I started symptoms in my late 40s, have had a previous hysterectomy due to pain from endometriosis and spinal issues. It is one road of hell, and nothing that drs warn you enough about. Estrogen affects every cell in your body, so replacing it is number one. HRT shouldn't be optional, it should be advised. Before I started taking HRT, I suffered from extreme anxiety (this is due to progesterone loss which happens first)...so much I had to quit my job. Then I got heart palpitations, racing heart out of nowhere, then memory loss and horrible insomnia, migraines, depression...later down the line have had muscle and strength loss. It can feel like you're dying literally. After researching more about menopause and hormone therapy...and you should...I decided to try a very low dose of estrogen patch and a progesterone topical (later learned this isn't ideal for absorption)...gradually had to work up to a higher dose around age 52-53 when full menopause usually kicks in. But it can be earlier or later for some women. When estrogen alone wasn't enough...added a low dose oral progesterone, but it has to be compounded to be low. If you still have a uterus, you will need progesterone, but the only oral dosing available is 100mg. That is way too much for some women, as it does cause sleepiness, dizziness...for me that was extreme. I found it helped me with sleep and anxiety at a lower dose. There are other forms of progesterone you can try like an IUD or vaginal (US drs don't advise this but in the UK they do). Testosterone is another thing that declines...but later. It might be optional, but I am trying this as well as heard it can help nerve structure and bone health. Also has to be compounded or can use gel packs prescribed to men, but at a much lower dosing rate. Most i importantly...no one size fits all, and you will have to trial and error all these hormones over YEARS...and you may get on a good regime, but suddenly it will have to change. Transdermal estrogen is safest due to almost no risk of clots like oral estrogen. I have not had migraine issues with transdermal, but I very often did taking birth control pills in my younger years. Oral estrogens can raise blood pressure also. I've found that transdermal estrogen and oral progesterone tend to lower my blood pressure. I already have osteoporosis also at age 52 and felt being on HRT wasn't optional. Until I can find a med for that i can tolerate, hormones are all I got. Find a good doctor to help you with menopause from the menopause society website: https://www.menopause.org. Most ob/gyne are not educated enough on HRT, nor PCPs or anyone else for that matter. I found videos by Louise Newson from the UK on youtube to be excellent. There's also a podcast by Dr. Lauren Streicher "Inside Information" that is great for recent news on menopause, myths and facts on therapy. Definately check it out. Women have to be very proactive and get this information out to more and more and push for more research!