In this episode, we answer a reader question.  This question is from Jen, responding to one of our articles. Jen's question is important because hormone treatment can often come as a prescription.  And it is important to understand our prescriptions and if they are actually going to be beneficial.

Jen's question relates to her current BHRT prescription that her doctor has recently put her on.  She has side effects from her medication. Plus she is not noticing the effectiveness that she was hoping.  

Question From Jenn:
Hi, I stopped cycle four yrs ago- for four weeks now – I'm taking E2/E3/T 1/1/4 (1/4 gr applied morning and 1/4 gr applied at night). If I am receiving 1/2 gram a day, I am receiving .50 mg E2 and .50 mg E3 & 2 mg of Testosterone.

I am getting dull headaches at the back side of head 4 to 5 hrs before the 12 hours app time, but breast tenderness which I hate. I have asked my doc to up to 1.5/1.5 per gram still applying the same quantity (1/2 gram daily)- and request Testosterone in a separate compound. Meaning I will receive .75mg of each E2/E3 a day and hold off on Testosterone to see if headaches are lack of E for sure.

After reading your responses, I wish I would have suggested a different ratio. Perhaps leave the E2 at 1mg/gr. Or drop to .50 and increase the E3 to 2.5 -3.0 mg. E3 might help w/breast tenderness? I take oral 1 mg prog at night. Your thoughts? Is 0.50mg/gr E2 which equates to receiving .25 mg of E2 a day too low, I want the benefits of E2 -hair skin happy, but don't want to feel fat and pregnant.
Thank you in advance for your response and your thoughts. Jenn

One thing we cannot stress enough is there is not a one-size-fits-all for BHRT dosing.  Everyone is unique, and there are many aspects to developing an individualized BHRT plan. In our patient population, everyone's BHRT is based on their personal and family history, health goals, symptoms, as well as lab data.  We then keep continuous follow up with them, because the body is not static.

People's BHRT doses will change over time, whether it is age, change in health goals, stressors, symptoms, etc.  It is important to keep close follow up with the patient to ensure their hormone doses are accurate and working well in their lives. We really like Jenn's message because her situation is common.  She is on BHRT, but it is not quite working for her and alleviate her symptoms.
Also, Jen is experiencing side effects from her prescription dosages. She is getting headaches and breast tenderness which is typical

When we started this podcast and writing articles, we were very naive about who would want to read this stuff. Honestly, I didn't think anyone would want to listen to a husband/wife couple-docs that only dealt with hormone balancing. Being an introvert, I am really pushing myself outside of my comfort zone with these articles and podcasts.
I cannot believe how many readers and responses we have gotten. I am absolutely amazed at how many responses we have gotten from people outside of the USA. I am truly flattered and amazed that people from all over the world are reading and listening to our content.
With that said, we have gotten lots of comments and questions from readers/listeners. It is hard to answer them one on one. So I wanted to write an article answering some questions that we have gotten. Some of these questions are from the states and others outside of USA.
Regardless of where we are from, we still experience hormone issues. I believe these questions might help others going through the same hormonal imbalances. And help us to know that our concerns are valid and we are not alone.
Question – Sherry
Hi, What is Estriol made from? I know that Estradiol is from equine urine, and I stopped taking it for that reason and also it caused my breasts to get really large and very tender. I want a natural menopause supplement that isn't animal derived. Does Estriol fit this description? Thank you, Sherry.
This is a great question. Many people are not sure of what BHRT and hormones are made from. Actual estradiol is not made from horse urine, or also known as equine estrogens. There are conventional hormone prescriptions that are made from horse urine.
These are commonly called Premarin and Prempro to name a couple. But estradiol is a bioidentical hormone. But as we talk about on this episode, estradiol is the strongest form of the bioidentical estrogens. Estradiol is an amazing hormone. It helps with bones, mental energy, hot flashes, sleep, libido, and vaginal atrophy to name a few. But like I mentioned, estradiol can be quite strong.
That is why Sherry is having the breast tenderness. For vaginal atrophy, we use estriol, which is the weakest, most gentle of the estrogens. It is great for vaginal dryness and atrophy without the side effects that estradiol can cause, such as breast tenderness and uterine thickening or spotting. So to answer Sherry’s question, both estradiol and estriol are bioidentical. But the estradiol may have been too strong for her, and that is why she had the breast tenderness.
Question – Rachelle
I have vaginal dryness, and I noticed a little bit of spotting today. I haven't had sex in over 3 yrs, but I do walk a lot. And I use cream from time to time. I also have a lot of burning off and on. The cream seems to help, but I don't want to use it too much.  That laser sounds worth it but too expensive for me. I was concerned about the spotting. I just had my pap smear done, and it came back good.
This questions came from an article that we wrote about vaginal dryness. The laser that Rachelle is referring to is a procedure that doctors are using to relieve vaginal dryness and incontinence. It works really well for both, and usually, only three treatments are necessary. But the drawback is that it can be costly, and insurance does not usually cover right now. We have seen many patients that have vaginal pa

