Women’s Health

frazzled perimenopausal woman pulling her hair

Are You In Peri-menopause?

By | Blogroll, Hormones, Picks, Women's Health

I often get asked, “How can I know if  I’m in peri-menopause?”  It seems like a simple question, but the answer is not so straightforward!

What exactly is peri-menopause anyway? 

Before you go through menopause, there is a period of time (up to 10 years!) where things start to change.  The changes can be subtle or not so subtle.  We call this phase of life “peri-menopause”, and it can be one of the most difficult transitions in a women’s life. Often women are told that they are too young to be in peri-menopause.  Sadly, some women are told to tough it out and that it will pass.

Addressing the hormonal symptoms of peri-menopause can dramatically improve quality of life for many women.  Let’s talk about what is going on.

Estrogen and progesterone levels are changing…

Estrogen levels usually start to decline around menopause (average age of menopause is 52), but progesterone levels start to decline much earlier!  In fact, progesterone can decline by as much as 80% during the decade of your thirties, so it is common to have relatively lower progesterone levels in your forties.

When progesterone levels start to decline because of age, and symptoms of hormone imbalance become noticeable, we call this “peri-menopause”.   Later, when estrogen levels also start to drop, symptoms can become even more problematic.

How will you feel when you’re in peri-menopause?

 Because progesterone levels naturally vary over the menstrual cycle, the symptoms vary as well.  

Typically the week after a period is the “good” week; you’re eating your broccoli, exercising regularly, and cleaning out your closets.  Then as you get closer to your period, symptoms get worse – including irritability, anxiety, and interrupted sleep. You may feel more negative, critical, impatient, and easily frustrated – and this can affect how you behave towards your family, friends and co-workers!

Progesterone is a natural anti-anxiety compound, helps with sleep and is calming – sort of like nature’s version of valium or a glass of red wine.  So if you don’t have enough, you may not feel like your best version of yourself during that time in your cycle.

This variation in symptoms is a big clue that hormones are the problem.  If your mood symptoms or insomnia are exactly the same every day in your cycle, it is less likely that hormones are the cause.

What symptoms can you expect in peri-menopause?

Here is a checklist of symptoms that you may experience if your progesterone levels are declining:

  • Insomnia (especially wakening in the night)
  • Night sweats
  • Anxiety
  • Irritability
  • Mood swings
  • Weight gain
  • Increased PMS
  • Pre-menstrual headaches
  • Heavier periods
  • Shorter cycles (periods coming less than 28 days apart)

Are there lab tests to tell if you’re peri-menopausal?

A blood test called FSH (follicle stimulating hormone) can be done.

When you’re pre-menopausal your FSH level will be quite low (often in the range of 2-10).  When your ovaries are no longer functioning their best, your FSH level will increase (typically women who are postmenopausal will have FSH levels above 25, and even over 100).  If your FSH level is starting to go up, you’ll know that you are peri-menopausal.

Your doctor may tell you that you’re “menopausal” if your FSH is over 25.  This causes so much confusion!  Technically, you are menopausal once you go for 12 months without a period.  Often FSH levels go up in the “menopausal” range several YEARS before you stop having a period. 

So if you are still having periods, you technically aren’t menopausal (even though your FSH is in the menopausal range), you are peri-menopausal.  Your FSH level doesn’t tell us exactly what is going on with your estrogen and progesterone levels,  just that ovarian function is changing.

What if you don’t have a period, but still have functioning ovaries?

Here’s where things get even more confusing.  Some circumstances where you may not have periods but still have functioning ovaries include:

  • You’ve had a partial hysterectomy (your uterus was removed, but you still have at least one ovary)
  • You’ve had an ablation (a uterine procedure that may stop you from having a period)
  • You have an IUD

If your ovaries are still producing estrogen, then you aren’t technically menopausal even though you haven’t had a period for at least 12 months – see how confusing this gets!  But you certainly could be peri-menopausal.  We’ll mostly need to go by symptoms to tell, and an FSH can be helpful.

Do you have to put up with the symptoms of peri-menopause?


If you are having symptoms and would like help, the first step is to have your hormones measured.  This is another thing that sounds easy, but turns out not to be so simple.

