In this episode, we talk about hormone treatments for perimenopause and menopause. There is a vast distinction between perimenopause and menopause when it comes to treatment options. We often see women who are being treated for menopause when they are genuinely not in menopause. Meet Linda: Linda is a listener who sent us a question on our website about her hormone replacement treatment. Linda is in her 40’s and has her period regularly. She was given an estradiol patch and gained 20 pounds. Linda is in perimenopause, yet being treated for menopause. This will cause weight gain and other symptoms, which we discuss in depth in this podcast. Let’s Read Linda’s Question: Hello, I am 44 still cycling. I am currently on estradiol patch 0.05 and progesterone and testosterone cream. Since I switched from Biest cream to the patch, I have put on 20lbs. Help. In this episode, we break Linda’s question into: ● Differences between perimenopause and menopause ● Does a woman in perimenopause need to take estrogen? ● Weight gain and hormone replacement ● What is estrogen dominance vs progesterone insufficiency? ● What symptoms will occur is estrogen levels are too high? ● What hormones should a woman take in menopause vs perimenopause? ● Does hormone replacement cause weight gain or weight loss? If you have a question, please visit our website and click Ask the Doctor a question.

Recently, Catherine posted a question on our website about Biest cream, and we knew this could interest our listeners. Biest is a combination of estriol and estradiol, one of the most common forms of estrogen therapy used in bio-identical hormone replacement. There are many doses, ratios, options, and methods of using Biest, so we thought this would be an episode dedicated to Biest and everything Biest. This episode of the Progress Your Health Podcast is for all the Catherines out there with questions about Biest hormone replacement cream. Catherine’s Question: Hello! Should I apply Biest only in the morning OR morning and night? My dose is 2 clicks. I’m asking because I’m wondering if Biest can be energizing. Thanks so much. In this episode, we address: ● What is Biest? ○ Biest is a combination of estriol and estradiol used for hormone replacement. ● Can Biest give you energy? ● Should you take Biest morning and evening? ● How to dose Biest. ● Other hormones involved in hormone replacement, such as progesterone and testosterone. If you have a question, please visit our website and click Ask the Doctor a question.

Welcome to the Progress Your Health Podcast! This is a podcast that helps you learn about balancing hormones, especially during perimenopause and menopause. We love hearing from our listeners. If you have a question, please visit our website and click Ask the Doctor a question. Let’s read Brigitte’s question! I have been listening and learning more. Your September 26, 2023 episode on symptoms of Perimenopause felt extremely validating!!!!! Almost everything you mentioned I am experiencing. I was first prescribed by my GYN the Estridiol patch and what you described was spot on and I am glad to confirm that it didn’t seem right as I still am getting my period regularly! I would be interested in your thoughts on the BiEST and perimenopause. I also really related to the “no thought of sex” whatsoever and not initiating, rejecting and feeling guilty. It can be sometimes over 6 months between. I thought I might be just losing interest because I can only think of maybe a couple of times in the last 10-15 years that I might have had a true orgasm. For a while now it seems it can be pleasurable leading in, but feels like it’s taking forever and then starts to feels intolerable (not pain) but more irritating – numb like – as though the nerves have been overstimulated or irritated (not pain – more like hitting your “funny bone”) where it doesn’t feel good anymore and its quite disappointing. I found a different episode about the estrogen patch and it was mentioned that the Estriol cream applied vaginally – could help with this. I also wonder about other things I have been experiencing, a lot of hair breakage or shedding and nail breakage and a huge change in my skin, and the muffin top!!!! Hoping and looking forward to a follow up episode on symptoms of perimenopause and hope to get insight on Estrogen bioidentical compounded cream! Thank you so much! This has helping me fill in the blanks and clear up confusion after my appointments! In this episode, we broke down her question into: – Using an estradiol patch in perimenopause – Low libido in perimenopause – Why is sex not as pleasurable in perimenopause? – What is estriol, and can it be used on vaginal tissues for lubrication and sex drive? – What is Biest, and can it be used in perimenopause? – Perimenopausal weight gain, aka ‘muffin-top’ – Perimenopausal effects on hair and nails Because Brigitte’s questions are so common in perimenopause, we also went on to talk about: – The vaginal microbiome – Changes in the vaginal vault and how that can increase susceptibility to infections. – Hormonal changes in perimenopause and menopause can make you more vulnerable to bacterial vaginosis, yeast, and urinary tract infections. I hope Brigitte’s questions and concerns may have helped others who might be experiencing symptoms of perimenopause. We appreciate all of our listeners and those who take the time to write us reviews and reach out with questions. If you have a question, please visit our website and click Ask the Doctor a question.

