Can you be in both in perimenopause and menopause? Can you be menopausal andperimenopausal at the same time? The difference between perimenopause andmenopause is not a line in the sand. It is not like crossing through the Peace Arch fromBlaine Washington to the country of Canada. And at times, there is nothing peacefulabout perimenopause or menopause.There is a gray area where you are just moving out of perimenopause and intomenopause, where you are not quite in perimenopause but are not completely inmenopause. We delve deeper into the place that is between perimenopause andmenopause:- What is the difference between perimenopause and menopause?- Can you be both in perimenopause and menopause?- The difference between perimenopause and menopause- What it feels like to go from perimenopause to menopause- Can you take estrogen or biest when you are going from perimenopause tomenopause?- Is bleeding in menopause considered perimenopause?- Top symptoms of perimenopause- Top symptoms of menopause- Are you a candidate for estrogen replacement in perimenopause?If you have a question, please visit our website and click Ask the Doctor a question.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 topromote consumer/public understanding and general knowledge of various healthtopics. This content is not a substitute for professional medical advice, diagnosis, ortreatment. Please consult your healthcare provider with any questions or concerns youmay have regarding your condition before undertaking a new healthcare regimen.Never disregard professional medical advice or delay seeking it because of somethingyou have read on this website. If your healthcare provider is not interested indiscussing your health concerns regarding this topic, then it is time to find a new doctor.

In this episode, we discuss a listener’s question about how to apply estriol to your face. ‘Connie’ is confused about whether she can use her Biest cream on her face. And she wanted to know the difference between estriol and Biest when it comes to treating menopausal symptoms.
We analyze Connie’s question into:

Applying estriol to the face
What is biest?
What is estriol?
What is the difference between estriol and biest?
Applying estriol vaginally
It is not a good idea to apply biest to vaginal tissues if you have a uterus

Connie’s Question:
“HI there, I loved your article on estriol for the face. I was prescribed an 80-20 bi-est cream for HRT. My question is, how is that different from a 0.3 estriol cream for the face like the kind My Alloy makes? Could I just use more of my Biest cream on my face? Would that be stronger than the My alloy 0.3 estriol cream? Lastly, the .3 estriol cream is not supposed to affect your overall hormone levels, but the Bi-est cream is supposed to affect your hormones and relieve symptoms of menopause. Why does one estriol work differently than the other? Thank you so much for any guidance you may be able to offer. It’s so hard figuring all of this out!”
 
If you have a question, please visit our website and click Ask the Doctor a question.
 
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 talk about where to apply hormone creams. Sadie, our listener wants to know if she needs to rotate the application sites of her hormone cream.
In this episode we discuss:

Where to apply biest cream
What to apply testosterone cream for females
Places you should not apply your testosterone cream
Best absorption sites for hormone creams

Sadie’s Question:”I have been using hormones for a little over a year. I swear by them!! I have not rotated sites at all. I use testosterone/DHEA cream behind both of my knees and E3/E2 on both of my inner thighs every morning. I take a progesterone capsule at bedtime. My doctor and everything I read says to rotate sites. I found an article by Dr. Collins and now I found your article about not having to rotate sites, so I am going to keep doing what I have been. I put the cream on both of the backs of my legs and thighs. My question is should I alternate one back of knee and then the other and the same with the inner thighs or does it matter?
If you have a question, please visit our website and click Ask the Doctor a question.
 
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 discuss a listener’s question. ‘Hannah’ has been dealing with vaginalatrophy, frequent UTIs, low libido, and reduced elasticity in her skin. She has been toher doctor for treatment that has not helped.We breakdown Hannah’s question into:- Can vaginal atrophy be reversed?- Menopause and libido- Vaginal microbiome- Menopause and UTI- Estriol vs conventional treatment for vaginal atrophy- Genitourinary syndrome of menopause
Hannah’s Question:Hi Dr. Maki and Dr. Davidson. I am told to keep using my Premarin cream. I was initiallyon estradiol 0.01% and changed to Premarin. I do not want to take Prempro. I haveused it for years with no improvement of my atrophic vaginitis and dysuria. I continue toget UTIs. And, as an OR nurse, I cannot drink water in the operating room, it is a risk tosterility. So I become water deficient, and I get urgency and I cannot leave the OR in themiddle of case. Sometimes a case can go 5 hours or more. Further, I am a 52 yearwoman and post menopause. I became menopausal in 2015. The skin on my face andneck are sagging — making wrinkles more pronounced. My vulva has become looserand sagging. I cannot perform sexually because I cannot get aroused using clitoralstimulation because it is so dry there. Lube does not help. I am very frustrated by this,as is my husband. I get anxious as well because my mind is constantly worried aboutmy atrophy and vulvitis. Going to a specialist— they are very conservative in treatment.My husband doesn’t understand. He continues to ask and I say my vagina is broken.Can you please help meIf you have a question, please visit our website and click Ask the Doctor a question.
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 topromote consumer/public understanding and general knowledge of various healthtopics. This content is not a substitute for professional medical advice, diagnosis, ortreatment. 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 somethingyou have read on this website. If your healthcare provider is not interested indiscussing your health concerns regarding this topic, then it is time to find a new doctor.

