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Welcome to The Modern Midlife Collective—where midlife isn’t a crisis, it’s a rebirth. Hosted by Dr. Ade Akindipe, DNP, and Dr. Jillian Woodruff, MD, this is the podcast for women ready to unapologetically own their power, thrive through the ups and downs of hormones, weight, and self-care, and show the world that thriving at 40 and beyond isn’t just possible—it’s your birthright.
Biweekly, we bring you science-backed insights on hormones, menopause, longevity, and sexual health—real tools to empower women in midlife and beyond. With a fearless blend of functional medicine, real-life wisdom, and no-nonsense empowerment, we’re here to challenge the norms, break through the barriers, and help you step into a life of vitality, confidence, and unstoppable strength.
Ready to rise? Let’s do this.
Jillian Woodruff, MD (00:04)
Okay, real talk. How many of you have Googled am I MP menopause at three in the morning because you can't sleep, your brain just won't turn off? So you're asking this question.
Dr. Ade Akindipe, DNP (00:14)
Yeah.
Dr. Ade Akindipe, DNP (00:17)
Yep, that should be everywhere on cars on a bumper sticker or something like that. And my imparing monopause, because I know that I definitely was looking to figure out what was happening with me. And I'm sure lots of women are facing the same thing in their late 30s and 40s. They know something is off. They just can't get anyone to listen.
Jillian Woodruff, MD (00:37)
And that's why we're here. That's what we are talking about today. Perimenopause, that transition period that can happen up to a decade, really, before you have your last period. And specifically, probably the question that I get asked more than almost anything else in my office is when do I start progesterone? Because they've been hearing about progesterone. So it's when do I start? Do I even need progesterone? Are there benefits?
Jillian Woodruff, MD (01:04)
For progesterone. I don't have a uterus, so I don't need progesterone, is also something that like a comment that I hear.
Dr. Ade Akindipe, DNP (01:07)
Mm-hmm. Yeah, and we are going to go deep into this conversation today. You know, the science, the evidence, the real deal, the symptoms, the myths, and the actual clinical decision making that needs to happen. And as always, we want to make sure that you leave with something that you can actually do with this information.
Jillian Woodruff, MD (01:29)
Yeah, that's right. So let's set the stage because perimenopause is probably one of the most misunderstood phases of a woman's life. I think women are talking about this a lot more now. So perimenopause is becoming one of those words we are hearing more, which is wonderful because it wasn't like that even five years ago. and even menopause, a better understanding of menopause, because people think it's like this one moment and then it's done, right?
Dr. Ade Akindipe, DNP (01:57)
Mm-hmm.
Jillian Woodruff, MD (01:57)
Like there's a light switch and you're in it. So the reality is it's a transition, a hormonal transition that happens over time. And like I said, it can be eight, 10 years before you actually have that last period. And all of that is called perimenopause. And during that time, there are multiple hormonal shifts that occur and they're different for everyone. And then that day you have your last period is not marked with any word at all.
Jillian Woodruff, MD (02:23)
But one year later then that is menopause and everything after that point is postmenopause, which also has a different set of symptoms. And for some women, perimenopause can happen in their forties, and for others, it can happen in their thirties.
Dr. Ade Akindipe, DNP (02:38)
Absolutely. And that's kind of what that perimenopause name means, right? Perry just means around. So it's kind of like around menopause. But more than that, it's not just, you know, this process or slow gradual decline. It really is, I don't know what other word to use for. It's more like chaos, but hormonally hormonally speaking, there's a lot going on at the brain. The brain is still trying to do its thing, it's still trying to communicate with.
Jillian Woodruff, MD (03:01)
Chaos. Yes.
Dr. Ade Akindipe, DNP (03:08)
Ovaries, it's still sending signals. and then you have you do have some decline in the follicles and then you know, declining in the number, right? And the quality. So, but month to month, when you are ovulating, some of them, you know, sometimes you're you feel normal and some days you don't feel as normal. So one minute you feel anxious and one minute you are very calm.
