Menopause Hormone Therapy: Everything You Need to Know in 2026

Do you have questions about hormone replacement therapy during menopause? Do you have questions about using estrogen, progesterone, maybe fears of using estrogen? And maybe your doctor recently recommended some estrogen therapy for you. Um, perhaps you're having a lot of symptoms or menstrual changes and you're trying to figure out what to do. Should you use hormones or not? These are all very common questions that I get asked every day by my patients and and women in my programs. And so I wanted to make this specific episode and video especially on this topic of the latest updates on what to do related to hormones during perimenopause and menopause so that you have one place you can come to get information, get up to speed, and be able to start making decisions about this for yourself and your health going forward. There's a lot to think about and understand, and so I want to really use this time and space to break it down as simply as possible and know that you can always then go do more research and know that it's always very important to individualize. I would say this for every kind of health issue that we're dealing with. Even though we're all humans doesn't mean we're all the same. And so we can make guidelines and we can look at research, but that doesn't mean that it's exactly what it should be for you. So you always need to, as you're listening and learning, it's always important that you connect with a practitioner who is also educated about this to know your case and what's the right decision for you and to help you monitor along the way. It's not a, this is not a cookie cutter, same person, everybody gets the same thing. It's also not something where your dose necessarily stays the same throughout your life. It needs to be monitored over time and adjusted as needed, and there's definitely some things to consider. So we're going to talk that through, and, um, so I'm glad you're here to join me for this. And if you're new, then welcome. I'm Dr. Doni Wilson. I am a naturopathic doctor and certified professional midwife, and I've been in practice for over 26 years. Now, while some of you, this might be a new topic, a new look at an old topic, um, maybe your gynecologist just mentioned a hormone therapy or prescription to you, and that's because some of the information I'm going to share with you today is based on some of the latest research, even in the past year or two. And I'm recording this in 2026, but there's been research in the past 3 years that have completely changed the landscape. Including how hormone replacement is approached by standard medicine, like your gynecologist, is the most likely place where you're gonna have this conversation. And at the same time, as a naturopathic doctor, I learned about hormone replacement therapy, how to help women to safely use hormones during perimenopause and menopause, over 30 years ago when I was in naturopathic medical school. So this is not a new topic to me, This is something that I've been helping with women with for decades. It's just that there's more and more women who now who are realizing, "Hey, this is something I should be thinking about." And honestly, there's more and more women in menopause every single year that goes by. And so because there's more of us and we have new information, that's why this is such a hot topic. And I, as you'll learn in this next half an hour, there's a lot of good reasons for you to be learning about this and thinking about it for your situation. And I'll help talk that through so you understand how to individualize your approach to hormone replacement. So let's start first with some terms because I find that there's a lot of confusion, there's a lot of different terms out there, and it, it makes it more complicated if we're using different terms for different things. So starting off with the term hormone replacement therapy, traditionally, historically, that's been the main way we refer to use of estrogen and progesterone in post-menopause is called hormone replacement therapy, but the terminology there is shifting. And so you're more likely to hear it referred to as menopause Hormone Therapy, or MHT. And so going forward in this video, instead of calling it HRT, I'm going to be calling it MHT, Menopause Hormone Therapy. And sometimes you'll even hear about it specifically as estrogen therapy or progesterone therapy or testosterone therapy. All of those are the individual hormones in menopause hormone therapy, okay? And then the next confusing term is understanding the different kinds of hormones. And so a lot of times you might hear natural hormones, you might hear— sometimes you might hear plant-based hormones or bioidentical hormones versus synthetic hormones or hormones that are synthetically produced, such as equine estrogen, otherwise known as Premarin. And so what I want you to know is the predominant words, and I find if we use this terminology it makes it a lot easier to understand, is to know that there's, there's what are considered bioidentical hormones. What that means is when we say bioidentical is that they look identical to what your human body makes, right? And that right away makes sense. Of course, if we want to introduce a hormone into our body, much better to introduce a hormone that looks the same as what our body's used to seeing at a biochemical level. And so bioidentical hormones are now considered preferred, even in standard medicine, even from pharmaceutical companies. It's the bioidentical hormones, and they— there's some situations where they might have been derived from a plant, Other times they've been produced from other methods, but it doesn't— it's not so much referring to how they were produced as it's referring to the fact that they look the same as what our human body makes. And so that's the terminology of the— what are now also referred to as the current formulations of menopause hormone therapy versus the old formulations. The old formulations from 30-plus years ago are no longer being preferred. We have current formulations that I'm going to tell you about that are bioidentical. And then the other possibility is synthetic hormones. And synthetic means that they were produced in a lab and they are— they might be estrogen-like or progesterone-like, but they're slightly different biochemically than what our bodies make. And when it's