dementia. So it's definitely worth still talking to your practitioner about that and making a decision for yourself whether that may be still a decision you want to make, especially if you have a family history of dementia. And that's a health concern for you. Okay? So please know that there's a lot of research related to preventing dementia and the use of estrogen. The earlier you can start it, the better. And if it's. If you're. If it's been 10 years, it's still worth considering because estrogen and estradiol specifically is known to help protect the nerves, help to increase neuroplasticity, help to prevent dementia in many different ways, like reducing amyloid plaque and enhancing the glial cells or so and helping with the glucose metabolism. That's why it helps prevent diabetes. Diabetes. So there's a lot of important things that estrogen is doing to protect the brain. Also, progesterone can be very protective to the brain. So when you're using estradiol and progesterone, there's a real benefit to protecting your brain. And that seems that the more years that you're using it, like if you can use the estrogen progesterone for at least 10 years, there's more benefit to preventing dementia. So this is an important thing for you to know when you're making this decision is, wow, this could be significant if we can prevent osteoporosis, if we can prevent dementia. And the other one that I want to talk about is related to cardiovascular disease, because that was another factor that sometimes comes into play with hormone replacement. And it's true when women are taking oral estrogen and they're over age 65, there can be an increased risk of having a stroke or embolism. And so we need to be. If you're over 65, we very likely will not use oral estrogen. More likely, we're going to use transdermal. Right? We're going to use a cream or a patch. Because when estrogen is delivered to the skin, it doesn't have such an increased risk of blood clots and stroke, for example. So, but that's really for women over 65 years old. Okay. So if you're less than 65, you potentially might use either oral or transdermal estrogen, and usually then it would be paired with.

Oral progesterone. So. Because what they're finding is that women are at ha are so much more likely to experience cardi. When we say cardiovascular disease, we mean a heart attack or stroke or other form of blood vessel and heart issue. Actually, more women die from cardiovascular disease than breast cancer.

This is really important thing to know that when women use estrogen therapy, they have 40, 50% decreased risk of heart disease than women who didn't use any hormone replacement therapy. And this has been shown by the Women's Health Initiative as well as the Cochrane Review and other studies. Studies Cochrane review showed 48% reduced risk of coronary heart disease and 30% reduced incidence of all cause of death. So this is like huge, right? If we can say, oh my gosh, the main condition that's actually causing death in women, we can reduce by using hormone replacement therapy. Right. That makes a big difference. And I think that's why I want you to know when you're making this decision that we need to be less worried about the risk of breast cancer and more concerned about ways we can prevent the things that are increasing in women, including heart disease and dementia and diabetes, then we can reduce the risk. That's why I think it's such an important thing to think through and consider. Estrogen replacement therapy is also shown to decrease colon cancer. Um, and so this is all important information for you to have when you're deciding about using hormone replacement. And from there, then it's a matter of working with a practitioner who can help you get the right formula for you. Because even when we're talking about bioidentical hormone replacement therapy, natural hormones, there's some you can get that are directly from a pharmaceutical company. So this might come in the form of a, a pill or a patch that you can get from the pharmacy. And so those are available. And sometimes even your gynecologist may be willing to, or already prescribing those for you. And or sometimes for women, if in the pharmaceutical version there might be, they usually are adding other fillers to an oral pill. And so sometimes then women prefer to, or need to choose a compounded, what's called a compounded hormone. So when we go to a compounding pharmacy, it's because a compounding pharmacy can make a substance for you that's not available from the pharmaceutical company. Right. So if you can get estradiol progesterone from a pharmaceutical company, and then it's often covered by insurance and you're not reacting to or have a concern with the other ingredients, sometimes they have, you know, other fillers. Other, like, for example, oral progesterone has peanut oil in it. So you want to look up what are the other ingredients in the pharmaceutical version. But if you're doing fine with that and your doctor will prescribe and you can get it covered under insurance, that's a fine decision because you can get estradiol and, or what's called oral micronized progesterone from a pharmacy. Or you might decide, hey, I really want to Use. You can also get, by the way, you can also get a patch, estradiol patch from the pharmacy. Right. You stick the patch on twice a week and it's delivering estrogen along the way. So those are options through a standard pharmacy and pharmaceutical company and usually the standard gynecologist. Now, if you want to use what's called a compounded hormones, which is where we then can have the pharmacy make a cream specific to you with a hormone dosing specific to you. So we can, they can make estradiol in the natural form, in a cream form or in an oral form. And it doesn't have other ingredients that you might react to. And we can really make the dose just specific to you. Right. When we go through a compounding pharmacy, we can, we can ask them to make exactly the dose that fits for you. Whereas with a pharmaceutical company it only comes in certain doses. Okay, so when we do, we go to a compounding pharmacy, they can make in a cream, they can make it in oral. So they might make the estrogen in a cream and the progesterone in oral form. Because again, especially.

