Perimenopause or “Am I Going Crazy?” Understanding Complex Symptoms and Hormone Fluctuations

Duncan Turner, MD discusses how perimenopause symptoms can be complex, obscure, and easily confused with other conditions, leading some patients to be prescribed medications like Xanax or antidepressants that may not address the underlying hormonal changes. He explains that perimenopause is marked by unreliable, inconsistent shifts as the ovaries “misfire,” with intermittent ovulation and fluctuating estrogen and progesterone levels that cause symptoms to change over time. Turner emphasizes evaluating the big picture and using lab work to better determine where a patient is in the transition, often starting slowly with small amounts of estrogen and/or progesterone to manage symptoms. He notes this is not a quick fix and typically requires ongoing care and patience over four to ten years as symptoms evolve.

https://www.turnermedicalarts.com

https://www.youtube.com/@thevaginadoctor

Non-Hormonal Options for Menopausal Symptoms

On the Vagina Doctor Podcast, nurse practitioner Sophie Mengele discuss non-hormonal options for managing menopausal symptoms such as hot flashes, night sweats, and mood irregularities. Sophie reviews several medication choices used when hormone therapy isn’t desired or isn’t an option, including SSRIs (noting Lexapro as a preferred option) and SNRIs for anxiety and mood stabilization. She highlights Veozah, which works on brain pathways involved in thermoregulation to reduce hot flashes and night sweats, emphasizing that it should be prescribed with ongoing monitoring and liver enzyme labs. She also mentions gabapentin and pregabalin as additional options that can help with uncomfortable symptoms and encourages listeners to speak with their healthcare provider about which approach may fit.

00:00 Non-Hormonal Menopause Treatment Options

01:09 SSRIs & SNRIs

02:05 Gabapentin & Pregabalin

02:33 Talk to Your Provider

https://www.turnermedicalarts.com

https://www.youtube.com/@thevaginadoctor

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

Pap Smears Don’t Screen for Ovarian Cancer—So What Does?

This episode explains that Pap smears do not screen for ovarian cancer and that there is no particularly good routine screening test, which contributes to ovarian cancer often being diagnosed at an advanced stage. The ovaries are best evaluated with ultrasound, which the office performs annually to assess appearance. A blood test can sometimes detect very early ovarian cancer, but it has not been found to be tremendously effective. A newer test, Galleri, measures methylated DNA to suggest cancer presence and help identify its source, but it is expensive and usually done for people over 50. Manual pelvic examination can sometimes detect enlarged ovaries, advanced ovarian cancer, or ovarian cysts, and annual exams remain the main routine approach in the U.S.

00:00 Pap Smears and Ovarian Cancer

00:18 Why Screening Is Hard

00:31 Ultrasound Yearly Checks

00:49 Blood Tests and Limits

01:00 Galleri DNA Test

01:16 Pelvic Exam Detection

01:42 What We Do Routinely

Subscribe On YouTube:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.youtube.com/@TheVaginaDoctor⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Follow Us On Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/thevagina_dr⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Turner Medial Arts:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.turnermedicalarts.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Body Composition Scans: What They Show, Who Should Get One, and Why It Matters on GLP-1s

Nurse Practitioner Sophie at TMA explains how body composition scans provide more useful information than a scale by showing where weight loss is coming from, including lean muscle mass, visceral fat around the organs, and total body fat. She describes using scans to track changes over time, especially for patients on GLP-1 medications, with the goal of losing fat without losing muscle. Sophie shares a patient example of a fit middle-aged woman on Ozempic with a low BMI whose scan revealed very low muscle mass despite normal body fat, which she notes is a red flag and raises concerns about overall health, bone health, and fall risk as people age. She recommends getting a baseline scan before starting treatment and repeating it every three months, and mentions using Health Span for scans at $150 with a discount code.

