Ep 37 | When Its NOT Peri: Functional Hypothalamic Amenorrhea (FHA) with Chrisandra Shufelt, MD

Vaginal dryness, itching, burning, and painful sex? Ah, the many gifts of perimenopause that nobody asked for. As estrogen levels decline, the vulva and vagina can undergo some pretty significant changes. And while these symptoms are common, they aren't something you just have to live with. Your vagina deserves better. In this episode of OvaryActive, the Docs are getting up close and personal with genitourinary syndrome of menopause (GSM). They explain why hormonal changes affect vaginal and vulvar tissues, how symptoms can range from mild irritation to recurrent UTIs, and why vaginal estrogen might just become your new best friend. From over-the-counter moisturizers to prescription hormones, they talk all about what actually works, what doesn't, and what's mostly expensive marketing. The doctors also explore vulvar skin conditions like lichen sclerosus and lichen planus, the role of pelvic floor physical therapy, and when it's time to get things checked out. Bottom line? Pain, itching, and dryness shouldn't be your new normal, and there are plenty of ways to give your vagina the attention it deserves. What you'll hear in this episode: [0:42] Vaginal Troubles [1:13] GSM Symptoms [3:19] Speak Up! (at your visits) [5:36] Estrogen's Exit Causes Tissue Changes [9:43] Infection or Hormones? [11:11] Slather on the Moisturizer…Down There [17:46] Estrogen Options [24:49] Local Therapy Matters [25:34] DHEA Delivery [28:19] Osphena: Pill Power [30:53] Testosterone Talk [36:40] Laser Hype [39:22] When It's NOT GSM [47:19] Get Examined!

Join us for one of our LIVE events: https://bit.ly/3UeeHEL Perimenopause is hard enough without being told you need expensive supplements, miracle hormones, and a new workout routine that apparently requires becoming an Olympic athlete. With menopause misinformation everywhere and wellness influencers selling solutions to problems you didn't know you had, how do you separate science from a really good sales pitch? Women's health and fitness coach Amanda Thebe joins the Docs on this episode of OvaryActive for a refreshingly unfiltered conversation about menopause, hormone therapy, and the business of women's health. Amanda shares her own difficult menopause journey, why hormone therapy isn't right for everyone, and how she went from struggling with symptoms to advocating for evidence-based menopause education and realistic lifestyle changes. Amanda and the Docs are talking all about menopause myths, misleading hormone claims, questionable supplements, and the growing industry profiting from women's fears. They also explore realistic fitness goals, the power of small habits, the mental load of midlife, and why a doctor's appointment alone isn't a complete menopause plan. You will learn how to recognize misinformation, advocate for better menopause care, and prioritize sustainable lifestyle changes without spending a fortune or being a complete jerk to themselves. What you'll hear in this episode: [1:37] Amanda's menopause journey [5:06] Menopause misinformation [8:47] Hormone therapy hype [13:54] Building a menopause community [18:51] Lifestyle over supplements [27:28] Reframing midlife expectations [31:25] Managing mental load [34:09] Menopause healthcare gaps [37:45] Coaching meets medicine [41:29] Healthcare inequality [45:01] Questionable hormone treatments [49:48] Advocating for yourself Links: amandathebe.com Join SPRING w/ Amanda Thebe

Is it ADHD, perimenopause, or has your brain simply decided it has reached maximum capacity? In this episode of OvaryActive, the Docs are talking about the very real overlap between ADHD symptoms and perimenopause. This includes brain fog, forgetfulness, disorganization, overwhelm, and the sudden inability to keep all those carefully balanced plates spinning. ADHD may become more noticeable in midlife, especially for women whose inattentive symptoms went undiagnosed as kids. They explain what ADHD can actually look like in women, why old coping strategies may stop working during perimenopause, and when it might be worth getting a formal ADHD evaluation instead of assuming hormones are responsible for everything. Sometimes the answer is hormones. Sometimes it's ADHD. Sometimes your brain has simply opened 47 tabs and refuses to tell you where the music is coming from. You'll hear about ADHD versus perimenopause symptoms, hormone therapy and stimulants, estrogen and dopamine, study limitations, and why worsening ADHD symptoms in your late 30s or 40s may be worth discussing with your doctor. The research still has plenty of unanswered questions, but one thing is clear: if your mental gigabytes suddenly feel full, you're not imagining it.

