Our raw material,
out in the open.

The AI's reference on clinical diagnosis after age 45, the preference for the transdermal route, the Body Identical HRT position, and the hierarchy of non-hormonal treatments.

The North American framework on individualizing HRT, the timing hypothesis, and the absence of any arbitrary maximum duration.

The hierarchy of non-hormonal options for hot flashes (CBT, paroxetine, venlafaxine, gabapentin, fezolinetant). Black cohosh, phytoestrogens, clonidine, and pregabalin are set aside.

Practical protocols on testosterone in women (HSDD, doses, monitoring), progestogens, and HRT monitoring schedules. A hands-on source for clinical tools in the UK.

An international framework that consolidates the regional guidelines on HRT, bone health, and cardiometabolic health.

The European position on the limited role of AMH and FSH after age 45, and their targeted usefulness in women under 40 for diagnosing primary ovarian insufficiency.

First-line treatment for postmenopausal osteoporosis, most often weekly alendronate, with anabolics (romosozumab) when the T-score is below -2.5 along with a fracture.

DEXA screening for all women starting at age 65, earlier if there are risk factors (family history, low BMI, smoking, corticosteroids, early menopause).

The reference tool the AI cites whenever a T-score comes up, covering central DXA, interpretation, and follow-up.

A modern lipid workup, Lp(a) at least once in a lifetime, ApoB measured selectively when the metabolic profile is at risk, CAC for reclassification, and the PREVENT-ASCVD equations.

An Lp(a) threshold of 50 mg/dL (125 nmol/L) as a cardiovascular risk enhancer. Used to interpret an elevated result.

A new elevated-BP category between 120-139 / 70-89 mmHg, with a systolic target of 120-129 mmHg when treatment is tolerated. Worth knowing it diverges from ESH 2023.

Dropping a universal 25-OH-D target and routine screening. The priority is to avoid outright deficiency and to supplement at-risk profiles pragmatically.

A hard rule. Never stop denosumab without a bisphosphonate to take over within the following 6 months. The source for the warning carried in section 6 of the report.

A major shift, local vaginal estrogen can be discussed with breast-cancer survivors after moisturizers and lubricants have failed, as a shared decision. Extra caution on aromatase inhibitors.

What it means in practice. The FDA commissioner calls it a scientific correction. The fear inherited from the 2002 WHI extrapolation is no longer a scientifically defensible position for most profiles.

What it means in practice. The first NK1/NK3 option becomes available in the United States. A better liver profile than fezolinetant, plus an added benefit on sleep.

What it means in practice. A mandatory ALT/AST monitoring protocol, with a check before starting, monthly checks for the first two months, then at 3, 6, and 9 months. Stop immediately if ALT/AST is greater than 3x the upper limit of normal with bilirubin greater than 2x the upper limit.

What it means in practice. The first targeted non-hormonal VMS option from a new class (a selective NK3 antagonist acting on hypothalamic KNDy neurons).

What it means in practice. The UK becomes the first market to offer elinzanetant. NHS access by prescription. France and Europe remain under EMA review post-2025.

What it means in practice. Real-world access in France depends on national listing decisions. Enhanced liver monitoring aligned with the FDA and MHRA.

The 2024 Manson reanalysis reframed the original reading. The risks seen in 2002 were tied to the average age at initiation (63) and to the conjugated equine estrogens plus medroxyprogesterone regimen, not to HRT in general.

The foundation of the timing hypothesis. HRT started soon after menopause in healthy women does not worsen the surface cardiovascular profile.

No lasting cognitive benefit, and no clear cognitive harm either. A mechanistic signal of lower brain amyloid plaque burden on transdermal estradiol vs placebo.

Confirms the timing hypothesis for vascular health. Estradiol started early slows the progression of atherosclerosis, an effect that disappears when initiation is late.

A real-world map of the transition, the median duration of hot flashes (7-10 years depending on profile), metabolic and bone trajectories, and ethnic variation.