slightly different than what our bodies make, we refer to it as synthetic. Okay, so if you hear me say synthetic, then I'm referring to those hormones that are not exactly like what our body makes. And what you're going to hear me describe is that those synthetic hormones— and I include in that category Premarin and also progestins like Provera— those are associated with increased risks, and so they are not the preferred form. They are no longer considered the preferred or recommended form. Again, we're going to focus on the preferred forms, which are bioidentical forms. Okay, so now there's the question of whether you get these hormones from a pharmaceutical company or from a compounding pharmacy. And where that comes down is a lot of it is personal preference because pharmaceutical companies have been making— they do make bioidentical hormones. Estradiol, which is the major form of estrogen that we'll be talking about, estradiol is a, is a specific type of estrogen called E2. So estradiol can be— is made by pharmaceutical companies in various different forms. In pills, in patches, in creams, in gels. So you can get that same estradiol in many different forms. And sometimes you can get an estradiol cream you either put on your skin, like on your arms and your legs, or an estradiol cream you put in your vagina. And I'm going to break that down here in a minute, but the main thing is to understand that some of these bioidentical forms can be from a pharmaceutical company, and The thing that I always emphasize with that is whenever you get a product that was produced by a pharmaceutical company, I recommend looking up or search for the other ingredients because they will always add— they have to add other ingredients to in order to patent the substance and give it a name and be able to produce it under the pharmaceutical company. So there will always be other ingredients, and it's important to look at those other ingredients to make sure whether you feel comfortable introducing those other ingredients into your body and whether you have any allergies or sensitivities to them. For example, a common bioidentical progesterone contains peanut oil when it's made by a pharmaceutical company, so if you're allergic to peanuts, you're not going to be able to use that one. Uh, some of the creams contain parabens. If you don't want to be exposed to parabens, then you're not going to want to choose those pharmaceutical forms. And sometimes the choice is a matter of financial choice because, depending on your health insurance and your health insurance situation, financial situation, you might be choosing a product made by a pharmaceutical company because maybe your insurance is going to cover the cost. And so you're going to weigh that out and each person is going to make their own choice, right? Whether you feel comfortable with the product and the other ingredients, and whether you need to make that choice based on financial reasons. The alternative to using a pharmaceutical company's product is to use a compounding pharmacy. And a compounding pharmacy is a pharmacy where the pharmacists produce the products right there on the spot for you. So they can make— they cannot make a patch in a pharmaceutical— in a compounding pharmacy at this moment in time, but they can make capsules and they can make lozenges you dissolve in your mouth, and they can make creams, and they can make gels, and they can make suppositories. So they can make all these different forms of hormones, um, in a bioidentical form without certain other ingredients. More often, a compounding pharmacy can use a cleaner base, so you can have fewer ingredients. Or you could even say, hey, I'm allergic to such and such, 'Please make it without that.' So it allows you to formulate your own product based on your body sensitivities. It is going to be out of pocket when you order from a compounding pharmacy, right? So there's the financial part of it is paying out of pocket, and that might be the decision you want or need to make based on whether you can consume or be exposed to those other ingredients and whether you feel more comfortable getting your hormones from a compounding pharmacy. But The idea of bioidentical hormones are available, currently available in both locations. Okay. Now I've just been mentioning different forms of these hormones, and that again makes it a very individualized choice. There's, there's not a one-size-fits-all. There's not one that everyone prefers. There's some people who prefer to use the patch, estradiol patch, for example. Now the patch is usually applied either once a week or twice a week. So you're not putting it on every day, but you're putting it on in regular intervals, usually every 3 days. So that's when, when people are using estradiol as a patch. There's also, as I mentioned, there's, there's with it when, whether it's estrogen and progesterone, there's lots of options between oral capsules, oral lozenges that dissolve in your mouth, creams, gels that you can use topically and/or vaginally. So just know that there's a lot of options out there, and it's more a matter of figuring out what's going to work best for you and your lifestyle and your preferences. Some people prefer putting on a lotion every day versus putting on a patch every 3 days, right? So you want to take that into account as well when you're thinking about what to choose. And try not to get overwhelmed with all the options. What I recommend is work with a practitioner. This is what I do when I work with women, and I do, I do offer one-on-one support to help you with finding the right hormone approach for you, is to start with a, a basic starting dose and a basic starting form, and then See how it feels to you, see what works for your lifestyle, and then you can change until you find the right dosing, the right form for your body, and then you can, you can go from there. So, okay, so we're going to get into what are some of the common starting places. I think that covers the majority of the terminology. One thing, just when we're talking about putting hormones on your skin, you might hear the term transdermal, right? It's transdermal, through your skin. Dermal is skin. Or you might hear topical, right? So topical, again, it's on your skin. And when you put it on your arms, your legs, these are common places, your inner thighs, your hips, when you put it on your skin like that, the