Dr. Hot Flash

What Your Menopause Symptoms Are Really Telling You About Your Hormones

Fri, 27 Mar 2026 03:54:30 GMT

For the last three decades, I’ve sat across from women who were told their suffering was “a normal part of aging.” They were told that hot flashes, brain fog, low libido, painful sex, anxiety, and exhaustion were simply the price of getting older. Let me be very clear: that narrative is not only wrong, it’s dangerous.

These symptoms are not a life sentence. They are biological warning signs that your hormones are no longer optimized, and your body is asking for help. It’s been part of my mission to shift the conversation away from masking symptoms and toward understanding what’s really happening beneath the surface of women in perimenopause and menopause. Because ultimately, when you address hormonal imbalance at the root, you don’t just feel better, you protect your long-term health.

In the 30 years that I’ve been treating women with bioidentical hormone replacement therapy (BHRT), there’s one thing I can tell you with absolute certainty: Your symptoms are not the problem—they’re the message.

Hot flashes
Night sweats
Vaginal dryness
Brain fog
Anxiety
Weight gain that appears out of thin air (usually right around your midsection)
Low libido
Poor sleep
Joint pain
Heart palpitations

These are not random annoyances you’re expected to “push through” because you’ve reached a certain birthday. They are biological distress signals telling you that your hormones are no longer optimized.

Yet most women are told the same tired story:
“Welcome to menopause.”
“Try an antidepressant.”
“Here’s some vaginal estrogen. Good luck.”

That approach infuriates me. And that frustration is exactly why I wrote A Woman’s Hormonal Health Survival Guide: How to Prevent Your Doctor from Slowly Killing You .

Symptoms Are the Smoke, Not the Fire

When a woman comes into my office telling me how hot flashes have disrupted her life, I don’t just see heat waves. I see her body’s estrogen receptors screaming for balance. When she tells me sex is painful because of vaginal dryness, I don’t just hand her a cream and send her on her way. I think about tissue integrity, blood flow, collagen loss, and the long-term health of her urogenital system.

Symptoms are like the “check engine” light on your car. When you ignore it, that doesn’t fix what’s going on under the hood, and it can lead to bigger, more costly repairs. BHRT is not about chasing symptoms. It’s about restoring the system.

Hormones Are Systemic, So Why Do We Treat Them Like Accessories?

Here’s what many doctors forget (or were never properly taught): hormones don’t work in isolation. Estrogen doesn’t just affect your uterus. Progesterone isn’t just for pregnancy. Testosterone is not just “a male hormone” (I could write a whole other blog on that).

Your hormones influence:

Brain function and mood
Sleep architecture
Bone density
Cardiovascular health
Metabolism and insulin sensitivity
Immune regulation
Skin, hair, and connective tissue
Sexual health and desire

So when hormones decline or fall out of balance, the effects ripple through your entire body. Treating one symptom at a time—without addressing the hormonal ecosystem—is like only watering one plant in the garden and hoping you get a full, healthy crop.

What BHRT Actually Does (It’s Not Just About Menopause)

Bioidentical hormones are structurally identical to the hormones your body makes. When prescribed properly, they replace what your body no longer produces in optimal amounts and allow your entire system to function the way nature intended.

BHRT is not about “giving you hormones.” It’s about:

Optimizing levels (not just making labs “normal”)
Restoring overall balance
Supporting adrenal and thyroid function
Improving mitochondrial energy production
Reducing systemic inflammation

“ While hormone imbalances can occur at almost any age, today most women can expect to

live anywhere from one third to one half of their lives in menopause; so of course we want

these years to be healthy, happy and fulfilled. HRT can help us achieve it.”

– Angela DeRosa, DO, MBA, CPE

Why Putting a Band-Aid on Symptoms Fails Women

I see this more times than I can count:

A woman is given an antidepressant for mood swings when the root cause is that her testosterone, estrogen, and progesterone are out of balance.
She’s given sleep meds when progesterone could help restore deep, restorative sleep.
She’s given vaginal estrogen alone while the rest of her body continues to decline hormonally.

This fragmented approach doesn’t just fail to help; it can also create new problems . Hormonal imbalance left untreated contributes to osteoporosis, cardiovascular disease, cognitive decline, and metabolic dysfunction. That’s not “aging gracefully.” That’s neglect.

BHRT Is Preventive Medicine

When your hormones are optimized instead of suppressed or ignored, you are actively protecting your long-term health. I don’t wait until a woman breaks a hip to care about her estrogen. I don’t wait until she has heart disease to think about vascular protection. I don’t wait until she feels “dead inside” to talk to her about testosterone.

BHRT is proactive, personalized, and powerful when prescribed appropriately. And, one-size-fits-all dosing doesn’t cut it. Each woman is not a textbook, but rather a complex, dynamic system, and EVERY woman deserves perimenopause/menopause care that reflects that.

A Final Word From Someone Who’s Seen It All

Your symptoms are valid. Your concerns are real. And you do not need to settle for “this is just part of getting older.”

Optimizing hormones isn’t about vanity. It’s about vitality. It’s about protecting your brain, your bones, your heart, your sexuality, and your quality of life—now and for decades to come.

As someone who has treated more than 20 thousand patients in the last 30 years, and written about BHRT, you might find my book, A Woman’s Hormonal Health Survival Guide: How to Prevent Your Doctor from Slowly Killing You , a helpful tool in your perimenopause journey and beyond.

Read more about hormones Chapter 3: Everything You Ever Wanted to Know About Hormones But Didn’t Know How To Ask: Hormones 101

Why Bioidentical Hormone Pellets Are the Gold Standard in BHRT

Mon, 01 Dec 2025 15:25:02 GMT

Ladies, pull up a chair—preferably one that isn’t vinyl—because if you're in the middle of a hot flash, you might stick to it. I’ve spent the last 30 years treating women who’ve been dismissed, misdiagnosed, or handed a prescription that did little more than turn them into a slightly more tired version of themselves. And after all these years women’s hormonal health, one thing has

remained crystal clear:

Bioidentical hormone pellets are the gold standard in hormone replacement therapy.