In this episode, we talk about the difference between perimenopause and menopause. Both Dr. Maki and I (Dr. Davidson) have worked with women in perimenopause and menopause since 2004 and sometimes get a bit myopic and technical when it comes to explaining the differences. The other day, a patient of Dr Maki’s asked the question, ‘Is perimenopause actually early menopause’? This is such an excellent, straightforward question. The question made us both pause. The answer is no; perimenopause is not early menopause. But you can imagine that many others may be asking this question, too. In this episode, we breakdown this question into: – What is early menopause, and is there such a thing? – When does perimenopause really start? – Can you have a period in perimenopause? – Can you have a period in menopause? – If you don’t have a uterus (hysterectomy) but have your ovaries, are you in perimenopause or menopause or neither? We love your questions. If you are having any questions about hormones, perimenopause, and/or menopause, trust me, others have the same exact question. When going through perimenopause, menopause, or any hormonal imbalance, you are not alone. Your questions can help other listeners find answers to their concerns as well as realize that their symptoms of perimenopause and menopause are valid. If you have a question, please visit our website and click Ask the Doctor a question.

We recently got a great question from a listener and want to share it with you. This question is about a perimenopausal 51-year-old female. She is still menstruating and having confusion about her hormone testing and the hormone therapy that she is currently taking. She is experiencing some breast tenderness and irritability related to her cycle. She is taking some supplementation and wondering if that is right for her and her hormonal concerns. And while she is nowhere near overweight, she feels that her body is carrying a little extra in the middle, despite exercise and healthy eating. Here is her question: ‘I am 51 and have had very regular periods, and still do. I do have heavier flow on day 2 and then a few days of light flow. It has been this way since my late 30s. I am 120lbs with a BMI of 19.4. I recently had saliva testing done because I felt I was very irritable during the luteal phase day 20 – 28(ish) sometimes my cycle is as short as 24 days, but more often 28. I noticed the tender breasts and irritability starting closer to day 15 or 17 more recently. The saliva test results are Estradiol 1.1, Estriol

in this episode, we answered a listener’s question. We love questions from listeners. If you have a question, please visit our website and click Ask the Doctor a question. Here is the listener’s question: I have been perimenopause for at least 4 years now I am 47 and after completing a Dutch test with a holistic chiropractor she told me to ask my doctor about Prometrium. I was scared to take it and then 6 months ago my sleep got really bad and three months ago I got very ill with gi issues and gallbladder issues. I had to have gallbladder surgey and developed full blown insomnia. I was sleeping 0 to 3 hours. Two weeks ago I got two very contradicting solutions for my low progesterone. The functional medicine/ gyno prescribed Promterium at 400mg and told me to go down to 200 mg if too sedating. A few days before that I saw an integrative doctor. She told me to take 25mg of sr bioidentical progesterone and bump it up by 25mg every week. I was also put on ashwagnhda 700mg at night and 100 mg of L-theanine at night to help lower cortisol and for stress and anxiety. I also take 200mg of magnesium glycinate at night. I am working with a sleep coach for my insomnia/anxiety. I have calmed down significantly and do not care or panick if I dont sleep The 25mg dose did nothing. I tried 200mg of Prometrium and it upset my stomach. I felt dizzy until like 3 and then was wide awake and then maybe fell asleep around 5am for 3 hours. After reading everything on here. I asked gyno to prescribe compounded sr bioidentical in 100mg. She still insisted I take 200mg. The integrative doc thinks it is dangerous to try various doses. I tried 100mg sr and it did not help me sleep. I tried 150mg for 3 nights and it helped me sleep some. I now increased to 200mg two nights ago and my sleep is still horrible but am sleeping a some. The integrative doc told me it is dangerous to do what I am doing with the doses and told me to stay on 75mg until I see her (that is in a month). The gyno/functional medicine doctor told me to take 200-400mg and will follow up here in a month. I am 110 pounds and the integrative doctor told me that 200 mg is way too high for me. She said progesterone will not be a quick fix for my insomnia. I don’t expect it to be but I keep on reading how sedating it is. How long do you need to be on a dose until you know if it is the right dose and what are the side effects of too a high of a dose? The bioidentical compounded dose does not hurt my stomach like the Prometrium. I feel slightly dizzy at night but not at all sedated. I am very confuse with advice but I would like to follow the gyno/functional medicine doctor. This listener had a few issues happening here. As that is the case with everyone. There is no clear ‘one size fits all’ when balancing hormones. In this episode, we broke down her question into: ● How progesterone relates to perimenopause. ● Forms of progesterone such as orals, creams, troches, and gels. ● Dosing of progesterone. There are multiple potencies and dosing of progesterone. ● The difference between Prometrium and micronized progesterone. ● Appropriate doses and forms of progesterone for a perimenopausal female. ● How sleep is affected in perimenopause. ● Consider gastrointestinal, liver, and gallbladder implications in perimenopause. ● Weight gain in perimenopause. ● Side effects and safety of progesterone therapy. ● How long does it take for progesterone therapy to work? Again, if you liked this episode, or have your own hormone concerns, please reach out and Ask The Doctor a question.

