HRT, Hormones, and Midlife: What Every Woman Needs to Know Before Deciding with Dr. Mindy Pelz

If you are somewhere in your 40s, 50s, 60s are beyond, and you felt like your body is changing, your brain is foggy, your moods are all over the place. Here's what I want you to know. You are not alone. So many of us experience this as we move into our postmenopausal years. So for starters, you're not broken. Just keep in mind that because you're going through a transformation and like any phenomenal transformation, it's really important to have a guide, not guesswork. So this is why I created what I call my reset academy. It's a really cool group of online women from all over the world where we come together to learn how to fast for hormones, how to eat for our brain, how to understand the behavioral changes that are going on with us, and to really give women an opportunity to feel at home in both their bodies and their brains again. In the reset academy, we do many live calls, we do lots of challenges together, we have monthly programs, and you have an incredible community that is built not only from me and my team of coaches, but from women who have been in the academy for years that have read my books, done my videos, listened to my podcast, and are working on making themselves the best version they can possibly be. So if you're looking for that community support, if you're wanting to lean into more knowledge, get off of the socials and into a really cool live community, come join me inside my reset academy. You can go to resetacademy.dotdoctormidipels.com and find all the ways you can sign up there. I will tell you my absolute favorite thing we do in this community are the Saturday morning coffee chats where two Saturdays a month you will find me not only working out with you all, but leading you through whatever is burning on my heart and opening up community discussion around how as women we can use our metapuzzle experience to come together and how we can use it to not only better ourselves, but better everyone around us. So excited to see you inside my reset academy. On this episode of the resetter podcast, I want to talk about a really hot topic, and this is not, this is, I should probably say no pun intended, because we have been inundated with questions around the new enthusiasm for HRT. We're seeing it in my reset academy. We're getting a ton of questions from women of all ages there. The interviews I've been doing for age like a girl. I've been getting a ton of questions about it there. And even in my own ladies' nights out, there seems to be a buzz about is HRT good or is it not good? So even though there's this incredible enthusiasm around it, what is it that we need to know? So on this episode, I'm going to break the science down. So I have gathered the most current research that's showing both the pro and the con so that you can make your own decision. This is a really important part. You make in your own decision is probably the most important thing I can say. And I want to talk through some of the lifestyle considerations, some of the blood work you want to look at. And I'm hoping by the end of this podcast that you're going to have the just the right amount of information to be able to make a smart decision for you. So with that in mind, let's dive in. Now first, if you're like, why is she talking about HRT all of a sudden? I do want to make a point out that last week, or depending on when you're listening to this a couple of weeks ago, the FDA announced that they were removing the warning label on hormone replacement therapy for menopause. This was a huge win according to many health influencers and menopausal experts, many of which I've brought you here on the Resetter podcast. And everybody was a buzz last week. But after that, just like many amazing emerging trends have come in in a lot of different media sources, the concerns. So I can tell you as a 56 year old woman that this gets very convoluted and there's a lot of nuance that you need to know. So we're going to go through all of that nuance. I also want to point out that the decision to go on HRT is a personal one. And so after you listen to this whole podcast, you decide how does this feel? Is it are you are you congruent with this decision to go on it or to not go on it? And then I really encourage you go to your doctor and you have a collaborative discussion. Now remember that your doctor is on your health team. When you go into that doctor's office, this isn't an opportunity to give your power away to the doctor and do whatever that doctor says. This is a time for you to come into communication with that doctor. You might even send that doctor this podcast and say, this is what I've heard. Tell me where you sit on it. Also, just in full transparency as a 56 year old woman, I do take HRT and I am in a really good team atmosphere with my OB. We are testing blood. My blood every 90 days making sure that we are dialing in the right HRT for me. So just so you understand the lens in which I'm coming from, I've done a lot of this research on my own. I've done a lot of the lifestyle changes. I'm going to recommend you make in here on my own. I've tried many different versions of HRT and I after years and years and years of triating these different versions have come up with a plan that works for me. And I want to, I'm hoping at the end of this podcast, you too will have a plan that works for you. So first thing to know is, or the first question to ask is why was the warning label even offered? Like why was it even on there? Now remember, I want to go way back. There's a really interesting statistic I found in the 1990s. It wasn't even the 2000s. The study was done in 2020. In the late 1990s, about one in four men and a pozzle women took HRT. Fast forward to 2020. By the year 2020, the