N. O. is a 36 yo female who had a hysterectomy at age 29, then both ovaries removed 10months apart at age 33. Pt was placed on non-bioidentical hormone and never felt it was helping. Pt seen in this office for 2nd opinion consultation with multiple moderate menopausal symptoms. Pt was trialed on bio-identical hormone replacement but her blood levels weren’t responding as would have been anticipated. After several levels and HRT adjustment, we recognized that her hormone graph mimicked that of a typical perimenopausal female in her late 40’s. That could only mean that she still had functional ovarian tissue that was left behind and she needed to be followed as if a typical perimenopausal female! Her bloodwork was put on a different time schedule and her hormone medication was adjusted; for first time she had significant improvement in many of her symptoms and now has hope that she can get on top of her multiple issues.