Perimenopause, Sleep Disruption, and Hormone Therapy Options (Estrogen vs Progesterone) | The Vagina Doctor Podcast

Duncan Turner MD and Sophie Mengele NP role-play a gynecologist visit with a 45-year-old patient who suspects perimenopause due to irregular heavier periods, mood changes, hot flashes, and especially disrupted sleep. The clinician explains that perimenopause is challenging because ovarian hormone output becomes unpredictable, with fluctuating estrogen and inconsistent progesterone depending on irregular ovulation, making random blood tests less useful; checking FSH early in the cycle can provide a clue. They discuss trying estrogen to address low-estrogen symptoms like hot flashes, night sweats, and insomnia, and consider nightly progesterone for its sedating effect and potential sleep benefits. They cover dosing approaches, the need for progesterone to protect the uterus if estrogen is used due to uterine cancer risk, and suggest baseline labs, an ultrasound, and trial-and-error experimentation.

00:00 Role Play Setup

00:23 Patient Symptoms Overview

01:09 Why Perimenopause Is Tricky

02:12 Estrogen Testing and Trial

02:55 Progesterone for Sleep

03:57 Dosing and Uterus Protection

05:20 Next Steps Labs and Ultrasound

05:39 Wrap Up and Follow Up