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:

Download PYHP 111 Transcript

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 anybody with what we’re talking about. It is very specific. You definitely have to be having some hormonal challenges. This is certainly not a podcast for men by any means. But we know that this kind of information is really hard to find on the internet which is the whole genesis behind the podcast in the first place. So, this is Amanda. I want you to go ahead and read the question.

Dr. Davidson: Okay. So, this question is from “Amanda” because like we always say we change everybody’s names just to try to keep the personal stuff and all that jazz to a minimum. So, this is from “Amanda”. So, Amanda says, “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.”

Dr. Maki: A couple of things. So, she works two 24-hour shifts a week. I’m not sure what that is, but that sounds awful.

Dr. Davidson: Well, depends on what it is.

Dr. Maki: Yeah well, it certainly depends on what it is but two 24-hour shifts a week? I mean maybe two 24-hour shifts a month, but the week? That seems very taxing on her body in some respects, right? Maybe she’s a firefighter. Maybe I’m assuming in a 24-hour shift she can probably sleep, but I’ve known people- when I was in college, I used to work at a hospital and people were on call and stuff, and you’re sleeping, but you have one eye open waiting for the phone to ring. I think it was pagers back then because no one had cell phones yet because it was in the early to mid-90s. So, you’re sleeping, but you’re not really sleeping because you’re waiting to be called to something because- so I don’t know. So, you’re not sleeping all that well, plus you have the stress of a middle-of-the-night response that you have to go to just adds to the stress. I’m not sure what she’s doing for a 24-hour shift, but from my experience, I did a lot of overnight shifts. I was a little bit of a night owl back. I couldn’t sleep ever. Working the graveyard shifts in a hospital is brutal after a while.

Dr. Davidson: I couldn’t imagine a 24-hour shift, but you know me. I like my sleep. But if Amanda is, obviously, she’s on call if she’s doing a 24-hour shift, and my goodness. If she’s a firefighter, thank you for your service. We we need you, we need you. And we also need you to be healthy and happy and have energy.

Dr. Maki: And awake.

Dr. Davidson: And yes, and be awake and not have anxiety. So, we really wanted to answer this question. I’m sure a lot of you listening, may not have a 24-hour shift twice a week and being on call like Amanda, but at the same time, I really think that this question can relate to a lot of women because she’s in her early 40s and I would say I’m in my late 40s, hence the Perimenopausal Plan book is very close to my heart near and dear because I’m right in it. But Amanda very well could be in that perimenopausal phase at 41 because it can happen anywhere between the late 30s to the early 50s is that time before menopause, which is almost like a completely different aspect for menopause. Because like Amanda said, and her doctor is spot, on day 21 of her cycle is- Did you hear that little sneeze? That was Bob, our little copilot dog, that goes with us everywhere.

Dr. Maki: He’ll sleep all day, but the minute we sit down and do a podcast, of course, he has to start moving around and making a bunch of noise.

Dr. Davidson: Yeah, he wants some attention, but sorry. Just to get back to Amanda. She’s 41. Her doctor is spot on doing her blood work on day 21, which is that luteal phase of the cycle when that progesterone really should be starting to surge and it is only at .5. So, it definitely is low which is one of the first signs you see in perimenopause is that progesterone drops. The estrogen doesn’t necessarily drop which is why she’s having regular periods, but the progesterone does. And low progesterone symptoms do cause anxiety, do cause trouble- She doesn’t have any trouble sleeping but a lot of perimenopausal women have trouble staying asleep. They either wake up for hours or they wake up multiple times. So, there are other symptoms. I do think taking some progesterone might be a great deal. It might help her a lot, help Amanda a lot especially with that anxiety or if she’s feeling that negative, irritable mood or snarky and grumpy. I think it would truly help. But 200 milligrams might be a little bit much.