number had fallen from one out of 25 women taking HRT. What was that from? And it was really from one study that we're going to break down. But understand that I'm just going to say it in and you decide how you, if this resonates with you, that is a profit loss for big pharma. To have that many women not have access to HRT. Does that mean this is the new resurgence of HRT is all driven by big pharma? No. But that makes me curious, not even skeptical, curious why all of a sudden we have this massive resurgence of HRT. What is driving the cultural conversation? Is it purely because women would do better with HRT or is there some other ulterior that's a personal thing that I keep questioning? Well, the FDA's website recently there was a huge outrage from a lot of health influencing doctors who are speaking about menopause on the biggest scale possible. Even doctors that are in practice that aren't necessarily doing teaching through social media, but are seeing how so many women are suffering through this experience that they started to worry that this FDA labeling was misleading and outdated. And they were seeing that many doctors were scared to prescribe HRT because of the fear on this black box labeling. That was the motivation is how do we remove that? So the doctors, this is important. So the doctors can make the right decision in conjunction with their patient and not be so fearful about this label that's on the side of the packaging. Now, the ground that the warning that was added to the hormone packaging was added in the year 2002. And it came after what they considered a groundbreaking study from the Women's Health Initiative. And this study said that HRT, taking HRT, increased the risk of heart disease, stroke, dementia, blood clots, and breast cancer. And that led to the warning that went on the black box. And we started to slow down using HRT as a tool. Now, the first thing I want to unpack with you is what happens in these studies. So for many, many years, when I was bringing fasting forward to the world, I would spend about 20 hours a week. I am not joking all of my free time when I wasn't seeing patients was diving into a search engine called PubMed, where all the peer reviewed journal articles go. And I learned a ton about science. And the first thing I want you to understand about a science article is that you want to know several things. First, you want to know sample size. So in this particular study, there was 16,000 menopausal women that were studied. Okay, that's a really good sample size. You also want to understand what were the parameters? How long did they look at this study? And what was really interesting is that this Women's Health Initiative study being one of the biggest ever done on women. And it was funded by the US government, by the way. And we'll go back into this in more detail, that it was supposed to be an eight and a half year study. They were going to take these 16,000 women and they were going to look at them over eight and a half years. But what they found is that the safety panel that was put in place to study these women, that after five years, they stopped studying these women because they started to see that women who were receiving HRT showed a major spike in breast cancer. They also saw that they had an increase in heart disease stroke and blood clots. And follow-up research also found a possible increase in dementia. So they didn't even see it all the way through. They didn't even get completely all the way through the study. And the researchers who published their data suggested that worldwide women stopped taking HRT, which is how we went from one in four to one in 25 and the label was put on the packaging. And that's the, by the way, that's close to a 70% drop. So over the years, what they started to see was women suffering less HRT use. So there was a correlation, not always a causation, but a correlation there that perhaps women were suffering because they weren't getting access. Now this is an important thing to know. Because since 1990, there are a lot of things. I just want to point out that have changed in the, not only our physical environment, but have changed with women's health. So before I go even any further into the, the, the workings of this article and into delivery systems at HRT, there's a lot I want to take you through. I want you just to stop and think for a moment that from the late 1990s till 2025, what has changed in our environment? And I want to point out that metabolic health has gotten worse. So this is going to be something we're going to dive into a lot on this podcast. Metabolic health has gotten tremendously worse. We have, when we went into the pandemic, we only had 17% of Americans. That was both men and women that were metabolically healthy with the introduction of ultra-process foods has come a metabolic mess. And there is a connection between poor metabolic health and poor sex hormone health. So even though doctors were seeing this flood of women coming into their offices with these increased menopausal symptoms, we can't say that it's because they didn't get access to HRT because they also were being exposed to more toxic food than ever before. The other thing that happened from the late 1990s till this moment where the, the warning label is taken off is that we have women that are more nervous, their nervous system is more dysregulated than ever before. Not only just from social media and overdoing everything in our life, so many women in 2025, their nervous systems are worse off than they were in the late 1990s. So we have had a massive shift in the environment, in the foods, and the way in which women are living. And so of course that's going to cause an increase in menopausal symptoms. And of course, OBs are going to be nervous about that. But is the increase in