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We have all heard of it and many of us suffer from it…PMS or Pre-Menstrual Syndrome.  Symptoms such as bloating, hunger, headaches, and moodiness can begin anywhere from 5 to 11 days before menstruation.  Most women (about 90%) get some sort of PMS symptoms each month and this is especially true for women in their 30s.

What are the symptoms of PMS?

Physical symptoms of PMS can include:

  • Swollen or tender breasts
  • Bloating or a gassy feeling
  • Cramping
  • Headache or backache
  • Constipation or diarrhea

Emotional symptoms of PMS can include:

  • Mood swings
  • Irritability
  • Increased appetite or food cravings
  • Feeling tired
  • Sleeping too much or too little
  • Trouble with concentration or memory
  • Tension or anxiety
  • Depression, feelings of sadness, or crying spells
  • Less interest in sex

How/why does PMS occur?

After ovulation, progesterone and estrogen increase to prepare the uterus for pregnancy.  If pregnancy does not occur, these levels begin to decline quickly.  It is the decrease in progesterone that triggers symptoms such as the increased craving for chocolate and the mood swings.

How do I test for PMS?

A qualified bio-identical hormone replacement center can do a simple blood draw to test your hormone levels (preferably on days 19-21 of your cycle).  This test and your symptoms will let your doctor know how to treat you.

How can I treat PMS?

Once your labs results have come back, your doctor may want to prescribe you supplemental progesterone for all or part of your monthly cycle.  This increase in progesterone can combat many of the physical and emotional symptoms of PMS.

What can I do at home to help control PMS?

  • Exercise—this helps your body deal with stress and releases endorphins that help create a positive mood.
  • Get enough sleep—sleep is critical to your body’s ability to deal with stress and succeed in repairing any cellular damage that occurs during the day.
  • Eat healthy—make good food choices (at least most of the time).  Meat, veggies, and fruits should makeup the bulk of your diet.

Dr. Melissa Miskell is the Medical Director of Hormones by Design, a bio-identical hormone replacement center in Waco and Boerne, Texas.  Her highly trained Nurse Practitioners have been treating hormone patients for more than 10 years and are accepting new patients.  In Waco call (254) 230-4225 to schedule with Women’s Health Nurse Practitioner, Suzy Hancock.  In Boerne call (830) 981-9540 to schedule with Family Nurse Practitioner, Nancy Beebe.


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Time flies the older we get.

It feels like one day we are chasing toddlers and the next we are nearing menopause. Two common symptoms that usher in this phase of life are hot flashes and night sweats.  For most women, establishing care with a qualified bio-identical hormone center makes these symptoms more manageable.

However, there are patients that cannot take bio-identical hormones (or simply do not want to).  What can those patients do? Here are some natural options for alleviating the frequency and severity of hot flashes and night sweats.

  1. Exercise Many scientific researchers have proven that exercise stimulates the release of feel-good hormones called endorphins. Brisk walking, jogging, and swimming are good aerobic activities that can help release tension in the body and mind.
  2. Relax and Mediate Practice deep abdominal breathing. Sit in a quiet spot to inhale and exhale slowly for just 15 minutes. Controlled breathing (characterized by slow and deep breaths) can calm and relax the body.  Waking up in the middle of the night because of night sweats?  Using this technique may help calm you.
  3. Keep a Diary – Keep track of the time of episodes, the stress level or emotional state when it occurs, food and drinks consumed prior to occurrence, clothing worn, sleeping conditions (if it’s a night sweat), activities done and other elements that might have triggered the episode.  This can help you avoid those triggers.
  4. Supplements – There are pharmaceutical grade supplements available that will help you through these symptoms.  For example, I recommend Xymogen’s Femquil.  This supplement helps your body deal with xenoestrogens (hormone disrupting compounds found in the environment) and promotes healthy hormone balance.  (More on Xymogen below).

You can try one or all these options.  They are all safe and do not involve the use of hormones.  Need more information on what you can do to help with your hormonal symptoms?  You can still see a qualified bio-identical hormone center.  On occasion, problems with your thyroid can cause symptoms like hot flashes or night sweats.  A simple blood test can help your doctor determine what you need (whether vitamin or prescription) and how much.

Interested in ordering the Femquil mentioned here?  Xymogen provides our pharmaceutical grade supplements we use in the office.  Simply go to Xymogen.com, Patients, Xymogen Xpress, and register.  Call or email our offices to get your Referral Code.  Physician Code is always: Miskell.

Dr. Melissa Miskell is the Medical Director of Hormones by Design, a bio-identical hormone replacement center in Waco and Boerne, Texas.  Her highly trained Nurse Practitioners have been treating hormone patients for more than 10 years and are accepting new patients.  In Waco call (254) 230-4225 to schedule with Women’s Health Nurse Practitioner, Suzy Hancock.  In Boerne call (830) 981-9540 to schedule with Family Nurse Practitioner, Nancy Beebe.


