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

Dr. Mindy Pelz 0:03 On this episode of The resetter podcast, I want to talk about a really hot topic, and this is not this is I probably say no pun intended, because we have been inundated with questions around the new enthusiasm for HRT. We're seeing it in my research Academy. We're getting a ton of questions from women, all ages there, the interviews I've been doing for age labor all, 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 the double 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 cons, so that you can make your own decision. This is a really important part you making 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. Might even send that doctor 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 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 trying 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 is it even on there. Now, remember, I want to go way back. There's a really interesting statistic. I found that in the early 2000s in 2000 where did they say in in in the 1990s it wasn't even the 2000s the study was done in 2020 in the late 1990s about one in four menopausal women took HRT. Fast forward to the 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, 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 A. 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 that cultural conversation? Is it purely because we're better with it, or some other alternative motive that's a personal thing that I question. Well, the 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 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 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 that 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 in to 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 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. Dr. Mindy Pelz 8:32 They were going to take these Dr. Mindy Pelz 8:33 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, 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 correlation there that perhaps women were suffering because they weren't getting access. Now. This is an important thing to know. Unknown Speaker 10:02 Since it's there are a lot Dr. Mindy Pelz 10:06 of things I just want to point out that have changed in the art, not only our physical environment, but have changed with women's health. So before I go even any further into this, into the the workings of this article and into delivery systems. It there's a lot I want to take you through. I want you just to stop and think for a moment that from the night 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. 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 processed foods has come a metabolic mess, and there is a connection between poor metabolic health and poor sex hormone health. Dr. Mindy Pelz 11:11 So even though doctors Dr. Mindy Pelz 11:15 are coming into their office 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 toxic food before. The other thing that happened was taken off is that we have women that are more nervous. Their system is more dysregulated than ever before, not from social media and overdoing everything in our life. So many women in 2025 their systems are worse than they were in the late 90s. So we have had Dr. Mindy Pelz 12:17 but any increase in these symptoms, due to the lack of HRT. Unknown Speaker 12:24 That's a question, Dr. Mindy Pelz 12:27 and I've been thinking about that a lot Dr. Mindy Pelz 12:33 during this time, when women Health Initiative study until now advances Unknown Speaker 12:43 so the study compared to what Dr. Mindy Pelz 12:49 being prescribed right now is a different type of hormone. We are Speaker 1 13:01 late 1900 1900 the hormones, the hormone replacement therapy was Unknown Speaker 13:11 some were injectable, were topical. Dr. Mindy Pelz 13:15 It the ones, and we break this down, have now been tagged or noted as being the problem, being the ones that Unknown Speaker 13:27 are potentially in this Dr. Mindy Pelz 13:31 influencer lens from your doctor's lens, bring this question to your doctor, what is it that we Need to Know About which delivery system is the safest Dr. Mindy Pelz 13:43 when you rub Dr. Mindy Pelz 13:44 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 oil 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. Speaker 1 14:13 This could be a conversion so that one parts about hormone Dr. Mindy Pelz 14:21 advances in HR have started to see that, gosh, maybe we need to live patches, at the gels, at the creams, or even some sprays, because they absorb your skin and we don't have to deal with The metabolic dysfunction and the detox dysfunction that's Unknown Speaker 14:47 happening from when the woman. Dr. Mindy Pelz 15:00 Environment has changed, but even the doctors that are prescribing it are also really looking at system. It's beautiful, and how you get into without having to always involve because the liver of many humans is in a complete mess, depending on whether 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 Dr. Mindy Pelz 15:41 that is going to Dr. Mindy Pelz 15:44 hemoglobin a 1c I'll explain all this as we go through. I have a hemoglobin a 1c of like 6.0 so I'm diabetic or pre diabetic, 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 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? A 1c 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 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 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 topical is a 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 estrogens derived from horses, and today, doctors are prescribing estradiol, which is a structurally ident is structurally identical to the naturally occurring hormone in your body, and most modern estradiol for HRT is synthesized from the ants. 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 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 dysregulated woman? This is something to consider. Now. 