What's Happening?

I think it is fair to say that menopause is not just about hot flashes, night sweats, and the end of periods. But I think many of us are surprised about how deeply menopause can affect our bodies, mood, sleep, metabolism, and even our sense of self.

In this issue, you'll meet Kathy.

Kathy is my menopause avatar and a story that reflects a pattern I’ve seen again and again over 20 years of clinical practice.

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Kathy Is In Menopause

And NOT Happy About It

By Dr. Valorie Davidson

Kathy is in menopause and not happy about it.

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​‘It’s got to be menopause. I just don’t feel like myself.

I’m not stressed, and my life is pretty darn good.

I love my job as a teacher, and I’ve been doing it for over 20 years. I love the kids, my co-workers, and my summers off.

My two daughters are in college and doing great. I have been married for, gosh, going on 25 years to Brian, and he is great.

But I am not great.

It’s not like I want to be 25 again. I’m not trying to chase some illusion of youth.

I just want to feel like myself again.

I am at least 20 pounds overweight. Now, I don’t want to be a skinny-mini, it's not like that.

But my doctor told me I need to lose weight and get more active. My cholesterol is too high, and I am pre-diabetic. My doc says if I don’t lose weight and improve my cholesterol and blood sugar, he is going to put me on medication. I don’t want to take medication.

I don’t eat bad. In fact, I skip meals bc I might have to work through lunch or be in a rush in the morning and just grab a granola bar. And don’t tell me, running around, standing, and working with 8-year-olds is not exercise. I always get in at least 5000 steps a day, if not more.

I know it's menopause. When I stopped my periods 2, maybe 3 years ago (I can’t remember, where is my brain!), that is when it seemed that things took a turn for the worse.

I sleep terribly. I wake up with night sweats every night. Or I just wake up and cannot go back to sleep. I refuse to take sleeping meds of any kind. I don’t want to get dependent on them. And my aunt took sleeping pills for years, and now she has dementia.

Not sleeping makes me so tired during the day. So maybe I might turn to some sugar and coffee for a little pick-me-up.

My mom said she never went through menopause, and I have no one to really talk about it with. My co-workers have so many mixed reviews… take magnesium, take sleeping pills, take anxiety or depression meds (I am not depressed or anxious), take HRT, don’t take HRT, it will give you cancer. I just don’t know.

Not to mention, my sex drive has flown the coop. Which is fine, bc it is really dry down there. Like sandpaper dry. I wanted to tell my doc, but it’s kinda embarrassing. I did mention that my privates felt very uncomfortable, and he said, I can examine you and test for infection.

I was like, I’ll wait and talk to my gynecologist, who I won’t see till next year.

Honestly, everything is dry, my skin, my hair, and down there.’

My hair! It's gotten so thin, and I worry about washing it bc so much comes out. I don’t care about the gray. I’ve earned those. And I like the silver color that is mixed with the blond that is still there. I just don’t want to lose anymore.

I know menopause is a normal stage of life that everyone goes through. But I just didn’t expect it to be this hard.

I don’t want heart disease or diabetes. I would love to exercise if I had more energy or motivation.

I want my brain back, bc I keep losing words, forgetting names. I am worried that I could be like my aunt. My doc says my brain is perfectly fine, and I need to lose weight and get my sugars down. But I sure don’t feel fine.

I know I shouldn’t complain. Others have it much worse, and my life is super. I am very grateful. But I just want to feel better, sleep better, have energy, and also protect and improve my health. I just don’t know what to do.’

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Kathy is not alone. Many women feel like they are suffering through menopause. And a lot of our moms never really talked about menopause, leaving us unprepared. Up until recent years, menopause was hush-hush and blown off.

So let’s talk about what Kathy and other Kathys out there can do.

Lab Testing:

A lot of docs say there are no tests for menopause. The ovaries have already stopped producing estrogen and progesterone, so what is the point of testing?

First, it is important to test the hormones in menopause to get a baseline. Maybe that baseline is a hormone level of zero. But it gives us a baseline to compare when/if using HRT or objective data to pair with subjective information (your symptoms).