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4 Common Activities that Trigger Hot Flashes

Yep, you know you are having a hot flash when you feel like you are going to spontaneously combust.  Nothing sounds better than standing in front of the open freezer door (and even then, that is not cool enough).  Well, there are some things in life that promote hot flashes.  If at all possible, you should try to minimize doing these things…

  • Drinking alcohol—I know, that glass of wine at the end of the day is one of the ways you relax.  I understand!  However, alcohol can trigger a histamine response in many women (you can see this when your cheeks start to get flushed after drinking).  This histamine response can also trigger a hot flash.  Try to limit your alcohol consumption and take a supplement like Xymogen’s Hist DAO before drinking.  (More on Xymogen below)
  • Eating spicy foods—Mexican, Thai, or Chinese…all these foods tend to be spicy.  Consumption of spicy foods tends to make you flush and sweat, leading to increased hot flashes.  Limit your consumption of spicy foods when possible.
  • Smoking—If you needed one more reason to quit, here it is.  Smoking increases hot flashes.  However, if you have a genetic predisposition to poor estrogen metabolism and increased sensitivity to environmental toxins smoking can make menopause in general more severe.  Consider kicking the habit.
  • Getting overheated—By this I mean getting overheated with no real way to cool down effectively.  Painting in a hot room with no air conditioning, or just being outside during a summer day in Texas.  Once you start the sweating and flushing, a full-blown hot flash can follow.  Try to plan these activities when the temperatures are not soaring.

avoid spicy foods to avoid hot flashes

One thing to always consider when dealing with hot flashes is when to see a hormone specialist.  Remember you don’t have to suffer.  Bio-Identical hormones can help replenish your levels to where you feel good again!  A simple blood test can tell your hormone doctor what you need to be taking and how much.Dr. Melissa Miskell is the Medical Director of Hormones by Design, a bio-identical hormone replacement center in Waco and Boerne, Texas.  Her highly trained Nurse Practitioners have been treating hormone patients for more than 10 years and are accepting new patients.  In Waco call (254) 230-4225 to schedule with Women’s Health Nurse Practitioner, Suzy Hancock.  In Boerne call (830) 981-9540 to schedule with Family Nurse Practitioner, Nancy Beebe.

Want to order some of the Hist DAO mentioned above? You can order pharmaceutical grade supplements through Xymogen Xpress.  Simply go to Xymogen.com, Patients, Xymogen Xpress, and register.  Call or email our offices to get your Referral Code.  Physician Code is always: Miskell.


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By now most people have at least heard about hormone replacement.  But how do you know if you need it?  Well, here are five distinct signs that hormone replacement could benefit you.

  1. Hot Flashes – If you have ever had one, you KNOW what I am talking about.  When it feels like your entire body is going to ignite and you need to stand in front of the open freezer, you are experiencing a hot flash.  This is a sure sign that your hormones are changing, and you need to investigate hormone replacement.  You don’t have to put up with this…it can be fixed.
  2. Night Sweats – Can sometimes go hand-in-hand with hot flashes but waking up with your nightgown soaking wet doesn’t have to be tolerated.  Not only is this a huge nuisance, it will inevitably interfere with your sleep, causing all the health issues that correspond with sleep deprivation as well.
  3. Weight gain – Yes, getting “thicker around the middle” can be related to hormone imbalance.  Particularly for women, weight gain is usually in the abdominal area.  Thyroid can also play a role in weight gain and should be checked along with hormone labs.
  4. Fatigue – Remember how much more energy you had when you were in your 20s?  Well, part of that energy was due to your increased hormone levels during that time.  Hormone replacement (in particular Bio-Identical Hormone Replacement) can help to replenish these hormone levels and get back the “pep in your step!”
  5. Lack of Sex Drive – Don’t be afraid to admit it…you may be apathetic about sex.  Not really wanting or caring if you have sex is a sign that your hormones levels are declining.  Women need testosterone too (in much smaller doses than men) in order to help keep their sex drive active.  If you find yourself just not in the mood, you need to see a qualified hormone replacement doctor.  Believe me, your significant other will thank you.

There are multiple other signs and symptoms that hormone replacement can help alleviate.  However, if you currently have any one of these five, you should see a doctor.  A simple blood test can show the levels of all your hormones and thyroid.

Dr. Melissa Miskell is a bio-identical hormone replacement expert who has been practicing for 18 years, and is the Medical Director of Hormones by Design in Waco, Texas. Suzi Hancock is a Women’s Health Nurse Practitioner that will love to see you in our Waco office! Hormones by Design is currently accepting new patients at (254) 230-4225.


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Although almost every woman learned about her menstrual cycle from other women in her life or in health class, menopause is rarely discussed even among the closest friends. With over 25 million search results for “symptoms of menopause” in Google, it is clear that most women seek information about menopause on the internet before turning to a doctor for confirmation.

For many women, the traits of menopause come as a gradual onset of slight body changes. Other women experience menopause like the last scene of “Invasion of the Body Snatchers” with brilliant hot flashes or night sweats.

The most common signs reported by women in perimenopause are night sweats and hot flashes, but other physical warning signs can be hard to connect to menopause because most women experience these maladies throughout their lifetime.

