Patient Question: Why am I getting acne in my 40s?
Short Answer: Women’s hormones are always changing. From puberty to middle age, to when the ovaries cease producing hormones in menopause. When we hit our 40s, our progesterone starts to decline. And our estrogen levels drop slightly as well. But the androgens, which are testosterone and DHEA do not decline. That means that there is less progesterone and estrogen to buffer the effects of the androgens.
Testosterone and DHEA are great, useful hormones for a female’s body. They help with muscle mass, motivation, ambition, libido, bone density, and stress management to name a few. But in our 40s when estrogen and progesterone start to decline that makes the androgens the ‘leaders of the hormonal pack.’
There is no buffer against the negative side effects of androgens. One being, acne. Women in their 40s are usually still getting a period and cycling. So that means that the breakouts and acne are worse anywhere from 7-14 days before their period. That is because women really only make progesterone in the last half of their cycle. Those days being days 14-28.  Because of the decline of progesterone, acne can be quite prominent before a period.
But because the estrogen may have declined a bit in our 40s, we are still apt to have breakouts all month long. Because acne in the 40s is from the unopposed androgens, the acne is mostly on the chin and jawline. Although the neck and back are also common in a lot of women in their 40s. And the breakouts are more cystic in nature. They are deep and hard to “pop” (which we all know we should never ever do, and yes, I can’t help it either). And cystic acne lasts for weeks. So when one cystic pimple is starting to heal, aggravatingly three more show up. It is very frustrating.
In addition too unbalanced androgens, stress, and cortisol levels can exacerbate acne. Women in their 40s are busy. There are family commitments, work, home life, and trying to stay fit is certainly not as easy as it was in our 20 and 30s. Plus the drop in progesterone and estrogen lets the androgens (testosterone and DHEA) make us feel more easily ‘testy.’ The stress and unbalanced hormones cause cortisol levels to rise. Which unfortunately also makes the breakouts worse.
We really like to use Acnutrol and Inflammatone to help with breakouts.
Below are some other episodes where we discuss other issues related to Perimenopause.

Listener’s Question: Hello, recently my Nurse Practitioner recommended that I should start taking progesterone because she mentioned that I was estrogen dominant. I don’t have any real symptoms, so just want to make sure if I even need to take the progesterone. Thanks.
Short Answer: If you don’t have any direct symptoms, then progesterone would not be necessary. We prescribe progesterone to women of all ages, but usually, they have a symptom profile that justifies the prescription. It is not likely for a woman to be truly estrogen dominant without any noticeable symptoms (fibroids, endometriosis, heavy bleeding, etc).
If a cycling woman does her blood work around day 12 of her cycle. The estradiol will be higher, and the progesterone level will typically be less than one (<1.0). It could appear to be too much estrogen compared to progesterone, but this is normal. A woman’s body does not produce any progesterone until ovulation, which typically occurs about day 14 of the cycle. This is why it is important to know what day of the cycle the lab work was done in order to interpret the estradiol and progesterone levels. Once a woman enters the 40s, her body begins to change; however, we don’t prescribe progesterone simply based on a blood test. The patient’s symptom profile is a better indicator of whether or not to prescribe progesterone. Some of the common symptoms we look for are heavy periods, irritability, anxiousness, and poor sleep quality. Generally, for a woman dealing with classic perimenopausal symptoms, we will prescribe 100 mg of bioidentical, sustained-release progesterone capsule taken at night 60 minutes before bed. This is a good starting point but may need to be adjusted based on the woman’s response. We do get a lot of questions asking about progesterone cream, but in our experience, it does not seem to be as effective at resolving perimenopausal and menopausal symptoms as oral progesterone. For more information about progesterone, below are links to previous episodes. PYHP 101 – Can I Take Progesterone All Month?  PYHP 111 – Does Progesterone Help With Perimenopause?  PYHP 113 – Can Progesterone Cause Dizziness?  If you have more questions about progesterone or other female hormone issues, feel free to contact us. We are here to help.   The post When Should A Woman Take Progesterone? | PYHP 118 appeared first on .

 
 
 
 
 
 
 
 
 
Sarah's Question:
Hi I was diagnosed with ovarian failure at the age of 36. Its been 4 years now, I have been to a few different clinics, trying to figure out what works best for myself. Right now I am using estrogen patches, which do seem to work well, and Prometrium. My main problem that I still face is lack of sleep. The estrogen patches help my mood and sleep some but I have tried a few different progesterone creams and pills, and have not found any improvement in sleep from it. I am wondering what is the brand name of the slow release progesterone you described. Thanks
Short Answer: 
We almost always use bioidentical sustained-release progesterone from a compounding pharmacy. A typical dose we like to start with for sleep is 100 mg. The commercial form of progesterone available at big box pharmacies is Prometrium, which is an instant release. However, in a situation like Sarah’s being diagnosed with Ovarian Failure at 36, we would consider prescribing Rhythmic Dosing to restore her hormones to physiologic levels. This type of dosing protocol is intended to initiate a period in a menopausal woman that still has a uterus. If Sarah still has a uterus, she would also resume menstruating on a monthly basis. Estrogen is what makes a woman a woman. In many cases, the more estrogen a woman has, the better she will feel. The better she will sleep. For more information, below is another episode we did explaining the rationale and how Rhythmic Dosing works.
Episode 91: How to Cycle Bioidentical Hormones?
One of the best pharmacies we work with for Rhythmic Dosing is Harbor Compounding Pharmacy, located in Costa Mesa, CA. They are PCAB Certified and are currently licensed in 32 states.
Feel free to contact us if you have more questions regarding Ovarian Failure or Rhythmic Dosing.
The post Can Ovarian Failure Be Treated? | PYHP 117 appeared first on .