 
Question: Hello, I am an almost 41 yr old female and I just read an article about cortisol levels (vampire, ghost, and zombie) that you wrote, and I'm curious to know more. I think that I'm like the vampire the most, but not exactly. I had a saliva test done recently and the results said that my levels were extremely low in the morning, then went to normal around noon but then by 4-5 they were dropping again. My doctor put me on progesterone because my estrogen to testosterone ratio was pretty severe (high estrogen/low testosterone). Although I take them at night because they make me extremely tired, I can't but feel the struggle even more in the morning now. Will DHEA help? Or anything? Thanks, Jaime
Jamie is referring to an article we wrote about cortisol levels, adrenal fatigue, and sleeping patterns.  Cortisol is a very important hormone. Without cortisol, we cannot live. But having your cortisol levels balanced plays an important part in daytime energy and sleeping patterns at night.  Cortisol is released from your adrenals glands in a diurnal curve . Meaning, cortisol is highest in the morning so you wake up bright eyed and bushy tailed , ready to start your day. Over the afternoon the cortisol will dip slightly.  Come evening it will drop dramatically so you are ready to go to sleep and stay asleep all night long.
In this episode, we talk about three dysfunctional cortisol curves that affect sleep and daytime energy. Having dysfunctional cortisol levels can create havoc on a person's quality of life.  We didn't want to poke light at these dysfunctional patterns as these are serious issues. But to help with learning and teaching we created three types of dysfunctional cortisol patterns relating to adrenal fatigue.
Three types of dysfunctional cortisol release patterns that affect and contribute to adrenal fatigue.  We call these types, The Vampire, Ghost A / Ghost B, and The Zombie.
Vampire: The Vampire has high cortisol in the evening and low cortisol in the morning.  That makes the Vampire feel really good at night. Inevitability because Vampires feel so good at night, they have a hard time falling asleep.  They will stay up late because they actually feel normal in the evening. But come morning, they have a hard time getting out of bed. These are the people that press snooze multiple times and usually takes them forever to get out of bed.  Even though they reluctantly crawl out of bed, they still complain about brain fog and feeling tired until at least midmorning.
Ghost: The Ghost is the person that falls asleep easily.  They always say, I have no problem falling asleep. My head hits the pillow and I am out.  But I always wake up a 2-4 hours later . That is because their cortisol is low in the evening.  But will raise up in the middle of the night, waking them up. You will find your Ghosts roaming the house in the middle of the night.  They might end up watching TV, eating, playing on their phones or even checking their email. Some get so fed up waking up in the middle of the night that they just get up and start their day.  Most Ghosts feel fairly well in the morning. But they disappear and Ghost everyone in the afternoon. Between 1230 and 330pm