In some ways, when the ovaries are closed, it makes goals and treatment easier. In perimenopause or as an in-betweener, they can be like a moving target because the ovaries are working some of the time. x

Lab List:

• FSH (Follicle Stimulating Hormone)
• LH (Luteinizing Hormone)
  • The FSH and LH are signals from the brain that tell us what the overall ovarian function is.
  • In menopause, the ovaries are retired, so the FSH and LH will both be elevated.
• Estradiol:
  • Estradiol is the best test for estrogen. We have three circulating estrogens: Estrone, Estradiol, and Estriol.
  • Doing a Total-Estrogens blood level does not have the accuracy that doing an Estradiol-only does.

• Progesterone:
  • In menopause (without HRT), the progesterone levels will be nonexistent.
• Testosterone:
  • Testosterone levels drop about 15-20% in menopause. That is why it is a good idea to test testosterone in menopause.
  • While testosterone is a great hormone, it can become a runaway train when the other hormones drop. Progesterone and estradiol can help buffer some of the side effects of testosterone. In menopause, the unopposed testosterone levels can cause androgenic hair loss (temples, forehead, and top of the head).
• DHEA-Sulfate:
  • DHEA is made from the adrenal glands. DHEA will circulate through the body and will convert to testosterone. DHEA conversion to testosterone is the main process that women make testosterone (as ovaries only produce about 15-20%).
  • The best way to test for DHEA (dehydroepiandrosterone) is to do the DHEA-sulfate. It is much more accurate and specific than a total DHEA level.
• Pregnenolone:
  • Pregnenolone is often very low during menopause.
  • Symptoms of low pregnenolone:
    • Short-term memory loss
    • Forgetfulness
    • Lack of motivation
    • Low mental energy.

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Knowing which labs to check is one thing. Understanding what the numbers and values actually mean is another challenge for menopause.

​Reference ranges and interpretation of lab values in menopause are covered in the paid newsletter.​

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So What Can Kathy Do? What Can You Do?

What can you and all the Kathys in the world do about menopause to get relief?

For menopause, as with peri and being an in-betweener, it is going to be a multifactorial approach. But let me show you what supplements and HRT can be helpful for menopause.

Supplements: Supplements can be very helpful in menopause, especially addressing:

• Hot flashes/night sweats (VMS)
• Sleep
• Mood/irritability/stress
• Metabolic steadiness/metabolism
• Bone /Skin/Hair
• GU/UTI-prone
• GSM

​Supplement selection and dosing guidance are covered in the paid newsletter.​
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HRT: Hormone Replacement Therapy

Hormone Replacement Therapy (HRT) can be transformative for women navigating the challenges of menopause. However, not all HRT approaches are created equal.

The two primary styles, Static and Rhythmic Dosing, both offer unique benefits and potential drawbacks. Understanding these options is key to making informed decisions about your health.

• Static Dosing: A consistent daily dose of hormones that can be effective for reducing common menopausal symptoms, such as hot flashes and night sweats.
• Rhythmic Dosing: A dynamic approach that mimics the body’s natural ovarian fluctuations. Rhythmic dosing can help with symptoms, but can be very effective for heart, brain, and bone health.

Static Dosing: Consistent and Predictable

What is Static Dosing?

Static Dosing involves taking a fixed dose of estrogen and progesterone daily. The dose is the same every day without change.

Static dosing can come in many forms:

• Cream, patches, troches, oral

Static dosing:

• Estrogen:
  • Biest (combo of estriol and estradiol)
  • Estradiol only
• Progesterone
  • Usually oral if you have a uterus. Oral is more protective of the uterine lining than cream.

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Note about Oral Estrogen:

Taking estrogen orally can be a burden on the liver, and the absorption can be inconsistent. Also, oral estrogen tends to become more bound with SHBG, making it less effective.

Biest (transdermal) Cream/Gel:

A common form of estrogen in static Dosing is Biest. Biest is a combination of estriol (E3) and estradiol (E2). It is usually prescribed as a cream.

When I say prescribed, here in the US, Biest is a prescription. In some countries, HRT may be available without a prescription, which can provide women with easier access. Biest is a transdermal application (as a cream or gel) because it can bypass digestion.