Let me explain why—doctor-to-patient, woman-to-woman, survivor-to-survivor.

“Bioidentical hormone pellets are physiologically the same as our own bodies’

hormones, and they provide the best and most consistent delivery and results.”

– Angela DeRosa, DO, MBA, CPE

If you’ve ever been told by your healthcare provider that your hot flashes, weight gain, brain fog, low libido, anxiety, or sleep issues are “just part of getting older,” it’s time to find a new doctor who truly understands perimenopause and menopause symptoms and how to address the root cause. Hormonal decline isn’t a character-building exercise; it’s a medical condition. And just like any medical condition, it deserves evidence-based, individualized, effective treatment.

Bioidentical hormones, particularly ones in the form of pellets, are the closest thing we have to restoring your hormones to the levels Mother Nature originally designed for you.

What Makes Pellets “Bioidentical”?

“Bioidentical” means the hormones are identically structured to the hormones your body naturally produces. Most bioidentical hormones are plant-based, including estradiol, progesterone, and testosterone.

Synthetic hormones, on the other hand, are chemically altered forms of hormones, some of which come from the urine of pregnant horses. These hormones aren’t a perfect molecular match with your natural hormone receptors, and this makes a difference to your body at a cellular level.

Your body recognizes bioidentical hormones as its own. Delivered in the form of pellets, which bypass your digestive system, this form of hormones has the potential to:

● Work better

● Have fewer side effects

● Allow your body to metabolize hormones the way it’s supposed to

● Reduce cardiovascular risks

● Protect breast tissue

Think of it like this: if bioidentical hormones were puzzle pieces to the cells in your body, they would provide the matching pieces for the exact fit (and therefore, potential for maximum benefits).

Why Pellets? Let Me Count the Ways…

You can get bioidentical hormones in many forms, including topical creams and gels; oral tablets and troches; injectables, and pellet implants. There are so many forms and dosage strengths that can be customized for your individual needs through compounded hormones. So why do I champion pellets? Why are they the gold standard in hormone replacement therapy?

It’s really quite simple: the delivery system matters.

A Ferrari filled with cheap gas is still a Ferrari, but it’s not going to run well. And, you're probably not going to get it up to speed with its engine purring. When prescribed correctly, think of pellets as the premium fuel of hormone therapy; the type of fuel that can rev up your menopausal body so it runs smoothly again. Let’s look at some reasons why.

1. Pellets Give You Steady, Consistent Hormones

Topicals and orals can create hormonal roller coasters, leaving you feeling like you’re starring in a soap opera you didn’t audition for. Sometimes your symptoms might subside, and sometimes you might feel miserable. That’s because how well your body absorbs topical hormones through your skin, or oral hormones that have to pass through your digestive system, can fall short and

even cause unpleasant side effects.

Pellets on the other hand offer more of a slow-release infusion of hormones. They dissolve into your bloodstream at the perfect rate, giving you:

● Lower instance of spikes and crashes

● Less worry about forgetting to rub on your cream each day

● No worrying if your husband, kids, or dog will accidentally get a dose of estrogen because they came into contact with your skin

Pellets are essentially the “set it and forget it” form of hormone therapy.

2. Pellets Are the Only Delivery Method That Truly Mimics Ovarian Function

Before perimenopause and menopause, your ovaries didn’t just release hormones once a day. They released hormones steadily, continuously, in rhythm with your body’s needs. Pellets replicate that. Nothing else comes as close.

3. Pellets Bypass the Liver (Your Liver Says “Thank You!”)

Oral hormones have to go through the liver, which can increase inflammation and impact clotting factors, especially if you are a smoker. Pellets go straight into your bloodstream, skipping the liver processing.

4. No Mess, No Fuss, No “Oops, I Forgot”

We’re all busy. As women, we often juggle careers, kids, marriages, divorces, pets, aging parents, and (my personal favorite) uneducated doctors who still think women don’t need testosterone.

Pellets help take daily compliance off your plate. Once inserted during a quick, easy, in-office procedure (you’ve undoubtedly had pap smears that were more unpleasant!), pellets offer your body a steady dose of hormones for the next 3 to 5 months.

5. The Results Are Often Much Better Than Other Forms of Hormones

I’ve seen thousands of women get their lives back (and then some) with the right combination and doses of hormone pellets, including:

● Boosted libido

● Improved sleep

● Less anxiety

● More energy

● Disappearing hot flashes

● Weight loss

● More even moods

● Less brain fog

● Happier relationships

In most cases, when women’s hormones are optimized and stable, everything else follows suit.

Pellet Myths I Hear All the Time

You’ve probably heard them too, so let’s bust a few myths while we’re here, shall we?

“Pellets are dangerous.”

This is simply not true. What is dangerous is walking around chronically hormone-depleted for decades. That’s what accelerates aging, increases disease risk (including cardiovascular, bone, and brain ), and drains your quality of life.

“Pellets make you grow a beard.”

While increased facial hair growth may be a potential side effect of increasing your testosterone levels, experienced pellet providers (key piece of the puzzle) know how to adjust your hormone doses to minimize that. As I’ve said before, if someone offered you a million dollar home for free, but you were responsible for mowing the lawn every week, would you say: “No

thanks! I don’t need the house of my dreams. It’s not worth the maintenance!”

If you have to wax your mustache for a couple months while your body gets used to feeling wonderful from the inside out, I’d say it’s a fair trade off. And, most likely, the extra hair growth will regulate itself, too— IF you even experience it at all.

“I heard pellets aren’t FDA-approved.”

Compounded hormone pellets are made with FDA-approved ingredients, and are highly regulated and held to their own set of standards within the compounding industry. It’s also a little-known fact that hormone pellet therapy has been in use since the 1930s. It’s not something new that hasn’t been scientifically and clinically studied. In fact, pellets and their positive effects

on overall health, have been studied significantly in the last several decades.

Why I’ve Dedicated My Career to Helping Women through Menopause

For decades, mainstream medicine has misunderstood women’s hormones, under-treated women’s symptoms, and over-prescribed antidepressants, sleeping pills, and anti-anxiety meds instead of addressing the root cause—hormonal decline.