hormone goes through your skin into your bloodstream and then it circulates around your whole body. So whenever you put a hormone on your skin like this, it's considered— what the term is, is systemic. S-Y-S-T-E-M-I-C. Systemic. And systemic means it's circulating around your whole body, right? And this is distinct from hormone that you put in vaginally. Now, if you put estrogen, let's say, into your vagina every single day at a high enough dose, it could become a systemic hormone replacement. But the distinction is that most times we will use estrogen vaginally for vaginal use, and we only insert it twice a week. And when you're only inserting estrogen twice a week, it's no longer considered systemic it's now local to the vagina. Okay, so this is— I really want to clarify because this is often a point of confusion. And so I thought about this analogy to help you all to think through, right, like, okay, of all these different options, what do you really need? Well, how to break this down. And the analogy that I want to use today is that of a sandwich. Right? If you're going to make a sandwich, you're going to have one piece of bread, and you're going to have another piece of bread, and you're going to, you know, put them on top of each other. But before you stack them, you're going to put something in between the bread, whatever you're going to put on your sandwich. It might be something simple, it could be just turkey, literally turkey and bread, that could be the sandwich. Or you might decide to put more things on your sandwich. So in this analogy of the sandwich, the two pieces of bread are the systemic circulating hormones, and the first one we're going to talk about is estrogen, and specifically the type of estrogen that we are now using in the current formulations, and the preferred form is estradiol. And I make that distinction because, because in years past, or decades there was something we called bi-est. Bi-est means when we would have two estrogens and they would be usually split into half or 80/20. In a bi-est formula would be estradiol and estriol together. But what we now know is that it's not considered necessary or beneficial to have estriol. And so for the most part now, most estrogen, systemic estrogen formulas are going to be 100% estradiol without any estriol in there. Um, occasionally some of you might still be using a biased formula because you might have been on it for years, and that's okay if you find that it's working and you like it. It's okay to use a biased formula, but going forward, um, now most times it's going to be just estradiol in your systemic estrogen, right? So this piece of bread is going to be an estradiol, whatever form, whether you're swallowing it or putting on your skin, however you're doing it. Estradiol, this piece of bread. The other piece of bread for the sandwich would be the progesterone, right? You're going to have a— if you're going to have a sandwich, unless you're going to have an open-faced sandwich, you're going to have estrogen and progesterone, right? And the progesterone is For the most part, the understanding of the progesterone is to prevent the growth of the uterine lining, because if you're taking estrogen, you're being exposed to estrogen every day, there is some likelihood that it's gonna stimulate your uterus to make a uterine lining, just like when you are menstruating, and eventually that uterine lining could thicken and it could become abnormal, and so we don't want that to happen. We want you to get the benefit from the estrogen without the risks to your uterus. And so the way that we figured out that we can block that or prevent that is by making sure you have the other part of your sandwich, the other piece of bread, which is the progesterone. So the progesterone, we need to make sure that we have enough of the right form and the right delivery of progesterone in order to prevent any, any growth of the uterine lining. Okay, so That's why we think about it as— I think about it as the sandwich with the bread is the estrogen, and the second piece of bread on top is the progesterone. Now, if you've had a hysterectomy, in that case you don't have a uterus, then the progesterone piece of the sandwich is not considered necessary. Although for some women, they still do like to have progesterone for the beneficial effects around the whole rest of your body, even if you don't have a uterus to protect. Okay, so most times we're gonna have a sandwich with two pieces of bread, and there, if you don't have a uterus, you might be having an open-faced sandwich without progesterone. Inside the sandwich is the third piece of this, which is the vaginal estrogen. And I emphasize this because a lot of times practitioners, including gynecologists, um, and women going in for menopause hormone therapy end up with just the two pieces of bread and they don't end up with the turkey inside of the bread. And so this is why I want to emphasize that vaginal estrogen is so important. And it's not that you're going to choose the systemic estrogen or the vaginal estrogen. It's, to me, based on the research, and I can explain this a bit further here, is that the vaginal estrogen is actually considered the most important. Um, I feel like it's a— it's not even a question now because there's so much research showing that when women postmenopausally use vaginal estrogen on a regular basis, which would be usually twice a week for the rest of your life, it helps to prevent infections We're talking bladder infections, vaginal infections like yeast, BV, and HPV. So, and it doesn't have any downside. Lots and lots and lots of research that's showing that the majority of women, there's no increased risk of, uh, with using vaginal estrogen. Now I want to make one caveat, which is any of you who have a history of breast cancer, anyone listening who has had breast cancer, you're absolutely going to need to check with your oncologist related to any of this, related to the any part of this sandwich. You're going to need to talk to your oncologist, right? Because, and I can come back to this, but there's some unique situations when there— when you've had any risk of breast cancer or have had breast cancer, this is a different situation even when it comes to the vaginal estrogen. But I want you to know that there's some new research that is changing some of the way we look at hormones with, with a history