Danielle’s Question: So, Thank you for this article. I’m having side effects from taking 200 milligrams of oral progesterone. I take forever to wake up and feel really, really groggy. I read where you said that take it early and when I take it early and out in an hour, I can barely keep my eyes open and feel drunk or drugged. So, I usually take it in half an hour before bed. I sleep like a rock but have a hard time coming to the next day. I’m a lightweight when it comes to any medication and always thought that might be due to being clean and sober for 32 years, but I might be wrong. I’m probably just sensitive. So, should I try a hundred milligrams of oral progesterone or change it to a compound? Because currently, I am taking Prometrium. I really love the solid sleep, but it takes hours to wear off in the morning and it seems like I’m just so tired. But I do take thyroid medication and I do have low morning cortisol and take some adrenal glandular as well. So, thank you so much in advance.
Short Answer: The commercially available form of progesterone is called Prometrium. It is an instant-release medication and comes in two doses of 100 mg and 200 mg. In our experience with patients, they tend to be strong for women and not well tolerated. It is not surprising that 200 mg is causing next-day fatigue. We typically prescribe 100 mg of bioidentical, sustained-release progesterone. Some women are still sensitive but is usually very well tolerated.
PYHP 112 Full Transcript: 
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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 going to just kind of dive right in. Of course, as we always do we have a lot of listener questions. So, for the future or for those that are listening, if you’re new to the podcast you can always send us an e-mail at [email protected], [email protected]. That is if you want to keep it somewhat private and discreet. We always change everybody’s name. So, there’s no question about who is sending in the question. You know, we do get sometimes some sensitive female issues. And I’m sure people wouldn’t want that to be kind of public knowledge. So, like I said, we do try to protect everybody’s privacy as much as possible and we love the questions because that means we know people are listening. And you know, it gives us kind of an unlimited amount of topics that we can discuss in the podcast. So, Dr. Davidson won’t you just kind of dive in and let’s go through Danielle’s question.
Dr. Davidson: Sure. Sure. So this question is from Danielle, but just on a quick little side note is we love all the questions. So, if you have any concerns, please write into us. But at the same time if it’s maybe not exactly like a lot of the questions were doing or pertaining to. You can probably hear our little pup in the background. He always gets a little more, I don’t know. When we do the podcast he gets a little more rambunctious or something.

Amanda’s Question: I’m 41. I have regular periods every 35 days. I have some anxiety, tiredness, stress, but I do work a lot. I don’t have trouble sleeping, but my doctor checked my serum progesterone level, and at day 21, it was .5. She said it was low. She had prescribed me oral 200 milligrams a day of compounded progesterone. I work at a job that requires 24-hour shifts twice a week. I’m trying to verse myself in information about this replacement therapy and if this is the right way for me to take progesterone therapy. She told me to just not take it on the days that I work, but I’m concerned with things that I read about replacement therapy and increased mood issues and anxiety. I don’t think I could deal with those any worse than I have than what I have. Can you please tell me if I’m on the right path as I’m scared to begin this therapy? Thanks, Amanda.
Short Answer: When women enter their early to mid 40’s, they typically stop ovulating, but continue to have periods. This lack of ovulation usually causes a significant drop in progesterone levels and can lead to many unwanted symptoms of perimenopause. Taking oral, bioidentical, sustained-release progesterone is a simple, but effective way to help deal with many of the unwanted symptoms. We typically start a patient on 100 mg of sustained-release Progesterone and they can increase to 200 mg later if needed. Some women may even need to cycle the progesterone dose. For example, taking 100 mg (1 capsule) from Day 1 to Day 13 of the cycle and then increase to 200 mg (2 capsules), from Day 14 back to the period.
PYHP 111 Full Transcript:
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Dr. Maki: Hello everyone. Thank you for joining us for another episode of the Progress You Health podcast. I’m Dr. Maki.
Dr. Davidson: And I’m Dr. Davidson.
Dr. Maki: We mentioned in the last couple of times on the podcast, you actually have a book coming out, The Perimenopause Plan. It should be out probably within the next, I would say, probably the next couple of weeks to the next month or so.
Dr. Davidson: Depending on when we post this podcast. It’s all written. It’s just having a little bit of issue trying to make it look pretty- the design process.
Dr. Maki: Yeah. It should be fun. We’re excited about. It’s going to be published in Amazon as an e-book. Perimenopause is something that we deal with all the time and it was definitely a- I know you like to write. You’ve always been the writer. That’s always been your forte for the most part so we’re definitely excited about that. We’ll keep you up to date on that. Now, diving in, we have again more questions. We just have lots and lots of them. So, hopefully, if everyone keeps sending us emails with their questions that I’m assuming that the questions that we’re answering, people are finding some value or enjoying the questions because we just keep getting more of those. So, hopefully, it’s not getting stale or we don’t want to be boring

