I have never seen a foreigner, so I really don’t know how the average foreign woman thinks about postmenopausal HRT? In China, HRT (hormone replacement therapy) is quite a struggle for ordinary people (in fact, many doctors are also quite struggling). There are many articles on menopause and HRT on the Internet, and I won’t talk about the benefits of HRT. I’m not going to talk about the benefits of HRT. I’m just going to talk about my personal feelings. When I first started working, HRT was very popular at that time, and people thought that estrogen could prolong life and keep youth forever, and it was like a tenfold tonic. When the results of the American study came out, the whole world was in an uproar, and HRT fell into a low ebb, as if taking estrogen would lead to breast cancer and blood clots. At that time, I had just started to study reproduction and endocrinology, and to be honest, I also thought that HRT was just an icing on the cake. Old age is old age, and one can’t beat it. However, people around me, including my relatives, seniors, teachers and so on, started to age gradually. I have seen the changes after menopause and the advantages of HRT, and I no longer think that HRT is optional. To put it simply, the perimenopause and postmenopause will undergo the following changes: At the age of 50, the menopause starts, including hot flashes, sweating, distress, insomnia, weakness, panic, shortness of breath, back pain, etc. In short, the body is uncomfortable, and you often go to the hospital frequently to check this department and that department, but nothing serious can be found (often you can also find some minor problems). The problem is that you can’t find anything serious (often you can also find some minor problems), and you don’t know how to get better after a few years of confusion. Or if you know that you are going through menopause, you just put up with it and it will pass after a few years. At the age of 60, frequent vaginitis and urethritis start to occur, and when anti-inflammatory drugs are used, it takes a few days, but if they are not used, they will commit again, and I don’t know how many anti-inflammatory drugs I have taken. At the age of 70, she began to suffer from osteoporosis and fractures. She became shorter, her strength was not good enough, and she was an old man at first glance. Of course, this also runs through the high blood pressure, heart disease, memory loss, etc.. Except for the “menopause” period, few people associate these problems with menopause, and always think that these are “old age diseases”. Many of my teachers and seniors have been taking estrogen for more than 10 years or even decades, and they are still energetic and quick-witted in their 70s. So I always tell my patients that HRT is a long-term thing, it will not be good for a short period of time, but after 70 years old, it will be very different compared to people of the same age. Many people also know the benefits of HRT, but they are afraid. They are afraid of gaining weight, breast cancer, blood clots and strokes. As you know, the neurology department of Tiantan Hospital is very famous, and the neurology doctors are not too enthusiastic about HRT. Regarding the issue of weight, I can tell you responsibly that HRT will never put on weight. It is natural for people to get fat in their middle age, and HRT not only won’t make them fat, but also helps to control their weight. I once did a project where I raised a group of rats, removed their ovaries to cause artificial menopause, and then supplemented them with estrogen. As a result, the rats without estrogen supplementation lounged around in the sun all day, and in no time their weight grew, especially their bellies got so fat that they couldn’t even run, and they could not even catch a single one. The rats fed with estrogen did not change their body shape at all, and their eyes were bright and shiny as they ran around the cage, so it was not easy to catch them and feed them medicine. At the end of the project, once weighed, there was a significant difference in the weight of the two groups! Think about it. By the way, the rats ate the same amount of food! About breast cancer. This is not clear. However, HRT has been used for almost 60 years, and now this issue is not conclusive, what do you think? With the development of modern medicine, a thing that is still not clear after 60 years, does it mean that there is not much relationship? Of course, this is just our tendency. It is true that we do not encounter that many breast cancers in the clinic. About endometrial cancer. Patients with a uterus can get endometrial cancer with estrogen alone, but with the combination of progestin, the problem is basically solved. About blood clots and strokes. As you know, modern medicine is based on Western medicine, and a lot of our knowledge is passed in from the West. There are many reports about blood clots in Europe and America. But in our country, there is really not much about this problem. There are two reasons for this: First, there are ethnic differences. For example, white people are prone to breast cancer, but yellow people are not prone to it. This is also known as the “treatment time window”. When we have just gone through menopause, our blood vessels are still very elastic, at this time estrogen can keep the blood vessels elastic and not harden and not grow plaques; while after the age of 60, atherosclerosis has occurred, estrogen makes the plaques on the walls of the blood vessels unstable and easy to fall off and embolism, followed by a stroke. Some years ago, the Chinese people did not pay much attention to health care, and those who came to see the doctor and prescribed medication were patients who could not stand the menopause, usually younger, so very, very few cardiovascular events were observed clinically. The European and American countries are different. The developed countries have money and think that estrogen is good, so all the elderly people in their 60s have to use it, and as a result, cardiovascular events happen. It is now recognized that the time window for HRT treatment is to start from early menopause, before all kinds of organic changes appear. If the disease has already developed, estrogen will never be able to return. As Prof. Yu Qi said, “Estrogen supplementation should be done as early as possible, but if it is too late, it will be too late”. At this point, some people may ask, “I’ve been going through menopause all day and I’m upset, but I’m not menopausal yet, should I take estrogen supplements?” Should I? It’s a little early. It is best to take it after menopause, but you can use it before menopause if you have symptoms, but you should be careful. Why? It starts with the mechanism of action of estrogen. Estrogen is a very ancient small molecule that is widespread in the world and has a wide range of effects. Almost all of our organs need estrogen to maintain their physiological functions. Organs outside the reproductive system have a very low need for estrogen. The estrogen produced by the ovaries during menopause is not enough to ovulate, but it is sufficient to maintain the function of other organs. The various discomforts we feel are related to fluctuations in estrogen levels and other endocrine changes, and cannot be solved by blanket estrogen supplementation. During this period, we recommend dietary supplements and pay attention to lifestyle and psychological regulation. After menopause, the ovaries no longer secrete estrogen, and the estrogen in the body is mainly estrogen in fat. At this time, the estrogen level has absolutely decreased and is not enough to maintain the normal function of all organs, so estrogen should be appropriately supplemented after menopause. So some people may ask, “I’ll take some herbs and supplements to take care of it. This is of course very good. Chinese medicine is very profound and has many effective remedies to relieve menopausal symptoms. The question is, how long can I take Chinese herbs? Moreover, the price of Chinese herbs has risen significantly in recent years, and supplements are not affordable for ordinary people. In comparison, estrogen is still very cheap. Regarding the issue of menopause, people have started to pay attention to it in recent years. The reason for this is that China’s economy has developed, life expectancy has increased, and quality of life has improved. In fact, the importance of HRT is only talked about when the average life expectancy exceeds 70 years. In the past, it was not easy to live to be over 60 years old, but nowadays the average life expectancy in Beijing has reached 80 years old. If people want to be able to participate in work and social activities when they are 70 years old, I am afraid that they still need to actively carry out HRT.