Dr. Ade Akindipe, DNP (03:30)
So that chaotic time around menopause is what we're really talking about. So it's not a you problem. It is basically biology just doing its thing. So
Jillian Woodruff, MD (03:40)
That's right. So let's see, if your cycles are getting irregular and we're thinking about cycles the first day of your period to the first day of the next period, if that was always coming every, let's say, 30 days and now it's coming at 27 days, 32 days, 26 days, or you're skipping months and not even having a period within a month, or maybe you have had PMS in the past, but your PMS symptoms are
Jillian Woodruff, MD (04:09)
Suddenly more intense. Those are all signals. And perimenopause is diagnosed clinically. We we do some labs to give us, you know, some clues, but really the diagnosis is clinical based on your symptoms, based on your menstrual history. There's no single lab value that will say, yeah, that's that's perimenopause. Sometimes what we do is we may check some lab values and then in one cycle and then
Jillian Woodruff, MD (04:35)
Check them at a different time of the cycle or in a different cycle at a different time of the cycle. So can, you know, compare them. But like you said, it's chaos. So sometimes the lab values we get are chaotic as well. Could be good, could not be good, could be okay. It's really difficult. So your FSH, that signal from your brain that tells your ovaries to release estradiol, can fluctuate quite a bit in perimenopause.
Dr. Ade Akindipe, DNP (04:45)
Mm-hmm.
Dr. Ade Akindipe, DNP (05:05)
Yeah, absolutely. And I think it's huge that you're spelling that out like that, Dr. Jill, because oftentimes women will say they went to their doctor and their doctor has told them that their labs are fine. But like you said, your that one number, like let they're checking that FSH or your estrogen level for, you know, that point of time, it's a snapshot. But, you know, the way your symptoms are today, we like we talked about.
Dr. Ade Akindipe, DNP (05:34)
For is different from a a different day. So women are walking out of the appointments kind of, you know, disappointed, but it's a it's a clinical thing. It's a clinical clinical diagnosis, if you will. So you could draw blood on your day if your ovaries happen to be function functioning well and in a different way. in a different day they're not. So your symptoms are real. I I really feel like we need to make sure that we are
Dr. Ade Akindipe, DNP (05:59)
Letting women understand that their symptoms and all those things that they're Googling at three AM, that these are actually happening and there is a reason for that. And we know we're gonna talk a little bit more about how progesterone might be the answer to some of those questions.
Jillian Woodruff, MD (06:13)
Right, right. Physiology physiologically, here's what's happening is the ovulation, your your ovulation just becomes really erratic. So sometimes you're ovulating, sometimes you're not. When you ovulate, you're releasing an egg. And when you're ovulating each month, that happens each month. You're releasing an egg that could later be fertilized by a sperm. So when you ovulate and release that egg, it triggers something forming called the corpus luteum, which forms in your ovary.
Dr. Ade Akindipe, DNP (06:22)
Mm-hmm.
Jillian Woodruff, MD (06:43)
Sometimes people call it the cyst of ovulation. This corpusluteum produces progesterone in a high amount. So this is one way, one thing we do is check if somebody's trying to get pregnant, let's say they want to see if they're ovulating. We check their progesterone level after ovulation because we know you ovulate, then you form this corpus luteum, which releases progesterone. So the level will start going up.
Dr. Ade Akindipe, DNP (06:51)
Mm-hmm.
Jillian Woodruff, MD (07:08)
So about a week after ovulation, we check that progesterone level, which is quite high. If it's not high, then you may not have ovulated because you didn't form a corpus luteum. So there is no surge of progesterone level. In perimenopause, if you ovulate sometimes and not other times, and sometimes you may produce progesterone and other times you may not. So you could have plenty of estrogen during this time. And in fact,
Jillian Woodruff, MD (07:38)
Estrogen can be quite elevated in perimenopause. You can have a lot more estrogen. We've talked about that fluctuation highs and lows. So you can have a lot more than you had in your earlier reproductive days, but your progesterone is already declining. So then that estrogen progesterone imbalance is quite pronounced and becomes the root of many of your perimenopausal symptoms.
Dr. Ade Akindipe, DNP (07:53)
Mm-hmm.
Dr. Ade Akindipe, DNP (08:03)
Hmm. I'm so glad that you mentioned that piece because that's kind of what I see when on the metabolic side too, because you have that yo-yoing of your hormones, but then that also kind of messes with your your insulin too. It's so heavily tied to insulin. It's, you know, tied to cortisol, how well your liver is clearing your hormones once the body's done using them. So when a woman comes in with heavy periods or
Dr. Ade Akindipe, DNP (08:32)
mood swings, breast tenderness. it's not just necessarily, yeah, the estrogen is is is is going up and down, but I'm also looking at, you know, blood sugar regulation, cortisol patterns, and progesterone's ability to kind of keep things, you know, keep pace with everything that's happening. Right. And the symptoms that wrecks everything on top of that is sleep disruption, which of course progesterone decline is one of the reasons why that's happening too.
