HRT 20 years after menopause

I had spontaneous early onset menopause at 38. Just started bhrt last year at 76. Love the results.

@gravity3 Sorry if I've asked this before... Could you share the details of your currrent regimen? I share your age with a 20 year gap between menopause and starting HRT in February. My regimen is Menostar patch and progesterone 14 days out of 90. I don't feel any difference but in my case the goal is better bones.

@tillymack

Glad to share. I have osteoporosis and even though I take medication I hope that this will also help. I knew that bhrt would not reverse osteoporosis. My primary goal was and is the return of my libido, help with vaginal dryness and atrophy. Very successful. I went after a regime that included testosterone.

I have a estradiol/testosterone pellet inserted every 12 weeks, estradiol vaginal cream, progesterone gel capsules. My provider just added dhea 5mg. Hope this helps.

@gravity3 Thank you! What is dhea?

@gravity3
Knowing you, I am sure that you are doing all of this, but just in case it might help someone else......

Watch your hormones carefully with the dhea. DHEA and pregnenolone pull some major levers in the body and may cause high levels of hormones and cortisol.

I, personally, would love to go the dhea or pregnenolone avenue of HRT, but I have been unable to do so because of the anxiety which they caused for me.

Pregnenolone, in particular, can have some great side effects of better sleep and less abdominal fat.

To understand better:
Pregnenolone is often called the "mother hormone," it is the direct precursor to DHEA, progesterone, aldosterone, and cortisol.
DHEA is known as the "mother of androgens". DHEA is synthesized into testosterone and estrogen
But....
While DHEA and pregnenolone are precursors to helpful hormones, they can cause anxiety because they also act as neurosteroids that directly manipulate brain excitability. Instead of just waiting to be converted into estrogen or testosterone, they (and their sulfated forms) interact immediately with neurotransmitter receptors that control your "calm" and "alert" state. This is where they hit me, but I also had great sleep and lost all my abdominal fat, sigh.
Plus....
Both can also raise brain levels that cause too much excitability in the brain and raise cortisol levels.
So they both pull some major levers in the body.
This is why doctors like to stick with using estrogens, progesterone, testosterone directly and not leaving to chance what our bodies may decide to do with dhea and pregnenolone. Some doctors will give just testosterone and let the body then convert to its own estradiol, but again it becomes iffy what you will get.
I use estriol because it just stays estriol, and I know what I am taking. (see attached hormone cascade of how hormones convert)
But frankly, if especially pregnenolone works for you without the counter side effects, I think that there are some real pluses to HRT with dhea and pregnenolone.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8781653/
Post about Pregnenolone and DHEA:
https://www.inspire.com/groups/interstitial-cystitis-association/discussion/e4db2d-hrt-thru-supplements-body-driven-hrt/
General information, not research:
https://gurneeandropause.com/dhea-and-pregnenolone-therapy/
https://holplus.co/pregnenolone-vs-dhea/
https://draxe.com/nutrition/pregnenolone/.

@tillymack
Dhea is a precursor for estrogen and testosterone