Estradiol (transdermal) Cream/Gel:

Estradiol transdermally is also available as a static dosing. As with the biest, it is applied twice daily to the skin.

Estradiol Patch:

The estradiol patch is starting to become quite popular with women wanting to address their menopausal symptoms. While it is good to have available, it is not my first choice for HRT. Only a few (up to 5) dosing options are available for the estradiol patch, which makes varying the dose based on the individual difficult.

I often find that women will have between 6 and 12 lbs of weight gain when starting the estradiol patch. This weight gain can be partly due to water and puffiness, as the body has an adjustment time to the patch. The patch is considered static dosing because it is supposed to release a consistent level of estradiol to the body, and the patch is changed every several days to twice a week.

Progesterone:

In static dosing for menopausal HRT, progesterone is taken as an oral capsule, tablet, or cream.

Progesterone is absorbed easily in the digestive system and will not burden the liver like estrogen can.

Progesterone is often recommended orally for individuals on biest or estrogen therapy who still have a uterus. That is because progesterone orally will help to keep the uterine lining thin. A thickened endometrial lining over time can be a risk factor for uterine cancer.

Oral progesterone can help modulate GABA better than the cream. This makes the progesterone capsule helpful for mood and sleep.

Rhythmic Dosing:

Mimicking Nature

What is Rhythmic Dosing?

Rhythmic dosing involves delivering hormones that mimic the body’s natural menstrual cycle. This approach aligns closely with how the ovaries produce hormones. Rhythmic Dosing recreates the menstrual cycle by using estradiol and progesterone.

You are being your 'own ovary.' I know it sounds a bit cheesy. But you are providing your body with bio-identical hormones in a way that matches the way the ovaries secrete estrogen and progesterone. But to truly understand Rhythmic HRT, let me explain the female cycle in more depth.

While static and the patch can be easier than the rhythmic dosing, it does not compare to the benefits that rhythmic dosing can provide.

Being that you are recreating true physiologic levels of estradiol can have a huge impact on heart, brain, and bone health.

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Rhythmic HRT, How Do You Do It?

Rhythmic HRT involved using varying doses of estradiol and progesterone in the same fashion as the 28-day menstrual cycle.

And yes, if you have a uterus, you will be getting a period. In fact, if you have a uterus, you are supposed to get a period when you are doing rhythmic HRT.

Benefits of Rhythmic Dosing:

• Nature Doesn’t Make Mistakes: This type of HRT closely follows the ‘As Nature Intended’ hormone replacement approach. You cannot get much closer to mimicking the hormone levels produced by the ovaries than the Rhythmic Dosing.
• Customization: highly tailored to the individual for their specific hormone cycle.
• Bone, Heart, and Brain Health: Can provide additional benefits for bone density, cardiovascular health, and cognitive function.
• If you are menopausal, you cannot get pregnant on rhythmic dosing of HRT
• Improved Outcomes for Persistent Symptoms: Because of the cycling and increased estrogen levels, I have found it to be especially helpful for some symptoms that static can fall short:
• Libido: can improve the physical response to sexual stimuli and help put sex back on the brain for initiation.
• Brain clarity: can help with mental energy, recall, cognition, and motivation
• Weight management
• Skin thickness and elasticity, and hair thickness/growth
• Genitourinary syndrome of menopause (GSM): vaginal dryness, urinary incontinence, and maintaining the vaginal microbiome

Menopause is not a flaw. It’s not “you being all dramatic,” and it’s not just “aging.” It’s a real physiological shift where your ovaries have truly retired. And when those hormones drop, your brain, sleep, metabolism, hair/skin, joints, energy, mood, and vaginal/urinary tissues all feel it.

Kathy doesn’t need more willpower. She doesn’t need to be told to “eat less and move more” while she’s exhausted, not sleeping, and trying to survive on a granola bar and caffeine. She needs a plan that matches what her body is actually doing now.