Jillian Woodruff, MD (08:59)
Yeah, sleep is so important to this conversation. And I guess we should probably just talk about some of the symptoms that women need to hear because they may only associate some symptoms with perimenopause and not think others are related. So beyond irregular cycles, which you do not have to have to have perimenopausal symptoms or be in perimenopause. So, you know, sometimes people may have significant.
Jillian Woodruff, MD (09:28)
Irregular menstrual cycles, and sometimes they don't. Those become a little more apparent in later period menopause. So other things are trouble falling asleep, trouble staying asleep, night sweats is probably a big one, anxiety, somewhat sudden anxiety, onset of new anxiety or worsening anxiety, heart palpitations, brain fog, mood changes.
Dr. Ade Akindipe, DNP (09:43)
Mm-hmm.
Jillian Woodruff, MD (09:56)
Vaginal dryness, that's another one. decreased libido, that starts to emerge or really become more significant, because we know that can start earlier for a variety of reasons and then become more significant during this time. joint pain, headaches. Headaches is is probably one of the more less very, it's actually something that is significant, causes significant distress.
Jillian Woodruff, MD (10:24)
But it's less likely to be attributed to perimenopause. They're always finding looking for these other reasons. And then sometimes people do have hot flashes during the day or they just feel warmer.
Dr. Ade Akindipe, DNP (10:28)
Yeah.
Jillian Woodruff, MD (10:37)
during the day. So there's a similar dry dry ice. That's another one that I think about that's happening. Mm-hmm.
Dr. Ade Akindipe, DNP (10:42)
Yeah, yeah. Yeah, absolutely. So how is this all sounding to you if you're listening right now? Are you sitting there mentally checking off the symptoms? You know, the sleep, the mood, which is another big one. Maybe you have joint pains you've just thought maybe it's because you're getting older and maybe, you know, arthritis, maybe some other symptoms that you're noticing. Cause if you are, then
Dr. Ade Akindipe, DNP (11:08)
You know, it's not a coincidence. you just haven't had anyone really teach you how to read those symptoms. So hopefully this is very enlightening for you as you're listening.
Jillian Woodruff, MD (11:17)
Yeah, I think I'm getting a lot of, you know, requests or people trying to find rheumatologists because of the joint pain portion. And they're having a difficult time because they're looking, looking, looking for what is the cause of this and always coming up with everything is normal. And I'm like, I know, it's perimenopause.
Dr. Ade Akindipe, DNP (11:23)
Mm-hmm. Yeah.
Dr. Ade Akindipe, DNP (11:33)
Right.
Dr. Ade Akindipe, DNP (11:39)
Very menopause
Jillian Woodruff, MD (11:42)
Yep, yep. so progesterone. We have to be clear about progesterone. So there is bioidentical progesterone. sometimes this is called micronized progesterone. one of the brand names of someone who makes progesterone is prometrium, it's a brand name for micronized progesterone. But typically I just write micronized progesterone and we know that that's your bioidentical form.
Dr. Ade Akindipe, DNP (11:48)
Mm-hmm.
Jillian Woodruff, MD (12:10)
this is chemically molecularly identical to what our bodies produce on their own, which is important. There are many synthetic progesterins, we call them progesterins. So a synthetic progesterone like madroxy progesterone acetate or MPA. This is what they studied in the original Women's Health Initiative study back in the early 2000s. It's a very powerful progesterone.
Jillian Woodruff, MD (12:38)
Progestin, excuse me. I mean I'll mess it up. Progestin, a very powerful progestin that we we don't typically use. and there are multiple other progestins like norothendrone, levonidrester, norothendrone acetate. and some of these we are in birth control. There are some that are in actually in combination with bioidentical.
Dr. Ade Akindipe, DNP (12:41)
Justin, yes.
Jillian Woodruff, MD (13:07)
estradiols and some we may use for someone who has heavy bleeding, reproductive age woman with heavy bleeding, they may use a progestin. They're very powerful and much more powerful than micronized progesterone, which is identical to what our bodies make.
Dr. Ade Akindipe, DNP (13:09)
Yeah.
