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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Discover the common and unfamiliar symptoms that you might be experiencing. Get access to cases of real women with hormonal conditions.
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.
