The Case:  Justine is 44 and dealing with sudden abdominal weight gain. She is also experiencing brain fog which is causing her stress. Her PMS is getting worse and she just doesn’t feel like herself. She saw her gynecologist who suggested birth control and antidepressants.  Medications are often the solution offered by traditional medicine but Justine wasn’t interested in going directly down that path. So, she came to me. I noted that she was still getting her regular cycle but suspected that the hormonal changes of perimenopause might be at play here.  The Journey to Hormone Balance My first step in helping Justine manage her changing hormones was to explore the connection between her symptoms and her hormonal changes. I reached out to Emily Sadri who is an expert in Hormone Replacement Therapy (HRT) and achieving hormonal harmony. You may remember Emily from past episodes, including 141 on Semiglutide (like Ozempic) and Weight Loss and 107 on Birth Control Use with Thyroid Issues.  The Fundamentals: Understanding Perimenopause and Menopause Despite the fact that half the population goes through menopause, there’s very little information available (and as Emily pointed out, this really should be something taught in school). So, let's lay the foundation with a basic understanding of hormones. Emily does a great job of explaining this in the episode. She shed light on the lifespan of hormones, highlighting that girls typically begin menstruating around the age of 11, which signifies a culmination of a year-long process where the brain and ovaries coordinate to initiate this significant change. Intriguingly, she drew parallels between menopause and puberty, suggesting that they are two sides of the same hormonal coin. Emily went on to discuss a fascinating aspect of hormonal decline, indicating that there's approximately a 10-year period before menopause when significant hormonal changes occur. She mentioned that the average age of menopause in the United States has been decreasing, from 51 to possibly 49, although precise data can be challenging to obtain due to various factors like contraceptive methods and hysterectomies. She stressed the unpredictability of when an individual might stop menstruating, emphasizing the importance of tuning into one's body and being attentive to subtle changes. Furthermore, she pointed out the availability of straightforward methods to test estrogen and progesterone levels, which can provide valuable insights into hormonal health. This knowledge gap in medical education, particularly regarding hormone testing, was an eye-opener for both of us during our conversation.  One of the most important things to note, with regards to Justine’s case, is the concept of hormonal acceleration, commonly observed between ages 41 and 43, where hormones can undergo rapid changes, often triggered by life events and stress, making it crucial for women to recognize the connection between these symptoms and hormonal fluctuations. Deciphering Hormone Replacement Therapy Hormones are the invisible architects of our well-being, influencing energy levels, sleep patterns, and even our emotional states. Achieving the right hormonal balance is paramount for optimal health.  One of the ways that women may choose to do this is with Hormone Replacement Therapy also known as HRT. At its core, HRT involves replenishing hormones that our bodies may no longer produce in sufficient quantities. Emily goes into a lot more detail in this episode, so I encourage you to give it a listen.  Why You May Want to Consider Replacing Hormones As with everything to do with our bodies, we are all different. When it comes to replacing hormones, the choice is up to the individual woman going through menopause. Emily and I discussed several reasons women may want to consider HRT. Here are a few:  Hormonal Decline: This could be at any time during the 10-year period prior to menopause when there's a significant hormonal decline. Women