Dr. Maki: Especially right out of the gate. Like her first prescription, we usually start for a situation like this, based on her age, based on her lab work, based on her symptoms, we would probably start out at a hundred milligrams, maybe even depending on the woman. Maybe even 50 milligrams, and then work our way up from there. We usually don’t go any higher than 200 just like this case, 200 is about as high as you need to go, but to start a woman on 200 milligrams, this is the kind of response you would expect. You expect them to be a little bit tired.

Dr. Davidson: Wow, that’s a lot, or it’s going to make you tired which is why the doc doesn’t want her to take it on her days off.

Dr. Maki: Which I think is- When you and I are talking about this prepping, I said well, just don’t take it the days you work. I mean, that’s a reasonable explanation, but the 200-milligram component I think is a little bit- That could be easily reduced. Also to whether it’s instant release or sustained release, we always prefer to use sustained release. It doesn’t specify whether it is or isn’t. I’d like to think that it’s sustained release but we’re not really sure about that part.

Dr. Davidson: But you think about in a female cycle, the estrogen is, when you’re having your period, your estrogen and progesterone or low. The estrogen comes up the first part of your cycle. Usually, it spikes around day 12 to day 14, so you have ovulation, and we really don’t make much progesterone until post ovulation. Once you hit that day 14 and you have that ovulation, you’re going to make progesterone thereafter. So, we really only make progesterone for a half of our “monthly cycle”. Now, Amanda has a little bit longer cycles. She’s not the perfect 28-day cycle, but who is. She’s a little bit longer, day 35. So, she might be ovulating a little bit later like around day 18. But on day 21, she should have had some progesterone present. So, I would probably- Usually, what I start with menstruating females, in the beginning, is I’ll start with just having them take that progesterone. I do like the oral. I love the oral in perimenopause. Capsule is for just half of the cycle, just mimicking what would naturally when that progesterone should come up because I find that sometimes when you give a menstruating female progesterone right off the bat all month long, it tends to shorten their cycles because sometimes progesterone can cause a period. So, if you try to give Amanda progesterone all month long, she might find that her cycles get shortened to 21 to 25 days, and then, not everybody wants to have a period every 3 weeks. So, I usually start that last tap. And since she’s only 41, it’s so much easier to start low and work your way up. There is no problem with that. But when you start a little bit too high and then you start to have issues with being tired or puffy or bloated or hungry, it’s really hard to back out of that. So, I would even start her at 50 and then work up to 75, work up to a hundred, see how she’s doing.

Dr. Maki: Now, you mentioned with a menstruating female, for a menopausal female, obviously, they’re in menopause so they’re their bodies are not producing any estrogen or progesterone. The definition of perimenopause is that like you said, that lack of progesterone production usually happens after they stop ovulating which is ovulation is what instigates the release of progesterone. If the progesterone goes down, that usually means that there’s no more ovulation which is going to happen somewhere between the early-to-mid 40s in most cases. Some women maybe a little bit longer than that, but usually, that’s the time frame. The other option for a situation like this to like I said, starting it initially getting them used to the progesterone, or if you started them early and then you cycle it. So, you start them on, not early but on a lower dose, and then they can-What we’ll typically do is we’ll use a lower dose in the first half of the month, and then a higher dose the second half of the month because technically, a woman does not make any progesterone for the first 2 weeks of their cycle. That’s actually true physiology. So, giving a woman progesterone all month long in some ways is going against the grain, but women just typically seem to respond pretty well when they have progesterone the entire cycle.

Dr. Davidson: That is absolutely true. Like I said, start off with half of the cycle and then maybe work up. Like I was saying, I’m 47. Yeah, I’m perimenopause. I sure am.

Dr. Maki: Oh God.

Dr. Davidson: Stop. And just for transparency, I take progesterone all month long. I stop on my period because you don’t want to necessarily take progesterone or any hormones on your period because you want that entire uterine lining to slough off and sometimes progesterone can inhibit that if you’re taking that during your period. But I take it from day 5 to my next period.

Dr. Maki: Are you taking it today?