Let’s talk about fertility for example we talked about those patients who don’t want to become pregnant during this phase of their life but what about the women who are in their late 30s and 40s and unfortunately you know they already started and they want to conceive what options do they have well. I think clearly you start and try and see if can you conceive spontaneously and as long as you’re having regular cycles then at least you know you you’re in theory ovulating every month if it turns out you’re only having two or three cycles a year then that means your your opportunity to conceive is only two or three times in a given year so if you find that your cycles are irregular you’re not conceiving. I would say that you should see a fertility specialist and I recommend you do that after age 35 once you’ve been trying for six to nine months without success are there some women that just say you know what I’m just gonna take it and I’m just gonna face it and it’s a natural cycle of life and it is what it is and certainly there are people that that do that the only reason to intervene is for quality of life so if you feel fine there’s no reason to take any supplemental medication if on the other hand you can’t sleep or you’re grumpy with your family or your kids or you’re having problems with menstrual irregularities then you should take something medicines available to help you absolutely and that’s what it’s there for evidence-based medicine shortest banned that a woman may experience menopause and then longest span so we talk about hot flashes which is probably the most debilitating symptom usually will occur through for about five years my experience is once you get to age 60 the hot flashes pretty much resolved so I think it’s somewhere anywhere from two to eight years but it’s pretty much through your decade of the 50s of the hot flashes tend to be the biggest problem you.