Why it is done this way
A real conversation about risk, not a reflexive no
Hormone therapy is not right for everyone. That is a reason to discuss it, not to dismiss it.
The decision depends on your history — breast cancer risk, clotting history, cardiovascular risk — and it deserves a proper conversation rather than a policy.
Thyroid disease imitates perimenopause almost exactly, so it gets excluded first. Levels also swing week to week in perimenopause, which is why a single draw can mislead.