Q&A: thyroid medication, fluid retention from HRT, finding a good hormone doctor, thick endometrium, issues with oral and suppository progesterone, dialing in HRT, mitigating the androgenic effects of testosterone, when to safely start HRT and MORE!

Transcript:

Ladies, thank you so much for all the amazing questions that were sent in for today’s Q&A. And there is a lot. This is, I think, the most questions that I’ve ever had sent in for one of these Q&A calls or Q&A podcasts. And it just got me thinking. how much help women need when it comes to their hormones, and how many women don’t go and get the help that they need. Hormones are very complicated. Each of us are individuals that need individual care. And I know that financially, not everybody can afford to go and get help that they need. But there are options. And so I’m not saying you have to work with me. That’s not what this is about. I mean, great if you want to, but I just want you to get the help that you need. So many of these questions, I kept thinking in my head, oh, I need to talk to this person one-on-one. This person needs more than just a quick answer on a podcast episode. So ladies, go get some help. Please, please, please, please, please. These are your hormones. This has to do with how well you feel throughout the entire second half of your life. Like this is not something to cheap out on. It’s not something to you know, put on the back burner and just be like, you know what, I’m just going to listen to 500 different podcast episodes to get the answers that I need about my own hormones, and I will deal with it myself. Because I think for many of us, myself included, I’ll put myself in that group. we can get very caught up and kind of suckered into the fact that there is a lot of free information to be had on the internet and on podcasts and blog posts and everything else.

We have so much now at our fingertips that it’s almost to a detriment because we constantly think to ourselves, the answer to my problems, are out there somewhere, either on a podcast or on the internet. And we really need to understand that when it comes to our health and our hormones, if you are struggling and not finding the answers by listening to a bazillion episodes of my podcast, Which thank you so much for listening to the bazillion episodes, I really appreciate it. But if you haven’t found the answer or you’ve been trying different things, and you’re still suffering and you still haven’t gotten your hormones dialed in. then please, I encourage you to find some help, some one on one help or the group coaching. I will pump up my own program here, ladies, but I have a very affordable group coaching program that I would say majority of people could find the money to afford. And we do weekly group coaching calls where you can send in your labs, where you can talk to one of us and say, hey, here’s what I’ve been experiencing. I need some help. And you can get it. And, you know, if it’s not with me, find somebody in your area that you can work with or online. Right now we do prescribe, we have doctors that can prescribe in every state. We have a prescriber for Alberta, British Columbia. and Ontario, and I do believe we just got on with Manitoba as well. We also have referrals, like we can, if you’re in one of those other provinces, we can refer you to a different company that could prescribe to you, or we can tell you, you know, how to navigate talking to your own physician about it.

There’s lots of options, and there’s just no reason to not get the help that you deserve and need. So, if it’s not with us, then please find somebody else that can help you because these questions are complicated and they really do, a lot of them need one-on-one direction and help so that you can really figure out what’s going on for your body. So there’s my spiel. Let’s get to the questions that have been sent in and I will do my best to help steer you in the right direction. Our first one is from Pam.

Hi Karen, I have Hashimoto’s and have been on armor thyroid, 90 milligrams for several years. My TSH was 0.76. A week ago, the nurse practitioner did not do any other labs this time. Six months ago, my TSH was 1.96 and T4 was 0.75. I’ve been having a lot of palpitations recently and I’ve had my heart checked having premature beats from the bottom of my heart. Cardiologist does not want to treat them. I feel like I may be a little hyperthyroid at this point and think that’s contributing. The nurse practitioner I saw doesn’t really understand armor but is going to have me decrease my dose two days a week to 60 milligrams. Do you think that’s reasonable or do you have any other suggestions? I’ve lost 40 pounds over the last 18 months and maybe I don’t need as much armor. I don’t see an endocrinologist. The thyroid lab still perplexed me at times and I’m an RN. Thanks for all you do to make a difference for so many women in North America. You’re the best.

