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?
Short Answer:
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 transition is where we come in. Helping with lifestyle, supplementation, and even medication to help the process.
Now surgical menopause is an entirely different story. In natural menopause, the ovaries start to decline and eventually cease hormone production. In surgical menopause, the ovaries are surgically removed. In an instant, you go from making hormones (estrogen and progesterone), to making absolutely none. This is a huge change. In a flash, a woman goes from producing hormones to an abrupt stop.
In most cases, the removal of the ovaries is necessary. Perhaps there is endometriosis where the ovaries have adhered to the abdominal wall, uterus, and/or colon. Or there are so many complicated cysts causing a tremendous amount of pain. There can be many reasons for an oophorectomy (removal of the ovaries). At this point, there is usually a hysterectomy (removal of the uterus) as well. As the uterus could have fibroids, polyps, and thickened lining. But in any case, removing the ovaries will put a cycling woman (having her period and usually in her 40s) into instant menopause.
After surgical menopause (depending on the reason for the removal of the ovaries), it is usually necessary to implement hormones. That being said, the abrupt decline of hormones can cause a woman to feel absolutely awful. From horrible hot flashes to not getting any sleep due to night sweats. There is weight gain seemingly overnight, hair loss, loss of libido, and vaginal dryness. Brain fog to the point of word recall being horribly embarrassing.
The thing with surgical menopause is dosing. In surgical menopause, you need to make sure to get the right dose for the individual to get a positive effect. Most docs end up starting too low when using bio-identical hormones (which unfortunately can give BHRT a bad name). BHRT can be amazing. But if not dosed well, it seems like, well, nothing. Many times, women are given an estrogen patch after surgical menopause. An estrogen patch is made up of estradiol. Which usually can actually be too strong. Being that it causes an instant 8-15 lbs of weight gain overnight and symptoms of estrogen dominance (which is a whole other podcast/blog post).
What we use for surgical menopause is Biest. Biest is a combination of estradiol and estriol. The estriol has a more gentle effect and helps buffer some of the strength (or side effects) of estradiol. But in the case of Biest, as mentioned before, it is about dosing. The difference between a conventional estradiol patch and Biest is like apples and oranges. The dosing is so different. So many women get underdosed with Biest. There are many ways to dose BHRT. It is so individualized that in our practice rarely are patients on the same dose. Everyone has their own individual doses based on their goals, health history, family history, and lifestyle. In some cases, we will do rhythmic dosing. Which is cycling hormone doses based on a natural 28-day cycle. As I mentioned, everyone is so unique that their BHRT dose is unique as they are.
Another unfortunate factor in surgical menopause is doctors’ neglect to implement progesterone. There is a conventional philosophy that if there is no uterus, there is no need for progesterone. But we firmly (very firmly) believe that progesterone is necessary for more than just a uterus. Progesterone has so many positive benefits. Such as helpful for irritability/mood and for breast protection for hair and skin (again, the benefits of progesterone is another podcast/blog).
As I said, surgical menopause is different from natural menopause. But it can be addressed in a way that can be incredibly helpful. If you have any questions, please contact us.
Other Related Episodes:
Episode 117 – Can Ovarian Failure Be Treated?
Episode 108 – What Should Esradiol Level be on BHRT?
Episode 1
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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.
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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.
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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.
