As mentioned in the previous article, the use of hormone replacement therapy in early menopause (less than 60 years old and less than 10 years after menopause) is not only effective in improving menopausal discomfort, but more importantly, in preventing stroke, blood clots and dementia. So how can you tell you are going through menopause? Can hormone replacement therapy be used by all menopausal patients? How to tell you are entering menopause early ① If you are over 40 years old and have two periods pushed back by 7 days or more within 10 months, this may be a sign of menopause. ②It is recommended that such women come to the hospital on the 5th day of menstruation to have their hormone levels tested. If the estrogen value is <5pg/ml and FSH (follicle stimulating hormone) is >40U/L, it indicates that ovarian function has started to fail. ③ If there is a change in hormone levels with symptoms such as hot flashes and irritability, it can be basically determined that you have entered menopause. ④ The maximum therapeutic benefit can be obtained by starting hormone replacement therapy (HRT) as soon as ovarian function begins to decline and associated menopausal symptoms appear. Not all menopausal patients can use hormone replacement therapy There are certainly some people who cannot use hormone replacement therapy, such as: (1) patients who are pregnant or suspect they are pregnant; (2) patients who have unexplained vaginal bleeding; (3) patients with breast cancer or suspected breast cancer; (4) patients who have or are suspected to have a sex hormone-related malignancy, active venous or arterial thrombosis within the last 6 months Patients who have or are suspected to have sex hormone-related malignant tumors, active venous or arterial thrombosis within the last 6 months, or serious liver or kidney dysfunction are at risk of aggravating their condition with hormone replacement therapy. ⑤ And patients with uterine fibroids, endometriosis, a history of endometrial hyperplasia, uncontrolled diabetes mellitus and severe hypertension, and a tendency to thrombosis should use hormone replacement therapy with caution and under medical supervision. Control symptoms with the smallest possible dose Even though you can use hormone replacement therapy, because each patient’s symptoms are so different, age, year of menopause, major symptoms and the presence of high risk factors such as cardiovascular disease all influence the treatment plan. In addition, the physician must respect the needs and desires of each patient and develop an appropriate treatment plan after he or she fully understands the pros and cons of sex hormone replacement therapy. Therefore, hormone replacement therapy for menopause is very individualized, meaning that there may be 100 protocols for 100 patients. However, all regimens must follow the basic principles: (1) the goal of treatment is to relieve the discomfort of menopausal syndrome; (2) the smallest dose that achieves symptom control is used. In other words, the dose of natural estrogen should be sufficient to maintain the level of E2 (estradiol) in the blood during the early follicular phase when administered systemically. For example, if the patient has only genitourinary related problems, such as vaginal dryness, pain, recurrent vaginitis, etc., then we can choose to use only transvaginal medication; ④ to choose high quality natural hormones. In the next article we will briefly introduce a few basic options for hormone supplementation therapy, but please follow your doctor’s advice on the specific medication to use.