Risk varies by HRT regimen. An excess of about 11 cases of ischemic heart disease per 1,000 women per year with certain continuous combined oral forms and with tibolone. No clear cardiovascular signal for the transdermal routes.

No increase in breast cancer with HRT in BRCA1/2 carriers after risk-reducing oophorectomy. In BRCA1 carriers on estrogen alone, a reduction in breast risk was observed.

The reference text for dismantling the binary HRT-equals-danger reading. HRT is neither a primary-prevention strategy nor off-limits. It is individualized.

High-intensity Resistance and Impact Training is safe in women with osteoporosis when supervised, and is the most effective mechanical stimulus for lumbar bone mineral density.

Confirms the generalizability of the HiRIT protocol. Serves as a methodological point of comparison for the postmenopausal woman.

The LIFTMOR protocol put into practice at clinical scale. The reference standard when the AI talks about supervised bone training.

A reduction of about 3.2 moderate to severe vasomotor episodes per day at 12 weeks vs placebo, at the 120 mg/day dose. A significant improvement in sleep. A better liver profile than fezolinetant.

Significant efficacy on hot flashes from the very first day of treatment at 45 mg/day, versus placebo. The scientific basis for the FDA approval in May 2023.

Additional weight loss on the order of 35% compared with tirzepatide alone, in postmenopausal women with obesity on the tirzepatide-plus-HRT combination. An observational signal, not a standard protocol.

HRT prescribed for hot flashes is not associated with any change in dementia risk. A relative risk of 1.16, with a confidence interval consistent with a trivial or null effect. Confirms that HRT is not prescribed to prevent dementia.

No increase in cancer-specific mortality with the use of local vaginal estrogen after a breast-cancer diagnosis. An adjusted hazard ratio of 0.77. A pivot for the second-line GSM discussion.

Hyaluronic acid restores the target vaginal pH (3.8-4.5) and tissue hydration in about 4 weeks, with efficacy comparable to estrogen creams over the short term.

The responsive-desire framework (vs spontaneous) that still shapes the clinical management of low libido in peri/menopause today. The reference for the Intimacy and mood section.

21 items, four subscales (psychological, somatic, vasomotor, sexual), scored 0-3 per item. This is the instrument that scores your Decodemeno quiz.

The international reference for staging the peri/menopause transition. Used to classify your phase (early peri, late peri, early post, late post) from your cycle profile and symptoms.

A validated questionnaire for measuring the impact of symptoms on quality of life (vasomotor, psychosocial, physical, sexual). Used alongside Greene for follow-up.

The reference scale for sleep. Used by the AI when sleep-maintenance insomnia and fatigue are front and center, before pinning everything on hormones alone.

Lets us quantify the anxiety-depression component of the transition, and guide how symptoms are read without confusing perimenopause with major depressive disorder.

Cross-validation of the severity tiers and the quality-of-life framing. Especially useful for international comparison.

The backbone of the symptom catalog (more than 47 documented symptoms), a timing-aware pro-HRT stance, and an anti-pseudoscience hierarchy.

The nutrition and metabolism chapter, anti-inflammatory eating, how to frame intermittent fasting, and the metabolic shift of perimenopause.

The neuroscience chapter. Estradiol as a central regulator of the brain's energy metabolism, brain fog, the Alzheimer's risk window, and the PhytoSERM.

The evidence-based anchor. The hierarchy of evidence, an anti-pseudoscience stance, GSM as standard of care, and the menopausal hormone therapy vocabulary.

A critical reanalysis of the WHI trial, HRT in breast-cancer survivors, and the Bradford Hill criteria applied to claims about HRT and cancer.

The healthspan framing, the four major diseases of aging, ApoB and cardiometabolic risk, and the training quadrant (Zone 2, VO2max, strength, stability).

A bio-psycho-social framing of perimenopause as a life turning point, micronized progesterone, and local vaginal estrogen. Used with explicit guardrails, the post-2018 anti-vaccine and energy-medicine positions are excluded from the knowledge base.

An editorial reference. The wise older sister tone, the lived experience of medical limbo, and the everyday language of the peri/menopause conversation.