these symptoms due to the lack of HRT? That's a question you have to answer for yourself. And I've been thinking about that a lot. The other thing that we have to look at during this time period is from that women's health initiative study until now advances have happened in HRT. So the type of hormone that is being prescribed, that was prescribed in the study compared to what is being prescribed right now is a different type of hormone. So we are looking at a much safer delivery system. So back in the early 2000s, late 1900s, the hormones, the hormone replacement therapy was oral, was mostly oral, some were injectable and a few were topical. The oral ones, and we're going to break this down, have now been tagged or noted as being the problem, being the ones that are potentially more dangerous. And if you'll start to see even in this from the health influencer lens, from your doctor's lens, bring this question to your doctor is what about the delivery system? What is it that we need to know about which delivery system is the safest? When you rub a cream on your body or you take a or have a patch, what ends up happening is you don't have to involve the liver in the breakdown of or the conversion of that hormone. Whereas anything that goes oral into your mouth has to be metabolized and reformatted by the liver. And if your liver is metabolically unhealthy, you're drinking a lot of alcohol, you have a high toxic load, this could be a hard conversion. So that one of the cool parts about hormone replacement therapy is that the advances in HRT have started to see that, gosh, maybe we need to look more at the patches, at the gels, at the creams, or even some sprays because they absorb through your skin and we don't have to deal with the metabolic dysfunction and the detox dysfunction that's happening in the liver. That's a win. That's a really good thing. So just in this time period, from when the study hit and everybody got off at HRT to now where we're having this conversation, not only has the woman going through menopause changed because the environment has changed, but even the doctors that are prescribing it are also really looking at the delivery system, which is beautiful. And how do we get it into the system without having to always involve the liver? Because the liver of many humans is in a complete mess. Depending on where you're listening to this video or this audio, if you go to my YouTube channel, I have done so many videos on fatty liver disease because it is an, it is a epidemic. More and more people are getting fatty liver disease. So if I'm a 42 year old woman that is going through perimenopause and I have a hemoglobin A1C, I'll explain all this as we go through. I have a hemoglobin A1C of like 6.0, so I'm diabetic or prediabetic, and I have fatty liver disease. Yeah, taking an oral version of that HRT could be a huge problem. And that might have been what they didn't look at in that study is who were the ones that got breast cancer? That that that caused the whole study to stop. Who were the people in that study that were getting breast cancer and what was their lifestyle? So something to think about. Also, where are you in this right now? What's your hemoglobin A1C? How healthy is your liver? These are things that we need to bring into conversation with your doctor. Now the difference of delivery system is interesting because today we have these HRT treatments that are patches and gels, like I've mentioned. And injections and early HRT pills caused estrogen to build up in this liver along with now, let's fast forward to all these women with with liver challenges. But when you absorb something through your skin, it doesn't it it it bypasses the liver and it produces more stable estrogen levels. And in a 2012 review in the Journal of Women's Health, they found that topical HRT avoids the increase of risk in heart disease, stroke and blood clots. Okay? That's exciting. So we're also seeing that the topicals have very good choice. And we're all they also found in this review that the form of estrogen matters. In 2002, HRT contained a conjugated equine estrogen, equine meaning from a horse, which were estrogen's drive from horses. And today doctors are prescribing estrogen dial, which is a structurally identical to the naturally occurring hormone in your body. And most modern estrogen dial for HRT is synthesized from yams. Okay? So can you see we've had an evolution of what HRT is? But we've also had a decline in human health over this time period. Again, follow me. This is important. In a 2014 study in JAMA, they found that estradiol, this new form of HRT is much safer than the equine form. Even if you're taking it early, it's the it's the quality. And that it carries a lower risk of heart disease, stroke and blood and blood clots. And so today's HRT is safer than what they were studying back then. But today's menopausal woman is sicker. And this is the challenge right here. Because what is coming out in this moment is this HRT has been rebranded. But what we're not talking about is the woman's health that is going through menopause and how HRT, even in its new latest and greatest format, how does it fit for the metabolically stressed out, disregulated woman? This is something to consider. We have a whole group of people after the black box was taken off, the label was taken off that are still very concerned. And this is what's come out this week. In the recent announcement about removing this warning label, the FDA made the following claim that women may also reduce the risk of cardiovascular disease by as much as 50 percent, Alzheimer's by 35 and bone fractures by 50 to 60 percent. So this is why everybody's excited. But they do something really strange here. They back this statement up with links to three studies. And I will leave those links