Okay, Pam, that’s a great question. Unfortunately, there’s not a lot of doctors that really do understand or nurse practitioners that really understand thyroid treatment. So when it comes to getting when you get the heart palpitations from thyroid medication, it can be several different things. It can be that yes, you are now on too much thyroid medication. It can also be that you don’t have sufficient iron levels. It can be from too low or too high cortisol as well. So those are the three main reasons why you’ll get heart palpitations from taking thyroid medication. It sounds like you could be overstimulated, but your T4 was actually below range, so it makes me think maybe that’s not it. The dosing of two days a week of 60 milligrams, you’re not gonna notice that. If you are hyper and you’re getting too much, I highly doubt that’s gonna make a difference. I don’t typically recommend just two days a week of lowering of a dose. I think it’s better and helps your thyroid to function better. If you’re planning to wean off and see or wean down, you should be doing it either every second day or preferably every day where you would just go down maybe by 15 milligrams. So if you’re on the 90, you would go down to 75 and see how that felt. You could try and make the plunge right down to 60 and take 60 every day and see if that eradicates those heart palpitations, which you’re gonna notice that I think pretty darn quick if it’s gonna help. You can also take your basal body temperature pump. So that’s a really good way to see if you’re maybe having too much thyroid, because if your temperature is high and you’re above 98.6 in the afternoon, that could tell you that yes, you are on too much medication. So I would try, or talk to your nurse practitioner about it, but try with the lowering of the dose first and see how that makes you feel. So maybe you could, if they’re in, I’m guessing you probably you’re on one and a half grain. So you would just, it’d be easier just to take out the one, the half grain. So maybe you want to do 60 one day, 90 the next day, and kind of go back and forth. And if you don’t notice anything, you’re still getting heart palpitations, then I would recommend that you try the 60 and see if that is helpful and see if it gets rid of it. So kind of play around with it a little bit and see. And if that doesn’t help, and you’ll notice within about two weeks, let’s say you lower your dose to 60, in about one to two weeks, if that was too low for you, A lot of women will notice, they’ll notice that their hyposymptoms start coming back. I know for myself when I dropped by 25 micrograms on my T3. I felt fine for the first week and then I started to get hypo and I quickly put on weight and I didn’t feel good. I got really depressed. And so I was like, oh, that was way too fast. So then I went back up and instead I went down by 12.5 and I stayed there for several months before I went down to the 50 micrograms. So T3s dose differently. you should feel pretty quickly whether or not that was a right move or a wrong move. Ideally, we want to see your free T4 in the middle of the range and we want to see free T3 in the upper third of the range when we’re talking ranges. So, you know, look at your free T3 levels and see what they’re at and go from there, okay? All you can do is kind of hack it a little bit yourself and see what’s causing it. And if it’s none of those things, if you’re still getting heart palps and you’ve dropped to 60 and you’re not feeling good on 60, then that tells us that you actually didn’t need to lower the dose and it’s not hyperthyroidism, but instead it could be that maybe your adrenal system isn’t doing very well, or I would check your iron and ferritin levels.

Okay, Darrella, I may have asked before, but I’m currently taking a biased, a progest, you’ve put progestin, and I’m wondering if you mean progesterone, I hope so, testosterone compounded, and I’ve been having really bad fluid retention in my whole body and face. Will this pass after a while, or should I discontinue this compound? Thank you.

So first of all, I never like taking everything in one bottle. It sounds like you’ve got this like the three all in one. And you never want to do that, especially when you’re first starting hormone replacement therapy, because now you don’t know which one is causing the problems. And it would be much easier if you could go, okay, let’s first take out the testosterone. See if that helps. If that doesn’t help, then let’s lower the bias. Let’s increase the progesterone. And so you can play around with those doses up and down. The fluid retention could be from any of those three. So estrogen can cause fluid retention, too much progesterone can cause fluid retention, and testosterone can cause fluid retention. So you really need to get those three things separated. And typically, you know, if it’s the estrogen, typically that will subside the water retention within usually about a month. For some women, it’s a little bit longer, but I typically see it not lasting very long. So maybe a month for your body to just get used to that. The progesterone, I typically see it causing water retention when a woman is using too much. Rather the estrogen, it’s not always a too much thing, like you’re not getting too, you might not necessarily be getting too much. It’s just your body’s not metabolizing it very well. Rather than with the progesterone, it’s typically a matter of it is too much and you’re carrying water from it. Testosterone, it’s usually that it’s an adjustment and it could be that it’s too much, kind of one or the other. So the answer being, get them separated so you know what’s causing what. And you don’t want bias and progesterone together because bias you would take every day, same with your testosterone, but progesterone you want to cycle. So you want to do at least three weeks on, one week off, preferably two weeks on, two weeks off in menopause. Okay, anonymous. Can you tell me how to find a doctor in my area that I can discuss hormone therapy and estradiol patch with? Do you talk to a specialist for menopause or a GP? Thank you, Judy. So Judy, I did this great episode. back in November of last year. The title is 20 pounds down, no more pain and energy is back. Plus what to look for and what to avoid in a hormone replacement prescriber. I’m going to link to that in the show notes. I really encourage you to go listen to that because I talk about what you’re looking for in a hormone prescriber. And it’s very detailed. But basically, you know, a GP is taught minimal about menopause. So 0-7% of medical doctors are taught about menopause and 0% are taught about perimenopause. it’s your doctor’s responsibility to educate themselves on hormone replacement therapy, menopause and perimenopause. And that means that they’d have to actually either take a self-interest in learning about it, or they have to pay to learn how to apply hormone replacement therapy to women in menopause and perimenopause, which means not too many doctors know about it because they’re not willing to pay out of pocket to go get that education on how to apply properly hormone replacement therapy. So I always say, try first with the GP. This is where it comes down to, we’ll try our best to get it for free, always, right? Myself included. And if they can’t help you, if they say things like, hormones will kill you, or I don’t know anything about that, or this is natural, just get through it. Here’s your antidepressant, here’s your birth control pills, here’s your hysterectomy, that kind of thing. Then you know that you’re not talking to the right person and that you want to go get help from somebody that really understands hormones. Now, once again, we can prescribe in every state. We also have several very affordable options for women in menopause, where you can get the estradiol patch and oral progesterone for very, very inexpensive ways. So if need be, you can always join the group coaching program and we can help steer you in the right direction. and help you basically dial in those hormones. Okay.