I was tired of watching women suffer.

I was tired of seeing women brushed off (myself included).

And frankly, I’m still tired of the inaccurate information being fed to women.

So I wrote my book, started teaching physicians, and dedicated my career to getting bioidentical hormone replacement therapy into the hands of women who deserve better.

If You’re Struggling, Please Know This: You Are Not Crazy

You’re not imagining your symptoms. You’re not “just stressed.” You’re not “just aging.”

Your hormones matter. Your health matters. YOU matter.

Pellet therapy isn’t just about optimizing hormones—it’s about giving women their lives back.

After 30 years and thousands of patients, I can confidently say: Bioidentical hormone pellets are truly the gold standard in hormone therapy; the most transformative method of BHRT.

Your ovaries may be retired…but with pellet therapy, your vitality doesn’t have to be.

As someone who has treated more than 20 thousand patients in the last 30 years, and written about BHRT, you might find my book, A Woman’s Hormonal Health Survival Guide: How to Prevent Your Doctor from Slowly Killing You , a helpful tool in your perimenopause journey

and beyond.

Read more about hormone delivery methods, including pellets in

Chapter 8: Giving Back What Mother Nature Intended Us to Have: Treatment Options

Explore the differences of synthetic vs. bioidentical hormones in

Chapter 2: Challenges, Myths and Misconceptions About HRT

Why Should You Replace Your Hormones? Your Life May Depend On It

Wed, 15 Oct 2025 15:19:02 GMT

What if I told you that replenishing your naturally declining hormones could have a significant positive impact on your heart health? Or protect your bones from osteoporosis? What if a steady supply of hormones as you age could reduce your risk of certain diseases, like breast cancer? Would you consider replacing your hormones then?

I begin this article with these little-known facts about bioidentical hormone replacement therapy (BHRT), because I’m guessing nobody (especially not your primary care physician or your gynecologist) is telling you about the numerous potential benefits of BHRT. It’s not their fault; they were never properly taught about perimenopause, menopause, and hormone therapies in medical school. And, the research about the benefits of hormone therapies hardly becomes part of mainstream medical information or our culture.

So, I want to answer this question about why you should replace your hormones, for you and for all the women who are struggling through perimenopause, menopause, postmenopause.

“There is plenty of data supporting hormone replacement therapy and its health benefits - most [physicians] just haven’t bothered to read it or learn it.”

– Angela DeRosa, DO, MBA, CPE

Perhaps you’re gaining weight you can’t lose; losing sleep because of hot flashes and racing thoughts; and contemplating divorce because your libido tanked and you frequently have to resist the urge to strangle your husband/significant other. These reasons alone are grounds for BHRT, but the added health benefits to your heart, bones, and overall wellness, should make the answer to this personal question quite obvious.

Uncertainty Often Surrounds BHRT

Maybe you feel uncertain about BHRT, like many women, because you’ve heard conflicting messages about hormone therapy over the years. Unfortunately, the flawed Women’s Health Initiative (WHI) study from the late 90s, instilled panic in the perimenopausal population.

However, more than 20 years later, the original WHI study was finally brought to light as flawed . They used synthetic hormones and the majority of women in the study were more than 10 years past menopause! This is hardly the target demographic for BHRT candidates, and bioidentical hormones are not synthetic! Bioidentical hormones are derived from plants and chemically identical to the hormones your body naturally produces.*

Now we know that for most healthy women who begin BHRT around the time of perimenopause or within about 10 years after menopause (before age 60), bioidentical hormone replacement therapy can offer profound benefits, not only for symptom relief, but for long-term health, as well.

Tip of the Iceberg: Relief of Menopause Symptoms

Does this sound familiar? As you’ve gotten older and your body’s natural levels of estrogen, progesterone, and testosterone decline, you began experiencing:

Hot flashes and night sweats
Mood swings, irritability, or anxiety
Poor sleep and fatigue
Brain fog or memory lapses
Vaginal dryness and discomfort
Painful sex
Low libido

Clearly, these symptoms can affect how you feel every day, and in some cases, make you downright miserable. BHRT helps restore hormones to a healthy, more youthful balance, often reducing symptoms within weeks. Many women begin sleeping better, feeling more energized, and noticing improved moods and mental clarity.

Beyond Symptom Relief: Long-term Benefits of Hormone Therapy

Now, let’s get to the long-term benefits of BHRT.

Hormones don’t just affect how you feel; they play a key role in so many systems in your body. Replacing hormones during midlife may support your long-term health in ways you don’t even realize.

Heart Health

Estrogen helps keep blood vessels flexible and supports healthy cholesterol, while testosterone helps optimize glucose metabolism, and prevent its intolerance. If your testosterone is too low, it can lead to insulin resistance, making it harder for your body to absorb blood sugar. Studies suggest that when started within 10 years of menopause, hormone therapy may reduce the risk of heart disease, the leading cause of death in postmenopausal women.

Bone Strength

Estrogen helps maintain bone density. Without it, your bones can weaken faster, increasing your risk of fractures. BHRT can slow bone loss and reduce the risk of osteoporosis-related fractures.

Sexual and Urinary Wellness

Estrogen is vital for maintaining vaginal and urinary tract tissue health. Restoring it can ease dryness, improve comfort during intimacy, and help reduce urinary frequency or urgency. Plus, testosterone affects clitoral sensitivity and ability to orgasm.

Prolonged levels of low testosterone in women usually leads to lack of desire and avoiding sex because it’s too painful and no longer a pleasurable experience. Research indicates a myriad of benefits from having sex regularly, including lower stress, less risk of diseases, better sleep, and increased longevity. Women who have sex at least once a week live longer than women who rarely have sex!

Brain and Mood Support

When your hormones are balanced, you’ll likely feel more focused, have more even-keeled moods, and experience improved memory and cognitive functions (forgetting words less is a wonderful thing).

Potential Cancer Protection

Contrary to common fears (most of which were perpetrated after the WHI study), certain BHRT regimens are linked to a lower risk of breast cancer compared to women who never use hormone therapy.

