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.
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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.

In this episode, we talk about Mary’s hormone concerns after ovarian failure. She is only 34, and in the last 7 years since her ovarian failure has tried many hormone replacement options, all without the success she was looking for. Let’s Read Mary’s Question: When I was 27 years old I was diagnosed with iatrogenic primary ovarian insufficiency due to chemotherapy treatments for a gestational trophoblastic disease (molar pregnancy). I am now 34 years old, and I am currently struggling most notably, with fatigue, low libido, dry skin/eyes/hair, low mood, annxiety, and brain fog. I began HRT about 3 years ago, but I was not consistent. In the beginning I tried estradiol 1mg and medroxyprogesterone 2.5mg with no symptom relief or rise in serum levels. For 9 months I faithfully took esterified estrogens/methyltestosterone 1.25/2.5mg and 100 mg of micronized progesterone at nighttime. My estradiol levels only rose to 16.9pg/mL (estrogens, total 56pg/mL), and free testosterone only rose to 0.2pg/mL (testosterone, total undetectable). The T actually decreased. My doctor was baffled by how stunningly this application failed. 3 months ago I began estradiol patches (0.1mg/twice week), testosterone 1% gel (12.5mg/1.25gm) pump (1/2 pump/day), micronized progesterone (100 mg/bedtime), and Intrarosa (vaginal DHEA) at nighttime. I do not have any current bloodwork for this new regimen. I have noticed a decrease in my symptoms, but I am no where near where I would like to be regarding symptom relief. Is it possible to increase my estrogen dosing? I’ve read POI dosing will often be signicantly higher. Fertility isn’t my primary concern (we have been blessed with two children), but I’ve heard mixed opinions that cyclic HRT for someone my age may have benefits outside of fertility such as the lining of the uterus becoming unresponsive to estrogen and the ability of cyclic HRT may stimulating the uterus to reestablish this responsiveness. I’ve never had a DEXA scan, nor discussed bone health with my provider, who is a university physician. I am also traveling to MN this summer to see a reproductive endocrinologist with the Mayo Clinic in hopes of finding further solutions. Thank you for your time. In this episode, we break Mary’s question into: ● What is ovarian failure? ● How hormone replacement is helpful for sleep, mood, libido, energy, and brain fog. ● Consider the long-term consequences of low to no hormones in women. ● Estrogen and bone density. ● Cyclic/rhythmic HRT vs static hormone dosing. If you have a question, please visit our website and click Ask the Doctor a question.

In this episode, we answer a listener’s question about her HRT dosing. ‘Donna’ is 63 years old and has been on some type of hormone replacement therapy for the last 13 years. Hormone therapy is not ‘one size fits all.’ There are so many types of menopause hormone therapies that each treatment needs to be […]

In this episode, we answer a listener’s question about her HRT dosing. ‘Donna’ is 63 years old and has been on some type of hormone replacement therapy for the last 13 years. Hormone therapy is not ‘one size fits all.’ There are so many types of menopause hormone therapies that each treatment needs to be tailored to the individual. And overtime hormone treatments will change due to age, specific health goals, symptoms, and life changes. Even stress can create a need to adjust hormone doses. Let’s Read Donna’s Question: Good morning, I am 63 & postmenopausal (menopaused @ 35). I was from age 50 to 58 on a combo bio identical hormones Biest (?) & progesterone 200mg. A few years ago the doses were dropped to Prometrium 100mg & Biest 0.3mg (1.5 mg divided by 4 days). My doctor isn’t interested in bioidentical hormones so I instructed myself. Now at 63, I am “reasonably” well but some vaginal atrophy/dryness, still some moodiness & bad sleep. I tried stopping & got really “weird” emotionally. I tried Estriol cream but it’s messy + Prometrium 100mg. Going back on the torches + Prometrium? I was going to try patches but your podcast made me reconsider. Any advises please. With kind regards We take Donna’s question and discuss: – What is vaginal atrophy or also known as genitourinary syndrome of menopause (GSM)? – Different types of hormone replacement: troches, patches, creams, and others. – Prometrium vs progesterone. – Not all doctors have a knowledge base of hormone replacement. – What is biest? – What is estriol? – How hormone replacement can help mood. – How to help treat vaginal dryness due to menopause. If you have a question, please visit our website and click Ask the Doctor a question.