Kathy says, hi, Karen. My uterine lining is 11 millimeters. Endobiopsy was negative. Good for you, Kathy, for going and getting the biopsy. It was six and a half a year prior. Okay, so it’s growing. Almost 56 and blood work indicates menopausal levels, but still having bleeding off and on, so not sure if legitimate menopause yet. Been off and on bioidentical hormone replacement therapy for the last couple of years, trying to get right dosage and delivery method. Currently not taking any hormones, but have an appointment soon for working through this now that biopsy was clear. Could there be a benefit in determining how I metabolize estrogen? Could this be why my lining is thick? What is the lowest estrogen I should take to still get heart, bones, and brain benefits? Thank you so much, Kathy.

Okay, so ideally we want the endometrial lining to stay under four millimeters. So yours is quite thick, Kathy. And this is something that is quite common in menopause, like in perimenopause to happen. So you’re still producing estrogen. And if, you know, go and have your levels checked, you want your estradiol ideally to be between 50 and 100 picograms per milliliter. And that is where it has shown to get heart bones and brain protection. However, Kathy, if you are in that range, and it’s not over that range, you are still having problems then with your estrogen. So that could be a matter of how you are metabolizing it. So you are right. If you are recirculating that estrogen, that little bit of estrogen that you are producing, then you could be in a very estrogen dominant state and your body is saying that it needs help with how you metabolize estrogen. And you’d want to get that help before starting on any estrogen replacement therapy. My recommendation for somebody that is having an overgrowth of the uterine lining is to use bioidentical progesterone suppositories in the vagina, because then it’s very localized and it’s going to help to decrease that uterine lining. So please talk to your physician about trying that. There is things that they can also do. They can cauterize the uterine lining. And it’s actually a pretty successful treatment with low amounts of side effects. That’s called an ablation. So you can talk to your doctor about that. But ideally, we want to get to the root of why it’s like that, which it’s likely because you’re still producing estrogen, but you don’t have any progesterone. So progesterone is going to be your first line of treatment if I were you. and see how that helps. And then also doing a Dutch test to see how you’re metabolizing estrogen so you know which pathway needs help. You might possibly need help with both of your pathways or all three of your pathways. There’s actually three pathways. There’s phase one, phase two, phase three. Phase three being how much are you pooping and how are you excreting that estrogen when it gets down there. In the next one, we’re going to listen to one of the speak pipes that were sent in. So this is a voice message from Sophia.

20:46 Sophia My name is Sophia. Thank you for the work you do for us women. I’m so, so grateful for that. So a family member in her late forties had a hysterectomy about four years ago because of fibroids and excessive bleeding. she still has her ovaries. So recently she did some blood tests and her estradiol was 165. I know during perimenopause estrogen fluctuates but my question to you is what is a healthy range of estradiol for someone like her? She’s also having inflammatory Note also she wasn’t put on any progesterone post-surgery. So she is on zero progesterone. Yeah, I know this one is a hot mess of a case, but your insight is most welcome. Thank you so much.

21:54 Karen Great question. Thank you, Sophia. So when you say vagina inflammation, I take that as possibly dryness, which would be from lowered estrogen levels. However, Sophia, her levels at being 160, that’s actually okay. And because she’s likely then still cycling, even though she’s not having a menstruation, because she had a hysterectomy, she’s still cycling. So we don’t actually know what day she tested that estrogen. And our estrogen fluctuates quite a bit throughout the month, as I’m sure you know. But 160, that is a normal level of estrogen in our 40s, especially for certain times in our cycle. It sounds to me like progesterone is definitely needed right now and that would probably help with some of these symptoms. And then she could do some localized estriol treatment for the vagina dryness, if that is what it is. If it’s not that, if it’s not dryness, but it’s inflammatory, I would definitely be speaking with a doctor or gynecologist about that and having a pap test done just to rule anything abnormal out. But yeah, so I would look at some estriol just for the vagina because it’s very localized in the vagina, estriol, and it can really help with lubrication and vagina atrophy. And then the progesterone would be a great fit for her if she could somehow figure out kind of where she is in her cycle. Like she may feel that she still has PMS or what she can tell when she would be on her period. So, gauge it from that as to when she should be on the progesterone and she should not be on it for what would have been the week of her period, possibly the first two weeks of that cycle, and then she would take progesterone for the last two weeks. And then just really keep eye on those levels, the estrogen levels, because at her age, they are going to be going up and down. Like you said, you know that they fluctuate. So, there’ll be some months where she may have normal levels, sometimes where it’s really Also, she can check her FSH because that would also tell you a little bit more. Maybe she caught it on a high peak day, her estradiol levels, but yet her FSH is above 20. That would tell us that her body actually does need a little bit of estradiol too. And so she would maybe start at a really low dose and put in the progesterone and that could really help to just transition her through into her menopausal years in a much smoother ride. Next up, we have somebody that would like to go by the letter K. Good choice in letter.