If you ask your primary care doctor or your gynecologist, they will typically be happy to order the FSH level, but do not typically order estrogen, progesterone or testosterone levels.  If you push, you may be able to convince them, but it’s very important that the hormone levels are checked at the right time of your menstrual cycle.  We want the levels done approximately day 19 of your cycle (day 1 is the first day of your period).  Since hormone levels fluctuate over your cycle, the timing of the test is very important. 

If you aren’t having a regular period, you can try to guess when your next cycle will be or just do the test anytime if things are completely unpredictable.  Your hormone levels will be very different if the test is done while you are on a period, the week after a period, or right at ovulation.  So you can see it’s not so simple, and the test results will need to be interpreted properly.

Another problem with having your primary care doctor or gynecologist order the test, is that they’re going to look at the “normal” range from the lab.  You are almost certainly going to land somewhere in the normal range, because the range is very wide, and mostly developed to identify things like tumors (which you almost certainly don’t have).  It can be very frustrated to work hard to have the test finally done, only to be told that everything is normal!  If it is normal, why do you feel so bad?

A Functional Medicine doctor can do a more comprehensive hormone panel to look at your sex hormones, and the other hormones that influence them, like thyroid and cortisol (your stress hormone).  Hormone levels can be measured in blood, urine, and saliva, and the best test for you depends on your personal history and circumstances.   

How can you get your hormones back into balance?

Depending on your test results, you may benefit from trying some natural progesterone.  Progesterone can help you sleep soundly, feel more relaxed and prevent PMS symptoms.  It can also help regulate your cycles, reduce night sweats, and helps reduce breast cysts and tenderness.

It’s important to use the natural, bio-identical progesterone (an exact match to  your body’s own progesterone).  There are many synthetic drug forms of progesterone (called progestins) that are used in things like birth control pills.  These are man made chemicals that are never naturally found in a woman’s body.  They can help prevent a pregnancy, and may help with things like menstrual problems, but there are health risks associated, like blood clots.

What are other natural treatments for peri-menopause?

You also want to consider your nutritional status, stress levels, and lifestyle habits, as these affect your hormone balance.  Many common chemicals are hormone disruptors, so it is important to gently flush these toxins from your body so your hormones can do their job.  If your symptoms are mild, making some lifestyle changes may be all that you need to get back to feeling great!

Don’t be held hostage by your hormones for one more day!

If you think that you may be in peri-menopause, and are having symptoms that are interfering with your health or quality of life, please know that help is available.  You don’t have to suffer! Together we can get you back to feeling like the best version of you again, because you deserve to LOVE the way you feel!

Yours in Health!

Dr Deb

PS.  Here are some ways you can learn more:

  1.  You can find more information at our website www.signaturewellness.org
  2. You can read my book, This is NOT Normal, A Busy Woman’s Guide to Symptoms of Hormone Imbalance.  It’s available on Amazon.
  3. If you are in the Charlotte area you can come to one of our FREE informational dinner seminars.  Call the office for details about our next seminar and to RSVP 704-752-9346
  4. If you would like to learn about becoming a patient you can contact the office to talk to one of our patient care coordinators about how we may be able to help you.  Call at 704-752-9346,  email us at questions@signaturewellness.org, or contact us online here: https://local.demandforce.com/b/signaturewellnesscharlotte/schedule
Woman with Hairloss

Hair loss worrying you?  Lets do something about it. 

By | Blogroll, Hormones, Women's Health

10 Common Causes of Hair Loss in Women (And What You Can Do About It!)


Are you dismayed by how much hair you see in the hairbrush and shower each day?  Hair loss can be extremely devastating for women.  It is not uncommon for women to be in tears in the office because of emotional distress from their hair loss.  While women don’t typically lose all their hair, once shedding is underway baldness feels like a real possibility!  

Here are 10 common causes of hair loss.

 1.  Thyroid problems

Thyroid problems are a common cause of hair loss, especially in women.  Other symptoms associated with low thyroid function include:  fatigue, weight gain, constipation, feeling cold, depressed mood, anxiety, poor memory, loss of sex drive, dry skin, and dry/dull hair.  Standard thyroid blood tests may miss subtle thyroid problems, but even mild problems can cause distressing hair loss.  Many women who are being treated with standard thyroid hormone replacement continue to have symptoms despite treatment.  Fortunately, we can optimize thyroid function and achieve healthier, thicker hair.  


An over-functioning thyroid gland can also cause hair loss, so good thyroid balance is important! 