of breast cancer or a risk of breast cancer. And so even if you had breast cancer, I still encourage you to talk to your doctor about hormone replacement and specifically estrogen vaginally. Okay, so coming back to this vaginal estrogen, what the studies show is that it's helping to prevent infections. And the fact is, is that there are so many women who are getting bladder infections and even dying from bladder infections in older age, over age 70. And so this is a real concern when using vaginal estrogen could prevent that from happening. And so absolutely, if you get a bladder infection or you're getting vaginal infections or you have HPV, Absolutely, we need to be thinking about vaginal estrogen. But I would say, all of you, I, I definitely encourage you to think about this, think about this, and really consider it. And even if you need to listen to this over and over and read the research yourself and talk to your gynecologist, think about vaginal estrogen, because as of right now, the research is very convincing about it being beneficial and not harmful to use Vaginal estrogen. Again, in this case, we can use estradiol vaginally, and that's— the pharmaceutical company makes a vaginal estradiol in various forms, little pills you can put in vaginally, or creams. There's even like a ring that you can put in, and there's also, um, from the compounding pharmacies, there's— we can make creams, we can make suppositories, and, and then they are cleaner version, right? They have no other ingredients that you don't want to insert vaginally. So there's options. There's also, instead of estradiol, we can use estriol. Estriol is a gentler estrogen. It's still shown to be effective at preventing infections and giving all the benefits of vaginal estrogen, but it's just using a gentler estrogen type. And so I tend to prefer using estriol vaginally And estriol, you're going to want to get from a compounding pharmacy or from a practitioner because there are forms of vaginal estriol that you can get, like, through my office or through a practitioner. And, um, so just want you to put that on your radar, right? If I was gonna— if I— a lot of times if I'm talking to someone, and of course depending on your age, but if you're over 50 years old and you've not yet been using vaginal estrogen I would be like, let's start there, right? Then we, we might not even have the bread on the sandwich, we're just going straight for the turkey on the sandwich because we're like, we need this vaginal estrogen ASAP. And you'll be surprised what a difference it can make in the way you feel and decreasing pain. But it's not just about ability to be sexually active, it's for even women who are not sexually active, very important. To consider adding. Okay, so starting with the turkey, and then we can go, okay, now let's think about the systemic estrogen, right? So you would have estrogen that you're using to circulate around your whole body, and you would have estrogen that you use vaginally. And definitely, if you have a uterus, you're going to want to add the other piece of bread, which is the progesterone. And then the next consideration is whether you would want to add more to your sandwich. Like if you would want to add testosterone therapy, DHEA, or potentially other hormones. And so these are other considerations, but I would first get this main part of the sandwich going, get the bread and the turkey going, and then we think about, do we want to add lettuce and tomatoes to this, to this sandwich? Okay, so just know that if you're talking to a practitioner, they really should be building this sandwich step by step. And usually you wouldn't just put everything, start everything overnight at the same time, because there's a lot of reasons for that. It usually tends to be better to start one hormone at a time and layer them in. I mean, you might be adding estrogen and progesterone at the same time, so you might be getting both pieces of bread going at the same time, and, and, or you might be getting the turkey and then soon after the pieces of bread. But probably you wouldn't add the testosterone right away. You'd want to get stabilized on estrogen, progesterone first, then we may add testosterone, then we may add DHEA. I just find it works better that way because otherwise it can get very confusing when you're trying to figure out the dose and you can't figure out, you know, because everyone responds to these doses differently, right? So we're gonna start at a standard starting dose, but you want to see how well is that working for you and find your best dose before we start adding more variables to the to the mix. Okay, so I know we've already— I'm hoping this is helping you already to get some clarity, right, to how to think this through and how to understand. And all of this is going to be depending on your age at this moment in time that you're making this decision, because the thing is, is that, um, it's a lot based on your current age, your— the number of years since menopause And maybe some of you are listening in before menopause. Menopause, the definition of menopause is one year has gone by since your last period. So if you're still menstruating, you're not yet in official menopause. Once it's been one year without a period, then it's officially menopause. And for the rest of your life, you're in menopause because sometimes women in their 70s or 80s are like, "Well, I'm past menopause." Well, you're past the time your period stopped, but you're still in menopause or post-menopause. That's still the rest of our lives. If you think about it, most of us spend half of our lives in menopause. Okay, so this is going to be true from, you know, the most common age of menopause is between 50 and 53 years old. Many women are surprised to find out that perimenopausal symptoms can begin even as early as age 35. And can go way beyond the hot flashes and night sweats to include fatigue, anxiety, sleep disruptions, weight gain, and joint pain. Women are also surprised to find out that the gynecology office is not likely to talk about advanced urine hormone testing or bioidentical hormone replacement for women in perimenopause and postmenopause. I'm Dr. Doni Wilson. I'm a naturopathic doctor. And midwife. I've been specializing in helping women with their health and with menopause for over 25 years. If you would like to learn more about menopause and your options to