So, are you feeling less apprehensive about considering bioidentical hormone replacement therapies that are personalized just for you? Not sure where to start? The best thing you can do is educate yourself, so you can ask the right questions when you speak to your healthcare practitioner.

*Read more about synthetic vs. bioidentical hormones in Chapter 2: CHALLENGES, MYTHS AND MISCONCEPTIONS ABOUT HRT

Check out Chapter 9: YOUR HEALTH SURVIVAL GUIDE CHECKLIST to see if hormone therapy is right for you.

Thinking About Your Thyroid? How "Standard" Blood Tests Miss the Real Hormone Info

Fri, 29 Aug 2025 14:17:15 GMT

If you read my blogs or have heard me speak, you know that I’m passionate about helping women get the hormones their bodies need to thrive at every age. I’m especially concerned about women getting the testosterone they need as part of their hormone therapy during perimenopause, menopause, and well into their later years of life, because providers often overlook that hormone. In fact, when I teach medical providers about hormone therapy so they can best serve their male and female patients, I always talk about the importance of testosterone for BOTH men and women.

In addition to being a testosterone advocate for women, I’m also a proponent for thyroid health. More often than not, well-meaning, but undereducated providers misunderstand the importance of thyroid hormones during perimenopause and menopause. As is often the case with tests that attempt to assess fluctuating estrogen, progesterone, and testosterone levels, thyroid tests often appear to be in the “normal” range for many women. I’ll explain why in a minute. First, let’s look at some surprising statistics:

One in eight women experiences a thyroid disorder in her lifetime.

Women are five to eight times more likely than men to have thyroid problems.

Nearly 60 percent of people with thyroid issues have no idea there's a problem.

Undiagnosed thyroid disease may put women at risk for serious conditions, including cardiovascular diseases and osteoporosis.

You have to wonder, why are so many women suffering from thyroid disorders instead of getting the help they need? It could be largely a result of inadequate testing. Standard blood tests often miss the REAL thyroid information.

Why Should You Think About Your Thyroid in Perimenopause and Menopause?

Thyroid hormones play an important role in regulating the female reproductive system. During perimenopause, fluctuating estrogen levels directly impact how your thyroid hormones function. It’s a complex, intricate connection between the thyroid and your hormones. And, to make things even more confusing, symptoms of a thyroid disorder mimic and overlap some of the same symptoms of perimenopause, like hot flashes, anxiety, heart palpitations, and weight gain.

Typically, when a woman in her 40s or 50s conveys these symptoms to her provider, she gets “standard” testing for hormone levels and TSH (thyroid stimulating hormone). But, this is a limited approach, and doesn’t portray the complete picture of your thyroid function.

To fully understand whether or not your thyroid is underactive (hypothyroidism) or overactive (hyperthyroidism), you need to have a more comprehensive thyroid test – one that evaluates T3, T4, and reverse T3.

All the T’s of Your Thyroid

When it comes to evaluating your thyroid, there are a lot of T’s involved! Let’s break them down:

TSH is the thyroid stimulating hormone released from the pituitary gland in your brain
T4 is thyroxine, an inactive precursor and the main hormone produced in your thyroid gland. It gets converted to T3.
T3 is triiodothyronine, the active hormone
Reverse T3 (rT3) is an inactive form of the thyroid hormone, after T4 is converted – a “byproduct” so to speak

Your body produces most of your T3 from your T4. T4 needs to be converted to T3 to perform optimally, and how well your body converts T4 into T3 is often a factor in thyroid disorders. T3 affects your heart rate, digestion, and metabolism.

With all these variable T’s in production and conversion, there are three ways your thyroid can run amok and cause symptoms like fatigue, weight gain/weight loss, hair loss, muscle aches, anxiety, and sleep problems. Here’s what typically goes undetected:

Your thyroid doesn't produce enough T4
Inactive T4 has trouble converting to active T3
Active T3 can't get into the receptors because it's blocked by reverse T3

Request a More Complete Thyroid Picture

Most standard blood tests for thyroid only indicate TSH levels. Reverse T3 can be tested, but your provider needs to request that specific bloodwork. It helps if you have a practitioner who truly understands the thyroid connection to other hormones, including testosterone, estrogen, and progesterone.

“Unless all of the levels are tested, you can’t properly diagnose thyroid disorders, and hypothyroidism is the one most often missed. Luckily, hypothyroidism is usually not difficult to treat.”

– Angela DeRosa, DO, MBA, CPE

As someone who has treated more than 20 thousand patients in the last 30 years, and written about thyroid and hormone therapies, you might find my book, A Woman’s Hormonal Health Survival Guide: How to Prevent Your Doctor from Slowly Killing You , a helpful tool in your perimenopause journey and beyond. You can read more about thyroid disorders in Chapter 3.

Hormones & Intimacy: Could Ignoring Your Symptoms Have Long-Term Effects on Your Relationship?

Thu, 03 Jul 2025 14:47:17 GMT

I recently read an article about how a man in a 27-year marriage to the same woman was contemplating divorce because the woman he married was a “completely different person” now that she was in her 50s and postmenopausal. In the article, this man went on to say their sex life was nonexistent, and his wife was “moody and mean” all the time. In fact, this husband seemed to be blaming his failing marriage wholly on his wife and menopause.

Could there be any truth to this? Or is the man just complaining because his wife has gotten older?

With little insight into the rest of their relationship, it’s hard to know what else may be a factor in this particular situation. But, what I do know is that when women attempt to ignore symptoms of perimenopause and menopause (or perhaps even be somewhat in denial of how their psyches and bodies have betrayed them in this natural stage of life), it could wreak havoc on any relationship.

There’s a physiological reason for all of this, though. These symptoms occur because your hormones – estrogen, progesterone, and testosterone in particular – begin a natural decline sometime in your 30s. Left untreated or ignored, the physical and emotional changes you go through in perimenopause and menopause could potentially have long-term effects on your marriage.

In fact, recent research indicates that more couples over the age of 50 are divorcing than ever before. Research also suggests that couples who have a mutually satisfying sex life are happier overall.

Whether you’re married, in a relationship, or single, perimenopause and menopause symptoms are real , even if your doctor has told you otherwise. (If that’s the case, find a new provider!)