If you have, if you're over 65, then we're going to want to use the estrogen cream. We can use progesterone orally. We can. You also sometimes will see progesterone in a cream form and testosterone, when we get into that, would be used in a cream form as well. So you start to go, okay, if I'm going to want to use a transdermal or cream and natural hormones in a dose that matches my body, then you're going to be working with a practitioner who can prescribe them through a compounding pharmacy. Okay, so there's some other options as well because there are some forms of natural estrogen and progesterone that can be found through a practitioner's office. So there's other options as well. So I encourage you. I hope this helps you to get a better sense of, like, what are the decisions, how to know whether to consider this. And then, then the next step is to find a practitioner who can help you with it. Now, again, this is something that I have been trained in and continuing education and, and have been helping patients with over the years. And so if you would like to learn more how I can help you with hormone replacement therapy, then I welcome you to reach out to my office. I'll put the contact information in the show notes. You can always email us@officer donney.com or call us at E553162 2114 and this way we can talk about how I can help you with hormone replacement therapy, specifically the compounding form, pharmacy form of hormone replacement therapy and or I can also refer you. I have a lot of friends and colleagues who work in this space and area who I know to be well trained experts. So if you're looking for another practitioner, I'm happy to also help you to find someone near you. Now it's you don't always with hormone replacement therapy you don't necessarily have to be working with a practitioner right in your local area. There's ways where we can work together to do hormone replacement therapy and not have to be in the exact same location. Okay. So reach out to the office so that we can talk it through in your situation and see if this is something that you would like help with. But no matter what, I'm going to put a summary down below so that you can use this whenever you're talking to a practitioner about hormone replacement therapy. What information do they need? What information to help you make a decision for your health now and into the future related to post menopause, your symptoms and your disease prevention and whether or not to be using hormone replacement therapy. I'll be also sharing again more videos on this topic and be happy to hear your questions so that I can understand more what would be helpful for you and if you would like to learn more about how patients work with me related to menopause. We have menopause program that I use work with patients through and so I can put a link down below to the our menopause program where you can learn more about how I help including what testing we use to monitor. Because this is the other factor is whenever you're using hormone replacement therapy, it's important to monitor the dose for yourself. Right. We don't want to just start a dose and never check in on it. We want to check in on a regular basis and there's different testing options. There's blood testing versus urine testing versus saliva testing. So I'll also do another video related to that decision. How do you monitor your hormones? Which testing is going to give you the best information? So how can you use this testing to help you make sure that your body is getting the most benefit from your hormone replacement therapy and the least risk. Right. I think that's one of the biggest issues is that a lot of practitioners just give women hormones and they never check in and they never, never test. And so you don't really know if you're on the right dose. So to me, it's much better to always monitor not only your doses, but also how well your liver is metabolizing estrogen. Estrogen is something that has to go through the liver and must be metabolized. We want to make sure your liver is able to metabolize it well and that helps prevent the any negative effects from from hormone replacement therapy. So again, I'll do another video for you related to lab testing and how can we monitor hormone replacement therapy. An effective way to keep it effective and safe. Okay, well if you would, if you're not already subscribed to How Humans Heal and My videos, I encourage you to subscribe so you don't miss those next videos on this topic. And again, please reach out if you have questions so I can bring that in and answer your questions along the way. And certainly reach out if you would like more help. All right, thanks for joining me today. I'll talk to you soon.

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