Tammy’s Question: Hi. Recently, I read your article about estriol. I’m currently using a Biest Progesterone Vaginal Cream, but it’s compounded, and it’s expensive. I could use an estradiol patch and Prometrium and this therapy could be much more affordable. Would I expect a big change in that?
Short Answer: First off, we don’t recommend using Biest for vaginal use. We use Estriol only for vaginal use, especially if a woman still has a uterus to minimize any spotting or bleeding issues. Switching to an Estradiol Patch and Prometrium will not produce the same results, and could cause some unwanted side effects. Using Estriol is best for vaginal dryness and pain with intercourse.
For more information: read the article about the difference between Biest vs Estradiol.
PYHP 110 Full Transcript: 
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Dr. Maki: Hello, everyone. Thank you for joining us in 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 in the swing of things. We’re just going to dive right back in. Now, this time, we have a question from Tammy. This is relatively pretty short, but you and I have actually had a couple of recent experiences with the estradiol patch. Let’s just dive right in, and why don’t you go ahead and read the question.
Dr. Davidson: Like we’ve said in our other podcast, we want to say that we always change everybody’s names. We get lots of email questions from people, so we’re really trying to get to as many of them as we can. So we really love that you are sending in those questions, but know that we do change any personal information and all that jazz. Okay. So this one is from “Tammy”. Hi. Recently, I read your article about estriol. I’m currently using a Biest Progesterone Vaginal Cream, but it’s compounded, and it’s expensive. I could use an estradiol patch and prometrium and this therapy could be much more affordable. Would I expect a big change in that?
Dr. Maki: Yeah, right. So her question, she’s using right now a compounded by Biest Progesterone Vaginal Cream which based on our last episode and we are not sure about the Biest Vaginal part. We’ll segue back into that a little bit just as a refresher. So her question is, can she switch completely the types of prescriptions to the estradiol patch, also called the Vivelle patch?
Dr. Davidson: Or CombiPatch. There are a few different names. Now, they have the generic. So Vivelle was around, but now they have generic. So just estradiol patch.
Dr. Maki: They are all still basically estradiol. It comes in a couple of different which seems like – and this is what we’re going to talk about – which seems like a relatively low dose .025, .05, .075, and then, of course, Prometrium. Prometrium is commercially available progesterone, instant release progesterone. That’s something key that we’ll get to in a second. So tell me your thoughts, Dr. Davidson.
Dr. Davidson: Well, she’s using it as a vaginal cream and she’s using a Biest. We don&#821

Kate’s Question: Hi, I’ve been doing extensive research and I came across your site. I don’t know if you’re still responding to email questions or not, but I thought I’d give it a try. I just completed my first year of no periods. Dryness, I have the beginning of atrophy, is really my only issue. But I was given 50/50 ratio Biest, one gram a day. I do that vaginally as an insertion for two weeks, and then I reduce it to two times a week after that. I don’t do any progesterone, but this is what my experience has been. After the first full week, I started bleeding. After the second week, it became heavier bleeding. So then they put me on it for a third week and I was supposed to drop down my Biest 50/50, but I continued bleeding. So, I do feel great. And now it’s week four, and the bleeding is starting to taper and I’m loving this but worried about the bleeding. So just wondering your about your thoughts. Thank you, Kate.
Short Answer: With our patients, we don’t use Estradiol vagainlly in order to minimize any unwanted spotting or bleeding. We only use Estriol for vaginal use as it is a “weaker” hormone and less likely to cause any bleeding issues.
PYHP 109 Full Transcript: 
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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 have a lot of questions to do. We have, it seems like we just keep getting more and more and more. So we really apologize that we’re not able to keep up with is as many of them as they keep coming. I think it’s a good thing. Alright, we have an unlimited amount of content to talk about. We are gonna dive in. This is Kate’s question. We are changing everybody’s name just to keep it, you know, just to keep it you know. So no one’s, there’s no identifying information. So if you did submit a question, we might have answered it or we were probably going to answer it but the name might be different so you might have to actually pay extra attention to the podcast. So Dr. Davidson won’t you go ahead and we’ll just dive in.
Dr. Davidson: All right, let’s dive in. So this question is from Kate. So, ‘Hi, I’ve been doing extensive research and I came across your site. I don’t know if you’re still responding to email questions or not, but I thought I’d give it a try,’ and this is why we do get a lot of email questions. We get a lot of, lot of questions on the website, but we want to do them for everybody to listen because it actually all this really applies to a lot of people. So, okay, just to continue with Kate here, ‘So I just completely…’
Dr. Maki: Oh sorry, that’s the copilot. Our co-host Bob is playing with his antlers, deer antlers. So sorry about that.
Dr. Davidson: And he loves to talk and make lots of noise.

