For this episode, we wanted to answer another reader question. We love answering reader and listener questions. Also, we understand that you might not be getting answers from your docs and feel frustrated. Honestly, we really try to go into depth on answering these reader/listener questions as we want to be as thorough as possible on conditions, symptoms, dosing, and options.
With that said, this is meant to be educational only and not meant for medical advice (there, my attorney will be very happy to have said that!). But as mentioned above, we want to be as thorough as possible in all aspects. This question is from Nickie. We love this question and really think others can relate to Nickie’s situation. She has been told she has Polycystic Ovarian Syndrome and has been prescribed oral progesterone.
She has concerns with taking progesterone, its side effects and the topical cream versus the oral. Nickie also has concerns with her symptoms such as trouble losing weight and thinning hair. So we are going to do our best to answer Nickie’s questions as well as go into depth on forms, dosing, testing and options for PCOS.
Nickie’s Question:
Hi, I was prescribed 200mg of Prometrium a couple of weeks ago to take on day 20-30 of my 32-day cycle. I ovulate around day 16. Day 20 was the night before our vacation, and after reading some potential side effects, I decided to wait until this next cycle to take them for the ten days.
They think I have PCOS, so I’m hoping it’ll make it easier to lose weight. My main concern are the potential side effects of the pills. Do you think using the cream is significantly better/less side effects than taking the two pills at night? I’ll also have a few drinks on the weekend and didn’t know how that would interact with the medicine as well. I have about two weeks to decide which I want to do, so I’m looking for advice.
Also a history I have many symptoms of low progesterone. Anxiety, thinning hair, inability to lose weight no matter what I do, and after having a miscarriage at 12 weeks last year, I had to take oral progesterone to stop the bleeding. Thank you!
Dr. Davidson’s Response:
First, we want to explain what PCOS is. PCOS stands for Polycystic Ovarian Syndrome. Which is exactly as it is described, being there are multiple cysts on the ovaries. In many cases of PCOS, the ovaries are likened to a string of pearls. Because there are so many cysts in the ovaries that it looks like pearls. However, there is so much more to it than just multiple cysts in the ovaries.
Typically there are very high androgens, being testosterone and DHEA. These androgens can cause hair growth on the body is called hirsutism. Being that hair is growing on the face, around the nipple and lower abdomen. I have even seen women that have hair growth on their necks. Not only is there unwanted hair growth, but there is also hair loss on the head. Hair can be very thin, especially the temples, hairline and top of the head. Also included in PCOS is infertility because of the multiple cysts and lack of ovulation.
Missing periods is common in PCOS. Some women can miss anywhere from 3 to 6 months of their menses. High blood pressure and elevated cholesterol, in particular triglycerides, can occur in PCOS. Weight gain is common in PCOS. This weight gain is not because these women are eating poorly or not exercising. It is because women with PCOS have an easier tendency to gain weight, especially in the stomach. This unwanted weight gain is partly due to the increased levels of insulin that are common in PCOS.
One important aspect we want to point out is, PCOS is not black or white. Many doctors will say, either you have it, or you do not. However, we have found that PCOS is more like a spectrum where some women will have the majority of the symptoms and others just a few. This could very well be the case in Nickie. Nickie has been pregnant but sadly miscarried. Also, she is having regular monthly periods. Although, Nickie does have the thinning hair and trouble with weight loss.
With this said, Nickie does not have all the usual symptoms of PCOS, but she does have some. First, it would be important to test Nickie’s blood work. Looking for the levels of androgens such as testosterone and DHEA-sulfate. Also testing her LH (luteinizing hormone) and FSH (follicle stimulating hormone) would be good. Typically in PCOS, there is a 2:1 ratio of FSH to LH. For example, an LH of 16 and an FSH of 8 would cause suspect for having PCOS or on the spectrum of PCOS. Also for Nickie, testing her thyroid function would be helpful.
I am sure she has had her thyroid tested, such as the TSH. However, actually testing the Free T4 and Free T3 would be extremely important in Nickie’s case. We have written articles and recorded podcasts on the importance of thyroid function. We believe it is not proper to rely on a TSH (thyroid stimulating hormone) alone to determine if a person has a thyroid issue. The TSH is just a signal from the brain monitoring overall thyroid status in the body.
