Kathy’s Question: I tried progesterone 100 mg pill. I felt dizzy and felt like I could not stand upright. Does a cream have the same side effect? I was also prescribed an estrogen patch.
Short Question: It is certainly possible that progesterone can cause someone to feel dizzy. It is often prescribed to help with sleep issues and anxiety, but some women claim to feel dizzy or “weird” after taking it. In our experience, this is more common with Prometrium, which is an instant-release form of progesterone. Bioidentical, sustained-release progesterone can still cause some of the same side effects but is typically much better tolerated. Progesterone cream usually does not cause some of the same side effects but is not effective for insomnia or anxiety. There is some research to suggest that progesterone is a vasodilator. This effect could lower blood pressure, which could make someone feel dizzy after taking.
PYHP 113 Full Transcript:
Dr. Maki: Hello everyone. Thank you for joining us for another episode of the Progressional Podcast. I’m Dr. Maki.
Dr. Davidson: And I’m Dr. Davidson.
Dr. Maki: So, again, we have another question. This one’s from Kathy. So, again, in the future, for those of you that are new to the podcast, hopefully we’re getting lots of new listeners all the time. If you are an avid listener, you like what we have to say, please give us a review on whatever platform. We are on all the major platforms. I still haven’t added our podcast yet, or I have had it added to an Audible or Amazon Music, but that’s on the list which I think is cool. But we’re on iTunes. We’re on Stitcher. We’re on Spotify. We’re on iHeartRadio. We’re on all those different podcast platforms. So, please give us a review. That’d be really nice. So, this question is from Kathy. Once you dive in and give it a whirl.
Dr. Davidson: Sure. We always change everybody’s name. We always say that on every podcast too. And these questions come from podcast listeners, and also from our website, from our blogs too. Kathy doesn’t say on here whether she got this from the podcaster or from reading one of the articles or one of the blog’s. So, this is from “Kathy”. I tried progesterone 100mg pill. I felt dizzy and felt like I could not stand upright. Does a cream have the same side effect? I was also prescribed in estrogen patch.
Dr. Maki: Yeah, so there’s a lot. This is a really simple question, which is nice. Right? It’s just a couple of questions and it’s fairly similar. We’ve done a bunch on progesterone. But this one adds a little bit of a different element with the progesterone patch or the estrogen patch. She doesn’t specify, but I would assume that if she’s getting the estrogen patch, that means she’s getting prometrium. We could probably make that as… Would that be a fair assumption to make?
Dr. Davidson: Yes, like you said, this is a short question. It seems simple, but it I like it because we can really extrapolate on it to help other people that might be in a similar situation, because this is really common. The estrogen patch is a very conventional type of hormone replacement. So we know she’s on an estrogen patch. She’s either menopausal, and she’s also on the progesterone. She’s probably gone through menopause and she has a uterus.
Dr. Maki: Yeah. So, we can assume at that point that she’s probably in her early to mid-50s, something like that. She’s probably having the classic hot flashes, night sweats, insomnia, all those…
Dr. Davidson: Brain fog memory, waking.
Dr. Maki: If she’s still menstruating, she’s not a candidate for the estrogen patch. That would not be good. It would just probably cause a lot of frequent bleeding. That’s one of the ways that you determine if someone’s a candidate or not, is their menstrual history. If they still have one, then progesterone is fine. You could do progesterone. Sometimes that’s very necessary. That’s kind of the more the perimenopausal window. But if they are menstruating, they are not really candidates for estrogen necessarily. So, the feeling dizzy and could not stand upright, a fairly a recent episode – I think it was the last one we did – was talking about someone not being able to wake up in the morning, right? These are fairly common side effects, would you say?