prevent symptoms and stay as healthy as possible even beyond menopause, and to learn all about what you're not hearing at the gynecologist's office, including the latest information about bioidentical hormone replacement therapy, then I welcome you to join me for my upcoming free masterclass called Mastering Menopause. Just click the link below and I'll see you there. Now, some women go through menopause surgically. If you have a hysterectomy, you might have a surgical menopause, in which case you go through menopause at that time you had the surgery, and, and, and it happens right away. Um, Other women may go through menopause early, like in their 40s or even in your 30s, in which case it's an early menopause. And these are— there's different considerations because we also start to think about your risk, the things that we know happen, tend to happen more likely when after women's hormones drop. So we're thinking about your age, how long it's been since menopause or your last period, and We're also looking at your symptoms. You know, how many symptoms are you having because of that change in hormones? And that's a whole other lecture, but everything from hot flashes and night sweats to sleep issues and mood changes and memory changes and joint pain and weight changes and skin changes, everything, anything in your body that could possibly— it could affect everywhere, right? So anything that you're noticing and experiencing as symptoms, we're going to want to look at that and say, "Could this potentially be helped by adding hormones?" It doesn't mean that's the only thing we're going to do. It's also important to make diet changes and exercise and supplements, including nutrients and herbs that have been shown to help with these symptoms. There's so much we can do, but in this presentation or this video, I'm especially focused on the hormones. And you can easily do them all together. That's what I help patients do, is to make a very comprehensive plan What is your diet? What's your exercise? What's your sleep and your stress recovery? What's your supplements based on your blood work, based on your other screening exams and, and other tests that we might do? And which herbs, nutrients are helping? And then put that together with a strategic, comprehensive hormone replacement plan, or MHT, menopause hormone therapy protocol for you and your body. Okay. And we also want to take into account As I was saying, the things that can happen, like what we know is that within the first 5 years of menopause, women tend to lose bone density. So you want to be thinking about your bones. Even in perimenopause, I recommend you start thinking about how to protect your bones from bone loss. You don't, you don't want to be 2 years into menopause and then have a fracture. Better to be like, let me start protecting my bones. Right away. We know that that bone loss is going to be happening. And sometimes you don't realize that your period is starting to be like every 3 months, every 6 months, and next thing you know, it's been a year and you're like, "Wait a minute," and it's already— you're getting bone loss. So start thinking about protecting your bones right away. And the other thing is to— we need to be thinking about the fact that after menopause, women have increased risk of heart disease. And that's one of the main things. A lot of times we're thinking about breast cancer, but actually it's a much more of a concern to be thinking about heart disease and dementia. In fact, there's 1 in 3 seniors have some form of cognitive dementia. And so, and especially women, and we can be preventing it way back within this first decade of menopause. So we need to be thinking about prevention of heart disease, prevention of dementia, prevention of osteoporosis, and yes, prevention of all different kinds of cancers. Now, the thing— the fear— the most common fear I hear from women related to hormones is the fear that the hormones, particularly the estrogen, could increase risk of breast cancer. And this is the part where I really want to help you to understand that that message came from the media because of researchers from the Women's Health Initiative from way back in like year 2000, 2001, where the researchers made an, an incorrect connection between estrogen and breast cancer. And now, and I believe it was came out in 2023, those same researchers came out and said, we got it wrong. It wasn't the estrogen that increased risk of breast cancer. Actually, it was the synthetic progesterone. So in that Women's Health Initiative, they were using equine estrogen or Premarin, and they were using a synthetic progestin or Provera. And that— what they realized when they broke down the research even further was that it was the Provera that was associated with the small increase in breast cancer. It was not the estrogen. And so now there have been so many more studies that came out too that showed that estradiol, which I've been teaching you about, estradiol, which is bioidentical estrogen, is not associated with breast cancer risk. In fact, there's even studies that are showing that it lowers breast cancer risk. So estrogen, we need to like rewrite that whole programming that we heard incorrectly for all those decades. Estradiol is not associated with breast cancer, and even the bioidentical progesterone that I'm going to be telling you is in the new current formulations— the bioidentical progesterone is also not associated with breast cancer risk. It's the synthetic forms that are, and that's why I don't recommend using the synthetic form. So if you're Doctor, are you using Premarin or Prevera? I would go rethink that. That needs to be switched, in my opinion, based on the current research, to a bioidentical form. So I hope that's clear and helps to take away. And then the other thing to know is that what estradiol or estrogen is now shown to protect is it's actually shown to prevent osteoporosis and bone loss. So starting estrogen or estradiol right away when you're going through menopause, or even before you get to menopause in perimenopause— now the argument is even starting estradiol before your period stops in order to prevent bone loss and in order to prevent dementia. So if you're listening and you haven't hit that point that your period stopped, That's wonderful because this is your chance to say, "I want to be proactive and I want to start supporting my body with