2.  Stress


Cortisol is your main stress hormone.  It is produced in your adrenal glands  to help you cope with stress. If cortisol levels  are abnormal, hair loss can result.  If you can reduce stress, your hair  loss may diminish, but you made need some help.  It is possible to measure  your cortisol level and while there are no prescription medicines to correct  this problem,  lifestyle changes and nutritional supplements can help.

3.  Menopause

Menopausal hormone changes can cause thinning hair (and thinning skin, and thinning bones….).  Restoring hormone levels with bio-identical hormone replacement can help improve the health of your hair (and skin, and bones!). 

4.  Prescription medications

Many drugs can contribute to hair loss in women, including the use of birth control pills.  The American Hair Loss Assocation (AHLA) recommends that women use a low-androgen index birth control pills to if they are genetically predisposed to hair loss.  Talking to your doctor about changing pills or choosing a non-hormonal birth control option may help to correct the problem.  .

5.  Pre-diabetes 

Diabetes, or even pre-diabetes may be associated with hair loss.   A holistic approach to managing blood sugar includes lifestyle changes, nutritional supplements, and weight loss.  This may help hair loss, as well as reduce the risks for some very serious longterm health issues.

6.  Nutritional deficiencies

While Americans are not typically malnourished, we tend to be nutritionally deficient due to poor quality food choices.  The food available at your grocery store may not have optimal vitamin and mineral content because of modern farming practices.   If you have symptoms such as gas, bloating, indigestion, heartburn, constipation or diarrhea, your ability to digest and absorb the nutrients in your food may be impaired.  Certain medications, such as antacids, can also impair your ability to digest nutrients.  Nutritional testing is available to determine whether this may be a problem for you.  One of the common nutrient deficiencies we see associated with hair loss is an iron deficiency.


7.  Chronic disease

If you have any chronic disease, hair growth may be slowed to help redirect your body’s resources to other areas to help promote healing.  In this case, hair loss is a symptom of another problem going on in your body, such as an auto-immune disorder or chronic inflammation.  Addressing the underlying problem should help your hair. 


8.   Androgenic Alopecia

This is the medical name for genetic hair loss (female pattern baldness)  This is hereditary and happens slowly over many years. Typically there is family history of baldness in male relatives and thinning hair in female relatives.  Women do not typically become completely bald.  The hair loss occurs even with normal levels of hormones so treatment for hair loss, such as a PRP (platelet rich plasma) treatment,  is frequently required to restore hair growth.

9.  Alopecia Areata

This is a medical condition where the immune system attacks the hair follicles, causing patches of hair loss.  This is much less common, but more difficult to manage.  The hair may not grow back on its own and may require treatment to restore hair growth.  PRP has been effective in helping with this type of hair loss.

 10.  Physical stress  

If you have any kind of physical trauma, such as a severe illness, a serious injury or surgery, this can trigger increased hair shedding.   The stressful event “shocks” the hair cycle temporarily, so less hair is shed around the time of the incident (you don’t notice this!).  When the hair cycle starts up again, more hair is lost all at once (so you notice the shedding!).  This typically happens 3-6 months later (which can be quite confusing!).  The good news is that this problem (called “telogen effluvium”) will resolve without treatment.


Tips to restore healthy hair growth!


Reduce stress.  Simplify your life if possible, and know that it is not always the AMOUNT of stress you are under that is the biggest factor, but how you ALLOW the stress to affect you that matters. 


Ensure hormonal balance – Take steps to restore hormone levels to optimal ranges.  Measuring your hormone levels and restoring normal hormone balance with natural, bio-identical hormone therapy can be life changing for women and has far more benefits than simply improving the health of your hair. 

Improve nutrition and optimize digestive health to allow better absorption of nutrients.  Eat whole foods including fruits and vegetables, avoid processed food and especially sugar.  Ensure that you are not iron deficient, and consider being tested for a full panel of nutrients. 

Get regular moderate exercise – exercise increases blood flow to the scalp and improves your overall health.  Since your hair is a reflection of your overall health, your nutrition and fitness level are important to hair health.

Take biotin, which is a B vitamin that can be helpful for hair and nails.  Our patients have found excellent results with RegeneMax Plus, which is a form of biotin with added silica (another nutrient important for hair).  This has worked better than standard biotin, and has quickly become one of our top selling supplements (people come back for more because they can see a difference!)


