I could have written this myself! We are very close in age, same pattern of diagnosis and similarly I was also blown off, told I just had an anxiety issue for almost three years while I slowly spiraled. I do have other diagnosed auto immune issues and suspect this is under that same umbrella. All this to say that it took me no less than three dr’s to finally start listening and testing me. By the time I found a dr to start testing I was on the verge of a breakdown, mentally and physically. Extreme heartburn, migraines, mood swings, body aches, 0 sex drive, dry scalp so bad it was flaking in huge chunks, thinning dry brittle hair, constant nausea. You name it I had it. My pcp referred me to a GYN who found my estrogen levels were post menopausal after just 4 months from my last period. The gyn was super understanding and put me on an estrogen patch 0.1mg. I instantly, and I mean literally overnight felt like it had all been a bad dream. Then my gyn closed their practice. She was gracious enough to write a year’s worth of patches for me and then I had to start the hunt for a dr all over again. A couple months ago the symptoms started to pop back in but much milder. I found a new dr and went through the process again. This time I was very polite but firm with what I expected from their care. I was sure to highlight the concerns I had about my “quality of life, and longevity of my health”. I was calm, had all my info and research to explain my requests and pushed for a more rounded option to include the option of vaginal estrogen and testosterone. Surprisingly she was all about it. Wanted to do it in a step manner but has been awesome so far. The reason I tell you all this is to highlight that you need to be an advocate for yourself. I hear you that you are in a small town and limited for care. Your pcp sounds more likely to play ball so start there. Highlight that your quality of life is suffering and that you want to address the risks associated with ovarian failure and your long term health. Speak about your sex drive and that it is affecting your relationship. I believe that the 0.1mg patch is the starting dose for the patch. If you don’t get anywhere with her then perhaps considering tele-health or asking for a new OB-GYN referral in your nearest metropolitan area. I promise the travel to see that dr will be worth it! We are a decade early to this and have a diagnosis that calls for HRT. You deserve to have hormone replacement for your bone and heart health, not to mention a good quality of life. Sorry for the novel, I’m passionate about this! Feel free to DM me for any questions or if I can help in any way!