Megan’s Question:  This was great information. I have been 130lbs until I turned 48. Now up to 157. Weight gain all in my stomach, legs, arms, boobs and butt. I have still been working out intensely with weights and cardio and no weight loss . After listening to this is sounds like I should do […]

Question: I am forty-six years old and a 34A. Now, I’m a 34BC. My breasts hurt at least two weeks out of the month. Swollen, heavy, painful, have to take ibuprofen. It’s annoying as hell and it’s changed how I view my body. Not to mention, my midsection has changed too. I never wanted large breasts. I know BC cup is not large, but it is to me. And now I need to wear two sports bras to run. And I like to run all the time. And I feel like I did when I was nursing. This totally stinks. Does it get better? 
Short Answer: During a woman’s 40’s, there are many hormonal changes that are happening, which lead to a wide variety of symptoms. Progesterone is declining, and estrogen is still being produced and stress levels can be all over the place. These changes can lead to many unwanted symptoms. Breast tenderness and an increase in cup size is generally related to too little progesterone and proportionally too much estrogen. There is not necessarily an increased amount of estrogen production, but really just a lack of progesterone that leads to many of the symptoms of Perimenopause.
PYHP 115 Full Transcript;
Download PYHP 115 Transcript
Dr. Maki: Hello everyone, thank you for joining us for another episode of the Progress Your Health Podcast. I’m Dr. Maki.
Dr. Davidson: And I’m Dr. Davidson.
Dr. Maki: So we’re back, we’re back in the saddle do another podcast.
Dr. Davidson: We sure are.
Dr. Maki: It’s been a little while. We haven’t posted any for a little while. We apologize for that. But we’ve been very busy. We got a new puppy.
Dr. Davidson: We did get a new puppy, a poodle puppy.
Dr. Maki: Alright. So we’ve talked about Bob, our little co-pilot. He is having a little bit of a crisis. He’s kind of having a crisis with the new puppy. About one minute, it was really funny, we brought her into her first grooming sessions placed here in town called Bailey’s and she looked like a little bit of a shaggy mess. And then they just really didn’t do much because this is her first one. She’s only like four weeks old and she came back from the groomer with a nice blowout. She got her hair done. And Bob was all interested and her name is Vivi, Vivian, one of my relatives. Bob’s named after my dad, and Vivi, our new poodle is named after another relative. She was technically my great aunt, but more like my grandmother. So it’s Bob and Vivi. She came back from that groomer, a grooming session. And Bob was, he was very… he changed his

Patient Question: A patient in her later 40’s, who is having a tough time with perimenopausal symptoms, recently asked me which is worse, perimenopause or menopause?
Short Answer: After dealing with many patients over the years, it is clear that both Perimenopause and Menopause are difficult and the symptoms can have a significant impact on a women’s quality of life. However, there are better treatment options for menopause then for perimenopause.
PYHP 114 Full Transcript:
Download PYHP 114 Transcript 
Dr. Maki: Hello, everyone. Thank you for joining us for another episode of the Progress Your Health Podcast. I’m Dr. Maki.
Dr. Davidson: And I’m Dr. Davidson.
Dr. Maki: So this morning, we’re just going to kind of sort of a question, but this was not actually one that someone answered on the website or wrote to us. This is actually from a patient that I recently saw. She’s 46, which is kind of a- I’m sure you would agree, it’s kind of like a very common age for our new patients. She’s kind of miserable at the moment, has a lot going on, and just does not feel very good. And she actually asked me the question because she hears horror stories about menopause, but she’s feeling pretty rotten right now. So she asked the question, “Which is worse, perimenopause or menopause?” So I thought that was a very nice way for us to do an episode around that.
Dr. Davidson: Exactly, because we see this all the time, you know, a lot of menopausal females, perimenopause. And sometimes, we kind of overlook a little bit of the differences between the two and how people feel because, you know, everyone’s different.
Dr. Maki: Yeah. Now, honestly, this is the reason why we’re doing the podcast in the first place, because when it comes to some of these female hormone issues in general whether it’s PMS, PCOS, perimenopause, menopause, the conventional treatments and approaches are just not very good. Women are kind of left to their own devices. They’re not really given a lot of options. We’ve kind of figured that out over the years, right? There’s this big gap in the problems that women are experiencing. Before, it used to be just, “Well, that’s just aging and you just have to deal with it.” I don’t think that’s really acceptable, really, in the 21st century.
Dr. Davidson: I think some people still hear that, you know, “It’s okay. That’s just getting older.”
Dr. Maki: Well, yeah. That’s easy for the practitioner to say when they’re not the o