Consider PRP (platelet rich plasma) treatments.  PRP is appropriate for most woman concerned about hair thinning.  By the time the hair thinning is visible, approximately 50% of the hairs have been lost.  Most women are well aware far sooner – their pony tail is thinner, their part becomes wider and they can see the hair shedding.  PRP treatments will have the best effects on hair follicles that still have some function.  This innovative procedure has been featured on  ABC news .  


For best results, it is important to address your hair loss BEFORE it is in the advanced stages  So starting sooner rather than later is recommended.

If you would like more information or need help to correct your hair loss issues, please contact the office at 704-752-9346 or email us at questions@signaturewellness.org.  More information is available here.   

Yours in Health!

Dr.  Deb Matthew, MD

Woman with healthy skin from eating healthy

Skin Health and Hormones

By | Blogroll, Hormones, Women's Health

 Want healthy, youthful skin?  Hormonal balance is a must!

There are many factors important in keeping your skin healthy at all ages:  a diet rich in fruits and vegetables, drinking lots of water, and regular exercise.  Important factors you should avoid include sun damage, smoking, sugar and processed foods.  But did you know that there are also hormones that can affect your skin?


Estrogen has many important effects on your skin.  It retains moisture to prevent dryness, and helps maintain collagen and elasticity, to prevent fine lines and wrinkles.  It also helps to maintain the thickness of your skin, to prevent “crepey” skin.  There are more estrogen receptors in the skin of your face than on other parts of your body, so your face can show more obvious signs of aging with low estrogen levels. 

Estrogen replacement can increase your skin thickness and elasticity, increase collagen production and reduce fine lines and wrinkles.  If you are post-menopausal, you may notice significant improvements in your skin, including a healthier glow, when your estrogen levels are restored.   You can learn more about estrogen replacement here.


Testosterone is commonly thought of as the male hormone, but women have testosterone too.   This hormone can cause skin problems when it is too low OR too high! 

When testosterone levels are low,  skin tends to become thinner, droopier and more “crepey”.  Testosterone adds some oil to the skin, so loss of testosterone can cause aging skin to be more dry.

On the other hand, excess testosterone can cause excessively oily skin and adult acne, especially along the chin and jaw.


Progesterone is one of the hormones that regulates the menstrual cycle.  It also helps maintain skin thickness and elasticity.  Progesterone reduces some the negative effects of testosterone on the skin, so a lack of progesterone can worsen the effects of excess testosterone.


Hypothyroidism (low thyroid function) is often associated with dry skin.  Many other skin symptoms are also seen:  pale skin, dry bumps on the upper arms, puffiness around the eyes, scalp hair loss, loss of the outer third of the eyebrow,  dry and brittle hair.   


Cortisol is your main stress hormone.  Stress has been associated with skin problems like acne breakouts and thin skin.  Since cortisol regulates your immune system, stress can exacerbate rashes such as psoriasis and eczema, which are due to immune system problems.  There is actually a new area of study called psychodermatology looking at the links between skin health and emotional stressors. 

As you can see, there are many ways in which hormones affect your complexion.  If you are having skin issues and feel that hormones may be part of the problem, please give us a call!  704-752-9346 or email us at questions@signaturewellness.org.  You can find more information at www.signaturewellness.org

Yours in health,


Dr Deb Matthew, MD

woman experiencing bladder leaks

Do You Pee When You Laugh?

By | Blogroll, Women's Health

Do you sometimes leak urine when you laugh, cough, or sneeze?  Do you have to empty your bladder before your  exercise class to avoid embarrassing accidents?

simple, painless solution for sexual dysfunction and urinary incontinence: The O Shot

Many women lose urine when laughing, coughing, or exercising.  This is called stress incontinence, and is caused by a weakening of the muscles of the pelvic floor.  It can be due to the effects of childbirth, lack of hormones or aging.  It can lead to embarrassment and hygiene problems, and while we don’t generally talk about it, this is a very common problem.  One study estimated that 68% of women over 40 experience urinary leakage!

Another common problem is urge incontinence (when you have to go, you have to go NOW!)  Ever have the experience of trying get your door unlocked in a hurry so you could get in to the bathroom before it was too late?

