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Doctor: "You're in perimenopause. Let's discuss management."
Patient: "I've been losing muscle. I was thinking of lifting weights."
Doctor: "Be careful. Cardio is gentler. Try yoga."
Patient: "Resistance training prevents osteoporosis better than anything else."
Doctor: "We have bisphosphonates for that."
Patient: "I'm exhausted. Red meat has been helping."
Doctor: "Red meat raises your cardiovascular risk. Limit it."
Patient: "Red meat has the iron, B12, zinc, choline, and cholesterol my body needs to make hormones."
Doctor: "Try wholegrains, legumes, soy."
Patient: "Soy gives me hot flushes."
Doctor: "Phytoestrogens are protective."
Patient: "Against the symptoms I'm having from the soy?"
Doctor: "..."
Patient: "What about HRT?"
Doctor: "There are risks. We prefer not to."
Patient: "The SSRI you mentioned has risks. So does the bisphosphonate."
Doctor: "..."
Patient: "So no meat for the hormones. No lifting for the bones. No HRT for the hormones again. Just porridge, a yoga mat, and a pill for the mood I don't yet have."
Doctor: "I'll book you in for six months."
Patient: "And until then?"
Doctor: "Have you tried mindfulness?"

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