Hi, Karen, I’m 63, five years into menopause and three months into HRT. Estradiol patch, 0.05, and 100 milligrams oral progesterone. I finally found a gyno that will prescribe these, but she only goes by symptoms, so no testing of hormones. I switched my oral progesterone to a vagina suppository. Days after the switch, I bled like a full seven day period. Then three weeks of smooth saline and all of a sudden started daily spotting that went on for nine days. Then I stopped the progesterone to force a bleed for five days, but spotting has continued for 17 days and counting. I met with the gynecologist today and she wants me to go back to an oral delivery of progesterone, which I will try. It just made me so tired even during the day. If this doesn’t stop the spotting, she suggested the Mirena IUD in place of oral progesterone for uterine protection. What are your thoughts on this? I’m not in the position right now to pay out of pocket for a naturopath or one of your programs. I’m learning. I’m trying to learn all I can and work with what I can get prescribed through my insurance. I so appreciate your podcast and all the educational information you share. Thank you.

You know, we do what we can. Okay, so here’s the thing. It does sound like the suppository was too much. And I will say that if the vagina suppository was a hundred milligrams, that is possibly it sounds like it was too much. We have to remember that it’s high when we take it oral, it comes in a higher dose, 100 to 200 milligrams typically, because it has to go through the first hepatic passage of the liver and our digestive system. So we lose a lot of the actual progesterone and it mostly converts to metabolites. So 100 milligrams of oral progesterone is actually only about 20 milligrams progesterone. in the body. The rest turns into metabolites. So the 100 milligrams in the vagina may have been too much and that is what caused the consistent bleeding. Now, if oral progesterone made you too tired, that is a very common side effect of oral progesterone because it converts to those metabolites, which one of them acts on what’s called the GABA receptor in the brain, which makes us tired. And some women, it’s really a good thing. It helps them to sleep. It’s very anti-anxiety. But some of us are too sensitive to that, in which case, I would recommend you trying transdermal progesterone cream, either anywhere between a 25 milligram dose or a 50 milligram dose, no higher. Use it still at bedtime and still cycle it and see if that helps you to not be too tired as well as control the spotting. Okay, if it continues, I would also recommend having an ultrasound done of the uterine lining to rule out anything else, making sure that the uterine lining hasn’t overgrown and that there’s no fibroids. Are you tired of feeling lost in the world of hormones, especially during midlife? It can be a real challenge to find practitioners who truly understand how to address women’s hormonal issues. If you’re seeking relief from debilitating symptoms like low libido, hot flashes, brain fog, fatigue, and weight gain, then explore what we offer at karenmartell.com.

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Meg says, Hi Karen, I’m 44 years old. In April of this year, I went to a midlife wellness center with a reputable OBGYN that seems to do things differently than most docs out there. We ran a bunch of tests. My testosterone was super low, total T was three, and my thyroid was struggling as well. I was put on NP thyroid. I was seduced by the promise of a pellet. They started at a hundred milligrams, which is supposedly a low conservative dose. And after six weeks, my levels were still on the low side. They gave me a 30 milligram booster in June. And my second pellet was in July. They did not increase my dose and still did the hundred milligrams. After that pellet, I could feel the surge. It was intense. And then that kind of died off. To be honest, I feel fine. And when I went for my six week post pellet test, we were all shocked that my total T came back at 432. So we retested the next week and it came back at a higher 535, not moving in the right direction. I’m freaking out a little bit over here. Haven’t noticed anything like hair fall or acne or anything like that. My nether regions might be more swollen or I could be imagining. The nurse suggested The nurse’s suggestion was to, one, work out even more, two, to stop taking DIM, and three, to take spironolactone, 50 milligram daily to get rid of my testosterone’s potential androgenic effects. What are your thoughts on this? Any idea why my body is having this reaction? I won’t be doing pellets ever, ever again. And the nurse said they suggest a trochee for someone like myself. I haven’t heard much about those, wanted to get your thoughts. Terzapotide wouldn’t have any effect on this, would it? I started two and a half weeks ago. What about thyroid medication? I know this can be so interwoven and complicated. Thank you.

Okay, so this is my really prime example of Holy, you need to be working with someone that knows what they’re doing, beg. Because so many things is wrong with this. So many things, it just makes me shudder. Number one, pellets, always, always. Same with injections. Make women’s total testosterone go sky high. Like I rarely see it coming under 150. Where’s the free testosterone? Why did they not test your free testosterone levels? That’s what you want to see. Total testosterone means it’s being bound up. A lot of it’s being bound up by sex hormone binding globulin. So we want to see what’s free and available for the body. And that’s going to give you a much more accurate idea of how much testosterone your body’s able to utilize. When you are put on NP thyroid, it raises SHBG, sex hormone binding globulin. So have them test that as well. Is it above 85? Because if it is, then we know it’s going to be binding up a lot of that free testosterone and you won’t be getting as much, but we need to find out. But you testing that free testosterone, And then second to that, it will bind up DHT and estradiol. Be careful being 44 that you’re on DIM. Every freaking pellet company and clinic puts every single woman on DIM without even looking at her freaking estradiol levels. It makes me very angry because DIM will drain your estradiol and that can cause you to go into menopause sooner and cause a whole bunch of reactions like weight gain. And then they’re just giving you a medication, spironolactone, which is what’s in birth control pills. And yes, it’s very good for stopping the androgenic symptoms of testosterone, which you don’t have. They’re just giving it to you as a potential remedy for the potential androgenic effects. Like that just makes no sense to me. Why would we want to use a medication if we don’t have to? I’m glad you’re saying that you’re never gonna do the pellets again. Thank goodness. Please switch to either cream or injections. Injections tend to work best. I like twice a week injections. To space that out is always better so that you don’t get the surge, right? If you get pellets, you do, you tend to get a big whammo of testosterone in the beginning and then it tapers out. Let’s see, why is my body having this reaction? Well, you’re not having like, you feel good. You’re saying, I feel fine. So you’re not getting acne, your hair is not falling out. So my guess is your free testosterone is not super high. It’s probably a normal range. High end of range probably, but normal. So ask them to test that, ask to have your estradiol tested on day 21 of your cycle and ask them to test sex hormone binding globulin and switch to a better form of testosterone and do not go to a pellet clinic that doesn’t know what they’re doing. Cause this just, there’s so much wrong with that treatment. Okay. Oh, you see, I get a little bit frustrated with this. Let’s go to our next speak pipe.