Dr. Ade Akindipe, DNP (13:27)
Yeah, and that distinction really is important because I've had some women come in and say, you know, years ago, I just didn't tolerate progesterone. So maybe they're looking to see if this might be right for them and they'll say they didn't tolerate that progesterone. So a lot of times I'm thinking it's probably some of the ones that you've mentioned, or maybe the progestins. And I completely understand why because back then the WHI scared everyone. It really shocked the world. Like, hey, everybody get off your home once. But
Dr. Ade Akindipe, DNP (13:57)
Like you just said, madroxy progesterone acetate is not the same compound as bioidentical. progesterone, right? So it doesn't behave the same way. It has some activity that may cause some other symptoms. You know, it that calming metab, you know, the metabolite that it turns into that helps that calming sensation that women have, you may or may not get that. And of course, you might have all those other risks that come with the progestines, like the cardiovascular risks, the breasts.
Dr. Ade Akindipe, DNP (14:26)
breast cancer risk that may come with progestins. It's not the same thing that comes with the bioidentical hormone. So hopefully that clears up some of that, some of that nuance get that got lost with that that study.
Jillian Woodruff, MD (14:40)
Yeah, that's exactly right. and the in the follow-up data from the WHI, in combined with more recently researched literature, it's the research is very consistent that micronized progesterone doesn't carry the same clinical risk profiles as synthetic progestins. In fact, bioidentical progesterone or micronised progesterone has a much more favorable impact on cardiovascular markers.
Dr. Ade Akindipe, DNP (14:54)
Yeah.
Jillian Woodruff, MD (15:09)
On breast tissue and metabolic health. And many societies have updated our their guidance on this, such as the menopause society. It's updated its guidance accordingly. And most hormone specialists today are using micronized progesterone when a progesterone is needed or when a progestogen is needed. If we want to talk about the the group. And you know, I know there are uses for synthetic.
Dr. Ade Akindipe, DNP (15:38)
Yeah.
Jillian Woodruff, MD (15:40)
Progestines, absolutely. There's uses for them for other issues. So it depends, but progestines, their molecular structure is a bit different, you know, and that difference can cause it to act a little differently in our bodies as well.
Dr. Ade Akindipe, DNP (15:58)
Absolutely. So I guess we could talk about what progesterone actually does in the body. we tend to look at it as a second hormone to estrogen. You know, estrogen is like, yes, you need estrogen, but progesterone also really, really matters. it has its own receptors in the brain. it you know, modulates, you know, the directions of like GABA, which is one of the things that helps with
Dr. Ade Akindipe, DNP (16:24)
You're calming neurotransmitter in the in the brain, which is why it's really important for women to take it for sleep, right? So when progesterone drops, women will say that it's harder for them to fall asleep. It's harder to stay asleep. So they're more anxious. They're more reactive to things that they wouldn't normally react to. so when that tends to happen, you know, women tend to wonder why this is happening. And sometimes maybe a progesterone might be the right fit for you if you're experiencing something like that.
Dr. Ade Akindipe, DNP (16:54)
Right, Dr. Jill?
Jillian Woodruff, MD (16:55)
yeah, that's a big one. People feel so irritable during this time, like just so angry sometimes. And you know, some of the ways we explain how they're feeling are a little scary, right? And I think sometimes they're scared, you know, they're scared of a feeling that they have like, ugh. So
Dr. Ade Akindipe, DNP (16:59)
Mm-hmm.
Dr. Ade Akindipe, DNP (17:09)
Ha ha ha.
Dr. Ade Akindipe, DNP (17:14)
I mean, I I made a I I I went for a speaking engagement and I actually described one person that said, I I I I hate my un my husband and I don't know why. And they were like, What? And I'm like, you know, it it just looks different for different women and they're trying to explain themselves. Like, I don't understand. It's not him. I know it's I don't know. So
Jillian Woodruff, MD (17:34)
yeah, I get it. I get it. For sure. They can talk to us. We understand. And it's not their fault that they feel that way. But there's something you can do about it. You know, if you want to not hate them, we can help you with that. So from a clinical standpoint, then progesterone does several things. One, it protect protects the uterine lining. So
Dr. Ade Akindipe, DNP (17:41)
Ha.
Dr. Ade Akindipe, DNP (17:45)
Right.