Dr. Davidson: Yes, because progesterone is very relaxing. You don’t want to take it in the morning. Although I will have to say, I have two patients that love taking their progesterone in the morning and they feel no grogginess or tired or anything. They are just like unicorns. But for most of us, myself included, if you take progesterone, it’s going to make you a little relaxed, a little tired. So it’s perfect to take it at night to help you sleep. And then progesterone is needed for anyone taking estrogen. They’ve got to take some to take some progesterone because you don’t want to give unopposed estrogen, especially if they have that uterus because that progesterone, I’ve said it probably a billion times, that progesterone is going to help protect that uterine lining when someone’s taking estrogen replacement therapy. But 100mg is pretty much an average dose for somebody with the uterus on menopausal taking hormone replacement with estrogen. So I wouldn’t say that we’d want to go lower because then that would just leave her uterus unprotected. And then at the same time, we wouldn’t want to switch to a cream. And maybe every practitioner knows this is a dance, this is an art doing hormones, but I’ve always found the cream is just not strong enough to protect that uterine lining.
Dr. Maki: Yeah. Right. And the progesterone cream doesn’t have that mental-emotional plane level of relief that the oral capsule does. So yeah, we don’t grant it. We contradict ourselves because we do use progesterone cream with rhythmic dosing. That’s quite something common. But in that case, if a woman has her uterus, now granted we’re really complicating things now, but in that case with the rhythmic dosing and progesterone cream, we want the women to have a period, which kind of goes against the gradual.
Dr. Davidson: It’s like one different kind of therapy. Exactly.
Dr. Maki: Yeah. And we’ve talked about the difference and we’ll hash this out again, the difference between static dosing and rhythmic dosing. What she’s doing and what is most common for most women is they’re doing static dosing. Same dose every day. With rhythmic dosing, the whole point of rhythmic dosing is to basically recreate the woman’s female cycle. So, she has a peak of estrogen on day 12. She has a peak of progesterone on day 20. And 8 days later she has a period. Something similar to that. So it’s the rise and fall or the peaks of those two hormones that initiate that process. When a woman is in menopause, all the hormones have kind of flatlined in some respects. All we’re trying to do is just raise the baseline, which does provide some symptom relief. I will now granted that’s not raising them to what a woman was when she’s in her 30s necessarily, but it does help with the hot flashes, it helps with the night sweats, it helps with all those kind of menopausal related symptoms.
Dr. Davidson: And like I’ve always said, not one situation fits all. Not one pill fixes all. So, some women love that rhythmic dosing and I have a lot of women on that. And then some women don’t love the rhythmic dosing. And we have a lot of women on static dosing. So that’s where you have to have that individual treatment plan. So even for our patients, one patient is on one particular type of dosing for her and her goals, and then another one’s on a completely different thing. I even have sisters and they’re on completely different therapies because we have to individualize this. So I feel like for Kathy that this treatment plan that she’s on with that estrogen patch and that 100mg of the progesterone may not be completely individualized to her.
Dr. Maki: Yeah, and we were discussing this before we press the record button. Even the estrogen patch could cause a little bit of dizziness and maybe not being able to stand upright. That’s certainly more on the progesterone side, but the estrogen could make her feel a little woozy at the same time.
Dr. Davidson: And like you were mentioning, she’s probably on a Prometrium, which is progesterone. It’s bioidentical progesterone, but there’s also a lot of fillers and excipients and whatnot in there, but it’s instant release. So, what she might be doing is taking it around dinner time, sitting down to watch some TV or something after dinner, and then, like, whoa, yeah, I’m feeling a little woozy. Like trying to get up and walk to the bathroom or get ready for bed. Or she might be taking it right before she goes to bed, let’s say 10 o’clock at night, then maybe she wakes up at midnight to go to the bathroom and can’t walk to the bathroom because it’s so close to when she’s taking it because an instant release is just like it sounds, it’s going to instantly release into your bloodstream and peak as high as it can as pretty much as soon as you’ve taken it. You know, 45 minutes after you’ve taken it because you’ve digested it.
Dr. Maki: Yeah. Now granted, hopefully she doesn’t mention it. Hopefully, that would help her sleep well.