We have have been getting a lot of questions regarding Bioidentical Hormone Replacement Therapy. We thought a good way to respond to these questions would be to answer them on the podcast. In this episode, we discuss a woman’s situation regarding her experience with testosterone pellets. Below is her exact email.
Listener Question: Nina 
Hello there, I have loved reading all your info with regards to BHRT, Hypothyroidism etc. There are two things I would love to get your opinion on. Firstly a quick background.. I am on BHRT and have had two rounds of Testosterone Pellets.
The first round, within 3 weeks of having it inserted I felt awful, couldn't sleep, cholesterol reading was high, cortisol readings were off the charts… and still only managed to get to my peak of 98 at 6 weeks( I believe the aim was to get to 150)… I swore I would never have it done again… however after 2 months and things had died down I decided to give it another go… this time my lovely doc increased the dosage to get me at my peak reading… this time around I was 10 times worse..my thyroid levels were bouncing around.. and had to increase my Synthroid from 75 mcg to 88 mcg and then to 100 mcg… couldn't sleep etc etc
Have just had my thyroid levels checked again, I was edging toward being Hyperthyroid… so I'm now back to 75mcg…I am due for my 3rd round of Pellets and I've decided this is not for me.
My GP just think this is all a coincidence when the Pellets are inserted.. my hormone doctor doesn't believe it either..
A friend s OBGYN said he dislikes the Pellets as he believes not enough study had been done on women, studies have come up that lipid and thyroid levels can go haywire…
I'm trying to get info and coming up against a brick wall.. nobody seems to believe me… do you have any thoughts on this… I would REALLY love to hear them.
Secondly.. I'm on Progesterone cream, have tried the tablets.. they were making me feel drowsy plus I was having some crazy dreams.. having said that after reading your article on uterine cancer and how it is better protected with oral progesterone, I'm willing to give it another try…
My Hormone doc says I'm pretty sensitive to medication (which I am)..
What do you think would be the best route for me to take with regard to drowsiness during the day.
Hope I'm making some sense…
Have bookmarked your page and will reread again and again… you seem to make so much sense.. I'm so glad I found you guys
Many thanks – Nina
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In this episode, we talk about how to lose belly fat.  Belly fat is one of the most common complaints we hear from our patients and listeners.  Weight loss, especially in the stomach is very common and more of a consequence of hormones rather than food.  
This episode is an extension from our article, 11 Tips on How to Lose Belly Fat in Perimenopause'. Because of the popularity of the article we wanted to expand on belly fat and ways to combat it.  This episode focuses on tips to help lose belly fat that you might not be aware of. That is because many of our tips go against the grain in the typical weight loss theory of eat less, exercise more.

How many of you have gone on a diet ? I think I went on my first diet at 13 years old.  For the majority of history, it has always been reduce your calories and exercise a bunch, and you will lose weight.  While many do this over and over. The long game is, the weight might initially come off. But inevitably the weight loss will plateau and come back.  How many of you have worked really hard to lose 15 pounds only to put most of it back on plus more, just by going back to a normal way of eating.
You do not have to starve yourself and exercise like crazy to lose weight and maintain it.  I have so many people complain that they are eating 1000 calories and do some form of intense cardio 5 days a week and they are actually gaining weight! I wish to lose weight that the simple math equation of calories in versus calories out acutally worked.  That would be amazing. But there are too many variables, whether metabolic or hormonal that influence this equation making it obsolete.

Reduce Stress: yes, this is easier said than done.  But stress raises cortisol which then causes an imbalance of glucose and insulin.  Insulin is the only fat-storing hormone. Stress can actually make your belly grow.  Stress = Belly Fat.

Get Better Sleep: getting enough restful, deep sleep will help prevent belly fat.  Sleep is when we heal, and our cells recover. Not getting sufficient sleep will cause your cortisol to elevate at night.  Which a mentioned above will alter the balance of glucose and insulin. I have had patients that we worked only on healthy sleep that lost weight.  All they did was sleep better, and their pants fit better.

Don't Drink Your Calories:  we all know that we shouldn't drink soda or sugary drinks.   Sure, we have all heard of a beer belly'. Yes, alcohol beverages like wine and beer can cause weight gain.  But fruit juices are still loaded with sugar. Any drink with sugar will raise your glucose and then your insulin, then your belly.  That goes for electrolyte sports drinks that are loaded with sugar. Even coconut water has a lot of sugar in it. Some protein powders are secretly loaded with sugar.  If your protein shake/powder has more than 5 grams of carbohydrates, do not drink it. Ideally, find a protein shake that ha