In this episode, we return to a listener’s question regarding thyroid dosing in perimenopause. In our previous episode, we answered Tracy’s question about taking estrogen in perimenopause. Tracy also asked us an additional question about her thyroid doses. Tracy does not have a thyroid gland and has been noticing her dose is continually increasing as she progresses from perimenopause into menopause. Does the hormonal changes in perimenopause and menopause cause increasing thyroid hormone dose? Tracy’s 2nd question: HI- I do not have a thyroid and take compounded T4/T3 daily. I have also noticed that I am also needing to take more thyroid hormone than I have previously to keep lab values in optimal ranges and to keep hypothyroid symptoms at bay. It seems that the farther I get into perimenopause the supplemental thyroid hormone Im requiring is increasing as my sex hormones are naturally decreasing. Are naturally decreasing sex hormones and thyroid hormone optimization in the body related? Do you see this in your perimenopausal and menopausal patients? Needing to supplement thyroid hormone to continue to achieve optimal results and acceptable symptoms? thanks! In this episode, we discuss: ● What is Compounded Thyroid Medication? ● What are the types of thyroid medication? ● Having no thyroid ● Do hormonal changes in perimenopause and menopause require increasing thyroid hormone dose? ● Thyroid testing ● Converting from instant-release thyroid to compounded T4T3 sustained-release thyroid medication. If you have a question, please visit our website and click  Ask the Doctor a question.

In this episode, we discuss a listener’s question regarding perimenopause and estrogen hormone replacement. Tracy is concerned because she is still having a period but also has symptoms of low estrogen. She is not sure if she is a candidate for estrogen therapy since she is still cycling. Tracy’s Question: Hi- you’ve discussed in past podcasts that you shouldn’t supplement with estrogen hormone replacement therapy if you are still cycling. I will be 50 in a few months and still cycling, albeit irregularly. My cycles will be 10 days long, 33 days long, 15 days long etc. I am taking bioidentical testosterone and progesterone. I am suffering from dry crepey skin,brittle hair, achy joints, really intense brain fog- so much so that I might forget to attend an appointment or random names while in conversation, etc. I am also struggling with some insomnia (waking at 4 am) and restless sleep even though I am taking progesterone (up to 200 mg per day depending on where I am in my cycle). I am concerned that my brain is not getting enough estrogen? What is your solution if you aren’t supplementing with estrogen even though it might be fairly low in lab values or at least the symptoms seem to show that? How do you help your patients find relief in the interim? Thank you! This episode, we will talk about: ● Estrogen therapy while still having a period. ● Perimenopause transition into menopause. ● Hormone levels in perimenopause and menopause. ● What is FSH and how does that determine menopause? ● What is Biest? ● Can you take Biest in Perimenopause? If you have a question, please visit our website and click  Ask the Doctor a question.

In this episode we discuss Jenell’s question she submitted on our website (Ask the Dr). Jennell has been having terrible anxiety since entering menopause and it is really affecting her quality of life. Jenell’s Question: Since starting menopause, I’ve had debilitating anxiety, especially bad in the morning. By evening, It practically goes away. I’m 54 and have been on BHRT 50/50 Bi-est and 175 mg progesterone for 3 months. My hot flashes reduced but the anxiety remained. Now hot flashes are returning and the anxiety is increasing even more. It was determined to put me on Bi-est 50/50 0.8 mg/ml of estrogen cream and 175 mg progesterone SR. I know I need estrogen to keep up serotonin levels. I tried this new delivery method (est cream and prog pills) for 2 days and felt drugged but with even more very high anxiety, if that’s possible. I’d like to get back to work of some kind, but I can’t seem to get this anxiety under control, although I’m told progesterone will do that. I hope you have some ideas. It’s been three years and my life has radically changed because of this anxiety. We breakdown Jenell’s question into: ● Why does menopause cause anxiety? ● Hormone replacement dosing for menopausal symptoms. ● How adrenals can affect anxiety. ● How to reduce morning fatigue caused by oral progesterone. If you have a question, please visit our website and click  Ask the Doctor a question.

