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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Protecting your `heart health` is crucial, especially during `menopause`, when risks can increase. In this `women’s health` episode, Dr. Valorie Davidson and Dr. Robert Maki share essential `health tips` and insights into how `hormones` impact cardiovascular well-being. Learn about important lab tests and supplements to safeguard your heart. You’ll learn: ● Why heart disease in women is often a “silent” problem until it’s serious ● The difference between general “heart disease” and atherosclerosis ● Coronary calcium scores: what they are, what the numbers mean, and when to consider one ● Why total cholesterol alone is useless (and often scary for no reason) ● The key markers that matter more: ○ Triglycerides ○ HDL ○ Triglyceride HDL ratio (and why 1.5 is a powerful insulin-resistance clue) ○ ApoB ○ Lp(a) ○ hs-CRP (cardio CRP) ○ Blood pressure & insulin resistance ● How estrogen decline in perimenopause & menopause affects cholesterol, visceral fat, inflammation, and heart risk ● How rhythmic dosing and thoughtfully prescribed HRT can support metabolic and cardiovascular health ● Visceral fat vs “roly poly” fat: why where you store fat matters more than the scale ● Foundational supplements for heart protection (education only, not personal medical advice): ○ Omega3s (EPA/DHA) ○ Vitamin D 2 ○ CoQ10 ○ Curcumin/turmeric ○ Magnesium Red yeast rice, bergamot, berberine & more metabolic support ○ Nitric oxide support (beet root, citrulline, etc.) If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried 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.
Can You Do Rhythmic Dosing After a Hysterectomy? Short answer: Yes, but there are some other factors to take into consideration to make sure someone is a good candidate. In this episode, Dr. Valorie and Dr. Maki explain how rhythmic dosing works without a uterus, why it can be an excellent option after total hysterectomy (with oophorectomy) or surgical menopause, and when a simpler static approach might be better. We cover candidates, myths (like “no uterus = no progesterone”), brain and bone benefits, and how to personalize dosing for real-life outcomes—sleep, mood, cognition, libido, and long-term bone strength. What you’ll learn ● Rhythmic dosing 101 (mimicking a 26–28-day cycle) ● Hysterectomy types: uterus-only vs. total (with ovary removal) ● Why rhythmic dosing can still help—even without a period ● Customizing estrogen + progesterone to symptoms and goals ● Brain fog & sleep: why declining estradiol hits cognition ● Bone density protection in the first 5–7 years post-menopause ● Endometriosis & fibroids: nuance, not one-size-fits-all ● When rhythmic dosing may not be ideal (e.g., 60 and off HRT for many years) If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried 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.
Confused by your DEXA scan results? Not sure if your T-score is “normal,” “osteopenia,” or “osteoporosis”or what to actually do about it? In this episode, Dr. Valorie Davidson and Dr. Robert Maki walk through three real viewer examples to show You exactly how to interpret bone density scores in your 50s and beyond. You’ll learn: ● How to read your DEXA scan: T-score vs Z-score in plain English ● The cutoffs: ○ 0 to -0.9 → normal bone density ○ -1.0 to -2.4 → osteopenia ○ ≤ -2.5 → osteoporosis ● Why two women in their early 50s can have completely different bone density ● What a T-score of -3.7 or -3.8 really means—and whether it’s reversible ● How surgical menopause, long-term steroids, vitamin D deficiency, RA, and genetics impact bone health ● Why your 50s are really about protecting your 70s (fracture risk, independence, and longevity) ● How weight loss, GLP-1 meds, and low muscle mass affect bones ● Practical foundations to protect and improve bone density: ○ Smart movement: walking, weighted vests, strength & resistance training ○ Protein targets & why bone = “calcified protein” ○ Stress, cortisol & steroid impact on bone loss ○ Vitamin D + K2, food-based calcium & targeted bone support formulas ○ Where HRT—and rhythmic dosing—fit into a long-term bone strategy If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried 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.
Many women confuse cycling static HRT with rhythmic dosing, but they’re not the same thing. In this episode, Dr. Valorie Davidson and Dr. Robert Maki from Progress Your Health break down the difference between the two, why it matters for your safety, and how to do hormone therapy the right way. In this video, you’ll learn: ● What “rhythmic dosing” actually means ● Why cycling your static HRT is not rhythmic dosing ● How improper dosing can impact mood, energy, and breast tenderness ● The risks of trying to adjust hormones on your own ● Why rhythmic dosing must follow the body’s natural ovarian rhythm ● How men and women can use synchronized rhythmic dosing safely If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried 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 Part 2, we go symptom-by-symptom so you can sleep through the night again. Dr. Valorie and Dr. Maki cover night sweats, frequent urination, heart palpitations, muscle cramps, headaches, itchy skin, vivid dreams, and when to suspect sleep apnea (under-recognized in women). You’ll hear practical tactics—electrolytes, targeted magnesium types, phosphatidylserine timing, glycine, L-theanine, and smart melatonin use—plus when HRT helps and how to pair data (CGM, wearables) with your sleep plan. You’ll also discover practical, science-backed fixes like: 💧 Smart electrolyte balance & targeted magnesium types 🧠 Phosphatidylserine timing for cortisol control 😴 Glycine, L-theanine, and optimal melatonin use 💊 When HRT makes sense—and how to pair it with CGM or wearable sleep data What you’ll learn ● What nighttime urination signals (estrogen & ADH, electrolytes, cortisol) ● Palpitations in midlife: estrogen link, when to see cardiology, calming strategies ● Cramps/headaches/itchy skin—common causes & quick fixes ● How/when to test for sleep apnea at home (and why it’s missed in women) ● Fine-tuning supplements & dosing; when HRT is the lever Still not sure what’s really causing your sleepless nights? Find out if you’re in the In-Between stage of perimenopause and menopause. If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried 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.
Why midlife wrecks your sleep—and how to fix it naturally. In Part 1, Dr. Valorie and Dr. Maki unpack the hormone triad behind women’s insomnia: shifting estrogen/progesterone, cortisol dysregulation, and blood sugar/insulin resistance. You’ll learn the difference between trouble falling vs. staying asleep, how low progesterone affects GABA (hello 2–3 a.m. wake-ups), and the daily habits that reset your circadian rhythm. What you’ll learn ● The hormone triad driving midlife sleep loss ● “Vampire / Zombie / Ghoul” sleep patterns—what they mean ● Why blood sugar swings trigger nighttime cortisol spikes ● Morning fixes that help nights: protein breakfast, light exposure, movement, temperature ● Starter supplements & how to think about them: magnesium (glycinate, L-threonate), L-theanine, glycine, phosphatidylserine, melatonin If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried 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.