The dreaded, uncomfortable, annoying, burning, itchy, achy, irritating vaginal infection. Ladies, we have all been there. And for those unicorns that have never had a vaginal infection such as yeast or bacterial vaginosis, well, you are certainly one of the lucky ones. While a yeast infection or BV is not life-threatening, not fatal, and maybe not an emergency, that does not mean it’s not urgent. Especially vaginal infections that are chronic or keep returning can be incredibly annoying, painful, and frustrating. It is very accurate that once you have a yeast infection or vaginal infection like BV, it can come back over and over. I have had many patients come to see me because no one could help them with their vaginal issues. Not only is it embarrassing and uncomfortable, but often, doctors will blow off vaginal issues. Perhaps it was not expressed enough as an issue. As I know it can be challenging to talk about issues ‘downstairs’ to a stranger, doctor, or no doctor. Geez, most women have told me that their mothers and grandmothers would not go near the subject of anything to do with ‘the vagina.’ So can you imagine telling a doctor you have never met that you are in pain, super itchy, tender, uncomfortable, and not-normal discharge is discharging, a lot… takes a lot of courage to say. As I said, a vaginal infection is not fatal. It might feel like your vagina is on fire, but you will live. Uncomfortably live to say the least. I think it is essential to talk about having a vaginal infection. If you had a sinus infection, no one would bat an eye. If you have an ear infection, that is easy to talk about. It should be the same with vaginal infections. Bacterial vaginosis (BV) and yeast (candida) infections have nothing to do with hygiene and are not contagious. They can happen for many reasons, just like an ear infection or sinus infection. So that leads me to a great question from a reader about her issues with vaginal infections. She says she had 6 yeast infections in six months and more months of grief with no relief. I really feel for this woman because that is not how to live life. After all the treatments she has used and put on/in her poor vagina, she is terrified to put anything else near it. I don’t blame her. But what a predicament to be in. I am sure she is not even contemplating being intimate, let alone sexual, when her poor privates are on fire. I’m sure she is constantly worried that darn infection lurks around the corner at every turn. Here is our reader’s question, which I will answer (we always change the name for privacy).   Melissa’s Question: I am 52. Have Sjogrens and Hashimotos. I have Atrophic Vaginitis. A year ago I started Vagifem for 3 weeks. Yeast infection after. Then I was put on Premarin Cream then yeast again. But I continued with the Premarin. I did this for 6 months and treated 6 yeast infections during this time. Finally I stopped all medications and took a vaginal moisturizer. I did well with this for three months. Then I got another yeast infection or so I thought. This has been a battle for another 2 months. The dr did swabs and everything negative for yeast BV STI. I feel swollen in the vag and when I urinate I feel pain afterward and sitting feels like my vag is hurting. No cystocele or rectocele. I have also reacted to lubes with glycerine or glycol. Now the Dr wants me to start Intrarosa and I am paranoid to start incase I get yeast. Does anyone have any advise as I am at my witts end! I will answer Melissa’s questions plus: What are GSM and Vaginal Atrophy? What is Vagifem? What vaginal Premarin? What is a vaginal moisturizer? What are yeast and BV? What is Interrosa? What is Sjogren’s syndrome What is Hashimotos? How about Estriol for GSM?   What are GSM and Vaginal Atrophy? GSM stands for genitourinary syndrome of menopause. It is a new term that replaces vaginal atrophy. But GSM and vaginal atrophy can be used interchangeably. When a woman enters menopause, her ovaries stop producing estrogen and progesterone. The vaginal cells and tissues respond and maturate to estrogen. So when the estrogen levels drop, you will see changes in the vaginal tissues and cells. Immature vaginal cells are called parabasal cells. Parabasal cells are like baby vaginal cells. You feed them estrogen, and they will grow into mature vaginal cells. When the estrogen levels drop in menopause, you will see changes in the vaginal tissues. It can cause vaginal dryness, pain with intercourse, and even bleeding from the fragile, thin tissues of the vaginal vault. Also, because there is less lubrication and more fragile tissues, it can alter the biome of the vaginal canal. The vaginal canal/vault has a symbiotic relationship with bacteria, yeast, organisms, and flora. When the vaginal tissues and cells change during menopause, this can disrupt the flora balance increasing the risk of vaginal infections. Also, when this flora is disrupted, it can cause an increase in urinary tract infections (UTIs). Disrupting the beneficial bacteria can allow e.coli to travel up the urethra to cause a UTI. Also, estrogen can help tone the urethra (the tube from your bladder to the outside world). When the estrogen levels drop in menopause, the urethra can become more lax, allowing easier access for the e.coli to cause a UTI. And it can cause urinary leakage, also called urinary stress incontinence. You know, jumping jacks, coughing, sneezing, laughing, exercising, anything you are putting a little strain on the bladder can cause a little leakage. I like the new term GSM, even if it is a mouthful to say, genitourinary syndrome of menopause. It explains that more can happen to the vaginal vault and urinary tract than just vaginal dryness.  

