Is Delaying Menopause the Key to Longevity? (NY Times)

Yes, I’ve thought that might be the case as well. My current approach is to keep my estradiol at a level just above the menopausal range (I’m a bit stumped on how how to phrase this politely) so I’m able to function adequately in my marriage which is to a slightly younger man. To my knowledge I don’t need high levels of reproductive hormones for anything.

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A couple of quick things on HRT - taken topically using FDA approved patches - monitoring levels is not needed - monitor by symptoms, so long as in the 0.025 to 0.1 mg/day range (most end up ~0.05). Make sure to be on micronized progesterone at night irrespective of whether one has a uterus as it is a great GABA agonist and normalizes sleep for most.
Do not use oral estrogens - topical only.
+/- add 10% of a male dose of testosterone.
That is a quick primer to my approach in this area - naturally lots of nuances, indications, contraindications … etc.
Labs of hormone levels aren’t needed UNLESS there are problems that aren’t obviously in need of fixing (exception would be if on testosterone I’d check occasionally). There reason is that we know the dose that is safe and effective with these preparations, and simply talking with the person generally lets us know if we are on a decent dose for them in regards to estradiol (skin, hair, sense of well being, for example) and progesterone (sleep quality, among others)

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Thank you sir! By some stroke of dumb luck or divine intervention this is my exact hormone regimen! Your input is always greatly appreciated and valued.

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Thank you for the information, may ask what is the reason for not using oral estrogen? Apologies if I missed something.

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Absolutely good question. Oral estrogens undergo first pass metabolism inducing clotting factors in the liver. Thus increased thrombosis (PE/DVT) and stroke. We should be using bioidentical on the estrogens now, so Estradiol - but I still see some physicians prescribing it orally - and they are increasing their patient’s risk of these complications for no conceivable reason when patches are available and eliminate this risk.
I also have patients come to me who have had prior DVT or PE and their doctor tells them they can’t have estrogens. This is incorrect - there is no increased risk of these issues with topical estradiol.
Hopefully that answers this one - let me know if any other questions.

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Yes, that explains it. And is it normal to start the patches when you are still getting period @50 years range of 21- 60 days. Or just wait and see whether Rapa helps with them continuing.

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What you said!!!
I had a clot once many years ago and recently asked about oral estradiol vs the gel I’m using, and the doc said not with your history.

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Peri-menopause is a complicated time on how to best manage the transition. There is some testing an planning needed. In general, we don’t want you having years of chaos with the transition, but need to sort out some stepwise sensible interventions to smooth the up and down of this time.
Seeing an expert is usually helpful in getting a plan together.
If one is of the understanding that optimizing hormones for life is probably the best approach for longevity - letting years of up and down happen along with metabolic and mental health effects may not be the best plan.
There is a risk/benefit with every intervention - or lack thereof.
Most of the time, individualized approaches are best, as one size doesn’t fit all.

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