Dr. Davidson: Hopefully she’s not taking it in the morning. Kathy, don’t take it in the morning.
Dr. Maki: Yeah. Hopefully, you’re not getting behind the wheel of a car. You’re not driving a car. You have to put like a warning label energy, not operate heavy machinery after taking progesterone.
Dr. Davidson: I think maybe no, it doesn’t have that.
Dr. Maki: I don’t think it does. Some of the other anxiety medications and any depressants, they certainly have those warnings on there. But this is a very common thing that we get from patients all the time and questions. This one, I think, has come up probably at least a dozen times, if not more. So we might have answered this in the past. If we have, sorry, but the repetition is good, right, because we’re getting new listeners all the time and these things, in some ways, the same. We’re trying to pick out the questions so we are not repeating ourselves. But there are always little nuances in every little thing that we can tease out a little bit. And hopefully there’s something that you’re learning or you’re pulling from it that is helping your situation in some respects. And that’s why this one is very simple, very straightforward, but at the same time, there’s a lot to tease apart there. Prometrium and the estrogen patch are just something that we would not do. That is just not the route we would take with a patient. We’ve talked about the estrogen patch and the vivelle patch fairly recently on how relatively strong that patch really is. I don’t think even practitioners even realize when you see the milligram amount, there seemed so minuscule as far as the milligram amount, but the effect that has on the woman is pretty significant in some cases.
Dr. Davidson: Yes, the patch is a lot stronger than doing bioidentical creams. So much more. And like you said, I don’t know if I would necessarily use a patch with her. I have a few people on it that they like it, but I probably wouldn’t, especially since it sounds like she might be a little bit sensitive, taking that 100mg of progesterone and not being able to stand upright. I would say for Kathy, you don’t want to go below 100mg of progesterone if you are on an estradiol patch. That just wouldn’t be protective. But what you could do is switch to a compounded sustained release. So, instead of that instant release just popping way up and you can’t even hold yourself steady, is you could take the sustained release and then it just comes up gently and stays up over the night, so that you can still get that dose of progesterone, get that protection, get the positive benefits from progesterone, but at the same time she probably would not feel dizzy and be able to stand up straight.
Dr. Maki: Yeah. She won’t feel punch-drunk from taking the progesterone. She’ll actually have a little bit more of a normal response. Still more of a sedating kind of a sleep-inducing response, but not one that’s going to make her compromise in any way. Certainly, nobody wants to feel like that if they don’t intend to. This one, like I said, was relatively short. Do we want to say anything else about this one? Or did we kind of cover the bases on this one?
Dr. Davidson: No, I liked it.
Dr. Maki: Yeah, so this one’s very short, but still I liked it because it was very short and there are a couple things to tease apart and some assumptions that were making based on her situation. So, until next time. I’m Dr. Maki.
Dr. Davidson: And I’m Dr. Davidson.
Dr. Maki: Take care. Bye-bye.
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Perimenopause is the time in a woman’s life prior to entering menopause. Most people are familiar with menopause, which is when the ovaries stop producing hormones and women stop their periods. There are many options to deal with menopause (which is an entirely different podcast and blog). But perimenopause is a completely different animal compared […]
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Episode 052 – What Biest Ratio is Best for Menopause?
This is such helpful information. I have often wondered who 80:20 is good for and who 50:50 is good for.
One thing I'm still confused by is the estrogen weight gain component. You said that estrogen (as well as menopause in general) could be the cause of her weight gain. I can relate. I was very thin my whole life, now 53 and about 30 lbs overweight. But you also said she might benefit from getting her estrogen balanced, and she was not using enough.