This episode of the Progress Your Health Podcast is a continuation to a recent blog post: 7 Tips on How to Cope with PMS. Most women have some PMS symptoms, but there is certainly a spectrum of symptom severity. For one woman, it might just be mild bloating, but for another woman, her cramps are so bad that she has to miss work due to the pain.
Unfortunately, when you go see your primary care doctor, or even your Gynecologist, the only conventional treatment option is birth control and over the counter Midol. As we discuss in this episode, there a many things you can do to help reduce PMS symptoms.
If you break down the word, Premenstrual Syndrome, it refers to the collection of symptoms that tend to show up prior to menstruation. It is common for PMS symptoms to show up somewhere in the 7 to 10 days before your period. This is time frame usually between ovulation and menstruation.
As you might be aware, PMS symptoms can range from physical symptoms such as cramping and breast tenderness to emotional symptoms such as irritability and anxiety. Over the years, we have seen so many different types of PMS related symptoms. Some symptoms are obvious, but others can be less clear. If you seem to be having recurring symptoms every 2 to 3 weeks, it could easily be related to your cycle.
Below is a list of some of the more common PMS symptoms. 
Symptoms of PMS:

Sugar and carbohydrate cravings (especially refined processed carbs)
Weight fluctuations (due to water retention)
Gain weight easily during PMS, and then you have to work really hard to lose it
Acne: especially around the chin and jawline
Breakout on the neck, chest and upper back
Bloated
Constipated
Breast swelling and tenderness
Anxiety
Spotting 4-8 days before a period
Cramps
Cramping can happen during the period or anywhere from 7-14 days before a period
IRRITABLE!
Angry outbursts, patience is nonexistent
Crying
Sad
Trouble staying asleep
Low sex drive

When it comes to hair loss, the first question women ask is, “can thyroid problems cause hair to fall out?”
The answer to this question is an obvious yes.
The next question women will ask is, “can hair loss from thyroid problems be reversed?
Again, the answer is yes, your hair will grow back, but the underlying hormone issue needs to be addressed.
Something to keep in mind, hair loss is not always just a thyroid issue. When it comes to hormones, when one is out of balance, other hormones are also out of balance. For hair loss. this would include the major metabolic hormones and sex hormones. The hormones include cortisol, insulin, DHEA, Testosterone, estrogen, and progesterone.
In this episode, we discuss ways to help hair loss from thyroid and other hormonal imbalances. For more information, you can read our article: Guide on How to Stop Hair Loss from Hypothyroid.  
We have seen many patients over the years and hair loss ranks towards the top of the list of importance. Women are so scared and desperate not to lose their hair and will do and try just about anything to make it stop.
Unfortunately, many doctors are not interested, or not trained to treat your hair loss concerns. Patients have told us their doctor says nothing can be done, or simply refers them to a dermatologist.
Hair loss is not just a consequence of aging. It is not something you have to simply accept, it is a symptom of an underlying hormonal or nutritional issue that can certainly be addressed.
The thyroid gland plays a role with just about every system in the body. An underactive thyroid can lead to many symptoms, hair loss being a very common one that we see with many of our patients.
When hair loss is due to hypothyroidism, it is from the root. It may be typically to find full pieces of hair all over the house. In the bathroom, bedroom, kitchen and even in the car. The hair will be thinning all over the scalp, but mainly on the top and the hairline. It is also common for people with hypothyroidism to be missing the lateral of their eyebrows, which is referred to as Queen Anne's sign.
Below are some tips to consider in order to stop your hair from falling out. 
Ideas to help with hair loss from hypothyroid and other hormonal imbalances.  

No Dieting (lowers T3) 
Reduce cardio exercise (increases cortisol) 
Improve sleep quality (lowers cortisol) 
Thyroid medication with T3 hormone (raises T3 levels) 
Lower High Reverse T3 levels (due to T4 only medication) 
Improve Liver function (improves T4 to T3 conversion) 

Other issues that could be contributing to your hair loss:

Uterine Fibroids are benign growths inside the uterus.  Some people do not know they even have fibroids and others have significant symptoms that can impact their quality of life. For more information, you can read our blog post about Uterine Fibroids. This podcast discusses:

What are uterine fibroids?
Typical physical and mental symptoms of fibroids.
Causes of uterine fibroids
What causes uterine fibroids to grow larger

Uterine fibroids can be genetic, and you seem them run in families.  Or it can seem out of the blue, and no one in the family has them except you.  Either way, remember that uterine fibroids are not cancer. Uterine fibroids are benign growths.

