Sky Women's Health

Episode 253: The Hormone Question I Answer Multiple Times a Day: Progesterone vs. Progestins

Is progesterone the same as a progestin? It sounds like it should be. It is absolutely not. And that distinction matters more than most women — and many providers — realize. This is the conversation Dr. Carolyn Moyers has multiple times a day in clinic — especially with women in perimenopause who are trying to understand their options, figure out why a previous hormone regimen made them feel worse, or advocate for a prescription that actually fits their biology. It is also one of the most consequential mix-ups in all of menopause medicine, and it is long overdue for a dedicated episode. Bioidentical progesterone and synthetic progestins are not interchangeable. They have different molecular structures, different receptor profiles, and meaningfully different effects on your breast tissue, your cardiovascular system, your sleep, and your brain. The WHI study — the one that scared a generation of women off hormone therapy — tested a synthetic progestin, not bioidentical progesterone. And the breast cancer finding it reported was not even statistically significant. That context has been almost entirely missing from the public conversation. Until now. In this episode: • What bioidentical progesterone actually is — and how it differs from synthetic progestins at the molecular level • The WHI study: what it actually tested, and why its results have been misapplied for 20+ years • Breast cancer risk: the ESTHER study and what the evidence actually shows • Cardiovascular differences between progesterone and MPA (Provera) • Why progesterone is a neuroactive steroid — and what that means for your sleep, anxiety, and mood • Uterine protection: what it is, why it matters, and whether bioidentical progesterone is sufficient • What to do if you don’t have a uterus — and whether you still need progesterone • Perimenopause: why the progestogen conversation is completely different when you still have cycles, variable ovarian function, and potentially need contraception • The levonorgestrel IUD, norethindrone acetate 5mg vs. the minipill, and Slynd (drospirenone 4mg) — what each one does and who it’s for • Exactly how to advocate for yourself at your next appointment Resources mentioned: • ESTHER Study (Fournier et al.) — progesterone vs. MPA and breast cancer risk • Women's Health Initiative (2002) • Prometrium prescribing information • Labia Logic (@labialogic) — vulvovaginal specialists | Memorial Day vulvar health post: instagram.com/p/DYqK9uvj2M8 [https://instagram.com/p/DYqK9uvj2M8] • Sky Women’s Health Podcast — Episode 158: Progesterone Intolerance | podcasts.apple.com/gb/podcast/episode-158-progesterone-intolerance/id1541657642?i=1000640152675 [https://podcasts.apple.com/gb/podcast/episode-158-progesterone-intolerance/id1541657642?i=1000640152675] Work with Dr. Moyers: skywomenshealth.com [https://skywomenshealth.com/] | In-person: Fort Worth, TX | Virtual: Texas & West Virginia 🔗 Connect with Dr. Carolyn Moyers 📸 Instagram: @drcarolynmoyers [https://www.instagram.com/drcarolynmoyers/] 🎥 YouTube: @drcarolynmoyers [https://www.youtube.com/@drcarolynmoyers] 🌐 Website: www.skywomenshealth.com [https://www.skywomenshealth.com/] Sky Women's Health Podcast is for educational purposes only and does not constitute medical advice. Please consult your own provider for personalized care.

Episode 252: Ask Me Anything: Hormones, Sexual Health, and Midlife Myths Debunked

You asked — Dr. Moyers answered. In this Ask Me Anything episode, Dr. Moyers — board-certified OBGYN, Menopause Society Certified Physician, and Fellow of the International Society for the Study of Women’s Sexual Health — tackles 18 of the most pressing questions she hears from midlife women every day in her clinic. From hormone therapy and blood clots to low libido, vaginal changes, bladder leaks, and medications for desire — no topic is off limits. If you’ve ever left a doctor’s appointment feeling dismissed, unheard, or more confused than when you walked in, this episode is for you. In This Episode • What to do when you’re on hormone therapy and still have symptoms • CombiPatch and progesterone — is it safe? • Blood clots and hormone therapy — is it really off the table? • Breast cancer and hormone therapy — the nuanced truth • Bioidentical vs. conventional HRT — what’s the difference? • How to know if you’re in menopause when you have an IUD and no period • Options to stop heavy perimenopausal bleeding without a hysterectomy • Why normal hormone levels don’t always mean you feel normal • Postmenopausal bleeding — what it means and what to do • Low libido and vaginal dryness — there is more than lube • How labia change during menopause and what a proper vulvar exam should include • How Addyi works in the brain and its interaction with antidepressants • Testosterone in women — normal levels, superphysiologic levels, and side effects 🔗 Connect with Dr. Carolyn Moyers 📸 Instagram: @drcarolynmoyers [https://www.instagram.com/drcarolynmoyers/] 🎥 YouTube: @drcarolynmoyers [https://www.youtube.com/@drcarolynmoyers] 🌐 Website: www.skywomenshealth.com [https://www.skywomenshealth.com/]