If too low a dose made her gain weight, won't an increased dose cause more weight gain? I have heard other podcasts and read articles that in menopause, we gain weight because our estrogen falls. Estrogen seems to be blamed for weight gain, whether it's high or low. Can you help clarify? There's something I'm not understanding. Thank you! Tracy
Often estrogen has been the scapegoat for weight gain. I'm sure you have heard too much causes weight gain. Too little can pack on the pounds. It can be pretty confusing. So which is it? Is too much estrogen causing my pants to become uncomfortably tight? Or is it too little estrogen that has given me the gut I never had?
Well, it’s not that simple. Estrogen levels do have a hand in weight gain and weight loss. But it is not the only variable. It really is the combination of the balance of estrogen with other hormones in your body. To name a few main players, progesterone, insulin, and cortisol, as well as enzymes, lipoprotein lipase (LPL), and hormone-sensitive lipase (HSL). Okay, I know that sounds vague and doesn't answer the question. Let's back up a bit and look at what women are saying about estrogen.
As soon as menopause hits, women complain that they are instantly 15-30 lbs heavier. Not because of diet or lifestyle. It's like menopause adds an unwanted 15-30 lbs overnight. Then some women are on hormone replacement therapy, taking estrogen, and are horrified because the HRT caused them to gain 10 lbs in a month. So what is it? Did the lack of estrogen in menopause cause that 20 lb weight gain? Or did that hormone replacement estrogen create rolls that were never there? Well, actually, both are true. Before you throw out your jeans in favor of high-waisted yoga pants, let’s learn about the other players in weight gain.
Progesterone will buffer estrogen. Estrogen does like to grow things'. That is why in puberty, you grow breasts and hips. Progesterone helps to balance some of the growth' that estrogen can cause. That is why in perimenopause, when the progesterone drops and the estrogen is running the show, the weight gain begins. That is also why when a woman starts estrogen therapy for menopause but not enough progesterone, there is weight gain.
‘Doc, I really don't feel like myself. I think it's my hormones. Could it be my hormones? Can you test my hormones?'
How many times have I heard new clients tell me this story? They go to see their GP, Gyno, or Internist, asking to have their hormones tested. Only to be told that there is no testing for hormones. Or that it's not necessary to test hormones. Only to leave feeling dismissed, with no answers to why they do not feel well.
While I understand that your GP, Gynocologist, and Primary Care Physician are not the jack of all trades,’ there are many tests for hormones. There are blood tests, urinary testing, and even saliva testing. The more difficult part of hormone testing is the interpretation. The basic lab values assigned by the labs are very vast, and without experience and training, it can be quite difficult to determine if there is a hormone imbalance.
If you are feeling like you have a hormone imbalance or having symptoms concerning your hormones, below is a list of common hormones to be tested and why. Because blood lab testing is so popular, I am going to stick to blood testing. Later we will have more labs and interpretations for urine and saliva.
To start, blood testing is just a look at one moment in time with respect to your hormone levels. In a menstruating woman, her hormone levels are changing every day. But in a menopausal woman where the ovarian function has ceased, her hormone levels are going to be pretty level day to day. So in a female that is still having her period, I like to try and aim for getting the blood drawn around day 12 and/or day 21. In a 28-day cycle, the estrogen will surge around day 12, and the progesterone will surge on day 21. This can give us better insight into her levels of progesterone and estrogen. In a menopausal woman that has not had a period or has sporadic periods with common menopausal symptoms, I will have her draw her blood any time of the month.
FSH and LH:
FSH stands for follicle-stimulating hormone, and LH stands for luteinizing hormone. These are not actually hormones. They are stimulating hormones.' Meaning both the FSH and LH are released from the pituitary gland (in your brain) in response to estrogen and progesterone production. The FSH and LH work in what is called a negative feedback loop.’ Meaning if the levels of estrogen and progesterone are high, then the FSH and LH are low. In turn, if the estrogen and progesterone levels are low, then the FSH and LH are high. It is like when you want your husband to take out the garbage. If he doesn't, you might raise your voice until he does. It is the same with all stimulating hormones. If the ovarian production of hormones is low, as in menopause or perimenopause, the FSH and LH levels will look high.
