Hormone replacement therapy (HRT) should be initiated before a woman reaches a menopausal state with flat-lined estradiol and progesterone and very high FSH/LH.

“we always use day five so if the initiation of Menses even if it's spotting is day one but we always just pick day five and that way we have a really consistent view specifically of FSH and estradiol progesterone is zero at that time but the FSH and the estradiol really give us a sense of how close she's probably getting to menopause and then we correlate that with symptoms to sort of start to think about initiating HRT”

“and when we initiate hormone replacement therapy and by the way we never want to wait until a woman is in that state where she has Flat Line estradiol Flatline progesterone Sky High FSH Sky High LH we want to do it long before that we want to do it as she's transitioning from this into that and that could be literally a year or two years prior to that state”