in here so you can do your own research. One was from a study done in 1996 that was published in the archives of the Internal Medicine. The second was a study done in 1991. The dates are important that was published in JAMA. And one was all the way back from 1990, which was published in the New England Journal of Medicine. So when you hear the great news of the day that we took the label off, it's safe for women. And we it's going to reduce cardiovascular disease by 50 percent, Alzheimer's disease by 35 percent and bone fractures by 50 to 60 percent. That is based off of old research. And we need some new research. And we need new research to be in conjunction with the new woman going through menopause who is potentially dysregulated and metabolically unhealthy. So we still can't believe everything that we're hearing coming out of the mouths of things like the North American Menopause Society and gurus that are advocating for HRT. These studies are decades old. And the third one was published almost 50 years ago. The one that was way back in 1980 that contributed to this thing that you would cardiovascular disease would go down by 50 percent, Alzheimer's by 35 and bone fractures by 50 to 60. That was the third study they pulled was from the 1980s. The HRT formulation in those studies aren't even being used anymore because newer and better research is finding that we need to use creams and gels and sprays. And that was a big bomb shell that was dropped in the 2002 original study that threw this whole conversation into disarray that that this old research. Remember this old research is wrong. And that the version of HRT that is being used in the 80s and 90s did more harm than good but they took the black label off based off of research done in the 80s and 90s. So we're still left without research. And we're still left with a very different menopausal woman. So of course I had to ask myself why would the FDA cherry pick these three? So why would they have very old studies and with no relevance to the modern day HRT? And maybe it's because the numbers looked very impressive on the surface and the problem they've been dealing with has since been debunked. For example, in a 2024 review in Curious they found that transdermal HRT caused women only a modest decrease in cardiovascular disease and only in some women. It didn't work for every woman. So it seems like maybe the FDA may have overstated the benefits of HRT which sucks. Let's just say it. You're the FDA. You're supposed to be protecting us. And we need to know what the current research is showing. And if there is still risks we need to be aware of and how does it fit for the modern woman that might have her nervous system dysregulated and her metabolic system completely off. So in this confusion I've tried to bring you all here on the resetter podcast a lot of differing opinions. So please go listen to the episode that I did with Dr. Nacia Winters. It has been the most popular one this year because a lot of women are very scared to get on HRT and Nacia is a cancer doctor who has been helping women avoid HRT because of the breast cancer concerns. I also brought you Dr. Kelly Kasperson who is a urologist that is a huge fan of testosterone specifically. That whole episode was on testosterone and how every woman should be taking testosterone and we dove into the the how testosterone can be affected by poor metabolic health. So please go and listen to those those so that you can have you know decide for yourself. I also brought you Dr. Vonda Wright who wrote an incredible book called Unbreakable who's an orthopedic surgeon also a fan of HRT. And so I wanted her to talk about that from a bone density standpoint. So make sure you dive into this if you want a more thorough analysis of it's right for you and those are three great resetter podcasts that I've done trying to give you opposing positions. But let's talk about the three biggest risks that still keep coming up with modern day HRT. The first is breast cancer. Now I'm going to quote some science that I found and then I want to explain a new new study that came out just weeks ago. So modern HRT is better than it used to be. We can all agree on that. But it still may have some concerns for breast cancer risks. So there was a 2024 analysis in the British Journal of Cancer that looked at data from 1.3 million women on various types of HRT. And they followed them for an average of 12 years. And they looked at both oral and trans dermal HRT. And they saw that they were, yeah, both oral and trans dermal was associated with a moderate, modest increase in breast cancer risks. This is an analysis from 2024 from 1.3 million women using various types of HRT followed for 12 years. This is not a schlocky study. And they find that there was a modest increase in breast cancer risk. But what they went on to say is that the oral, the oral HRT estrogen and progestin carry the highest risk. We're back at the delivery system. The delivery system matters. And that the trans dermal estrogen carried a lower, yet still statistically significant risk. It's better than it used to be. But HRT can still increase your odds of getting breast cancer. Now, I don't have on a study on the next thing that I want to tell you. I spent a lot of time in my clinic helping patients who, especially women, who had breast cancer with lifestyle. And the massive holes we are seeing in these studies is what other things were these women doing that might have contributed to breast cancer. And I can tell you two big ones. The first one were back at metabolic health. So in this study with 1.3 million women, they followed for 12 years. I'd like to know what was the average hemoglobin A1C? What was their metabolic health? It is a well-known fact that poor metabolic health can lead to cancer. So we don't know