We have an announcement! OvaryActive has a Patreon! Help support the show — become a patron for as little as $5/month! patreon.com/cw/OvaryActive Progesterone: soothing hormone, sleep savior, uterine bodyguard… or wildly overhyped perimenopause celebrity? In this episode of OvaryActive, Dr. Rebecca Dunsmoor-Su and Dr. Amy Voedisch take on micronized progesterone, progestins, and the many confident claims the internet has made about both. Because apparently even hormones need a PR team. The Docs explain the difference between progesterone, progestogens, and progestins; why micronized progesterone is formulated the way it is; and why progesterone creams and "natural" wild yam products are not doing what TikTok may have promised. The episode also looks at progesterone's reputation for improving sleep, why some people feel dramatically better while others feel absolutely nothing, and the small subset who can experience poor mood effects instead of calm. Finally, Rebecca and Amy tackle the complicated evidence around micronized progesterone, breast cancer risk, and long-term hormone therapy. Listeners will walk away knowing what the research actually says, what it definitely does not say, and why "it depends" remains medicine's least satisfying but frequently most correct (for now) answer. What you'll hear in this episode: [0:46] Progestogens: Pick a Lane [3:43] Micronized, Not Magical [5:34] Please Don't Put That There [8:10] Protecting the Uterus, Ideally [12:12] Bleeding: Worth Investigating [17:51] Allopregnanolone Enters the Chat [21:27] When "Calming" Backfires [23:16] More Doesn't Always Mean Better [25:10] Sleep Savior? Let's Check the Data [32:20] Breast Cancer Risk: Hello, Nuance [41:07] The Five-Year Rule That Isn't Really a Rule [42:17] Progesterone: Neither Villain Nor Savior Follow the show @OvaryActive Instagram | YouTube | perimenopausedrs.com/ovaryactive Estrogen, Interrupted by Dr. Rebecca Dunsmoor-Su & Dr. Amy Voedisch Support the show: patreon.com/cw/OvaryActive Meet the Docs: More information about Dr. Rebecca Dunsmoor-Su: Gennev: www.gennev.com/clinician/dr-rebecca-dunsmoor-su LinkedIn @rebecca-dunsmoor-su

We have an announcement! OvaryActive has a Patreon! Help support the show — become a patron for as little as $5/month! patreon.com/cw/OvaryActive Blood clots and hormone therapy: two things that can make perimenopause feel even more delightfully complicated. In this episode of OvaryActive, Dr. Rebecca Dunsmoor-Su and Dr. Amy Voedisch dig into the risk of blood clots with menopausal hormone therapy, and why the internet's favorite phrase, "It's totally safe," deserves a few very large asterisks. Rebecca and Amy take a data-driven look at what we actually know about oral versus transdermal estrogen, including findings from the Million Women Study. They also explain what "provoked" blood clots really mean, when prior clots may make estrogen especially risky, why a hematologist might need to join the group chat, and how shared decision-making should work when the research doesn't give a clean yes-or-no answer. Listeners will come away understanding why hormone therapy recommendations need to be individualized, what questions to ask their clinician, and why "we don't have enough data yet" is sometimes the most medically accurate answer available. What you'll hear in this episode: [0:43] Clot risk controversy [1:54] Not birth control estrogen [3:15] Million Women Study [10:31] Let's talk about our high risk ladies [12:03] Provoked clots debate [18:54] Prior clot evidence [25:05] Clinical counseling approach [30:25] Shared decision making