Ignoring the Symptoms of Perimenopause and Menopause Won’t Make Them Go Away

In perimenopause – the years leading up to menopause – you may begin to experience miserable symptoms, like hot flashes, low libido, vaginal dryness, and mood swings as a result of declining hormones. Imagine how ignoring these symptoms not only affects your health and well-being in the moment, but also how it affects your significant other.

“I honestly believe that many couples break up when women start going through perimenopause and it’s largely due to testosterone deficiency.”

– From A Woman’s Hormonal Health Survival Guide: How to Prevent Your Doctor from Slowly Killing You

I mean, can you even slightly ignore a hot flash or night sweats? If you share a bed with your husband, he’s going to notice that you’re no longer snuggling up to him for warmth and intimacy, but now sleeping with the fan on high and the thermostat on 62 in the middle of winter. And, he might also notice that you toss and turn because you aren’t sleeping well. Then he might notice that you struggle to get out of bed in the morning because you’ve barely slept, yet you still have personal and professional obligations to meet. Is it surprising that you’re in a bad mood as you trudge through your day wishing you could remember how great you used to feel when you could sleep for 7-8 hours a night?

Beyond all of this, your partner surely will notice when you’re no longer interested in sex because 1) you have ZERO desire or energy, and 2) you’re suffering from vaginal dryness, so sex is now really painful instead of really pleasurable.

If you’re having trouble getting through a week of your life during “the change” – the menopausal transition – then I imagine after months or even years of these experiences, it’s bound to put a strain on your relationship! Beyond emotional strain, untreated hormone deficiencies and imbalances can have long-term physical effects on your brain, heart, and bones, too.

Let me be clear here: You are the one going through the rollercoaster ride of perimenopause and menopause – not your husband. You owe it first to yourself to address your symptoms with bioidentical hormone replacement therapy (BHRT), not only for the short-term relief, but for the long-term health benefits. And, a bonus “side effect” of you taking care of your own health as you get older is that perhaps your marriage, other relationships, and even your professional life won’t be caught in the middle of it all.

Why Choose to Replenish Your Hormones with BHRT?

As I mentioned, there are many reasons to replenish your hormones as you get older. The short-term relief of symptoms seems like an obvious one, including getting your libido back and overcoming vaginal dryness so sex isn’t painful.

But, the long-term health benefits often go unconsidered, simply because most people aren’t educated about how an estrogen deficiency increases your risk for osteoporosis, high blood pressure, and heart disease. Or, that years of low testosterone can also affect your brain health, and increase insulin resistance, which often leads to pre-diabetes. The bottom line is that, as a woman, you need balanced levels of estrogen, progesterone, and testosterone to keep yourself healthy and your relationships – especially the intimate ones – thriving, too.

***

Progesterone: Why So Many Providers & Women Don't Fully Understand It

Mon, 23 Jun 2025 13:08:32 GMT

Progesterone: Why So Many Providers & Women Don't Fully Understand It

If you grew up watching The Wizard of Oz (circa 1939) then you probably held a lifelong belief that Glinda was the good witch who helped Dorothy get back to her home in Kansas, while the Wicked Witch of the West tried every possible tactic to defeat Dorothy “and her little dog, too!” It was all very black and white; we knew who was good and who was bad.

This all made perfect sense until the Broadway musical Wicked came out in 2003, and then most recently, the 2024 movie version. The backstory of how Glinda and Elphaba (for 64 years we never even knew the Wicked Witch had a name!) turned everything we knew about these opposing forces of good and evil totally upside down. Without totally revealing the plot, we come to realize how Glinda and Elphaba actually complement each other in terms of their character strengths and flaws, and how they need to peacefully coexist, and even maintain a close relationship.

Why am I talking about Wicked in a progesterone blog? Because, much like we now know that Elphaba is a completely misunderstood character , progesterone is also a highly misunderstood hormone when it comes to women in perimenopause, menopause, and hormone replacement therapies. My hope is that after reading this blog, you’ll have a better understanding of progesterone’s role in optimizing your hormones, and why it needs to peacefully coexist with estrogen and testosterone.

Why Progesterone Matters Even After Reproductive Years

Throughout a large portion of a woman’s life, progesterone plays an important role in preparing for pregnancy. During child-bearing years, each month, your body produces follicle-stimulating hormones (FSH) and luteinizing hormones (LH) which cause a new egg to mature and be released from your ovaries. Estrogen production increases and thickens the uterus lining.

So, ovulation occurs, progesterone levels rise in the second half of your menstrual cycle, and your body continues to produce progesterone. If pregnancy occurs, your body keeps producing progesterone to help nourish the development of a baby. But when pregnancy doesn’t occur, both estrogen and progesterone levels drop, the lining of the uterus breaks down, and you have your period.

So, if you’re in perimenopause or menopause (when you’re no longer capable of having a baby), you no longer need progesterone, right? It’s not that simple. Even though progesterone’s most important function is to prepare your body for pregnancy, your body continues to need a harmonious balance of estrogen, progesterone, and testosterone, so you can feel your best as you transition out of child-bearing years and into menopause.

“Progesterone can be annoying, but like the nagging sibling, you really need her in your life, you just have to find the balance. When she’s not around, you start to notice.”

– Angela DeRosa, DO, MBA, CPE

Like Glinda the Good Witch, estrogen is a “feel good” hormone, but progesterone is like the Wicked Witch of the West. You hate to see her coming because she’s often responsible for symptoms of premenstrual syndrome (PMS), like bloating and mood swings, and she might even set you on fire by making your hot flashes worse! However, we can’t simply blame progesterone as the “bad hormone,” because hot flashes and other perimenopause symptoms are more likely to be the result of unbalanced estrogen and progesterone levels.

See where the misunderstanding happens?

As I talk about in my book, A Woman’s Hormonal Health Survival Guide: How to Prevent Your Doctor from Slowly Killing You , the idea is to keep your hormones – particularly estrogen, progesterone, and testosterone – balanced. Estrogen is like Glinda – the beautiful, popular girl, and progesterone is like Elphaba – the ugly, misunderstood, brooding girl. Testosterone is the happy-go-lucky guy who keeps the peace between the two.