Anne’s Question: Since moving to the high desert, I have to use very large doses of Bio HRT or bioidentical hormone cream, and it is still not getting blood levels up to where my doctor would like. I tried switching to the patch and the level dropped to less than half. This is all giving me terrible symptoms and impacting my quality of life. I am worried the high doses are harming me somehow. Can I just rub some DMSO on the skin prior to applying the cream or will that help?
Short Answer: This is somewhat of a complicated question to answer because it is based on the type of BHRT a woman is using. We do have different blood level targets for women using static dosing vs women who are using rhythmic dosing. When prescribing BHRT for a patient, we have some very general blood levels that we are trying to reach, but the woman’s subjective response is a much better indicator for dosing. How she feels is much more important than her blood level of Estradiol. In regards to DMSO, we don’t typically use or recommend this for women, but we do add DMSO to testosterone cream for men because they have more body hair.
PYHP 108 Full Transcript: 
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Dr. Maki: Hello, everyone. Thanks for joining us for another episode of the Progress Your Health Podcast. I am Dr. Maki.
Dr. Davidson: And I am Dr. Davidson.
Dr. Maki: Of course, this is audio so nobody can see anything but you and I are getting ready and we were having a little problem with our boom mic stand. It was not sitting at the table. You are getting a little impatient with me and then you end up fixing it which was great. As we are just starting, our dog, Bob is at my feet right now and he is upside down, chewing on like a little bone.
Dr. Davidson: It is so cute. It is so cute.
Dr. Maki: I am trying to stay focused on doing the podcast and he is upside down with a little bone in his mouth. It is too cute. We are back into podcasting land. We have a ton of questions to get to. We are just going to do it. I think we kind of for a while we were kind of doing a few questions per episode. I think it is a little bit better, a little more focus by doing just one question per episode. It is also easier to figure out a title for it, that is more specific to what the question is about. This one is from Anne. So why not you go ahead and read the question.
Dr. Davidson: Now he just got up and you shake it around. All right. This question is from Anne. Of course like we always say, we change everybody’s names and any kind of pertinent information just for privacy protection. We kind of renamed her Anne. From Anne. Since moving to the high desert, I have to use very large doses of Bio HRT or bioidentical hormone cream, and it is still not getting blood levels up to where my doctor would like. I tried switching to the patch and the level dropped to less than half. This is all giving me terrible symptoms and impacting my quality of life. I am worried the high doses are harming me somehow. Can I just rub some DMSO on the skin prior to applying the cream or will that help?
Dr. Maki: Yeah. This comes up a lot, people are worried about absorption. DMSO is one of the rhythmic dosing protocols we use for men. We do add… The compounding pharmacy we use doe

Carrie’s Question: I am currently taking, .25ml’s Biest which is 1.25mg, 70/30 ratio per gram. I apply it to the labia and vaginal area at night, every night. About how long do I have to wait for it to absorb before having intercourse? I am getting conflicting reports. My doctor says I do not have to wait at all, as it will not affect my husband but the pharmacist says, it will affect my husband and not have sex for several hours after application. Thank you.
Short Answer: Carrie is taking a very low dose of Biest. However, she is applying the estrogen cream vaginally, so in theory, her partner could absorb some estrogen during intercourse, but Carrie’s applied dose is only about .30 mg. This small amount of Biest is barely enough to affect Carrie, let alone her husband. If the male partner is worried about the estrogen, simply skip applying the cream until after intercourse. If the Biest cream is being used to help with pain and discomfort during intercourse apply about an hour or so before activity. For vaginal use, we typically only recommend Estriol cream and not Biest, which has both Estradiol and Estriol.
PYHP 107 Full Transcript:
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Dr. Maki: Hello everyone. Thank you for joining us for another episode of the Progressional Podcast. I am Dr. Maki.
Dr. Davidson: And I am Dr. Davidson.
Dr. Maki: Well again, we are trying to do our best to get back in the swing of things back in podcasting land. It actually feels pretty good. On the last podcast, we talked a little bit about the book that you have coming out. I would just mention it real fast up for perimenopause plans, going to be available on Amazon. We will keep you up to date when that comes out. If you have any questions, just in general. You can always send us an email at [email protected].
We are going to do another question today again because we took some time off over the summer. We got a whole slew of questions for us to do, this one does come up quite often. Why do not we just dive into it? This question is from Carrie.
Dr. Davidson: We always change everybody’s names and personal information just for privacy, but this is a really good question. We are going to break it up a little bit, give the general answer to it. And then I am going to get probably a little nitpicky on it because I like the math part. But, this is from Carrie. “I am currently taking, .25ml’s biased[?] which is 1.25mg, 70/30 ratio per gram. I apply it to the labia and vaginal area at night, every night. About how long do I have to wait for it to absorb before having intercourse? I am getting conflicting reports. My doctor says I do not have to wait at all, is it will not affect my husband but the pharmacist says, it will. And she capitalizes ‘WILL’, which will affect my husband and not have sex for several hours after application.” Thank you. She is wondering which way should she go?
Dr. Maki: This one comes up a lot and I guarantee you that the husband is worried about the estrogen, right? Men are always worried about little estrogen, It is probably more of his concern, he is more of, what about that estrogen? He does not want to grow boobs or something. To be honest, every man is worried about that, but I do not think it is really that big of a deal. She might not want to apply it vaginally and hav