the metabolic health of this 1.3 million people. So this modest increase in breast cancer risk may have happened to the women who did HRT and had poor metabolic health. That could have been the deadly combination. The other deadly combination that we know about breast cancer is that a lot of women are putting endocrine disruptors onto their skin through beauty products. And these are synthetic estrogens. I wrote about this in age like a girl. My new book coming out and a book I put out years ago called the Menopause Reset that there are toxins in our environment that will start to spike estrogens, synthetic estrogens. It's not real estrogen. And so as it spikes synthetic estrogen, all of a sudden that estrogen gets higher and higher and higher. And then now you put on a cream with estrogen and maybe you put poor metabolic health in there and you have a smoking gun. So what we're not getting in this HRT conversation and what we're not getting in these studies is that when it says it was associated with a modest moderate in modest increase in breast cancer, we don't know the metabolic and toxic load of these the people who got breast cancer. So just before you all rip your patches off, understand there's an underlying lifestyle here that I believe works, makes HRT work, which is why I'm on HRT. And there's an underlying lifestyle here that makes HRT dangerous. And it's that lifestyle that needs to be talked about now. So know that those measurements, the endocrine disruptors you put on your skin and the hemoglobin A1C are really important. Okay, the second challenge that doctors are still concerned about with this new version of HRT is that it has been stated that HRT lowers heart disease risk for some, but it doesn't work for everyone and it depends on the form you take. I'm also going to say it depends on the body it meets. So we talked earlier about the 2024 review and curious that looked at HRT and cardiovascular disease and it found that the transdermal hormone replacement therapy caused a modest decrease in cardiovascular risk in some women. But that the oral HRT caused a modest increase in heart attack and stroke risk. So that review, again, the delivery system mattered for cardiovascular disease. So is it possible that we just need to dial in the right delivery system? Oral HRT caused up not just a moderate increase in heart attack and stroke. It causes your blood to clot abnormally and then those blood clots can break off and block blood flow throughout your whole body. It's something called a thromboemalism and this is especially risky if you have high blood pressure. We are back at metabolic health. I hope you're seeing a trend. I hope you're seeing that we have conflicting science. I hope you're seeing that the delivery system matters and I hope you're seeing that your metabolic health is a massive piece of this puzzle. Let's get your metabolic health in order and then the conversation around HRT becomes one that's a lot safer. Now this 2024 review all forms of HRT can increase blood triglycerides by up to 20%. And if you have high triglycerides, this could be dangerous. So how do we make sure that you keep your triglycerides in good shape? This is a function of eating good fat, not bad fat. So if I go on even the patch that's the right delivery system but I already have high cholesterol, I already have high triglycerides and I'm eating an ultra-process diet. Then yeah, there's a good chance that I'm going to see a higher increase in my triglycerides. They say up to 20% doesn't matter the delivery system and I'm setting myself up for a cardiovascular event. And this review that I'm continuing to talk about here in the 2024 found that HRT in any form is risky for overweight women or women with a family history of heart disease or stroke. Okay, again, how do we make HRT safe? How can it be used in a way that allows us to thrive at going through menopause but not to set us up for these diseases? We're going to talk about that in a moment. I'm going to give you a plan at the end of this so don't go anywhere. The third challenge is that we have a lot of people who have side effects. So HRT isn't like taking a painkiller and your pain goes away. There is a learning curve. And there was a 2021 review in the front tears of endocrineology that found HRT was particularly good for vaso motor issues through menopause like hot flashes and night sweats. I know a lot of women. I would say most of the women I've talked to who have been on HRT will say that it helped the hot flashes. But they also note in this review and many of the women I've talked to and many of you listening to this is that there were side effects of HRT including mood swings and depression and migraines and nausea, bloating, breast tenderness, acne and fatigue. So bottom line HRT depends on your unique biology. It depends on your metabolic health. It depends on your toxic load. It depends if your nervous system is regulated and balanced. And so if those are not in order, they're still a very big question mark if this is right for you. And these are the questions I want you to take to your doctor. Because just because we removed the black box labeling doesn't mean it's safe for everyone. We need to still work on lifestyle. And I also want to point out as did Dr. Nesha in my interview with her is that you do have alternatives. And I'm going to talk about those now. A lot of the doctors that I talked with about HRT and I've talked to a ton is that there are super simple lifestyle tools that you can use before you go to HRT that will help you make yourself feel better. So let's go through the first one. The first one is change how you eat. And by that I mean the timing of your food and I mean the quality of your food. The number one thing that every single menopausal woman over 40 needs to