This episode we respond to a reader question. Jayme had sent us a question earlier in the year based on an article we wrote. Now she has additional questions about taking progesterone as part of her BHRT. Jayme has had a hysterectomy and wasn’t sure what dose of progesterone is best for her. Or for that matter, if she should even be taking it.
Also, she has questions about her lab work and her estrogen dose. We really like Jayme’s question, because we get similar concerns often. By answering Jayme’s question, we hope to help other listeners understand a bit more about BHRT dosing, labs and progesterone with or without a hysterectomy.
Just to throw it out there, this is not meant for medical advice and intended for educational purposes only…
Jayme’s question:
Dr. Maki, Thank you for answering me. Recently my doctor increased my biest to 4mg twice a day. I also stopped my progesterone to see if it was making any difference and I felt exactly the same, so I have not continued it. I had a complete hysterectomy, do you have thoughts on taking progesterone? I was taking compounded progesterone 200mg/day. Before my biest increase, I had my labs taken twice in one day: morning and late afternoon because I was feeling like they wore off. I was correct:
Jayme’s Labs:
Total estrogen 112 morning and 60 evening
Estradiol 35.4 morning and <5 in evening
My estradiol has never gotten above 35.4.
Any new insight would be so appreciated. Jamie
We wanted first to address the progesterone. If a woman has a uterus and is taking estrogen, she absolutely needs progesterone. Estrogen thickens the endometrial lining. This can increase the risk of uterine cancer without sufficient progesterone. But there is a theory in the medical community that if you do not have a uterus, then you do not need to take progesterone. Whether a woman has a uterus or not, we never give unopposed estrogen.
Progesterone helps to balance estrogen. Estrogen is a beautiful hormone but can have side effects. Some being weight gain, increasing breast density, moodiness, and even anxiety in some cases to name a few. Progesterone is great at balancing these negative side effects of estrogen. Progesterone itself is very helpful for many symptoms.
It is great for helping a woman fall and stay asleep. When the progesterone levels drop during perimenopause and menopause, can make staying asleep difficult. Often women will complain of either waking up multiple times in the night or waking up for hours in the night. Adding in a little progesterone at night can really do wonders for sleeping. Progesterone can also be great for mood and irritability as well. When progesterone levels are low, women often remark that their patience has disappeared. Their tolerance levels have dramatically dropped. Progesterone can have a remarkable impact on helping mood and reducing irritability.
Back to Jayme. She had a hysterectomy and does not have her uterus. We still think that Jayme needs some form of progesterone. Because she does not have a uterus, that gives us some versatility in dosing and form of progesterone. To protect the uterus, you usually need an oral form and at least 100 mg taken at night.
Depending on Jayme’s symptoms we can use any dose and any form such as a capsule or cream. I think it would be a good idea to reduce Jayme’s progesterone to 75-100 mg orally taken at night. As mentioned above, this will help with her sleep and balance her estrogen. Moving forward her dose can be modified depending on her sleep.
I would like to address Jayme’s concerns about her labs.
Labs are very important, but you do not want to chase the lab numbers. You also want to base doses on a person’s symptoms, personal and family history and their own health goals. For lab testing, we are looking for absorbency.
For accuracy, apply your hormone cream 3-5 hours before your blood draw. For example, say you have your blood tested without having applied your cream that morning. This will show your levels non-medicated. Which in menopause will be zero. This doesn’t really tell us much about dosing and absorbance.
I cannot stress how important it is to apply your hormone cream 3-5 hours before the blood draw. Also, to assess estrogen, always use the estradiol levels. Total-estrogen in the blood is not accurate enough to determine absorbability and dosing. Jayme took her labs twice in one day, so that gives us some important information. We are going to assume Jayme did put on her biest hormone cream 3-5 hours before her blood draw.
We need to base her dose on her symptoms, but her estradiol level is pretty low in the morning at 35.4. Based on this, it may be helpful to raise her biest dosage. Bio-identical estradiol and estriol are a great way to treat menopause. But they do not have a long lifespan. That is why it is important to apply your biest twice a day.
If you only took your biest in the morning, by bedtime or the middle of the night, it is pretty much nonexistent. That could be why Jayme’s estradiol levels were so low in her evening blood test. More than likely, her dose may be low, to begin with. By evening, it has worn off completely.
But we truly believe that less is best.’ If Jayme feels pretty good with this biest dose, then keeping it low may be a good idea. But if she is having symptoms such as hot flashes, night sweats, vaginal atrophy, hair loss, mood swings, insomnia, brain fog, skin thinning and changes, then it might be helpful to adjust her biest dose.
We really appreciate Jayme taking the time to share her concerns, labs levels, and BHRT doses. There is not a one-size-fits-all dose for dosing BHRT. It really is a customized art and communication with the patient is key.
As you can see with Jayme, she knows her dose, and she knows her labs. We always find it essential to explain to a patient, what they are taking and why. That is why it is important to address all of these questions and concerns when dosing BHRT. Again, thank you Jayme, and we really think your concerns and questions can help others listening to this podcast.
If you have any questions feel free to comment below or you can 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.