Perimenopause and Progesterone Sometimes Don’t Mix

To further confuse things, during perimenopause, testosterone typically declines and drops out of the picture, leading to an imbalance between estrogen (who sometimes likes to dominate) and progesterone, who decides since there probably won’t be any pregnancies in the picture, she’s going to stop doing her job. Progesterone often gets blamed for this imbalance, but many providers also don’t realize how much to prescribe and what types of dosage forms are optimal. ( Hint: if you still have a uterus, oral progesterone helps protect the endometrial lining).

What I often hear from women in perimenopause is that their provider tested their hormone levels at a time during their menstrual cycle when progesterone just happened to be low, which is a normal phase. Based on these snapshot lab results, the provider prescribes what ends up being too high of a dose of progesterone. As a result, these perimenopausal women who are still having periods, experience the side effects of too much progesterone, such as weight gain and fatigue.

On the other hand, some providers tend to only prescribe estrogen for women in menopause who are no longer having periods because estrogen can address many of the miserable symptoms of hormone deficiencies, including low libido, painful sex, hot flashes, and irritability. However, if you only increase estrogen without balancing progesterone (and testosterone, too) you can end up with estrogen dominance. Without the balance of progesterone, too much estrogen can lead to cancerous cell growth and even tumors in your uterine lining.

Balancing hormones is a combination of data, medical expertise, and personalization that finds just the right doses for your particular needs. Every woman is different. You know how you feel and you know when something isn’t quite right. It’s important to find a healthcare practitioner who understands the nuances of how progesterone, estrogen, and testosterone all work together for optimal results – peacefully coexisting like Glinda, Elphaba, and the Wizard of Oz.

***

Testosterone: What Menopause Conversations Are Missing

Mon, 23 Jun 2025 13:05:44 GMT

May is Women’s Health Month, and Women’s Health Week is May 11 - 17th.

Since this month is all about educating and empowering women about their own health and wellness, I want to have a candid conversation with you about perimenopause, menopause, and the role of testosterone.

As you may already know, if you pay attention to mainstream and social media, we’re having a lot of conversations about “the change of life.” What was once taboo or only talked about with your doctor (if that), is now front and center.

Today, you have your pick from a slew of books about how to manage menopause. You can even follow menopause groups and hormone replacement conversations on Facebook and Instagram. Everywhere you look, self-proclaimed “menopause experts” are hosting panel discussions and throwing menopause parties, complete with nonalcoholic drinks, because for many women, alcohol leads to night sweats and a restless night’s sleep. These menopause party hosts want to show middle-aged women how we’re “all in this together” and finally taking a stand on getting the support we need through this often troublesome – sometimes outright miserable – aging process.

While I’m very happy to see women finally talking about this natural part of life that is perimenopause and menopause, these “experts” are missing a vital piece of the hormone puzzle. They’re all talking about symptoms and even bioidentical hormone replacement therapy (BHRT), and how women need to replace estrogen and progesterone, and this is all good! But, nobody’s talking about testosterone – the most abundantly produced hormone in the female body for much of our lives!

Yes, you read that right: TESTOSTERONE. Typically, it’s the hormone only associated with men. In reality, women’s bodies produce more testosterone than estrogen on a daily basis before reaching menopause.

However, when women’s hormones decline (typically beginning in our mid-thirties when perimenopause begins), that includes lower testosterone levels, too. And for many women, a testosterone deficiency can have similar effects on your body as it does for men – low sex drive, decreased arousal and sensitivity, and difficulty reaching orgasm.

When men have these issues, the medical community rushes to their aid, doling out little blue pills so men can rise to the occasion (pun intended!) without worry. But, what about women?

Where is our testosterone replacement therapy?

Beyond Intimacy: Long-term Effects of Low Testosterone in Women

Beyond sexual wellness issues that are frequently a result of declining testosterone levels for women during perimenopause, you may also experience low energy, brain fog, and difficulty concentrating, plus loss of muscle tone (think jiggly arms, thighs, and bellies).

If you opt for hormone therapy that only addresses low estrogen and progesterone, and you don’t optimize your testosterone levels as well, you could experience the long-term effects of low testosterone, which can impact your bone health, potentially increasing your risk of osteoporosis. Long-term low testosterone levels have also been shown to increase a woman’s risk of cardiovascular disease and impact overall heart health.

Knowing all of this, why are women missing this vital piece of the hormone therapy puzzle, which doesn’t include testosterone? Because most of the “menopause experts” are not hormone therapy experts. They don’t fully understand advanced BHRT protocols. They just know that the “female hormones” of estrogen and progesterone need to be replenished, so testosterone gets erroneously assigned only to men.

As a woman in perimenopause or menopause, what can you do about this?

Find an expert hormone therapy provider who truly does understand women’s hormones; one who will listen to your concerns and not dismiss your symptoms. Beyond that, find a medical professional who doesn’t take a one-size-fits-all approach to hormone replacement therapy, but rather prescribes what’s best for you, as an individual.

Not sure where to start? The best thing you can do is educate yourself, so you can ask the right questions when you speak to your healthcare practitioner.

“Many women have testosterone deficiencies long before perimenopause because so many doctors unknowingly prescribe medications that reduce testosterone levels, and worse yet, they don’t recognize the effects.”

– Angela DeRosa, DO, MBA, CPE

Dr. DeRosa on the A little bit TIPsy Podcast

Mon, 15 Mar 2021 15:46:00 GMT

Check out more episodes here .

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One Hot Minute – Medical Weight Loss

Wed, 16 Sep 2020 20:50:00 GMT

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Solutions For Female Incontinence

Mon, 29 Jul 2019 21:37:00 GMT

It’s something most women don’t like to talk about- incontinence.

The condition is more common than you might think, according to Dr. Angela DeRosa, and it’s not something you have to live with.

Many associate female incontinence with new moms or older women, but they’re not the only ones who have to cope with the often embarrassing issue.

“It can happen at any age,” DeRosa said.

There are two main categories: stress incontinence and urge incontinence.