35:27  Hi, Karen. Two questions. One is I originally started on BHRT about two and a half years ago. I’m 43 still. have my period regular. Originally the bias cream and the tea cream were working and then we added in the pea cream and everything was good. My levels got to T being 50, my progesterone being 29.3 and my estradiol being 196 where I felt great. I didn’t have migraines, I was losing weight and then everything dipped. Now, because the creams got so expensive, I started the Estradiol patch about 0.5. And then I do the Prometrium rectally of 100 milligrams and the tea cream still. And I’m noticing more migraines. I’m swollen. I’ve gained 20 pounds back. What can I do? I’m trying to get balanced again. It’s only been a month with the Prometrium. I haven’t started my period since I started the Permetheum and should be starting any day now. And once I do, I’m going to be cycling off of that for at least a week. I know you say two. I don’t know if a week’s enough time to cycle off, but I know the estradiol patch might take some time to get used to. So I’m trying to be patient, but the weight gain is really getting to me and also the migraines coming back.

36:57 Karen She got a little bit cut off there, but she’s saying help help me Oh Okay, so it sounds to me like you’re getting too much progesterone. What I had just said to that other woman, which is putting a suppository and of 100 milligrams could be giving you too much. So you’re taking it rectally and I’m wondering why that is. Why didn’t you just stay with it being an oral and why are you switching to rectal? because now you’re going to be getting 100 milligrams of progesterone rather than 20 milligrams of progesterone, which can cause water retention and can cause other issues. It can make you just feel like garbage. The other thing that might be happening is that it’s the estradiol patch and you went from using a bias, which would have a really low estradiol in it to doing a patch. And so your body may be having troubles with metabolizing that estradiol and the patch for some women can be really strong. So I would If the switching back to oral progesterone, hopefully that’s an option and you did okay on oral progesterone and you can switch back to it and you go back to feeling good, then awesome. Stick with that. If the symptoms don’t go away, then you’ll want to play around with the patch and you might want to cut it in half and start with half the dose. And then put in some things to help you metabolize the estrogen just to give your body that little helping hand. That is what I would recommend the first two things that you do. But first off, the progesterone, hopefully you can switch. If you didn’t feel good on oral, then try transdermal and see if that helps and do two weeks on, two weeks off. And if that isn’t it, then like I said, try cutting the dose of estradiol patch in half. And then in a couple months, you can increase it to the full dose and see how that feels. Always talk to your physician, of course, about making sure that that’s okay for you to adjust those doses.

Tasha. Hi, Karen. I had my IUD Mirena removed at the beginning of August and I’m planning to do hormone testing. Do you recommend waiting for a certain amount of time before doing so? Thank you.

Yes, I do. I recommend waiting for three months, especially if you’re still in your cycling years, so that you can get an idea of what your hormone levels are at, because it does take a couple of months for them to kind of get back online because you’ve been suppressing them with the Mirena, just specifically progesterone. So wait for three months and then go back on it. I mean, then do your testing. Okay,

Cassie.

Hi Karen, I am 52 and after taking birth control for 14 years for PMDD, which is premenstrual dysphoric disorder, I came off it four months ago. I still have not had a period and do not expect to have one as my FSH and LH are high. I have been supplementing with progesterone, but not but not estrogen, as I have many symptoms of estrogen dominance. The progesterone has knocked out the hot flashes, but insomnia, muscle aches, and hair loss remain. I have had blood tests done, which showed basically no hormones, estrogen, progesterone, testosterone. Despite being on birth control, I didn’t put much weight on these, as I know, hormones. Sorry, that’s how she wrote it here. I know hormones fluctuate. I just had a Dutch test completed and was surprised to see that my estrogen was zero. Well, progesterone had slightly come up with supplementation and testosterone was still being next to nothing. I thought I had estrogen dominance and now confused. I’m trying to figure out if I should also supplement with estrogen and if that would help some of the symptoms. I’m concerned that adding estrogen may continue to make my weight go up. And I found that my body favors the unhealthy pathway for metabolizing estrogen. I’m confused and could use some guidance. Thank you.