Jillian Woodruff, MD (18:03)
Estrogen stimulates the endometrium or the uterine lining to grow. Progesterone counterbalances that and causes the lining to shed properly. This is also known as your period. So this is a period during reproductive stages, and but the same thing can happen without a period. Progesterone still counteracts the stimulation of the estrogen, even in menopause without a period. So without adequate protection or progesterone.
Jillian Woodruff, MD (18:32)
Protection of the uterine lining. This is called unopposed estrogen stimulation. And over time, that stimulation of the uterus with estrogen can lead to endometrial hyperplasia, which is like a proliferation, overgrowth of uterine lining, which could then have some atypical cells, also increases the risk of uterine cancer. So if a woman has a uterus and is on estrogen therapy.
Jillian Woodruff, MD (19:03)
In any form she must have progesterone as well. Full stop. Yes.
Dr. Ade Akindipe, DNP (19:07)
Period. That's right. No, no questions about that. so for women who are not on estrogen, like you're you're like thinking, well, I'm not in menopause, then you know, progesterone can still help, right? this is where I think a lot of women are probably not getting the answers that they need because they're in perimenopause. But it's, you know, like we talked about for sleep, for your mood, for anxiety.
Dr. Ade Akindipe, DNP (19:35)
a study actually published in menopause showed that women using oral micronized progesterone had better sleep compared to placebo. So this is definitely needed, even if you're not in menopause or maybe you're not on estrogen.
Jillian Woodruff, MD (19:54)
Yeah, that's very true. So it has that sedating effect, that calming effect. I I really like oral progesterone taken at night. Makes a lot of sense. You're using that natural sedating quality to your advantage. And I do talk a lot about that with patients, and I know you do as well, Dr. Aday. Timing and delivery method of these hormones are important. So it's not just whether you take them, but also how.
Dr. Ade Akindipe, DNP (20:00)
Mm-hmm.
Dr. Ade Akindipe, DNP (20:09)
Yes.
Dr. Ade Akindipe, DNP (20:24)
Yeah.
Jillian Woodruff, MD (20:24)
So the delivery method for progesterone matters. Oral, so taking micronized progesterone by mouth is well absorbed and produces those neurologically active metabolites. neurologically active, meaning those are the ones that affect the GAPA receptors, leading to the calmness, helping with the sleep. Okay. Taking it vaginally, because you can take that same.
Jillian Woodruff, MD (20:51)
Pill you put in your mouth, you can actually put it in your vagina. It's also well absorbed in topical roots, like a cream. Like if you have a cream made, there's no commercially available creams. some people have them compounded and you can put that on your arm or legs. They don't produce the same CNS effects or neuro neurologically active metabolites as the oral root, but they can be used for other things. So
Dr. Ade Akindipe, DNP (20:51)
Mm-hmm.
Jillian Woodruff, MD (21:20)
They can be used for uterine protection. And some, there's also some other methods. They just they don't make you as sleepy. But, you know, sometimes even the topical ones people have taken that make them more calm, just not, they may not have the sleep effects, but they can still have some of the calming effects in some. It's not as reliable as the oral progesterone.
Dr. Ade Akindipe, DNP (21:30)
Yeah.
Dr. Ade Akindipe, DNP (21:47)
Yeah, I absolutely agree with that. And you know, of course, the there are other methods which I guess we're gonna talk about later. I know sublingual. I'm not sure if you've tried sublingual for women who may be having PMS progesterone, which is a great way to take it without that it's not metabolized through the liver, so it bypasses that and women do really well with that. So yeah, absolutely. So yes.
Jillian Woodruff, MD (21:59)
Mm-hmm.
Jillian Woodruff, MD (22:12)
Yeah, I like that method too. Yes. Mm-hmm.
Dr. Ade Akindipe, DNP (22:15)
All right, so we get into when do we actually start? So this is one of the questions I bet you've been waiting for. When can I start progesterone? And the on honest answer is it depends on your symptoms picture, your goals. so scenario one, you're in menopause, you have a uterus, and you're starting estrogen therapy. Even low dose estrogen, even a patch, progesterone is not optional, like Dr. Jill said before. You need endometrial protection.
Dr. Ade Akindipe, DNP (22:45)
Period.
Jillian Woodruff, MD (22:47)
Yes, the rules do change if you've had a hysterectomy. And let me clarify, because this gets under my skin, hysterectomy. When people are saying total impartial, patients are saying something and meaning something completely different than what it means to me as a surgeon when you're doing a hysterectomy. Hysterectomy only applies to removing the uterus.