In the cases of urge incontinence, when you have to rush to the restroom, the bladder wall is spasming uncontrollably. “That is a neurological problem, that’s most often treated with medications,” DeRosa explained.

Stress incontinence, in which you urinate a bit when you cough, sneeze, laugh or exercise, is the most common type of incontinence in women. It happens when the muscle supporting the bladder weakens causing it to drop.

While there are surgical options and medications, there are also some other things you can try.

A therapeutic pessary, for example, can be inserted into the vagina to lift the bladder back into its proper position.

DeRosa said she also recommends using a kegel ball, which is meant to exercise the pelvic muscles.

“It causes the vagina to contract,” DeRosa explained. “It lifts the bladder back up because you’re building the muscle that sits underneath it.”

The kegel balls, also known as Ben Wa balls, come in three different sizes, 28 grams, 38 grams, and 48 grams.

The most important part of treating female incontinence is having a conversation with your doctor.
“The key is to come talk to us and we can help you decide what type of incontinence you have and then how to best fix it,” DeRosa said.
Proper Tests Diagnose Hypothyroidism 1/11/2014

Question: I’m 43, feel tired and achy, plus I’m gaining weight. It’s hard to stay positive when my doctor says it’s just stress and aging.
Answer: Aging and stress can play a role, but not exactly in the way your doctor might think. Symptoms of extreme fatigue, weight gain, sore muscles, aching joints, hair loss, and cold intolerance scream hypothyroidism. Slow heart rate, cold hands and feet, and a swollen neck are all clinical indicators of hypothyroidism.

By age 50, about one-third of women and one-fifth of men will have hypothyroidism/low functioning thyroid. Too many medical professionals have lost the skill of using the patient’s history, physical exam and appropriate blood screening necessary to make a correct diagnosis of hypothyroidism, and they rely solely on the standard TSH blood screen test. Thyroid 3 (T3), Thyroid 4 (T4), and reverse T3 levels combined with physical symptoms and health history are true indicators of thyroid function. Many people with normal TSH levels have hypothyroidism, so missing the diagnosis leaves patients feeling awful and at greater risk for cardiovascular disease, inflammatory conditions, and cancers, including breast and colon cancer.

The hormone testosterone drives the thyroid and metabolism. Deficiencies tend to manifest in thyroid symptoms that in turn inhabit proper thyroid function. Share this information with your doctor. If he or she does not properly test your thyroid, find a new doctor.

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How to Boost Your Sexuality, Intimacy

Sat, 27 Jul 2019 21:33:00 GMT

All couples have ups and downs when it comes to sex and there are many ways to boost intimacy. But we wanted to share a few ideas for improving your sex life that you might not have thought of.

COLOR: Sexy Billionaire Christian Grey may have his red room of pain in the saucy bestseller “Fifty Shades of Grey,” but it turns out purple is actually the sexiest color you can paint your bedroom.

A new survey has found that people with a purple color scheme in their boudoir have the most sex, chalking up to 3.49 intimate encounters each week.

Despite the title of the EL James blockbuster, those with grey bedrooms notch up a paltry 1.8 weekly romps according to littlewoods.co

NUTRITION: Lean proteins and good fats feed our brain and many people say good sex starts in our brains

MANAGE STRESS : Stress is one of the top sex-drive killers that most couples complain about

EXERCISE: Exercising releases all kinds of chemicals and hormones in our bodies, improving the likelihood to want to have sex. These chemicals and hormones all play a key rule in your sex drive and sexual experiences.

HORMONE BALANCE: If none of these suggestions help, get your hormones tested. You may need a testosterone boost or help for thyroid.

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Foods That Can Ease Menopause Symptoms

Sun, 21 Jul 2019 21:30:00 GMT

Ask any women who’s been through “the change of life” and she’ll probably tell you that with its hot flashes, insomnia, fatigue, headaches, and pounding heart, menopause certainly is no picnic.

Dr. Angela DeRosa, who went through menopause herself when she was just 35, says there are foods that can help ease the symptoms.

“Women can have it at any age,” DeRosa said. “It’s considered premature before the age of 40. After the age of 40, it can be natural for that particular woman. It’s genetically determined.”

Other symptoms of menopause include night sweats, skin flushing, forgetfulness, decreased interest in sex, mood swings, vaginal dryness, joint aches, and heart palpitations.

DeRosa said foods rich in calcium and vitamin D can help head off bone loss, as well as aiding in cancer prevention.

“Also, vitamin D can prevent fibromyalgia-like symptoms,” DeRosa said.

Fiber-rich foods help decrease glucose swings and help you avoid gaining weight. They also decrease inflammation and constipation. Tofu and soy contain phytoestrogens that help combat many menopausal symptoms. Decrease in estrogen is one of the hallmarks of menopause.

Goof fats can help keep your good cholesterol up.

Water, of course, is essential.

“Typically, an average diet should have at least a gallon of water a day,” DeRosa said. “Here in Arizona, when we have excessive heat and you’re out doing a lot of activity, you might need to double that.”

The caution there is that you need to make sure you keep your electrolytes balance. Sports drinks can help with that.
Just as there are foods that can help ease symptoms of menopause, there are those that exacerbate them. Doctors usually recommend avoiding caffeine, processed sugars, starches, alcohol and spicy foods.

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Doctors Reveal Hidden Erogenous Zones for Men, Women

Mon, 15 Jul 2019 21:28:00 GMT

When it comes to find erogenous, most couples are aware of the obvious ones.

It’s a topic that’s not always easy to discuss openly. “There’s an element of embarrassment,” says Dr. DeRosa. “As women, we’ve been taught to be ladylike and never talk about sex, so to actually talk to our partner about what we want, there’s actually a big stigma associated with that.”

Dr. Borhan says that studies show that men can have many erogenous zones, besides the ‘expected’ spots. “There are many areas like the inner thigh, and surprisingly, the back of your knee,” he says. “Men’s hands are very sensitive, and that was one of the newer things that came to the forefront.”  Dr. DeRosa explains where women’s so called ‘hot spots’ can be found. “Women love the lips,” she says. “Also, the nape of the neck.” The lower back and inner thigh are also considered erogenous zones for women.