PMDD number one is typically caused by a progesterone sensitivity, not an estrogen. So I don’t know if you thought that and if that’s why you think you’re estrogen dominant. The hair falling out, severe joint pain and muscle pain is likely from the loss of your estrogen. Estrogen lubricates our joints and it helps with hair growth. So without it, we have problems as well. When we start losing our estrogen, we start gaining weight because we become more insulin resistant. And then you’re wondering why you gained weight. So that’s why. The estrogen, it has the biggest impact on our weight. When we lose estrogen, we start gaining weight. You need testosterone replacement if you don’t have any. Likely you do, I can’t say for sure, but sounds like you need it. And then, and also it’s very well known that birth control will suppress testosterone, more so oral birth control, not so much IUDs, but I’m sure, oh, you didn’t say you’re on, the other women were on IUD. It doesn’t say here if you’re on IUDs. So birth control pills will suppress testosterone. I mean, it’ll suppress all your hormones, but very well known to suppress testosterone. And so I’m not sure why you think you’re estrogen dominant, because you’re very clearly showing on all your blood work, all of your symptoms, your FSH, your LH are high. These are all you have low estrogen. So get over the fact that you think that you’re estrogen dominant. Every freaking woman thinks she’s estrogen dominant. Very few women actually are. like actually have too much estrogen. Most of us have too much xenoestrogens and too little progesterone, which can make you have symptoms of estrogen dominance. So I would talk to your doctor about, of course, starting estrogen and you will find that that severe joint pain and the muscle pain and the hair will start to reverse. In most cases, it does. Also, check your thyroid because with the loss of these hormones, your thyroid can become affected, which could also be causing severe joint pain, muscle pain, insomnia, and hair falling out.

Amisari says, hi Karen, I’m on 1.0 estrogen patch and 200 milligram progesterone, no testosterone. For the most part, my symptoms have improved, but I still struggle with my weight. But I feel my biggest issue right now is stomach problems, bloated, pain, gas, mainly after I eat, what could be happening? So I’m guessing that this is kind of, is this maybe a new thing?

Like you’ve started the estrogen progesterone and now suddenly you’re getting stomach problems. I’m not sure if that’s what you’re saying or have you always had stomach problems and bloating and pain? When it comes to gut things, you really want to make sure that you’re addressing your gut issues because your gut will help you to metabolize that estrogen. I have several different protocols for gut and how to improve on the gut health and get rid of the bloating and pain. But I will tell you, everybody is different because we can’t say, is it candida? Is it just something that you’re eating? a food that you could be reacting to. That’s kind of where I go first typically with my clients is, what’s your daily diet? Is there something in there that’s a strong food sensitivity like gluten, dairy, eggs, nuts and seeds? These are all very high as soy. These are all really high food sensitivities for people. So eliminating those first and foremost can be a good first line of treatment. And then if that doesn’t get rid of it, then you can start looking at what possible infection there could be. Could there be parasites, SIBO or candida going on in there?

Lena, hi there, I’m a 50-year-old woman in perimenopause. I still get my monthly cycle. I had a Dutch test that showed all hormones were low. My doctor started me on oral progesterone, testosterone, perianal. and has ordered estrogen through and gonna do the menopause method, which is biased. I’m slowly building up my dosage as I have had issues with breast tenderness in the past taking oral progesterone. I’m up to 75 milligrams, I’m feeling well, I’m sleeping better and feel more relaxed. I had a little breast discomfort the first few days, which has subsided. I’ve heard you say that women should cycle their hormones. Can you please share your thoughts on women in this phase? And if I should be cycling, my progesterone, and any other suggestions you would have. Many thanks, Lena.

So if you’re still getting a monthly cycle, absolutely, you should be cycling your progesterone and going with your cycle. So that would be from days 14 to 28, so the first day of your menstrual cycle, and then you would stop. Testosterone, so you’re taking it, is the perianal, I’m guessing, is your perineum? Rubbing it down there, maybe on your labia too, I’m guessing, which is great. That all works fine. And you’ve got some extra bias coming. So you’ll be using that if you’re gonna be doing the menopause method. And he cycles, the menopause method cycles progesterone. So you’ll be cycling that. I’m sure they’ll tell you to cycle that as well, which I, like I said, I would definitely be doing. And you want the testosterone back to that woman that was on the pellets. Hopefully she’s still listening. I forgot to say, do not do trochee. That was the other thing that was a red flag there. Trochee, when you take oral estradiol or estrogen in any form and testosterone, trochees or swallowing it, You will raise sex hormone binding globulin, and the estradiol will convert to estrone, and you just never, ever, ever want to take testosterone or estrogens orally. Only progesterone and only in a certain dose for progesterone. You don’t want to go too high on oral progesterone in the dose form either, because it can cause breast inflammation. See, so many nuances. Okay, let’s listen to what Sarah says.

48:17 Sarah Hi, Karen. This is Sarah from Iowa, and I have a question. Why does my tongue feel like sandpaper and bumps, creases along the side, especially right before I get my period? I assume there’s something to do with hormones. I am taking tapopooey, taking some progesterone to help with my high estrogen levels and working with a functional medicine doctor. So just wondering if that has something to do with it or if it’s just because my estrogen is still very high. So thank you. Love your show.