The dreaded, uncomfortable, annoying, burning, itchy, achy, irritating vaginal infection.
Ladies, we have all been there. And for those unicorns that have never had a vaginal infection such as yeast or bacterial vaginosis, well, you are certainly one of the lucky ones. While a yeast infection or BV is not life-threatening, not fatal, and maybe not an emergency, that does not mean it’s not urgent.
Especially vaginal infections that are chronic or keep returning can be incredibly annoying, painful, and frustrating. It is very accurate that once you have a yeast infection or vaginal infection like BV, it can come back over and over. I have had many patients come to see me because no one could help them with their vaginal issues. Not only is it embarrassing and uncomfortable, but often, doctors will blow off vaginal issues.
Perhaps it was not expressed enough as an issue. As I know it can be challenging to talk about issues ‘downstairs’ to a stranger, doctor, or no doctor. Geez, most women have told me that their mothers and grandmothers would not go near the subject of anything to do with ‘the vagina.’ So can you imagine telling a doctor you have never met that you are in pain, super itchy, tender, uncomfortable, and not-normal discharge is discharging, a lot… takes a lot of courage to say.
As I said, a vaginal infection is not fatal. It might feel like your vagina is on fire, but you will live. Uncomfortably live to say the least. I think it is essential to talk about having a vaginal infection. If you had a sinus infection, no one would bat an eye. If you have an ear infection, that is easy to talk about. It should be the same with vaginal infections.
Bacterial vaginosis (BV) and yeast (candida) infections have nothing to do with hygiene and are not contagious. They can happen for many reasons, just like an ear infection or sinus infection.
So that leads me to a great question from a reader about her issues with vaginal infections. She says she had 6 yeast infections in six months and more months of grief with no relief. I really feel for this woman because that is not how to live life. After all the treatments she has used and put on/in her poor vagina, she is terrified to put anything else near it. I don’t blame her. But what a predicament to be in. I am sure she is not even contemplating being intimate, let alone sexual, when her poor privates are on fire. I’m sure she is constantly worried that darn infection lurks around the corner at every turn.
Here is our reader’s question, which I will answer (we always change the name for privacy).
 