Dr. Ade Akindipe, DNP (22:54)
Yeah.
Jillian Woodruff, MD (23:12)
Which is the cervix is attached. So the removal of the uterus in the cervix is a hysterectomy. Has nothing to do with your ovaries, has nothing to do with menopause. If you remove your uterus, yes, you won't be having a period anymore, but it does not mean that you were in menopause. So even if you go a year without a period because you don't have a uterus, does not mean you're in menopause. You still have ovaries. A removal of the ovaries is a completely different surgical procedure, which is often done at the same time, but
Dr. Ade Akindipe, DNP (23:34)
still have Ories. Mm-hmm.
Dr. Ade Akindipe, DNP (23:38)
Yeah.
Jillian Woodruff, MD (23:41)
If you have a total hysterectomy, that simply remove means that you've removed the uterus and the ovaries. If you have a partial hysterectomy, which surgically we don't use that term to mean what people think it means, but if you had a partial, that means you've removed your uterus and left your cervix inside. So we call that a supra cervical hysterectomy, but others may refer to that as a partial hysterectomy.
Jillian Woodruff, MD (24:10)
So that's like a clue, that's like a little key, right? If you're telling them, yes, what?
Dr. Ade Akindipe, DNP (24:12)
Thank you for clearing that up. But I have a question for you. I have a question for you. For women who let's say the reason they took away their uterus is because they had endometriosis. Now, this has been, I've been kind of reading back and forth about this. And they they still, well, okay, maybe okay, they have their ovaries. They had their uterus taken out because of endometriosis. And someone had told them, well, you don't need
Dr. Ade Akindipe, DNP (24:40)
progesterone because you don't have a uterus. What are your thoughts on actually putting them on progesterone because they had a history of endometriosis?
Jillian Woodruff, MD (24:48)
Yeah, well, I think that progesterone is useful for many things. And so, no, they don't need it for uterine protection, but they may need it for other protections and other side effects that are useful to them. Hist endometriosis is a difficult one because sometimes people do have a hysterectomy with bilateral salpingo-o-ophorectomy, which is removal of the ovaries, or you can just say I had hysterectomy with my ovaries removed.
Dr. Ade Akindipe, DNP (25:07)
Yeah.
Jillian Woodruff, MD (25:18)
And because there are many different avenues of what leads to endometriosis. And so some of them have to do with the uterus and having menstrual cycle and and ha you know and having backflow of the blood into the abdomen, having your the lining shed into the abdomen instead of all outside. So
Dr. Ade Akindipe, DNP (25:25)
Let me show it says right.
Dr. Ade Akindipe, DNP (25:43)
Right.
Jillian Woodruff, MD (25:44)
The uterus, if that is one of the causes that led to endometriosis, then that removing the uterus may be enough. For some people, they have to stop that whole picture, all of the ovulation and everything. And so they may have to remove the uterus and remove the ovaries. If you leave your ovaries in place, some people that there's a lot of studies that show that that's adequate for a lot of people. But you know, as we know, not everybody's the same. But if you leave those ovaries in place.
Jillian Woodruff, MD (26:14)
Typically, people are still needing to do something to stop their ovulation. If they're in perimenopause and they're you're still cycling, you're just not having bleeding, you're still having those cycles. I think progesterone could be very useful in in this person, especially if they tend to have endometriosis on other areas of their pelvis, on their intestines, on their bladder, on their sidewalls. Yeah.
Dr. Ade Akindipe, DNP (26:28)
You're right.
Dr. Ade Akindipe, DNP (26:35)
Exactly. That's the concern. Yeah. Right. They might have tissue there. Mm-hmm. So progesterone.
Jillian Woodruff, MD (26:43)
So progesterone can counteract that estrogen. Very useful.
Dr. Ade Akindipe, DNP (26:46)
Okay. Thank you for clarifying that. That's exactly what I was getting at. I was like, I hope she understood what I was talking about, but
Jillian Woodruff, MD (26:51)
Yes. Well you know that I'm long-winded, Dr. Ade. I like go around and around and around. There's so much that like pops in and I'm like, we have to say this.
Dr. Ade Akindipe, DNP (26:56)
More concise. I'm like, but she got to what I was trying to figure out. Thank you.