00:00 Intro to Body Scans

00:33 Why Scans Matter

01:07 Key Metrics Explained

01:40 Using Scans on GLP-1s

02:40 Patient Case Study

03:51 Risks of Low Muscle

04:11 Where to Get Scanned

04:26 Timing and Follow Ups

Subscribe On YouTube:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.youtube.com/@TheVaginaDoctor⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Follow Us On Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/thevagina_dr⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Turner Medial Arts:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.turnermedicalarts.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Dr. Naz on Foot Pain Misdiagnoses, Orthotics, and Building a Concierge Podiatry Practice in Santa Barbara

Nurse Sophie Mengele interviews her friend Dr. Naz, a board-certified podiatrist with surgical residency training in Kansas City and a minimally invasive surgery and limb reconstruction fellowship at Emory, now running a small concierge podiatry practice in Santa Barbara and working for a local nonprofit. Dr. Naz explains she is currently nonsurgical and often provides second opinions, post-surgery guidance, and alternatives for active patients who want to avoid downtime. They discuss common misdiagnoses, including heel pain labeled as plantar fasciitis that may be posterior tibial tendonitis, suspected nail fungus that often requires biopsy and testing, and “warts” that can be painful porokeratosis related to pressure and biomechanics. Dr. Naz shares pedicure safety considerations, benefits and candidacy for custom orthotics, and her COVID-era move to Santa Barbara, including the sacrifices made to start and grow her practice.

00:00 Meet Dr Naz

01:29 Her Podiatry Journey

02:53 Residency And Fellowship

03:59 Santa Barbara Practice

04:33 Second Opinions Not Surgery

07:35 Common Misdiagnosis Heel Pain

11:25 Nail Fungus Or Not

13:07 Pedicure Safety Tips

15:37 Nail Salon UV Talk

15:58 Warts Or Callus

16:57 Spotting The Difference

17:27 Pressure And Biomechanics

17:52 Custom Orthotics Explained

19:51 Moving To Santa Barbara

21:04 Starting From Scratch

23:25 Living In The Office

27:00 Making It In SB

28:44 Foot Red Flags

30:03 How To Reach Her

Subscribe On YouTube:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.youtube.com/@TheVaginaDoctor⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Follow Us On Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/thevagina_dr⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Turner Medial Arts:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.turnermedicalarts.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Avoiding Contaminated Hormone Lab Results: Timing, Application Sites, and Common Mistakes

Nurse Sophie Mengele and Duncan Turner, MD discuss how topical hormone replacement therapy can contaminate blood test results, leading to unrealistically high lab values that don’t match other markers like FSH. Using a recent patient example, they explain that contamination can occur when hormone cream is applied too close to a blood draw or transfers to the draw site, making results hard to interpret and requiring repeat testing. They recommend patients continue medications as usual but time labs about four hours after application, or if needed, hold only the morning dose so the last dose is about 12 hours prior rather than 24. They also advise consistent application in the same area to create a stable “reservoir,” using one hormone per area (often separate thighs), avoiding mixing multiple hormones in one syringe, and not applying right before showering or exercising.

00:00 Contamination Explained

00:17 Karen’s Lab Surprise

01:07 Timing Your Dose

02:06 Spotting Bad Results

03:34 Preventing Cream Transfer

04:04 Apply Consistently

05:05 One Hormone One Area

06:00 Showering and Exercise

06:39 Wrap Up

Links To All Platforms: https://www.thevaginadoctorpodcast.com/Subscribe On YouTube:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.youtube.com/@TheVaginaDoctor⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Follow Us On Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/thevagina_dr⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Turner Medial Arts:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.turnermedicalarts.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

Why Your Labs Look “Normal” but You Still Feel Awful in Perimenopause & Menopause

Nurse Sophie Mengele and Duncan Turner, MD discuss why patients—especially those in perimenopause or menopause—can have debilitating symptoms despite being told their lab work is “normal.” They emphasize that many “full panels” may not include hormone testing at all, and that when hormones are tested (progesterone, testosterone, estrogen, FSH), results must be interpreted in context, including timing within a 28‑day cycle because levels can vary dramatically. They also note that patients on hormone replacement therapy may not have key hormones like estrogen monitored, and that clinical circumstances such as age and life situation matter. They highlight how oral contraceptives can mask menopausal status and suggest considering recent birth control use and waiting at least six weeks off it before rechecking FSH.

00:00 Why Labs Look Normal

00:51 Are Hormones Included

01:17 Cycle Timing Matters

02:04 HRT Without Estrogen Checks

02:40 Which Labs Were Run

03:00 Birth Control Masks Menopause

03:29 Recheck FSH After Stopping

03:38 Patient Frustration Wrap Up

Links To All Platforms: https://www.thevaginadoctorpodcast.com/Subscribe On YouTube:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.youtube.com/@TheVaginaDoctor⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Follow Us On Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/thevagina_dr⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Turner Medial Arts:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.turnermedicalarts.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