Until now we did not have good solutions for these common problems, other than wearing a pad or having surgery.  The O-Shot has been a game changer in managing incontinence – it is non-invasive, simple, fast and relatively inexpensive, with virtually no risks. 

It starts with a simple blood draw.  We separate out the portion of the blood containing growth factors (the Platelet Rich Plasma  or PRP).  The PRP is injected into the clitoris and into an area in the roof of the vagina that is important for sexual function.  Don’t worry – the area is numbed prior to the procedure, so there is little to no discomfort!

The PRP activates stem cells in the area.  The stem cells get to work stimulating growth of muscle fibers,  blood vessels and nerves (like turning back the clock and making your tissues younger!).  This allows stronger muscles  and improved ability to prevent urine flow.  In many cases, the incontinence may be completely resolved.   

Another important effect of the O-Shot is improved sexual function.

Up to 50% of women experience sexual problems.  This may include lack of desire, vaginal dryness, loss of sensation, or discomfort during intercourse.  This is sometimes hard to talk about with your doctor, but now there is help!

While every woman’s response will vary, many patients report:

Increased sex drive

Greater arousal


Increased natural lubrication

Stronger orgasm

Decreased pain with intercourse

Decreased or resolved urinary incontinence


If you would like more information about how this procedure could help you, please call now at 704-752-9346 or email us at questions@signaturewellness.org and request your free consultation!

Yours in health, 

frazzled perimenopausal woman pulling her hair

Are You in Perimenopause?

By | Blogroll, Hormones, Uncategorized, Women's Health

Tired?  Irritable?  Over 35?  Maybe its your hormones!

Before you go through menopause, there is a period of time (starting around age 35) where things start to change. The changes can be subtle or not so subtle. We call this phase of life “perimenopause”, and it can be one of the most difficult transitions in a women’s life. Sadly, some women are told to tough it out and that it will pass. And often women are told that they are too young to be in perimenopause.

Addressing the hormonal symptoms of perimenopause can dramatically improve quality of life for many women. Lets talk about what is going on.

The two hormones that are involved in your menstrual cycle are estrogen and progesterone.  Estrogen levels start to drop when you are in your late 40s or early 50s (the average age of menopause is 52).  Progesterone levels start to decline much earlier.  In fact,  your progesterone  may drop by as much as 80% between age 30 and 40.  When progesterone levels start to decline because of age, and symptoms of hormone imbalance become noticeable, we call this “perimenopause”.

Progesterone levels decline after age 35

Progesterone levels naturally vary over your menstrual cycle, so the symptoms vary as well.  Typically the week after your period is a “good” week; you are eating your broccoli, exercising regularly, and cleaning out your closet.  Then as you get closer to your period,  symptoms get worse and worse – you may feel irritable, anxious, negative, critical, impatient, and easily frustrated – and this can affect how you behave towards your family and co-workers!  Other common problems before your period can be waking up at night, feeling more tired and having food cravings.

In fact, this variation in symptoms over the month is a big clue that hormones are the problem.  If your mood symptoms or insomnia are exactly the same on every day in your cycle, it is less likely that hormones are the cause.

Progesterone has mainly been studied for its effects on your uterus and monthly cycle.  As progesterone levels drop, menstrual cycles can start to change.  Your period may get heavier, your cycles may become shorter (less than 28 days), and you may have more PMS symptoms.

It turns out that progesterone has other important roles to play besides regulating your period.   You have progesterone receptors on cells in all parts of your body, and surprisingly,  the cells with the most progesterone receptors are your brain cells.  (If you have PMS symptoms with mood swings and irritability you may not be surprised at all!)  Progesterone is naturally calming and helps with sleep.  It is sort of like nature’s version of valium or a glass of red wine.

Symptoms of perimenopause

Here is a checklist of symptoms that you may experience if your progesterone levels are dropping:

  • Insomnia
  • Night sweats
  • Anxiety
  • Irritability
  • Mood swings
  • Weight gain
  • Increased PMS
  • Pre-menstrual headaches
  • Heavier periods
  • Shorter cycles (periods coming less than 28 days apart)
  • Irregular periods

If this sounds like you, please know that there is help!   You can feel like YOU again!  To learn more click here

You can find more information at our website www.signaturewellness.org or contact the office at 704-752-9346 or questions@signaturewellness.org.

After all, living well is the best medicine!

Dr Deb Matthew, MD