natural progesterone," or that's what sometimes I call it, natural progesterone. It's the bioidentical form or bioidentical estrogen or both before your period stops, because then you have your best chances of preventing bone loss. And now the research is showing that it has real potential for preventing dementia. And also prevention of heart disease. So there's like some real reasons in terms of preventing health issues for considering this as well. So we used to be thinking, oh my gosh, we're afraid estrogen is going to cause cancer. And now we've completely flipped and said, actually, I'm afraid if I don't use estrogen that I might be at risk of these other health issues. And so now this leads me to talk about this was this hypothesis that's referred to as the critical window, which you might hear from your doctor as a 10-year window. And what that is, is, again, is a hypothesis based on research that shows that, especially within the 10, the first 10 years after menopause, this is why, you know, like a lot of times women be like, think, "Well, I'm just going to wait and see how I'm doing." And next thing they know, 10 years has gone by and they're already out of this critical window. So I want to emphasize that if you're— if you recently had your last period or you're within that 10 years since your period, your last period, this is a really important time to think about adding estradiol and progesterone to the systemic forms, right? Because it's— that's in this time frame, this 10-year window, is when the research, the current research, right, this Now, in 20 years from now, this could completely shift. But right now, you'll see a lot of practitioners referring to this 10-year window because it's in that 10-year window that we can prevent the most bone loss, we can prevent the most dementia, we can even be preventing the most metabolic changes and heart disease risk. And so I really encourage you, if you're in that window, this is the time to think about it and try it. Even if you try hormone replacement or menopause hormone therapy, you don't have to use it forever. Even just, even if you say, hey, I'm just going to try and see how it feels to me. It's not something where you, you know, sometimes that's a good way to just start with something is to say, hey, it's not like you, you have to use it forever. You might choose to use it long term, but it's better to just start and then realize, hey, if something doesn't feel good, I either need to change my dose or form 'Or get more help with this to get the right benefit.' And if I really— something really doesn't feel good to me, then I can stop. But it's better to try, I would say, especially if you know you have a lot of symptoms and you want to be preventing, or you have a health family history of these health issues, then you definitely want to be thinking about this strongly. And it's not to mean that everybody needs to do hormone replacement or hormone therapy. I'm not saying that at all either. I don't think it's 100% everybody should use it, but I do think I want every woman to know the latest information so you can make the right choice for you and your situation, right? So that's what I want to emphasize. So, um, now the thing is, is that this 10-year critical window sometimes is tricky. If you're, let's say, you're at 11 years and you're like, 'Okay, well, I'm past the 10-year window, but can I and should I still be thinking about adding hormones?' And so the answer is yes, you can still think about it. You're going to want to talk to your practitioner. You're going to want to have a practitioner like me who's really well-versed and educated and has a lot of experience helping women with this, to be able to look at all of your risk factors and decide whether it makes sense for you to add hormone replacement even if you're past that 10-year window. And I believe again that in the next 5-10 years we're going to have even more research in this area. We don't— that's one of the areas we need more research is what about women who are outside of that 10-year critical window. And there's some theories about something about what's called a healthy cell, um, bias. And this is a different way to look at it instead of just giving everybody a 10-year window to work with. With the, with this healthy cell perspective, what we're doing is we're saying, hey, let's look at your body. Let's look at it on an individual basis. If you're, for example, when it comes to dementia prevention, if we're, if you're already seeing signs of issues with your neurological functioning, or you're already seeing signs of plaque associated with Alzheimer's disease, then it's less likely that they're going to start estrogen at that point because the research seems to be indicating that the estrogen helps the most when you're using estrogen on a healthy brain, right? So if you have a healthy brain and healthy nerves, then estrogen is more likely to preserve that. It's neuroprotective. Estrogen and progesterone, by the way, both the progesterone is also shown to be neuroprotective. It protects our nerves. If the nerves have already been damaged, then it's not going to be— the research seems to be saying that it's not as likely to be helpful. And so your doctor needs to be looking at your specific case. If you don't yet have any signs of dementia, and they might be doing blood tests, they might be doing imaging to determine this, then in your— you— they think your body is relatively healthy state, then you could still benefit potentially from adding estradiol even if you're past that 10-year window. And same for if you already have some bone loss or you already have, you know, then you're— that might be a reason still to add estradiol to prevent further bone loss. Okay, so please know that we have to really individualize these decisions, including if you have any risk or history of breast cancer, because now this is, is all really shifting. It really depends on the type. I mean, if you had DCIS, which is a precancer, that's very different than if you had actual breast cancer. And it also depends on whether you had a hormone receptor positive cancer or hormone negative cancer. And usually what the doctor is going to talk you through is How many years since your treatment? What was your treatment and how many years since you completed treatment? If you had a hormone-sensitive cancer, did you do some tamoxifen