Oestradiol + FSH (women)

Oestrogen protects bone, vessels and brain; its loss at menopause is the main driver of women's “accelerated ageing”: 10% bone loss in 5 years, LDL +10–15%, more visceral fat. Recognising perimenopause (FSH, symptoms) enables timely hormone therapy — before 60 or within 10 years of menopause the benefit mostly outweighs the risk.

From 40 with symptoms (hot flushes, sleep disruption, cycle changes); the diagnosis is clinical, the lab confirms. Yearly on HRT.

Transdermal oestradiol + micronised progesterone (with a uterus) via a gynaecologist; strength training and protein against bone and muscle loss; phytoestrogens (soy) have a mild effect on hot flushes.