The thyroid makes T4 which then travels in the body converting to T3. A free hormone is the bioactive hormone, which is why we like to test the free T4 and free T3. If Nickie’s thyroid function is low that can affect her female hormones, especially progesterone. Low thyroid function usually has the consequence of lower progesterone levels in women. Not to mention it can also be part of the culprit of weight gain, infertility, higher risk of miscarriage and fatigue.
To further answer Nickie’s question, Prometrium is bioidentical progesterone. If you are taking progesterone, make sure you are taking bioidentical and not any type of progestin. However, Prometrium has its own drawbacks. Prometrium has many fillers that people can be allergic to. In particular, it has peanut oil that many people are allergic or sensitive to. Prometrium only comes in 100 mg and 200 mg oral doses.
Sometimes 100 mg might be too high for some women. Or 100 mg might be too low, and 200 mg Prometrium is too high. Also, Prometrium is an instant release progesterone. Meaning as soon as you ingest it, the levels immediately rise and then can quickly fall. Other options to Prometrium is to use a compounded bioidentical progesterone. This would have to come from a compounding pharmacy, which are very common throughout the United States. Compounding gives more versatility in dosing being able to tailor any milligram of progesterone to the unique individual.
Also, a compounding pharmacy can make the bioidentical progesterone as a sustained release. Sustained release stays in the system longer and can help with mood and improved sleep through the night. Progesterone can come in many forms. It can come in capsules, creams, gels, vaginal suppositories, sublingual troches.
We find that oral progesterone is more helpful for protecting the uterus when a woman is taking estrogen. Oral can be more helpful for thinning the lining of the uterus reducing heavy periods. And we find the oral to be more helpful for women that have trouble staying asleep through the night. Transdermal progesterone such as creams can also be helpful for mood and can be taken during the day as it does not make you as tired as the oral forms can. Oral progesterone seems to be more helpful in low progesterone during the first nine weeks of pregnancy.
Low progesterone level in early pregnancy can have a higher risk of miscarriage. Although as mentioned taking oral progesterone in the day can make you sleepy. Often in the first nine weeks of pregnancy, for a woman with low progesterone, taking oral at night and cream or transvaginal during the day can be helpful in raising the level to prevent miscarriage.
But to further answer Nickie’s question. Depending on the health goals, personal and family history of the individual, progesterone is quite safe. She should not experience any side effects from taking the progesterone. However, keep in mind if Nickie is allergic to peanuts or the fillers in Prometrium. Also, keep in mind her dose and whether instant or sustained release works best for her.
Nickie is going to cycle the progesterone, taking it from day 16 to her period. This is common, as menstruating women make progesterone the last half of her cycle. I have many women that take progesterone all month long. It really depends on what our goals are. Taking progesterone all month long can help with periods, mood and sleep to name a few. However, taking progesterone all month long can inhibit ovulation. It might be that Nickie is working on conceiving. In that case, taking progesterone for half of her cycle is appropriate.
Back to the rest of Nickie’s question. She was concerned about having alcohol and taking progesterone. There are no contraindications to taking alcohol and progesterone. Just keep in mind that progesterone can make you tired and alcohol is a sedative. Be aware of that when taking the combination at the same time might make you feel quite drowsy.
I would like to go back and talk about the stubborn weight gain that Nickie was working on. Other tests that might help Nickie, in this case, would be to check her fasting insulin levels. Remember when I mentioned in PCOS higher levels of insulin can contribute to easy weight gain? So working on reducing the insulin burden in the body would be a key aspect to losing weight. Progesterone can help to an extent. But honestly, taking progesterone is not going to make Nickie miraculously lose weight.
There is a connection between insulin and cortisol that can contribute to gaining weight easily and having an impossible time trying to lose it. Both cortisol and insulin manage blood sugar/glucose. When cortisol is elevated, it can raise glucose levels. And when glucose levels rise, that will cause the pancreas to secrete elevated levels of insulin. Cortisol levels rise with stress, mental and physical.