Estradiol and Progesterone:
Always test estradiol to get specific results for estrogen levels. Estradiol is much more specific for estrogen levels than simple total estrogens. Ideally, in a menstruating woman having the blood test around day 21 will give you insight if that woman is ovulating. It will so give you insight if there is progesteron
Michelle’s Question: Hi, thank you so much for sharing your knowledge with us!
In March 2022 at 42 years old, I had a total hysterectomy with bilateral salpingo-oophorectomy because of stage 4 endometriosis, grapefruit-sized fibroids, ovarian cysts, and my left ovary adhered to my colon.
I was immediately put on an estradiol patch. I was recovering and doing well until the beginning of June. Then I started having hot flashes, 24/7 anxiety, insomnia, and not feeling well every day.
Since March, my dosage has gone from .25, .5, .75, and 1 mg. But I saw no improvement in my symptoms and have said this was the worse summer of my life.
I am debilitated by it. After much research, I decided to try bio-identical creams that have estriol, estradiol, progesterone, pregnenolone, and DHEA.
Even though I no longer have a uterus, I know that my body is used to having these hormones and am hoping they help me get through this surgical menopause and be able to function again. Is this a combo hormone protocol you've ever done for your patients?
If so, should I apply estriol and estradiol in the morning, and progesterone, pregnenolone, and DHEA at night?
Surgical menopause is much different from what you could call your typical menopause. Honestly, there is nothing typical about menopause. Some women breeze through menopause and others have symptoms so severe it can seriously affect their quality of life, not to mention the people around them. And I (Dr. Davidson) can say this honestly, being just shy of 50 and feeling the effects of menopause. But being that I am a hormone doctor, I have some advantages to easing my transition. This is why we do what we do, here at Progress Your Health Inc. We know that hormone imbalance can alter how you feel. From your energy to your sleep, to your libido (or lack of) and more. Hormones can even affect your actual overall health.
Menopause is when the ovaries naturally start to decline and then cease producing hormones. Those hormones in particular are estrogen (estradiol) and progesterone. Menopause is a natural part of life. Those ovaries have worked well for a long time and are ready to retire, naturally so. Making that transi
Laura’s Questions: I am on 25 mcg of Levothyroxine for 6 yrs with hypo symptoms, every one! My endocrinologist just took a panel, and the results are the following:
TSH 2.36 uUI/mL Reference Range = 0.45 to 4.5 uUI/mL
Free T4 1.1 ng/dL Reference Range = 0.82 to 1.77 ng/dL
Free T3 2.9 pg/mL Reference Range = 2.0 to 4.4 pg/mL
Should we up my dose of Levothyroxine to 50 or should I just switch to Synthroid or Armour? Thanks!
Short Answer: We typically don’t recommend or prescribe Levothyroxine or Synthroid for our patients. Both of these medications only contain the T4 hormone. This is referred to as T4 Monotherapy. These medications do a good job of lowering the TSH level but do not always help the patient feel better. We like to prescribe thyroid medication that contains both the T4 and T3 hormones. In our experience, our patients tend to feel much better on a combination medication, rather than on a T4-only medication.
In our opinion, we feel that sustained-release compounded thyroid medication is the best option most of the time. This type of thyroid medication gives the doctor many dosing options, which is certainly good for the patient and their overall symptom profile. Because this medication is compounded, the T4 and T3 hormones can be changed independently of the other hormone. With a commercial prescription, there are only so many dosing options, and both hormones are affected when raising or lowering the dosage. Also, the sustained-released nature of the medication helps to reduce any unwanted side effects that are common with commercial instant-release thyroid medications.
Related Podcast Episode:
PYHP Episode 038 – Do You Have a Low Free T3 Level?
Check out Dr. Davidson’s new book – The Perimenopause Plan
Buy the book on Amazon.
If you have questions about your thyroid or any other hormone related issue, feel free to contact us.
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