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, and the recent announcement about removing this warning label, the FDA made the following claim, women may also reduce their risk of cardiovascular disease by as much as 50% Hold on. Time out. Whoever's editing this, I gotta go back and read this. Now, when the label was taken off, the FDA made this announcement. That women may also reduce the risk of cardiovascular disease by as much as 50% Alzheimer's by 35 and bone fractures by 50 to 60% 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 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% Alzheimer's disease by 35% and bone fractures by 50 to 60% 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 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 will go down by 50% Alzheimer's by 35 and bro in 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 Dells and sprays. And that was a big bombshell 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 and with no 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 would sucks. Let's just say it. You're You're the FDA. You're supposed to be protecting us like 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 recenter podcast, a lot of different opinions. So please go listen to the episode that I did with Dr Neisha winters. It has been the most popular one this year, because a lot of women are very scared to get on HRT. And Naisha is a cancer doctor who has been helping women avoid HRT because of the the breast cancer concerns. I also brought you doctor Kelly has person who is a urologist that is a huge fan of Dr. Mindy Pelz 24:35 testosterone, specifically that whole episode was on testosterone and how every woman should be taking testosterone. And we dove into 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 you dive into this if you want a more thorough analysis of it's right for you. And those are three great reset or 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 risk. 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 transdermal HRT, and they saw that they were Yeah, both oral and transdermal 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 that the oral HRT, estrogen and progestin carry the highest risk. We're back at the delivery system. The delivery system matters, and that the transdermal 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 a lot of 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 who over, they followed for 12 years, I'd like to know what was the average hemoglobin, a, 1c 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 estrogen, synthetic estrogen. 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, modest increase in breast cancer. We don't know the metabolic and nerve and toxic load of these breasts, the people who got breast cancer. So just before you all rip your patches off, understand there is 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 the the. On hemoglobin, a one, THC 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 depends on the body it needs. 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 thromboembolism, 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 hydride triglycerides, this could be dangerous. So we 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 though a patch, that's the right delivery system, but I already have high cholesterol, I already have high triglycerides, and I'm eating an ultra processed 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 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. Dr. Mindy Pelz 33:04 Okay, again, how do we make HRT safe? How can it be used in a way that allows us to 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 frontiers of Endocrinology 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 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 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 every. Everyone we need to still work on lifestyle. And I also want to point out, as did Dr Neisha in my, in my, my interview with her, is that you do have alternatives, and I'm going to talk about those now. So 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 that 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, is absolutely making it more dangerous for you. Let's get off the jump. 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, I could, 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're start your fasting window at like 5pm instead of 9pm 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 in to the aging years, is that it becomes less efficient at using glucose, meaning it can't use the food you eat, the glute that 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 my, probably my favorite interview of 2025 it was Dr Georgia Edie. She has 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 four or five 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 fast. 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, God, giving you brain fog. And you're 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 it's really important to understand the ketones for brain house, 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 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 have 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. You know, when you get the book, you'll understand more. 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 it's a function, it's a function of exercise variation. So, so that's something to that's something to think about. Okay, third one is your sleep habits. Now, in AIDS, other girl, I have a whole chapter on how to sleep for the menopausal woman. Woman, because estradiol, 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 the evening sun. So sunrise and sunset have a red hue to that, to that, to to the color, and that triggers a part of your brain that lets it know where it is, in the in the in the circadian rhythm of the day, so that it knows when to make melatonin. So before we start lathering 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, Dr. Mindy Pelz 42:01 and then we also need to look at the the social and emotional changes that happen with HRT. And this was really the heart of of or that happened through menopause. This really was the heart of H like a girl, you 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 got rid 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 Neisha 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 three. It's not a loss of estrogen patches, it's diabetes type three. 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 HRT make sure you're on the right dose. And when you're doing blood work with your doctor, zone in on hemoglobin a 1c get that sucker closer to five, 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 something I've been studying for over 10 years. Is what is the purpose of menopause? Why do we get less 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 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 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. Dr. Mindy Pelz 48:19 So let me know if this helps. Wherever you're Dr. Mindy Pelz 48:23 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 16. I talk about everything that I just talked about is in age like a girl and the lifestyle part two is the lifestyle and 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 of the pill, that you have control over your health. And it all starts. The starting place is metabolic health. Start with amazing so as always, I hope that helps. If you need more support in this, 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 1000s 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 as always.