consider is getting off ultra processed foods. These are your inflammatory oils. These are your refined carbohydrates, your refined sugars, get off the junk. That is making your menopausal symptoms more. And if you are on HRT, it is absolutely making it more dangerous for you. Let's get off the junk, get on to nature's foods. In age like a girl, I have a whole cookbook called Eat Like a Girl. I give you the formula for healthy eating for the female body when it comes to hormones. In age like a girl, I have lists, I have a new plan that I'm bringing forward called the primal menopausal diet that's really easy to follow. So we want to get on to healthy foods and off the toxic food. The second part of eating is look at when you're eating. Now I just got off a class with my reset academy and I'm teaching that in my reset academy I teach how women can customize their fasting lifestyle. And your eating window where you move your eating window is up to you. So there's some new research coming out saying it's better to eat for hormones if you eat in the morning. I could see that. I'm not a personally hungry in the morning. But if you're hungry in the morning, maybe you need to eat first thing in the morning and stop eating so late at night and you start your fasting window at like 5 p.m. instead of 9 p.m. So you get to move your eating window around wherever you want to put it. But the most important thing for the menopausal brain as it is moving into the aging years is that it becomes less efficient at using glucose meaning it can't use the food you eat. The when you eat you make all that food breaks down into these little tiny glucose molecules. And those glucose molecules when they hit your brain, your brain cannot use them as well. And so it needs you to go to your other fuel source which is a ketone. I did what was probably my favorite interview of 2025. It was Dr. Georgia Ede. She is a metabolic psychiatrist and she talks about how powerful ketones are for the menopausal brain. So even if you change your food, I encourage you to think about your timing of your food. And if you like eating in the morning, eat in the morning and shut down your eating window around 4 or 5 so that you leave longer for fasting. The most important study that was ever done on fasting for women was done on women going through traditional breast cancer treatment. And what they found is that if women post conventional breast cancer treatment fasted for as little as 13 hours every single day that they had a 64% less reoccurrence of breast cancer. We're not talking long fasts. Tack a fasting window onto every single day with good eating and you're giving your brain ketones and you're bringing down the inflammatory foods that are causing your brain to swell, got given you brain fog and you're going in alignment with how your brain wants to be treated. I have a whole chapter on this in age like a girl, a whole chapter on it. It's really important to understand the ketones for brain health because I've witnessed it with millions of women who are not on HRT who you start to teach them a fasting lifestyle and their brain comes back online. The other thing you want to look at with when you're making the decision of HRT or no HRT is not just how you eat or when you eat but are you exercising? So I agree we need to be exercising more. In fact in age like a girl I found some really cool information that shows that when our reproductive system shuts down we have a renewed energy and that renewed energy is meant to go towards fitness. So if you're 50 and you're not rocking your workouts, if you're not lifting weights now is the time to do that. You were meant to be more fit. All that energy was restored back to you so it's under something called the grandmother hypothesis. When you get the book you'll understand but it's really important that we are exercising and a variety of exercises. I believe we should be exercising in nature so we can bring cortisol down. I love the idea of lifting heavy weights. I think that is fabulous. I'm a huge fan of yoga for flexibility and balance and regulating your nervous system. So I think it's a function of exercise variation. So that's something to think about. Okay third one is your sleep habits. Now in age like a girl I have a whole chapter on how to sleep for the menopausal woman. Because ester dial she actually coordinated your circadian cycle. So it's more important than ever that you're getting out and seeing sunlight. Specifically the morning sun, the evening sun. So sunrise and sunset have a red hue to that, to that, to the color and that triggers a part of your brain that lets it know where it is in the circadian rhythm of the day so that it knows when to make melatonin. So before we start relathering ourselves with cream praying it's going to work, have we started to get out into the sunlight and look around to make sure that we're telling our brain what it needs to be able to bring its circadian rhythm back. I have a whole chapter on that in the in the book. And then we also need to look at the social and emotional changes that happen with HRT and this was really the heart of or that happened through menopause. This really was the heart of age like a girl. Your brain is rewiring as you go through menopause and many of the behaviors that served you in your younger years do not serve you anymore and there are changes to your life that need to be had. Maybe it's changes to your relationships, maybe it's changes to how much you're working, maybe it's it's changes to toxic friends that need to be let go of. But I would encourage you when you look around where are the toxic environments that make you feel horrible and can you avoid those. So now we're going into our 40s let's say and we can ask ourselves am I eating clean? Am I fasting? Am I getting out