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Baby Blues: What to Expect After Expecting

Tue, 09 Jul 2019 21:26:00 GMT

Being pregnant completely alters a woman’s hormone levels. As hormones rise to 20 to 30 times their normal levels, they can cause some nasty side effects, as evidenced by Kate Middleton’s much publicized hospitalization for extreme morning sickness. However, the sudden drop in hormone levels after giving birth can have some equally nasty side effects.

It’s completely normal to feel tearful, anxious, and tired after giving birth. The dramatic drops in estrogen and progesterone postpartum can leave many women feeling depressed, irritable and moody, similar to PMS. The “Baby Blues” occurs in 75-80 percent of women, starting two to three days after giving birth and peaking around seven to ten days postpartum. Normally, these feelings will subside as hormone levels stabilize, but 10-20 percent of woman will experience more intense long-lasting side effects that can threaten their health.

For these women, postpartum depression, or PPD, usually sets in four to eight weeks post delivery, but it can occur anytime up to a year after giving birth. It’s most common in first-time mothers or those who tend to have severe PMS. Symptoms include frequent bouts of crying, sleeplessness, agitation, anxiety, anger, fear, unexplained sadness or suicidal thoughts. In these cases, it’s essential to receive professional medical care, as untreated PPD can have significant impact on both the mother and the baby.

Thyroid levels can also drop dramatically after giving birth, and it’s estimated that 10 percent of women will go on to develop thyroid issues. Postpartum thyroiditis is an autoimmune disorder caused by antibodies and the gland first becomes inflamed after a woman gives birth. Woman will usually become hyperthyroid first, feeling anxious, nervous, or breathless and unable to sleep, and then move on to hypothyroid three to six months postpartum. Low thyroid symptoms also mimic depression, so women experiencing these types of symptoms in the months after giving birth should definitely see their doctors.

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Vaccine Doesn’t Send the Wrong Message

Wed, 03 Jul 2019 21:23:00 GMT

Question: Should I be considering the Gardasil vaccine for my daughters? I don’t want to send the wrong message.
Answer: It’s important for parents to openly discuss human sexuality with their children in an age-appropriate manner. Gardasil is a preventive vaccine against human papilloma virus, or HPV, which is the most common sexually transmitted infection (STI), and it’s recommended for boys and girls. The Gardasil is not a signal to your kids that it’s OK to become sexually active. It’s a sign that you care about their long-term health.

Several types of HPV can cause cervical warts or cervical cancer. Nearly 75 percent of all men and women will become infected with HPV in their life-time, most often during their first two to three years of sexual contract. The Gardasil vaccine has proved effective against the four most common strains of HPV, reducing the risk of women developing cervical cancer by 75 percent, and cervical warts by 90 percent.

Since men and women can be infected, carriers can transmit the virus to their partners. While it’s important to practice safe sex, condoms are only partially effective in preventing the spread of the virus, and symptoms not usually visible. Women are screened through pap smears, but there is no effective screening test for men. If they are infected, they are putting their partners at risk.

The goal is to vaccinate young people before they become sexually active. The best age to vaccinate is around age 11-12 in boys and girls, but it can also benefit young people ages 9-26. If you’re a parent, be sure to ask your family doctor about the Gardasil vaccine.

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Trying to Shed Pounds? Don’t Give Up

Fri, 28 Jun 2019 21:17:00 GMT

Q: This year I want to lose weight, but I’m already struggling. What could I be doing wrong?

A: Losing weight and keeping it off requires dedication, healthy foods and good hormonal balance. Without proper levels of testosterone, our thyroid becomes sluggish, slowing our metabolism and launching a vicious cycle of weight gain that puts us at a greater risk for developing heart disease, cancers and other health conditions. Besides eating foods that aren’t good for us, there are lots of ways we sabotage ourselves. One of the worst things you can do is not eat enough, because restricting food intake too severely can cause weight gain. When the body’s furnace consistently lacks fuel, it decides food is scarce and rather than burn fat, it will begin storing fat to live off of during the perceived famine.
Skipping breakfast is another common mistake. A healthy breakfast with protein and nutrient rich fruits can kick off a day of fat burning. Add exercise and you’re on the right track. But workouts can be another way we sabotage ourselves. We feel good afterwards and may decide to reward ourselves with pizza or a burger or eat too much.
Don’t be fooled by “lite” foods as they ate usually packed with sugar and chemicals used to make them taste good. Don’t confuse thirst with hunger. Try drinking a glass of water a half hour before eating. Some juices, coffees, and smoothies can have up to 500 calories per serving, and alcoholic drinks are packed with empty calories. Eliminating foods loaded with potential allergens (like wheat or beans) can also help with weight loss.

Watch for Postpartum ‘Baby Blues’

Q: I’m expecting my first child. My mother had severe bouts of depression after giving birth. Am I likely to have the same experience?

A: During pregnancy, hormones rise 20 to 30 times their normal levels, causing nasty side effects like morning sickness, irritability, tearfulness and hypersensitivities to smells and tastes. The sudden drop in hormone levers after birth, however, can trigger severe side effects for some women. The dramatic drops in estrogen and progesterone postpartum can leave many women feeling depressed, irritable and moody, similar to PMS. This is known as the “baby blues.”

The “baby blues” occurs in 75 to 80 percent of women, starting two to three days after giving birth and usually peaking about seven to ten days postpartum. Normally, these feelings subside as hormone levels stabilize, but 10 to 20 percent of women will experience more intense, long-lasting side effects that can threaten their health. For these women, postpartum depression, or PPD, usually sets in about four to eight weeks post delivery, but it can occur anytime up to a year after giving birth. It’s most common among first time mothers or those who tend to have severe PMS.

If your mother experience severe PMS, and you do as well, it is important to let you doctor know so your post pregnancy symptoms can be monitored closely. Symptoms of PPD include frequent bouts of crying, sleeplessness, agitation, anxiety, anger, fear, unexplained sadness or suicidal thoughts. In these cases it is essential to receive professional medical care, as untreated PPD can have significant impacts on both the mother and the baby.

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