The good news is this: menopause is one of the most straightforward phases to support because hormone levels are no longer a moving target. With the right combination of education, lab baselines, lifestyle support, targeted supplements, and (when appropriate) HRT, you can absolutely improve sleep, energy, mood, hot flashes, body composition, and protect your long-term brain, bone, and heart health.

This is not your ‘new-normal.’ You’re not behind. And you certainly do not have to “just suffer through it.” You deserve relief, clarity, and a plan that is tailored to you, not a one-size-fits-all protocol.

Thank you for reading, DrValorie

Simon Says:

Simon Says: Read a good book. Reading stabilizes dopamine rather than triggering rapid reward signals. Reading lowers stress in the brain and supports the vagus nerve. This helps put your body into a parasympathetic nervous system state (rest and recovery) rather than a heightened fight or flight reaction.

Welcome to Winter!

Yes, winter technically began on December 21st, but for many of us, it doesn’t feel like winter until January arrives and the holiday energy fades. That’s often when the winter blues show up.

And it looks like Punxsutawney Phil, the Groundhog Day forecaster in Pennsylvania, saw his shadow and, according to tradition, that means ‘six more weeks of winter.’ Boo! ​
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I live in Washington State, where gray winters are expected, but I’ve seen seasonal mood dips everywhere. Even when I practiced in sunny Nevada, patients still felt the winter drag. While seasonal affective disorder (SAD) is often discussed north of 37 degrees latitude, winter blues can occur well below that line.

We’re focusing on winter blues, not true SAD. They share biology, but true SAD can be severe and should be addressed medically.

What’s really happening comes down to light, hormones, and timing.
Daylight enters through the retina and signals the hypothalamus, the part of the brain that regulates our internal clock, hormones, and mood. In winter, shorter days mean weaker light signals, which disrupt circadian rhythm, shift melatonin earlier into the evening and later into the morning, and lower serotonin and dopamine.

Since moving to Washington State from sunny Nevada in 2017 (almost nine whole years!), This is the first winter, and I’m kinda feeling a little dip, the wintertime blues.

Has dark days of Washington state finally caught up with me?

I think it’s my menopause.

During menopause, this seasonal dip is amplified. Estrogen helps support serotonin and dopamine signaling, and progesterone supports the brain’s calming systems. When these hormones decline or fluctuate, the brain becomes more sensitive to seasonal light changes. The result can look like early evening fatigue, restless nights, difficulty waking, irritability, low motivation, brain fog, and that deep desire to stay under the covers when it’s dark and cold.

If you’re feeling the way I am, here are some winter blues pick-me-ups: (educational purposes only, not medical advice)

• Vitamin D3: less sun means less vitamin D. There are a lot of vitamin D receptors in the brain and immune system.
  • Taking supplemental vitamin D3 can help your mood and perk up your immune system (bc it’s still cold and flu season).
• Omega-3 fatty acids (EPA/DHA):
  • Helps support brain/neuronal function to help support mood
  • Reduces inflammation
• Magnesium L-threonate:
  • Help with sleep, reduce cortisol levels, and can help with stress and motor mind
• Rhodiola rosea:
  • Can help modulate dopamine levels
  • Helps with stress and energy
  • Helps support mood (especially irritability)
• B-vitamins (methylated)
  • Supports neurotransmitters, which can be helpful for mood
  • Can help with mental energy and brain fog
• Low Dose Melatonin
  • Low dose can at bedtime can help lower cortisol levels and support the circadian rhythm
• 5-HTP:
  • Can increase serotonin levels to help with mood and anxiety
  • Can have contraindications with certain meds like SSRIs, and also the herb St John’s Wort
  • Can convert to melatonin to help with sleep
• Mucuna pruriens:
  • A source of low-dose L-DOPA to convert and help increase dopamine levels
  • Can help with motivation, focus, drive, and energy
• Light therapy:
  • 10,000 lux full-spectrum light
  • Bright light (10,000 lux gives the brain a strong morning light signal and can help reset the circadian clock for better mood, energy, and sleep
• Exercise:
  • Increases serotonin and dopamine
  • Can improve circadian rhythm
  • Can improve sleep

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Or we can be like birds and migrate to the equator for the sun and fruity drinks. Meetcha there!

-DrValorie

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