49:06 Karen I have never heard that before, so I actually did a little bit of research on it. And hormone fluctuations can cause issues with the tongue, like canker sores and things like that. It does sound to me, when you were talking about it, is that you are eating something that you are reacting to in your mouth, which is causing that rawness, the feeling of sore and raw. And when our hormones are near our period or on our period, they can influence how we react to foods. And so you’re likely more sensitive around your period time, and now you’re reacting to these foods that normally don’t bother you. So number one culprit is citrus. So if you eat tomatoes or oranges, pineapples, things like that, lemon, lime, That is what will cause that rawness on the tongue. Besides that, I really don’t know and I wish I could help you more with that.

Earl says. More about testosterone for postmenopause. Pellets, intermuscular injections, which is better and where, how can you get? I used pellets for years and my testosterone was high. I had slight facial hair growth and enlarged clitoris, but I also had a ton of energy and great sex drive. Now I quit the pellets and I’m tired, tired, tired, no sex drive and no motivation at all. Life sometimes sucks. I’m at a loss on what to do because of all the controversy I now hear over pellets. I use progesterone cream, but I do not use any estrogen at all. So frustrating that there is little info for us that are in postmenopause and how far into postmenopause can one be and start and use hormones? I’m 58 and roughly 10 to 12 years postmenopause.