Melissa’s Question:
I am 52. Have Sjogrens and Hashimotos. I have Atrophic Vaginitis. A year ago I started Vagifem for 3 weeks. Yeast infection after. Then I was put on Premarin Cream then yeast again. But I continued with the Premarin. I did this for 6 months and treated 6 yeast infections during this time. Finally I stopped all medications and took a vaginal moisturizer. I did well with this for three months. Then I got another yeast infection or so I thought. This has been a battle for another 2 months. The dr did swabs and everything negative for yeast BV STI. I feel swollen in the vag and when I urinate I feel pain afterward and sitting feels like my vag is hurting. No cystocele or rectocele. I have also reacted to lubes with glycerine or glycol. Now the Dr wants me to start Intrarosa and I am paranoid to start incase I get yeast. Does anyone have any advise as I am at my witts end!
I will answer Melissa’s questions plus:

What are GSM and Vaginal Atrophy?
What is Vagifem?
What vaginal Premarin?
What is a vaginal moisturizer?
What are yeast and BV?
What is Interrosa?
What is Sjogren’s syndrome
What is Hashimotos?
How about Estriol for GSM?

 
What are GSM and Vaginal Atrophy?
…

Can Progesterone Cause Anxiety?
Often we get reader/listener questions about their own experience with hormones. We love that readers of our blogs and listeners of the podcast (TheProgressYourHealth Podcast) reach out for more information. If they have concerns and questions, that means many, many other people have the same concerns. A lot of questions we get are hard to get answers online.
Honestly, hormones and hormone replacement is an art that should be designed around the patient. Every person taking hormone replacement has different reasons for doing so. Those hormone goals can range from weight loss, mood improvement, insomnia, bone density, energy to sex drive just to name a few. Those of you that are regular listeners/readers, I’m sure, have heard this from me a thousand times over. And I will continue on that soap box, so bear with me.
Hormone replacement is not a cookie-cutter approach where one size fits all. It needs to be tailored to the individual. This article is about a recent podcast that we did on a reader question. I feel this is an interesting question because it is about hormone replacement therapy, but there are so many nuances to tease apart. When talking about hormones, everyone is focused on the estrogen and progesterone dosing and not considering the other hormones involved that could be part of the issue.
Here is the question (we always change the names of readers and listeners to protect privacy).
 
From ‘Kathy’
Hi Dr. Davidson.
My question to you, is what do you suggest if a woman is on Biest and can’t take the Prometrium because it has the opposite effect and gives her anxiety?
Yes, she has a uterus, yes she is on Biest, but what if cream is her only option? Thanks in advance 🙂 – Kathy
 
There is a lot to tease apart here, but let’s explain a little more thoroughly about the hormone regime she is on.
 
What is Biest?
Biest is an estrogen combination of estriol and estradiol. There are three main estrogens in a female’s body. Those are Estrone (E1), Estradiol (E2) and Estriol E3). Estrone is not commonly used, and it is mainly seen in younger women going through puberty or is made by adipose tissue. Adipose tissue is ‘fat’ tissue, and yes, your fat is like its own endocrine gland, secreting other hormones and estrone (lepton, adiponectin to name a few popular ones).
Biest is part of bio-identical hormone replacement, meaning the estriol and estradiol are made from plants to look exactly like what our own bodies make. So if it looks just like what our bodies make, then it will have a better response and fewer side effects.
Kathy is taking a Biest cream for her estrogen replacement, which is commonly used as a cream. She applies her biest cream topically, also called transdermally. You can apply your hormone cream to the inner thigh or back of the knee. Because all hormones are fat-soluble, and the inner thigh, as we all know, has an excellent fatty pad there, making it a great site. Applying hormones to thin tissue like the inner arms, can cause quick absorption and then it is eliminated from the system quickly. Plus, inner arms means you could share it when you hug or touch or carry pets or other humans. Some research shows that the neck and face are excellent places for transdermal absorption. But if you love giving kisses to your pets, little ones or family, you could end up sharing your hormones.
 
Progesterone for Uterus Protection:
As Kathy mentioned in her question, she could not tolerate the Prometrium (an oral form of progseterone), and she has a uterus. The reason she mentions this is because it is essential to take progesterone anytime you are taking estradiol/estrogen therapy and you have a uterus. Estrogen loves to grow things, especially the uterine lining. If Kathy did not take progesterone and only took biest (estriol/estradiol), it would be a…