In this episode, we discuss a listener’s question. Amanda is 50 years old and starting to have menopausal hot flashes and weight gain. However, she is most concerned about the heart palpitations she is having. Amanda has had a cardiovascular workout and does not have heart disease. Most people might not be aware, but feeling abnormal heart rhythms without heart disease or feeling like your heart is doing flip-flops in your chest can be a symptom of menopause. Amanda’s Question: Hello, I am 5o y/o and had HYS sparing ovaries at age 40. Been on oral micro progesterone and love it. However over last few years the flashes started and supplements helped for a while, and had about a 7 ibs increase over the last 18 months slowly and my small frame felt it. Then our of the blue 3 months ago I started having pvc palpitations (with no chest pain, dizziness etc,,,, just annoying and not a comfortable sensation. I am super fit and eat very clean. My Functional GYN started me on BiEst 80/20 about 3 weeks ago. I do 4 pumps in the am on my thighs (not sure if I should be rotating thighs) my throughout the day palpitations felt a little better within the first week then came back BUT seems a few when I wake up, I do the cream and then they go away and now they start again about 1pm and throughout the rest of day into evening….occasionally they wait until evening 5-6pm to start again. I have kept a record. I have my follow up in June, but don’t want to wait to try and see of two times a day is better for me? two questions….am I metabolizing through it? Should I split 2 pumps in am and the other 2 in the evening when the palps start again? Will that backslide any progress I have made? Should I rotate thighs every day? Thank you In this episode we break Amanda’s question into: ● What are heart palpitations? ● How does estrogen affect the heart? ● Why does menopause cause heart palpitations? ● How to dose hormone therapy to help heart palpitations? If you have a question, please visit our website and click  Ask the Doctor a question.

In this episode, we discuss a listener’s question about perimenopause. ‘Maggie’ is in her 40’s and experiencing severe insomnia with anxiety. She has tried supplements and different doses of progesterone with minimal results. She is having so many ups and downs with her insomnia, anxiety, and hormones. She is wondering how long this is going to last and whether will it ever end. Let’s read Maggie’s question: Help, I am about to turn 44 and entered peri menopause 1.5 years ago. I suffered, almost overnight it seemed, from severe anxiety/panic attacks which led to severe insomnia. My integrative doc started me on 100mg bioidentical oral progesterone and then it had to get increased to 200mg because my anxiety was so severe and that’s what I’ve been on for about a year now. It has been a roller coaster of ups and downs, nothing consistent but it generally helped the anxiety. Recently though I’ve been experiencing pretty severe insomnia where I can’t even fall asleep! I get maybe 0-2 hours a night. I haven’t changed anything in my routine or diet and nothing stressful has happened in my life. I take things to help like magnesium, glycine, melatonin, ashwagandha, gaba, drink calming teas and more as advised by my doctor to help with sleep and anxiety. I also have a strict routine of daily exercise, getting sunshine, not sleeping in past 7, and not watching tv or on my phone late at night, eating hormone balancing foods and even taking Epsom salt baths to help relax my body before bed. Like I said it’s been a roller coaster but two months ago I started sleeping like I was 20 years old again getting 8-9 hours of sleep for the first time since entering perimenopause however it just stopped few weeks ago and now I can’t sleep at all! My eyes seem wide awake though my body is exhausted and. I have Xanax and Trazedone as a last resort as prescribed by my regular MD but I really hate using them for lots of reasons. Will this phase pass quickly, just another ride on this crazy hormone roller coaster or will I not be sleeping for awhile? Is it other hormones now off that need addressing? I don’t see my doctor until June and it’s April. I know how much sleep is crucial for balancing hormones so I feel like my body is working against me and everything I’ve been doing to balance those hormones. I’m a stay at home mom of four and would love even a few hours at this point! Any advise would be greatly appreciated. Thank you! There are so many relevant points pertaining to perimenopause in Maggie’s question. And Maggie is not alone. Insomnia and anxiety are hallmarks of perimenopause. In this episode, we talk about: ● Perimenopause symptoms. ● Perimenopause and insomnia. ● Perimenopause and anxiety. ● Supplements for perimenopausal insomnia and anxiety. ● Stress and perimenopause. If you have a question, please visit our website and click  Ask the Doctor a question.