or other medication for 5 years, at least 5 years of use? So they're going to look at what was your treatment, what was your continued treatment after the cancer, what was the type of cancer, and usually they may wait 3 to 5 years because that's a greatest likelihood of a recurrence, they may wait 3 to 5 years. And then if you're 3 to 5 years and you completed your treatment, depending on the type of cancer, you, you could talk to your— and depending on your symptoms, right? You maybe have tried everything else, and if you're still not feeling well and you're like, hey, I'm past treating cancer, then you could definitely still talk to your doctor about using estrogen and progesterone hormone therapy. So please know that it's not that it's a, a definite no. There are some times where it could be considered based on all of those potential factors. So, um, even if you have a risk of breast cancer or history of breast cancer, definitely still worth talking to your practitioner, and definitely still worth thinking through all the different factors, including your symptoms and your health risks going forward. Okay, I hope that's helping to make sense of this and to see that this is There's ways to think this through, and there are more and more practitioners who have awareness of this. They're educating thousands and thousands of medical doctors every month now because this wasn't part of their training for the past couple decades. Medical doctors weren't trained in menopause or menopause hormone therapy, so they're now learning. So you're likely to hear this from your doctor if you haven't already, and if you go talk to them, they're more likely to be making some recommendations. And again, if we think about the basic starting place, right, what is this current, most common current formulation, you're going to be thinking about it as— the simplest way I find to think about it is with estradiol systemic, right? It's going around your whole body, whatever form you're using. Estradiol systemic is going to— the basic dose is going to be 1 milligram. Now, when you convert that into a patch, it's going to be at a 0.05 patch. Okay, so that's a starting estradiol And progesterone, that's starting to match up with that. The other side of the bread, of the sandwich, is 100mg of oral micronized, which is the bioidentical progesterone. Okay, so the easy way to remember it is 1mg and 100mg. And then if you increase the estrogen to 2mg, let's say, then you're going to increase the progesterone to 200mg. So they go together. You have to— you wouldn't have estrogen at 2 milligrams and progesterone at 100. It wouldn't— you need to, if you raise the estrogen, you've got to raise the protection so their sandwich is meeting, right? You wouldn't want a whole piece of bread and then half a piece of bread. You want the whole— they want the sandwich matching up. So you're going to— that's how your practitioner may be adjusting the doses. And there's increments in between. It might be, maybe you're at a half, starting at a half dose. Maybe you're doing 1.5. Maybe you're doing a 2, you know, so you're going to you're gonna find what's the best dose. Now, one thing I want to mention is related to estrogen orally. Most times now, we're not using estrogen orally, and it is something that exists and can be made in a compounding pharmacy. However, uh, when estrogen is swallowed, it goes through the liver and is metabolized before it goes around to circulate around your body, and so it's less beneficial. You end up getting more exposed to the metabolites than to the estradiol. And also, especially if you're over age 65, there's increased risk of stroke associated with oral estrogen only. If you put the estrogen on your skin, and again, it goes through your skin and circulates around your body that way, there's not an increased risk of stroke So, or, or blood clots of any form. So that's why most times, even if you're under age 65, most practitioners are going to use a transdermal or topical estradiol in order to get the most beneficial estrogen and the least risk of blood clots. And for those of you who may have a bleeding disorder, transdermal estrogen is still a possibility for you. So go back and talk to your hematologist and say, hey, even if I have a bleeding disorder, can I use topical or transdermal estrogen? I'm not going to swallow it because there's the potential risk of blood clots, especially over age 65. Okay, now progesterone is opposite. Progesterone, based on the current research, the more optimal form is oral, swallowing a capsule or a pill. So Progesterone, you're more likely to have it prescribed as an oral formulation that you swallow. The 100mg or the 200mg is going to be in a formula that you swallow. Again, it could be from a pharmaceutical company, it could be from a compounding pharmacy. Either way, it's swallowed because when we swallow progesterone, actually what it gets metabolized to, the metabolite is actually more protective to our nervous system, more beneficial for sleep. And so, and it's more protective to the uterus. You could choose, there are some, if you, if you're, if you, for you the oral progesterone doesn't, isn't matching up, then you could do a vaginal progesterone that you're using on a daily basis as a cream or a gel. So that's another possibility is a daily vaginal progesterone, but I would say most times I see oral progesterone. So the prescription would be some sort of transdermal estradiol, either patch or cream or gel, and combined with oral progesterone in a pill form, and the vaginal estradiol or estriol that's either in a cream, a suppository, or another form. Okay, so those are your— that's how you build your menopause hormone therapy sandwich. And then you can decide about whether and talk to your practitioner about adding testosterone. Testosterone is also known to decrease with menopause, and the main approved testosterone use is for libido. So definitely, if you are experiencing low libido and wanting to improve your libido, of course there's a lot of things, other things for us to consider, including making sure you have enough vaginal estrogen, but you could also think about using testosterone for that reason. And there's more and more research showing that testosterone, testosterone therapy for women in menopause can be helpful for other reasons, such as helping with energy, mood, like helping with