Episode 251: What Every Woman in Menopause Needs to Know About Dementia Prevention

Two-thirds of dementia cases are women. Two-thirds of caregivers are women. And the brain changes that lead to dementia begin 20 to 30 years before symptoms appear — which means, for most women, that window falls directly during the menopausal transition. That's not a coincidence. It's a clinical reality that neurologist Dr. Ashanthi Gajaweera has built her entire practice around. Dr. Gajaweera is the founder of Healthspan Neurology PC in New York and one of a rare few clinicians who holds dual expertise as a board-certified neurologist and a Menopause Society Certified Provider. With 25+ years of clinical experience, she specializes in cognitive longevity and dementia prevention — with a particular focus on women. In this episode, we cover: • Why dementia is, above all else, a women's disease — and what that means for prevention • What is actually happening in the menopausal brain — and why it matters • The 14 modifiable risk factors identified by the Lancet Commission — and the four critical factors specific to women that don't appear on that list • Why the menopausal transition is the most powerful window a woman has to protect her brain • Evidence-based strategies you can start now The brain is resilient. The window is open. This episode will show you what to do with it. 🔗 Connect with Dr. Carolyn Moyers 🔗 Connect with @dr.gajaweera on YouTube, Instagram, LinkedIn www.healthspanneurology.com [www.healthspanneurology.com ] 📸 Instagram: @drcarolynmoyers [https://www.instagram.com/drcarolynmoyers/] 🎥 YouTube: @drcarolynmoyers [https://www.youtube.com/@drcarolynmoyers] 🌐 Website: www.skywomenshealth.com [https://www.skywomenshealth.com/]

Episode 250: Shift from Surviving to Thriving: Your Nervous System Reset

Did you know that declining estrogen weakens your body's natural ability to buffer stress? Dr. Moyers and yoga therapist Tatiana Miller (Rx4Life) explain exactly what happens to your stress response in perimenopause and menopause — and what you can do about it today. No overwhelm. No jargon. Just real science, simple tools, and a conversation that might make you feel seen for the first time in a while. Mentioned in this episode: Shift from Surviving to Thriving — a Nervous System Reset & Restore Day at Sky Women's Health. Sunday, May 31 | Fort Worth, TX. Spots are limited. Register here: https://luma.com/pt71wg1v [https://luma.com/pt71wg1v] 🔗 Connect with Dr. Carolyn Moyers 📸 Instagram: @drcarolynmoyers [https://www.instagram.com/drcarolynmoyers/] 🎥 YouTube: @drcarolynmoyers [https://www.youtube.com/@drcarolynmoyers] 🌐 Website: www.skywomenshealth.com [https://www.skywomenshealth.com/]

Episode 249: Elevated Ferritin in Menopause: It's Not Just About Iron

Your ferritin lab came back flagged. Your doctor said "don't worry about it." But what if it's actually telling you something important? At Sky Women's Health, we noticed something in our own practice data: an unusually high proportion of healthy perimenopausal and postmenopausal women were coming back with elevated ferritin. Our pathologist dug into the numbers. The answer had everything to do with menopause. In this episode, I break down: • What ferritin actually measures (it's more complicated than "iron stores") • The estrogen-hepcidin-iron axis — and why it shifts dramatically in perimenopause • Why ferritin rises 3.46x after the final menstrual period — and keeps rising • Why elevated ferritin in midlife women can signal fatty liver and metabolic syndrome, not just iron overload • The honest truth about the "optimal ferritin 30–50" target promoted in some menopause circles — what the evidence supports, and what it doesn't 🔗 Connect with Dr. Carolyn Moyers 📸 Instagram: @drcarolynmoyers [https://www.instagram.com/drcarolynmoyers/] 🎥 YouTube: @drcarolynmoyers [https://www.youtube.com/@drcarolynmoyers] 🌐 Website: www.skywomenshealth.com [https://www.skywomenshealth.com/]