The DB GLOW

PERIMENOPAUSE: Your periods haven’t stopped. But something has changed.
Sleep disrupted. Brain fog creeping in. Your cycle becoming unpredictable.

Could it be perimenopause?
This transition towards menopause usually begins in your 40s, sometimes earlier, and can last several years.

Know the clues:
* Changing periods: Cycles becoming shorter, longer or less predictable. A change in your usual pattern is a key clue.
* Hot flashes and night sweats.
* Disrupted sleep, irritability, anxiety or low mood.
* Brain fog: Trouble concentrating or finding the right word.
* Vaginal dryness, reduced s*xual desire, and joint or muscle aches.
Every woman’s experience is different. These symptoms can also have other causes, so recognising the pattern and getting an appropriate assessment matters.

You don’t have to wait until your periods stop to get educated and to seek help.
What is happening to your hormones? How can it affect your sleep, brain, heart and s*xual health? And which treatments actually help?

Join us for the menopause sessions at the Masters of Medicine Conference on January 17, 2027. Understand the changes. Explore the evidence. Know your options.

* Nichols AR, Chavarro JE, Oken E. Reproductive risk factors across the female lifecourse and later metabolic health. Cell Metabolism, 2024
* Hamoda H, Moger S, Morris E, et al. Menopause Practice Standards. Clinical Endocrinology, 2024.

The American College of Obstetricians and Gynecologists recommends systemic MHT as a first-line treatment for menopausal vasomotor symptoms (VMS) and VMS-related sleep disturbance in patients without contraindications. The regimen is estrogen plus a progestogen if the uterus is intact, or estrogen alone if endometrial protection isn’t needed (strong recommendation, moderate-quality evidence).

This comes from ACOG’s November 2026 clinical practice guideline on managing menopause-related vasomotor, sleep, and mood symptoms.

Other societies: ACOG’s position matches The Menopause Society and the Endocrine Society, which both endorse hormone therapy as first-line treatment for VMS.

ACOG Clinical Practice Guideline: Management of Menopause-Related Vasomotor, Sleep, and Mood Symptoms
American College of Obstetricians & Gynecologists’ Committee on Clinical Practice Guidelines–Gynecology

Obstetrics & Gynecology 148(5):p e345-e369, November 2026. | DOI: 10.1097/AOG.0000000000006428

Serve from your overflow. Dainia Baugh, MD, FRCP, Edin - Menopause | Medical Aesthetics

Putting the data where my mouth is. 😂

EVERY SINGLE means of weight loss even diet alone causes muscle loss.
All GLP-1s can cause muscle loss but clinical data does not show that GLP-1 medications cause worse proportionate muscle loss than standard dieting. The fraction of weight lost as fat-free mass (FFM) is broadly comparable to very-low-calorie diets.
However, because the total weight dropped is so massive and rapid, the absolute amount of muscle lost is greater.

This makes muscle-sparing protocols absolutely critical.

Where GLP-1s differ is that they produce large, rapid weight loss, so the absolute lean/muscle mass lost is larger than with modest lifestyle change. Modest lifestyle change, however, does NOT approximate the fat loss of GLP1s, nor does it approach the impact on multiple disease processes. STAY TUNED for a post on this particular point.

HOW TO GET MOISTURE BACK DOWN THERE 💧
Vaginal dryness after menopause is common. But common does not mean you have to live with it.
As estrogen levels fall, the tissues of the va**na and v***a can become thinner, drier and less elastic. You may notice:
• Dryness or burning
• Irritation or itching
• Pain with s*x
• Tiny tears or spotting after s*x
• Urinary urgency or burning
• More frequent UTIs
• A feeling that things are simply… not the same down there
This is part of what we call Genitourinary Syndrome of Menopause (GSM), and unlike hot flashes, it often doesn’t simply go away with time.
So, how do we get the moisture back?
💧 START WITH A VAGINAL MOISTURIZER
This is different from lubricant. A va**nal moisturizer is used regularly to help maintain hydration and comfort.
💦 USE LUBRICANT FOR S*X
Lubricant reduces friction during s*xual activity. Water- and silicone-based products are good options. If dryness is significant, silicone-based lubricants often last longer.
🌸 LOW-DOSE VAGINAL ESTROGEN
va**nal estrogen is one of our most effective treatments. It helps restore the va**nal tissue itself, improving thickness, elasticity, lubrication and comfort.
It is available as creams, tablets/inserts and va**nal rings.
And an important point: low-dose va**nal estrogen is not the same exposure as taking systemic hormone therapy.Very little estrogen is absorbed into the bloodstream with standard low-dose preparations.
🌿 ANOTHER OPTION: VAGINAL DHEA
Prescription va**nal DHEA (prasterone) can also improve va**nal dryness and painful in*******se in appropriate patients.
💊 THERE’S ALSO A NON-HORMONAL PRESCRIPTION OPTION
Ospemifene is an oral medication that can be considered for some women with moderate-to-severe va**nal dryness or painful s*x.

Moisturize. Lubricate. Treat the tissue when necessary #. And talk about it.
Because va**nal health is health. 💧
Menopause WomensHealth

“I stopped my GLP-1. My Doc didn’t insist I shouldn’t. I’m sooo hungry, What now?”

A : GLP-1s can generally be stopped outright with no medication “withdrawal” etc.
The harder issue is what happens after cessation, particularly if the drug was being used for obesity/weight management.

Weight regain after stopping a GLP-1 is expected, biologically driven, and not a failure of willpower. Patients can regain about two-thirds of the weight lost within a year of stopping GLP-1s, with reversal of the blood pressure, glucose, and lipid improvements gained.
🗣️🗣️🗣️This is physiology, not failure.

Importantly, the first ~6 months after cessation is the critical window when most regain occurs, so acting promptly matters.

💫One encouraging point: a portion of the benefit - roughly a quarter of the initial loss- tends to be sustained, so patients usually remain below their pre-treatment weight.

Ask your Doctor to discuss the physiology of weight loss and regain with you. What exactly is happening? Which hormones are triggering the counter-regulatory response, and to discuss treatment options designed for you. 🤓

Season 2 - Car Chronicles. 👀. Drop your questions below or in the DM. medicine are all fair game. Ask away!

Do I HATE pellets for HRT? 🫣.