Some of these menopause indicators include:

  1. Fatigue: As mothers, wives and professionals, all women know fatigue as their friend every day, but the fatigue that comes with menopause is sometimes accompanied by a depression that makes the simple act of getting out of bed too much to accomplish. Suddenly, a woman can go from tired at the end of the day to completely without strength before the day even starts.
  2. Breast Tenderness (or general changes): Any woman that has experienced her period knows the signs of breast tenderness. Like that favorite bra that will not fit right for a few days out of the month, breast tenderness is a constant indicator of menopause as well as PMS. Anytime breast changes are noted, a doctor should be consulted to rule our breast cancer, but breast tenderness at non-PMS times can be a suggestion by the body that menopause is on the way.
  3. PMS: Notice that the letters do not change? Whether discussing pre-menstrual syndrome or perimenopause symptoms, the signs of menopause can mirror PMS. The first changes most women notice is a worsening of PMS mood swings, change in the length of periods or flow of periods, and an on-going inability to focus.
    Lower Sex Drive: All women encounter times when they are just “not in the mood;” however, by their mid-thirties, most women know themselves enough sexually to know when their sex drive shifts. If a woman goes from “not tonight” to not in recent memory, especially in a relationship where intimacy usually exists, then a lower sex drive might be a signal of menopause.
  4. Bladder Leakage: With the decrease of Estrogen and other female hormones, women sometimes experience bladder leakage when laughing, coughing, or sneezing. While sending women searching for the middle ground between a maxi-pad and Depends, bladder leakage can be an indicator that menopause is around the corner.
  5. Vaginal Dryness: As Estrogen declines, many women experience vaginal dryness due to the thinning of the vaginal walls and decrease in lubrication as a part of their journey into menopause. Sometimes, the decrease in lubrication can lead to painful sexual intercourse, which may in turn trigger low sex drive.

 

The easiest way to determine if the symptoms are indicators of perimenopause or the onset of menopause is to visit a doctor and have your blood tested. Many women put off visiting a BHRT doctor, who specializes in bioidentical hormone replacement, once they notice the indicators because they are embarrassed or concerned about the next step.

The best way to find out the truth is to make an appointment with a qualified healthcare provider that specializes in BHRT to guide you through each step of menopause and help maintain your current quality of life.


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The term “bio-identical hormones” has been bantered about by alternative medicine physicians for years. Suzanne Sommers brought the concept to millions of women through her multiple publications. It can be quite confusing, however. You do not have to be 50ish to be symptomatic. Many people begin to have symptoms such as insomnia, mood swings, decreased sex drive, apathy, and foggy thinking as early as 35. Women make estrogen, progesterone, and testosterone. Progesterone and estrogen are the primary female hormones. They are made in the ovaries and are the reason that women have a monthly cycle, become pregnant (well, not the reason, but they allow it to happen), and feel like a woman. The decrease in these hormones marks the onset of menopause.

For women, progesterone is the first hormone to start to decline in concentration. The reason for this is because progesterone is only produced in the ovaries, whereas estrogen and testosterone are also made in the adrenal glands and fat cells. The production of hormone from the ovaries begins to decline after the age of 30. This is why peak bone mass occurs at age 31 and then declines. Since progesterone is only made in the ovaries, women may begin to feel the effects of this decline well before they actually go through menopause.

For women, there are 3 basic categories to hormone replacement. The first, is over-the-counter plant based formulas. These are comprised of phytoestrogens derived from plants such as soy, wild yam, or black cohosh. These molecules will weakly bind to hormone receptors. The second category is comprised of pharmaceutical hormones. Examples of these would be Premarin and Provera. Premarin is derived from Pregnant Mare Urine and is therefore conjugated equine estrogens (currently all the estrogens have not been identified). Provera is a completely synthetic molecule, not found in nature. These molecules will bind to the receptor, but have excess atoms that can be detrimental. This was shown in The Women’s Health Initiative Trial which proved that Premarin and Provera increased the risk of breast cancer and heart disease. The third category is bio-identical hormones. These are compounds that are the exact molecular makeup of the hormones produced by the ovaries. They fit the hormone receptors perfectly and do not cause cancer.

It should be noted that cancer is caused by free radicals. Free radicals are caused by radiation, pollutants, heavy metals, cigarette smoke, etc…not hormones produced naturally by your body. Now, do not mistake, there are some cancers that are estrogen and/or progesterone receptor positive. Your own natural hormones or bio-identical to your own natural hormones will cause these cancers to grow. But they do not cause the cancer.

In short, bio-Identical hormones can be compounded to fit your exact needs. Testing should be done to determine the concentration of hormone in your body and then a specific combination of hormone can be compounded to improve your quality of life and promote healthy aging.


There are hundreds of clinics attempting to treat hormone imbalance. What makes us different? We listen, then we take action. Our business model makes it possible for us to start your treatment on day one. Faster treatment = feel better faster.

Copyright by Hormones By Design 2019. All rights reserved.