in the sun at the right times the day so I can make sure I get to sleep at night? Am I getting rid of the toxic environments that I sit in that toxic people and toxic relationships and toxic work environments? Have I have I learned to navigate that? Do I have tools to be able to manage the stress? And am I doing exercise variation? So that's a lot that's a lot and people like Dr. Nesha feel like we should be doing all of that before we put the cream on. I will tell you that I sit somewhere in the middle. I sit somewhere where I would I would say that we definitely need to dial in our lifestyle before we patch it up before we cream it up and these things that I'm mentioning that can take 90 days it doesn't it's not hard but we can't leave lifestyle out of the equation and if you don't do those things and you go on to HRT then you're seeing some of the risks and we know Alzheimer's is diabetes type 3 it's not a loss of estrogen patches it's diabetes type 3 it's a metabolic problem fix the metabolic system doing many of the things I just explained and your chances of Alzheimer's become less so there's like a complete picture here that we should look at let's clean up the lifestyle first if that's not working then go on to HRT make sure you're on the right dose and when you're doing blood work with your doctor zone in on hemoglobin A1C get that sucker closer to 5 maybe 5.2 because if you're there not only are your menopausal symptoms are going to be better not only are you going to need less of your hormone replacement therapy but you might not need it at all so this is why I wrote age like a girl it's it's something I've been studying for over 10 years is what is the purpose of menopause why do we get left 42.5% of our life without a reproductive system and how are we going to navigate this as a modern culture and it's not because we were scared off by an old study with an old HRT delivery system and HRT may be right for some of you it may be the miracle that you need it to be but you know what the true miracle is your own intelligence inside your body your own brain that's rewiring itself your own neurochemical system that is changing and upgrading you are the hero of menopause not HRT not your doctor you can make the changes that you need in your lifestyle so that you may either avoid HRT or if you go on HRT you won't get the side effects that they that many of these studies are still proving it's all comes back to lifestyle and at the heart of lifestyle is metabolic health so I hope that makes sense I hope you understand the trajectory of what has gone on here and I hope you see that there's no one-size-fits-all and I can give you a case for it I can give you a case against it but what I cannot do is leave lifestyle out of the conversation so talk to your doctor about how you improve your metabolic health talk to your doctor about how you can start to regulate your nervous system talk to your doctor about what recommendations they have for lowering your endocrine disruptors these are the kind of things we need to be in conversation with as we go through the process of deciding yes or no to HRT and unfortunately the sound bites of social media the sound the excitement of the OBS out there that can can confidently use this tool right now are overshadowing this root message that lifestyle still matters and this root cause of poor hormonal health and cancer and cardiovascular disease and Alzheimer's and dementia the root of all of that is poor metabolic health I promise you I have watched millions of women restore their own health just by looking at that one target and improving that one target and this isn't a conversation around now you do HRT with ozempic which some of your doctors will be recommending that's up to you this is about you rolling up your sheet sleeves and making sure you're eating well that you're sleeping well that you're exercising well and that you're hanging around and putting yourself in positive environments that matters especially to the female body so let me know if this helps wherever you're consuming this write me a review let me know age like a girl is out and ready to be ordered depending on when you're listening I should say it comes out on December 16th I talk about everything that I just talked about is in age like a girl the lifestyle part two is the lifestyle I'm recommending for you so that you can thrive at HRT if you choose to do it or you could avoid HRT if you don't make sure you have a great doctor make sure you're not getting gas lit make sure your doctor is a team member of your health and don't ever give up on yourself if you start feeling better with HRT HRT wasn't the magic you're the magic keep reminding yourself that you are the solution not the patch the cream on the pill that you have control over your health and it all starts the the starting place is metabolic health start with amazing metabolic health so as always I hope that helps if you need more support in join me in my reset academy we'll leave links below and you can you can partake in the in the conversations we're having over there with thousands of women who are all navigating their own personal decision so don't give your power away you have the power to not only go through this experience with smooth and or maybe very little symptoms but you have the power to stand equal with your doctor and to bring them science like what I just brought them what brought you right now and you have the power to decide if this works for you or not don't give your power away as always I hope that helps thank you so much for joining me in today's episode I love bringing thoughtful discussions about all things health to you if you enjoyed it we'd love to know about it so please leave us a review share it with your friends and let me know what your biggest takeaway is