Dr. Ade Akindipe, DNP (27:06)
That's right. It's gonna help somebody. All right. Scenario two, you're in perimenopause. You're not on estrogen yet, but you're waking up at 2 or 3 a.m. and you can't fall back asleep. So I'm sure you see this a lot, right? You fall asleep fine, maybe easily, and then you wake up a few hours later and you just cannot shut your eyes. So a provider might hear that and say, well.
Jillian Woodruff, MD (27:08)
Yes, yes.
Dr. Ade Akindipe, DNP (27:33)
It's anxiety disorder. And we do find a lot of women that end up on medications for anti-anxiety or sleep medications that can be tough to kind of get over if you so typically micronized progesterone would be amazing for something like that. a hundred to two hundred milligrams micronized progesterone. I think it's reasonable, it's evidence supported and
Dr. Ade Akindipe, DNP (28:01)
That can be it's FD approved, so you can find that in your pharmacy. and it's really easy to address. Of course, lifestyle, you know, things can definitely help with that. Shutting down your phone and you know, setting a really good routine can really help. But that's something you can do if you're in perimenopausing, you don't necessarily need estrogen.
Jillian Woodruff, MD (28:22)
You know, anti-anxiety medication. I am definitely not against anti-anxiety medication, but someone right, but someone with new onset anxiety and perimenopause, I just think we need to think twice, you know, evaluate everything because that medication, another big problem that people have in perimenopause is low libido. And the majority of anti-anxiety medications cause low libido. So it would further exacerbate that.
Dr. Ade Akindipe, DNP (28:28)
Me neither.
Dr. Ade Akindipe, DNP (28:35)
Mm-hmm. Yes.
Dr. Ade Akindipe, DNP (28:49)
Mm-hmm.
Dr. Ade Akindipe, DNP (28:52)
Yeah.
Jillian Woodruff, MD (28:52)
The other thing that people experience in perimenopause is the brain fog. And so if you're thinking about what were the other medications? the sleep medications, they also can have cognitive effects. So thinking about things, we need to be really augmenting all of the good things, you know, augmenting our nutrients that and the good things that we have, building them up to protect us later in life. And I think, you know, those the sleep medications are addressing the root cause of the sleep.
Dr. Ade Akindipe, DNP (29:05)
Yes.
Dr. Ade Akindipe, DNP (29:17)
Yeah.
Jillian Woodruff, MD (29:22)
problem. So I just think we have to be, you know, a little more specific and strategic. Yeah. Yeah. And then progesterone can be used cyclically or continuously. So you can, and I think many people recommend taking it for like the first two weeks. So in their their luteal phase of their menstrual cycle. So the time leading up to their period.
Dr. Ade Akindipe, DNP (29:22)
Sure.
Dr. Ade Akindipe, DNP (29:27)
Yeah, yeah, absolutely. Yeah.
Dr. Ade Akindipe, DNP (29:46)
Mm-hmm.
Jillian Woodruff, MD (29:50)
Or you can just take it continuously every single day. I tend to like to recommend continuous taking of mycronized progesterone. But in some who Yeah. But in somebody who like maybe only has those symptoms during the their luteal phase or maybe their symptoms are more exact exacerbated during this time, then this would be a good use for taking it cyclically.
Dr. Ade Akindipe, DNP (29:55)
Continuous. Yeah.
Dr. Ade Akindipe, DNP (30:11)
Absolutely. And this is where lifestyle meets hormone replacement, right? We kind of talked about that. you know, I I'm a big proponent of checking to see what your metabolism is doing. How are you processing sugar? Are you spiking your blood sugars in the middle of the night? two two or three a.m. No amount of progesterone is really going to override that stress signal, right? So are you stabilizing your blood sugar? Are we actually protecting our sleep hygiene?
Dr. Ade Akindipe, DNP (30:40)
sometimes if we're eating really late at night, or remember your your body really needs to work on trying to digest everything that you're eating. So your your brain is supposed to be working on, you know, regeneration and kind of getting ready for the next day. So you don't want to divert all of that into the gut. So that can also cause sleep disruption. But absolutely, you know, progesterone along with everything else can make a huge difference for for any woman.
Jillian Woodruff, MD (31:10)
That's right. Let's see. Scenario three. You're in perimenopause. You have heavy or really like a flood of period because of that estrogen dominant picture we talked about, where your estrogen level is like super high, progesterone is low. So let's say you're giving your progesterone cyclically in the second half of the cycle, the labial phase. So days
Jillian Woodruff, MD (31:36)
Like 14 people typically, if you have a 28-day cycle, ovulate on day 14. To you give that progesterone 14 to 28. This can really help regulate the uterine lining and significantly reducing that bleeding. I probably it's easier, you know, I probably like to take it just every day. But sometimes micronized progesterone may not be enough if somebody has really heavy bleedings. This may heavy bleeding, this may be the time where
Dr. Ade Akindipe, DNP (31:49)
Yeah.