depression, and potentially helpful for preventing dementia. So this is what we're going to be learning more about in research coming soon, is all the other potential benefits of testosterone. So this might be some lettuce or tomatoes you want to add onto your sandwich. To help in addition to the other parts of the sandwich. I mean, I suppose a person who's not using estrogen, progesterone could just use testosterone, but it's way less common to just use testosterone. It's more often that we add testosterone to the others. And, and the testosterone, currently there's no formulation approved for women. There are formulations that are used for men that sometimes are modified for women to use, but the dosing is really difficult. So most times when women are gonna add testosterone, it's gonna be in a cream made from a compounding pharmacy, which means it's gonna be out of pocket. And testosterone is a highly regulated substance. It's a Schedule substance, which means that it ha— there's more particulars in terms of how it can be prescribed, how often it can be prescribed. And, and it has tighter controls around it, but it absolutely is possible. So it's something to consider. Usually we would do a blood test first, total testosterone test, to see what is your total testosterone, is it low, before we add a testosterone cream. And then we would start at a low dose and only increase based on your symptoms. You're not going to want to go to a high dose because you don't want the side effects of testosterone, which might be hair growth where you don't want it, or voice changes, and so on, unless that is what you want. Um, but most cases of menopause therapy, we're wanting to use low doses to get those other benefits that women are looking for. And, uh, DHEA is another one that can actually be— DHEA you can find over the counter, uh, 5 to 10 milligrams, or you can get it by prescription in various forms: oral, topical, and so on, and, and vaginal. Sometimes we'll add DHEA vaginally to help the vaginal tissue. So you could be using the estrogen vaginally and DHEA vaginally and potentially testosterone vaginally as well. So we can, we can add extras, but we want to get the basics down first, okay? And there's another type of therapy that some of you might have heard of called pellets, which is pellet therapy, which is when we put— they put the hormones— they make a laceration on your hip and they insert the hormones as a pellet that stays stays in your body for months, and I don't recommend them because I find that I've just seen so many patients who've had side effects. And then you can't discontinue it, you have to wait till it wears off. And I just don't like something that you, that you can't immediately discontinue if needed. And, and it's very difficult to get the right dose. So to me, the preferred hormone therapy would be that transdermal estradiol, the oral progesterone. But there, please know that there's a lot of ways we can adjust that based on your preferences and your life and your body and your risks and your all of that, right? We got to individualize this. So, okay, so I'm hoping that gives you like a really good starting place of understanding all of this. Taking— you hope you took lots of notes. Please know that this is something that I help with in my practice all the time, whether it's patients who I've helped already with HPV, or maybe you're in the midst of dealing with HPV and following my HPV protocol to clear the HPV, in which case using vaginal— if you're postmenopausal, we're gonna want to use vaginal estrogen because it's gonna help protect your vagina from HPV. And then I can also help you one-on-one with with, uh, the systemic hormones, um, and/or I'm hoping this helps you when you go in to see your doctor who's prescribing your hormones so that you're more informed about the options and the decisions that you're making. Um, so more than anything, I'm just glad to be able to provide this information. Every year I go through at least 20 to 30 hours of additional continuing education and then review the research papers to be able to bring this information to you because you deserve to have as much information as we have available at this point in time. Please know that it can change, though. We— there's research studies coming out all the time, and thank goodness, and hopefully there's more and more and more. I was hoping for over 25 years for the research we currently have, and I'm sure in another 25 years we're going to have a lot more. But women deserve that information because, unfortunately, for the past couple decades, many women didn't have this information. And so I just want to help you all get up to speed so you can make decisions for yourself and get the right support. And to know that there's ways to individualize these doses and to monitor as well, to monitor how is your body doing on your hormones. Don't just assume, "Oh, I got this dose and I have to stay with it." If something doesn't feel right, if you're getting breast tenderness, if you're getting headaches, if you're feeling bloated, anything, then that means that the dose needs to be adjusted and you need to— sometimes practitioners will leave you too long, I find, on the incorrect dose. So if you don't feel good on your dose, definitely go talk to your practitioner and say, "Hey, I need something to be adjusted because I'm not feeling optimal." Really, when you get the optimal hormone therapy dose, you should be feeling better. You should be sleeping better, energy better, mood better, joint pain better, uh, and seeing other parameters in your health improving, including, uh, your bone density and your heart health and your brain health and so on. So we want to be seeing that we get the right benefits and not just assume that you're on the right dose. We want to be checking, we can be monitoring in blood work and urine to make sure that you're getting the benefits and that your body's, um, you know, doing well with your current form of hormone therapy. Okay, so I hope this helps. Please write back to me, let me know, and let me know if you have questions and I can cover in another video. Thanks again so much for joining me for this special episode, and I look forward to connecting with you very soon. Take care. Thanks for listening to How Humans Heal. If you liked this episode, leave a rating and a review. And for more resources, visit drdoni.com.