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;
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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’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:
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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 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

Kathy’s Question: I tried progesterone 100 mg pill. I felt dizzy and felt like I could not stand upright. Does a cream have the same side effect? I was also prescribed an estrogen patch.
Short Question: It is certainly possible that progesterone can cause someone to feel dizzy. It is often prescribed to help with sleep issues and anxiety, but some women claim to feel dizzy or “weird” after taking it. In our experience, this is more common with Prometrium, which is an instant-release form of progesterone. Bioidentical, sustained-release progesterone can still cause some of the same side effects but is typically much better tolerated. Progesterone cream usually does not cause some of the same side effects but is not effective for insomnia or anxiety. There is some research to suggest that progesterone is a vasodilator. This effect could lower blood pressure, which could make someone feel dizzy after taking.
PYHP 113 Full Transcript: 
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Dr. Maki: Hello everyone. Thank you for joining us for another episode of the Progressional Podcast. I’m Dr. Maki.
Dr. Davidson: And I’m Dr. Davidson.
Dr. Maki: So, again, we have another question. This one’s from Kathy. So, again, in the future, for those of you that are new to the podcast, hopefully we’re getting lots of new listeners all the time. If you are an avid listener, you like what we have to say, please give us a review on whatever platform. We are on all the major platforms. I still haven’t added our podcast yet, or I have had it added to an Audible or Amazon Music, but that’s on the list which I think is cool. But we’re on iTunes. We’re on Stitcher. We’re on Spotify. We’re on iHeartRadio. We’re on all those different podcast platforms. So, please give us a review. That’d be really nice. So, this question is from Kathy. Once you dive in and give it a whirl.
Dr. Davidson: Sure. We always change everybody’s name. We always say that on every podcast too. And these questions come from podcast listeners, and also from our website, from our blogs too. Kathy doesn’t say on here whether she got this from the podcaster or from reading one of the articles or one of the blog’s. So, this is from “Kathy”. I tried progesterone 100mg pill. I felt dizzy and felt like I could not stand upright. Does a cream have the same side effect? I was also prescribed in estrogen patch.
Dr. Maki: Yeah, so there’s a lot. This is a really simple question, which is nice. Right? It’s just a couple of questions and it’s fairly similar. We’ve done a bunch on progesterone. But this one adds a little bit of a different element with the progesterone patch or the estrogen patch. She doesn’t specify, but I would assume that if she’s getting the estrogen patch, that means she’s getting prometrium. We could probably make that as… Would that be a fair assumption to make?
Dr. Davidson: Yes, like you said, this is a short question. It seems simple, but it I like it because we can really

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