Jillian Woodruff, MD (32:06)
We recommend a synthetic progestin that is more powerful in the short term basis for the bleeding part. And this is also a time where I think the the what you do for treatment digresses. Like, are we treating the heavy bleeding? Are we treating the other symptoms? Sometimes you can have one treatment for both, and sometimes you have to address one and then come back and address the other.
Dr. Ade Akindipe, DNP (32:32)
Yeah, I I can imagine you see a lot of that when you have they're having perimenopausal symptoms, which can be addressed with biobedical hormones, but then you have that other piece too, right? You know, women who have heavy bleeding, all of those things can really impact their quality of life. So absolutely places where you can have an IUD or some other methods can definitely help that. So, and you know, the conversation that women need to be having with their providers needs to be
Jillian Woodruff, MD (32:55)
Yes.
Dr. Ade Akindipe, DNP (33:03)
Specific about your symptoms, not just I don't feel like myself. Because if you're telling your provider, tell your provider, I'm I'm waking up between two and four, I can't fall back asleep. I have new onset anxiety. That is one piece of the puzzle. You know, my periods are getting irregular. If we can trend all of these things that are all happening at the same time, and then being able to have that conversation and say, I believe these may be signs of.
Dr. Ade Akindipe, DNP (33:33)
Perimenopause transition. I'd like to discuss where whether progesterone is a good idea for me. And ideally, if the provider doesn't really know or understand, it's not their fault, but you there should be that conversation. Hey, I'm this is not my my place. Hey, I'm gonna refer you to someone that can help, someone who has training in hormone care, menopause certified.
Dr. Ade Akindipe, DNP (33:57)
Cyclic versus continuous, you know, there's a lot of nuances to to to hormone health. It's not just one size, you know. Everyone's a snowflake, is what I say. It's never one size for everybody. So yeah. The snowflake is just different. It's just, you know.
Jillian Woodruff, MD (34:08)
Hello.
Jillian Woodruff, MD (34:10)
I like that.
Jillian Woodruff, MD (34:13)
Snowflake. I would like to be a snowflake. We're all unique. Yes. Okay, let's do a quick myth bust round. So I know our listeners have heard some things maybe we haven't addressed or they just need to hear it again. So give us a myth.
Dr. Ade Akindipe, DNP (34:29)
Mm-hmm. All right. Myth number one You shouldn't start hormones until you're fully menopause. True or false?
Jillian Woodruff, MD (34:39)
I'm sure they know it is false. They've been listening to us. We've been talking about hormones and in perimenopause, and they know that the menopause society guidance supports initiating therapy during the perimenopause transition for women who are symptomatic. So they know you can start hormones even if you aren't in menopause. And there's benefits when you think about that timing hypothesis and your benefits to longevity.
Dr. Ade Akindipe, DNP (35:03)
Absolutely.
Jillian Woodruff, MD (35:08)
Benefits to cardiovascular health and brain health. The earlier you start.
Dr. Ade Akindipe, DNP (35:13)
There you go. All right. myth number two, bioidentical hormones are completely unregulated. that was supposed to be you. Well, myth number two, bioidentical hormones are completely unregulated and not FD approved. What's the nuance here, Dr. Jill?
Jillian Woodruff, MD (35:35)
You go ahead, you take it. You got it.
Dr. Ade Akindipe, DNP (35:37)
Okay. Well, so micronized progesterone is absolutely I love it. it's absolutely FD approved. When we're talking about FD approved biodentical progesterone, we're, you know, on solid regulatory and evidence ground. So this is something that's FD approved. You can go to your pharmacy. wait, hold on.
Jillian Woodruff, MD (35:39)
I know you like to talk about this, bioidenticals and such. Yes, yes.
Dr. Ade Akindipe, DNP (36:04)
I'm completely f confused. Where is my
Jillian Woodruff, MD (36:06)
Okay, we're gonna stop it because it's just gonna be easier to do.
Dr. Ade Akindipe, DNP (36:09)
Let's stop because I'm like completely thrown up.