While fibroids are not cancer-causing, they can still affect a woman's quality of life.  Fibroids can have many symptoms from minor to excruciating.
Symptoms of Uterine Fibroids: 

Terrible period cramping.  Seriously a 15 out of 10 on a pain scale.  I have had some women that bring heating pads to work.  Some women take so much Tylenol and ibuprofen that their liver and kidneys become compromised.
Heavy periods.  When I say heavy periods, I mean heavy periods.  I have had some women that call in sick to school and work during the heavy days.  I have had some women use two tampons at once (yes at the same time, inside) during the heavy days.  Some women cannot even use tampons because the flow is so heavy, it will flush it out.
The periods are so heavy that the women become anemic.  Low blood iron levels from so much bleeding.
Irregular bleeding.  Fibroids can cause bleeding all month long.  Spotting after exercise or finding blood on the toilet paper.  There is nothing more of a buzzkill to sex is to notice bleeding.  Mid-cycle spotting, spotting a week before and after a period. 

Some women can have one fibroid or many fibroids.  Fibroids can be located all over the uterus. They are commonly found inside the uterus.  But fibroids can also be inside the uterine muscle wall. Fibroids are inside the uterine wall can cause a tremendous amount of pain.  I have had patients that have had hysterectomies because the pain is unbearable.

There is so much more you can do for fibroids that removing the uterus.  I understand, when there is that much pain and so much bleeding, a hysterectomy might be the best option.  But there are other alternatives to help keep the symptoms low. And there are reasons for why the uterine fibroids actually grow in the first place.  

Lifestyle and food can cause existing fibroids to grow, creating more symptoms.  And your own hormones can cause fibroids to grow, exacerbating symptoms. This podcast will explain in depth what lifestyle and dietary choices can increase the risk of fibroids.  And what you can do to reduce the s

Endometriosis can be very painful. It can have a significant effect on a woman's quality of life. Below are few of the common symptoms of Endometriosis.

Painful periods
Pain with intercourse
Heavy period
Mid Cycle spotting

Endometriosis occurs when the uterine tissue gets seeded outside the uterus. Removing the uterus can help tremendously with the following symptoms:

Heavy periods lead to anemia
Painful periods
Mid Cycle spotting
Bleeding outside of sync with your period
Bloating

As you probably already know, a Hysterectomy is the removal of the uterus.  Leaving the ovaries inside and intact. Removal of ovaries is oophorectomy.
Usually, with the hysterectomy for endometriosis, your surgeon will clean up and remove any endometrial tissue she/he sees in the pelvic area.
Unfortunately, the endometrial tissue can grow back on the ovaries and elsewhere in the pelvic area in some people. It’s hard to say why. After a hysterectomy, you do not have the retrograde menstruation, but if there was any micro endometrial tissue, it can grow back.  You still can get endometrioid cysts on the ovaries. Or elsewhere such as colon and bladder.
The likelihood that endometriosis comes back or you experience the same pain as before the hysterectomy is much less. Women do say they have so much relief, but it can happen.  Could be genetics, hormonal imbalance, lifestyle, or just luck of the draw.
In the case of estrogen dominance that can exacerbate endometriosis. Estrogen likes to grow things.  So if estrogen is high or there is not enough progesterone to balance estrogen, that can make endometriosis worse.
Taking estrogen-only treatment or the dose of estrogen is high can cause endometriosis to flare to come back. The estrogen will grow the micro-lesions of endometriosis that your surgeon could not see.
There are many factors that can increase inflammation and exacerbate the symptoms of endometriosis. Below is a list of factors that can increase overall inflammation:

Smoking
Sugar / High fructose corn syrup
Processed and refined carbohydrates
Alcohol
High glycemic index foods
Lack of healthy fats

Below is a quick list of tips that can help endometriosis after hysterectomy:

Reduce sugar
Improve liver function (caffeine, alcohol, sugar)
Low carb / ketogenic diet
Increase healthy fats: olive oil, avocado, MCT, fish oil, Omega-3 fatty acids (EPA/DHA)
Maintain a healthy weight
Improve sleep quality

Sometimes a Hysterectomy is the final option for a woman with endometriosis to get some relief. Typically endometriosis will improve significantly, but in some situations, it can reoccur after a hysterectomy.  If you have any questions, please leave a comment below or you can send an email to [email protected]
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