Great question. So from what I was saying to the other lady, the pellets are definitely not my favorite. I know that they can work for some people. Some women do great on pellets, but I find more women don’t do great than do great, especially long term. I do prefer either cream or the intramuscular injections. As I said before, twice a week injections is preferred over once a week injections in my eyes. That’s just my own personal opinion. If you’re having the facial hair growth and enlarged clitoris, then you are converting down into the dihydrotestosterone pathway. When we give our body a large dose, like what’s in pellets, so they put the pellet inside of you and you do get a very high dose to start with, and then it starts to peter out. Same with once a week injections, you get a whammo of testosterone and then your body’s got all this testosterone that it needs to shuffle somewhere. It needs to metabolize it and quickly so it’s going to shove it down these pathways and you’re going to be shoving a whole lot more down the dihydrotestosterone pathway. What I would recommend is trying because you felt good on them but you had these you know, the masculine features coming out, I would switch to the intermuscular injections. I’ve talked to your doctor about it. I own how you can get it. You can get it through me. I, we do injectable testosterone in our clinic. And we also do cream. So if you want to do cream, you can do that too. And you can start by taking some saw palmetto or a DHT blocker natural supplement. You can find them on Amazon. They’ll have a combination of saw palmetto and lake Lycopene, what else is in there? Nettles, zinc. These are all things that will help your body not to convert down to dihydrotestosterone. And I’ve seen it work really, really well for these things. And because you’re on the injection, you may find that you don’t get quite as much of the masculine features. And putting in that safeguard of that herbal supplement, I think you’ll find that it will work well. You may not have quite as good of a sex drive as you did when you were on the pellets because That was caused by the very high dose of testosterone and pushing down the dihydrotestosterone pathway, you get a really high sex drive when that happens. It’s why men have much higher sex drives typically than women. Very unfair. Estrogen should be part of it. It can help buffer those androgenic side effects as well. It can be really important for energy, for sex drive, like I can’t tell you how many women it’s estrogen that makes their sex drive come back. So it would really help. And you really want to have that well-rounded hormone replacement therapy where you’re doing the progesterone, testosterone, estrogen, and getting them to where you feel like you’re optimized without those side effects and you’re feeling really, really good. Now, as far as, is it too late? Not at all. You just want to go very low and slow when it comes to how far into menopause you are. You just have to take things a little bit slower. So with the estradiol specifically, you would start at a lower dose and slowly work your way up over a couple of months till you get to optimal levels. But we, of course, over here at our online clinic, we can absolutely help with all of that to optimize you. So don’t hesitate to reach out. I’ll put the link in the show notes. It’s always in the show notes. And don’t settle for any of that pearl, please. We want you feeling great, full of motivation with your sex drive back, and all of that is possible without growing a beard or a clitinous, okay? There’s also medication too. Our doctors do use finasteride and dutasteride, which can help with blocking the conversion of testosterone to DHT. So if the herbal stuff doesn’t work, you could explore a medication that could help with that. Becky says, thank you, Karen, for all the information you share. I’ve been a long time fan of your work and your podcast. I have a question regarding progesterone. I’m taking utragestine vaginally 100 milligrams in the evening for 12 days per month. Body identical prescribed. I’ve heard other women love their progesterone and feel amazing and calm on it. I’m literally the complete opposite. Angry, tearful, exhausted, stressed, and brain foggy. Do you know the metabolic pathway for progesterone? Could there be a missing cofactor and nutrient deficiency that’s causing the problem? Is something not converting and I’m unable to metabolize or process it? Ideally. Thank you for your help. I’m considering the Mirena coil as next step as I’ve been feeling so rubbish on Utragestin. I’ve been on it a few years now. I can’t believe you’ve just gone a few years feeling like this on it. That’s so uncalled for. Okay, number one, where’s your estrogen? Do you maybe need that? Are you menopausal? I would say that all of you women that take these things in the vagina or anally, you’re doing these anal suppositories or vagina suppositories in these high doses of progesterone, which the when it it’s not just localized obviously this is why you’re feeling it systemically in your body it’s the same as putting it on the skin it’s and that’s a high dose we don’t produce 100 milligrams of progesterone when we’re in our fertile years when we ovulate so that’s a very high dose and so you are getting too much for your body and it’s causing these unwanted side effects You could cut that dose in half and see how that helps, because that would be a much more appropriate dose to be taking in intramucosal, so 50 milligrams. As far as nutrient deficiency, methylated bees, specifically B6, can really help with this. Also, you may just want to switch over to bioidentical progesterone cream, which I know you’re in the UK, so I don’t know if they have progesterone cream in the UK. I have a feeling they don’t. I don’t know if you guys have compounding pharmacies, but you could try and find progesterone cream or you can try and find it. Sometimes you can find a place in the United States, occasionally on Amazon, where there is a bio-identical progesterone cream that you can order online that is a good option that has good reviews. It seems to be a legitimate source. So you could check that out as well. But do those things please before switching to the Mirena coil. Progesterone, ladies, always keep that in mind that too much progesterone is not good. We don’t want these super high doses of testosterone, progesterone or estrogen. We want, let’s just write, we want Goldilocks. And I’m going to also say a lot of doctors don’t think that transdermal progesterone works because it doesn’t raise blood levels. But it does work. It’s been used for decades and decades, transdermal progesterone. It’s all I ever use. And I do not have any problems with my estrogen or my other hormones because of it. I will only use transdermal. Please keep that in mind. So you can always try topical because oral, a lot of women react to the oral. It makes them too tired, makes them, oh, here we go. We’ve got another person right here actually in the next question, but bloated, weight gain, water retention, all these things, depression, moodiness, weepiness can happen from oral progesterone. Once in a blue moon, I’ll see somebody that reacts to all forms of progesterone with those symptoms, but mostly it is the oral progesterone. Okay. Stacey says, 54 and a half, still regular period, all hormones checked, estrogen low, but just under normal. So moody, hasn’t slept in seven years, sex is eh, weight gain of five pounds in the last year and a half, which that’s, hey, five pounds isn’t bad. Tried oral progesterone, first 100 milligrams, then 50 milligrams. Both doses made me feel awful and flu-like headaches, nausea. Is there a better way to be taking progesterone that will not cause these side effects? I really want to be successful in feeling better. I did a two-part podcast about progesterone. It’s called The Progesterone Puzzle. I will link to it in the show notes. Please listen to it. Once again, you are reacting to the oral side of progesterone. Please switch to topical progesterone cream and you will likely not have those problems and stay on top of that estrogen. If it is just under normal, now’s the time you want to start replacing it with the care of a doctor, under the care of a doctor, because the less you have, the more problems you’re going to have. And then it’s harder to reverse those issues like weight gain that can happen from low estrogen. Stay on top of it. Last question. Joni, I’m 58 years old and been postmenopausal about nine years. I originally was told no HRT due to my mother having had breast cancer. I understand now that it is okay as long as done correctly. Is it too late to start now? My doctor says there are more risks when it’s been this long. The Menopause Society came out this year to retract how long women can be on HRT. It used to be that we had this 10-year window, and God forbid we went past it. And this is because of old, the WHI study, and women on oral premrin, estradiol, and progestin, when on it post-10 years, based on increased risk of a heart attack and stroke. So, now that we’re not using Premrin, well, I mean, there’s still some people that do, but in most cases, we’re not using Premrin anymore. Don’t take it orally. And then it is, the menopause society says it is now, they’re now saying that we can stay on our hormones for as long as we like, past the 10-year window. When it comes to starting hormones, when we have been out of cycling for a long time, so your postmenopausal, you said about nine years, you just need to go low and slow. So working with a practitioner that understands that is key and just like a very low dose and you slowly, slowly increase because basically In a very simple way to put it, our receptors, it’s like they go to sleep. When there’s no estrogen around, there’s no progesterone around, the receptors will start to downregulate because there’s not a lot of purpose for them because there’s no estrogen being used floating around that it can dock onto these receptors and come into the cell and do their job. They’re signaled. They signal through to the cells. Anyways. When we’ve been without hormones, these receptors, they’re going to go to sleep. So we have to slowly wake them up or else you go into a bit of an estrogen dominant phase until your body starts to take in that estrogen and utilize it and metabolize it. So just low and slow and slowly work your way up to it. And yeah, the research does show that women that replace their hormones do have a less risk of getting breast cancer, but you’d still want to be very careful because estradiol is a growth hormone and it can make it grow your cancer. So if you have cancer, it’s not a good thing. So always stay on top of it. But you can absolutely start HRT past the nine years. I’ve started many women on HRT that are well past that 10 year window. Okay, that is it. Thank you everybody for all of your questions. If you have questions for our next podcast Q&A, then be sure to either leave a voice note on my speak pipe and I’ll put that in the show notes, or you can send it in on the jot form. I do them every couple of months, usually every six to eight weeks, I’ll do a Q&A so I can answer your questions. If you would like You can always join our OnTrack program and have your questions answered on a weekly basis if you need help with your hormones. If not, please find somebody that can give you help with your hormones. All right, ladies, thank you so much for tuning in. I will see you next time, same place. And have a wonderful day wherever you are in the world.

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