High intense cardiovascular exercise can raise cortisol. Life stressors can also raise cortisol. This all has an impact on causing weight gain, especially in the abdomen. One aspect of reducing insulin and cortisol is to reduce stress. I know this is easy said, but not easily done. However, switching your exercise to weights and walking over intense cardio is a great first step. Also changing your diet can remarkable reduce your insulin.
High glycemic foods such as sugar and processed, refined carbohydrates cause your insulin to soar which in turn causes your weight to soar. We have a program that we wrote called, The Keto-Carb-Cycling-Program (or KCCP as we abbreviate it). The KCCP is a free download on our website and can help you reduce cortisol and insulin.
I really want to thank Nickie for reaching out and asking about her situation. Reader and listener questions can be so helpful to others. And it also helps you understand that you are not alone in your hormonal concerns. If you have any questions, leave a comment below, or send an email to [email protected].
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Are you gaining weight around your midsection during perimenopause or menopause—despite eating the same and trying everything? You’re not alone, and it’s not just about willpower: In this episode, Dr. Valorie and Dr. Maki dive deep into what’s really going on with that frustrating menopause belly. From insulin resistance to estrogen and cortisol changes, they break down the complex hormonal shifts that make weight gain in midlife feel inevitable—and nearly impossible to reverse. Here’s what we cover: ✔️ Why the “unearned weight gain” often starts in perimenopause ✔️ The truth about insulin resistance and menopausal metabolism ✔️ The role of estrogen, progesterone, and cortisol in midsection fat ✔️ Why muscle mass is your best metabolic insurance ✔️ Whether hormone replacement therapy (HRT) or GLP-1 meds (like semaglutide) can help ✔️ Actionable steps to reduce belly fat and improve metabolic health Plus, we’ll share why willpower alone doesn’t cut it—and how biology always wins unless you work with it (not against it). Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode of the Progress Your Health Podcast, Dr. Valorie and Dr. Maki tackle a common yet surprisingly confusing question: When is the best time to test your blood levels if you’re using hormone replacement therapy (HRT)? Lisa, a fellow Washingtonian, submitted a thoughtful Ask the Doctor question about testing estradiol and FSH levels when using a trochee or transdermal cream. Should it be 4 to 6 hours after application? Or 10 to 12? And what do the results actually mean? We’ll break down: The ideal timing for blood draws depending on delivery method (trochee, patch, cream) How estrogen and progesterone absorb differently Why testing too soon — or too late — can skew your results How to interpret estradiol and FSH together (and why context is everything) Why the number isn’t the whole story — and how you feel matters most Plus, Dr. Valorie shares insights from her own hormone journey, including rhythmic dosing tips and lab timing mishaps. If you have a question, please visit our website and click Ask the Doctor a question. Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
Is there really an age limit for hormone replacement therapy (HRT)? What if you’re in your 70s and still feel better on hormones—but your doctor says it’s time to stop? In this episode, we answer a great question from Mary, a 76-year-old woman who’s been on HRT for over 20 years. She’s dealing with weight gain, breast tenderness, and pressure from her gynecologist to quit hormones altogether. We break it down: Why stopping HRT just because of age isn’t always the answer What to consider when switching from a trochee to a cream Why estradiol levels matter more than total estrogen The connection between insulin resistance, weight gain, and hormones How to adjust HRT in your 70s to maintain quality of life without unnecessary risk Whether you’re well into postmenopause or just starting HRT, this is a must-listen if you’re wondering how long is too long to stay on hormones. If you have a question, please visit our website and click Ask the Doctor a question. Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode, we’re answering a thoughtful (and very relatable) listener question from Kari, who’s been struggling with unexpected body pain and inflammation after starting hormone therapy. She wonders if she might be hypersensitive to estrogen—something most doctors don’t talk about. Dr. Valorie Davidson and Dr. Robert Maki unpack why this happens and what to do if you suspect your body is reacting to estrogen differently than expected. In this episode, we discuss: Why some women experience increased pain, fluid retention, or inflammation on estradiol—especially starting at higher doses too quickly. The importance of starting low and increasing slowly, especially for sensitive individuals How Dr. Davidson’s personal experience with estrogen sensitivity helped shape her approach The role of the liver’s phase 1 and phase 2 detox pathways in clearing estrogen metabolites Why form, dose, and timing of hormone therapy (cream vs. patch, AM vs. PM) can affect results What to consider when adjusting your Biest ratio (80:20 vs. 90:10) or Rhythmic Dosing HRT ✉️ Here’s Kari’s full question: “I used Biest 80:20 for 3 years and suddenly stopped absorbing. I’m not sure why, but I do know I didn’t always use it the same time every day. From the moment I went on hormone therapy I’ve had body pain and thought I had fibromyalgia. When my estrogen dropped due to the absorption issue I realized the body pain completely went away. I then went on a patch because my doc said we should change the method. Immediate body pain again and even worse. Terrible. I was on 0.025 and it was tolerable, but after raising it to 0.05 it got really bad. I think I may ask to go on the compounded cream again—maybe change the site that I apply it and be more consistent. I’m very frustrated because no one talks about a subset of people that are very sensitive to estrogen. They only talk about it making joint pain go away. Do you think I should use 90:10 instead? What would you recommend that I do? I’m so sad and frustrated.” If you have a question, please visit our website and click Ask the Doctor a question. Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode, Dr. Valorie Davidson and Dr. Robert Maki respond to a great listener question from April, who’s navigating hormone replacement therapy (HRT) while dealing with a history of endometriosis, polyps, and chronic cramps. April’s experience is all too familiar: spotting, cramping, hormone experimentation, and the frustrating search for symptom relief. So, can women with endometriosis safely use HRT—especially estrogen? The answer: Yes, but it has to be customized. �� In this episode, we cover: Why HRT is absolutely possible for women with endometriosis—but must be individually tailored The difference between static vs. rhythmic dosing and why rhythmic HRT may be better tolerated for some women Dr. Davidson’s personal story of having endometriosis, cysts, and polyps—and how she now uses rhythmic dosing herself without flaring The important role of progesterone in managing endometriosis and minimizing estrogen reactivity How to approach spotting, cramping, and cyst formation during HRT ● Why estrogen isn’t the enemy—but why it must be dosed thoughtfully ✉️ Here’s April’s full question: “Hi—I am a 57-year-old woman in perimenopause. My question is: is it possible for women with endometriosis or adenomyosis to do HRT? I started oral progesterone 2 years ago, got as high as 300 mg, but didn’t get much symptom resolution. Switched to a progesterone troche—50 mg morning and night. About 3 months ago, I added testosterone (0.25 mg once daily, 5 days/week) and Biest 80/20 (1 ml daily, can go up to 2 ml). Everything was good for a while, but now the cramping and spotting have returned. I’ve had heavy bleeding as long as I can remember. My main complaint is menstrual cramps throughout the month—not just during my period. I do not have fibroids, but I’ve had many cysts and polyps over the years and have had many ultrasounds and transvaginal ultrasounds because of this.” If you have a question, please visit our website and click Ask the Doctor a question. Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In this episode, Dr. Valorie Davidson and Dr. Robert Maki dive into a hot topic: Does Hormone Replacement Therapy (HRT) actually slow down aging? While the short answer may surprise you, the real conversation is about something even more valuable—your quality of life. Here’s what we cover: How HRT can support energy, strength, and resilience as we age The role of hormones in brain function, memory, and mental clarity Why estrogen and progesterone matter for muscle tone and bone density ❤️ The powerful connection between hormones and cardiovascular health. Why HRT isn’t about extending your lifespan—but enhancing how you feel through the years Obviously aging is inevitable—but suffering doesn’t have to be. This episode is all about helping you feel more like you again, even as your hormones shift. If you have a question, please visit our website and click Ask the Doctor a question. Want more insights like this? Be sure to subscribe to our newsletter for hormone Q&As, educational guides, and real-world strategies to help you feel like yourself again—especially during perimenopause and menopause. Join the Progress Your Health Newsletter Stay Connected Instagram: @drvalorie TikTok: @drvaloried Join the Hormone Community: Click here to subscribe Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
