Histamine Well Podcast: Exploring Histamine, Methylation & Holistic Health · Joanne Kennedy

32. Hormone Replacement Therapy in Perimenopause: Interview with Rachel Schaefer

·1 hr 14 min·4 clips

Most women in perimenopause need hormone testing, not a fixed protocol, because estrogen can swing from high highs to low lows.

1. Histamine Well Podcast: Exploring Histamine, Methylation & Holistic Health episode 32 centers on hormone replacement therapy in perimenopause. 2. Joanne Kennedy hosts the episode as a naturopath, author, and educator, and Rachel Scheiffer joins as founder of Ginkgo Integrative Medicine in California with over two decades of clinical experience. 3. The episode asks how HRT can be used safely and individually when perimenopause brings rapid hormone swings, sleep disruption, mood changes, fatigue, and histamine reactions. 4. Rachel describes perimenopause as unfolding in two phases, with the first marked by reduced ovarian reserve and lower progesterone as ovulation becomes less reliable. 5. She says the second phase is late perimenopause, when estrogen starts to decline after first becoming erratic, and she compares the last bit of estrogen to “the rest out of a ketchup bottle.” 6. Rachel links rising FSH to the brain’s attempt to push the ovaries to make more estrogen, which makes hormone patterns hard to read without context. 7. She says progesterone supplementation, Vitex, herbs, and nutrients are often part of early support when progesterone falls before estrogen does. 8. Joanne and Rachel tie estrogen dominance to breast tenderness, fluid retention, mood changes, heavier periods, longer bleeds, clotting, and incomplete bowel movements. 9. Rachel also connects estrogen dominance to endometriosis and adenomyosis, which she says are common pathology examples of estrogen imbalance. 10. The conversation brings in methylation by linking estrogen metabolism, COMT, histamine symptoms, and Joanne’s MoodSense testing approach. 11. Rachel explains that oral micronized progesterone is usually started around 100 milligrams and often increased to 200 milligrams when estrogen is on board. 12. She says oral progesterone is converted in the liver to allopregnenolone, which can act through GABA and create sleepiness, relaxation, or spaceiness. 13. Rachel notes that some women with histamine issues, MCAS, or hypermobility syndrome may find that sedating effect too strong because of an existing glutamate-GABA imbalance. 14. She says vaginal progesterone can be useful when oral progesterone is not tolerated and can be more directly progesterone-dominant without as much allopregnenolone conversion. 15. Rachel distinguishes vaginal progesterone from progesterone cream and says cream does not provide uterine protection when estrogen is being used. 16. The episode also covers estrogen delivery methods, including patches changed twice a week, compounded cream, and EVA mist, with humidity, sweating, and sauna use affecting absorption. 17. Rachel and Joanne sound highly conversational and clinically detailed, with frequent examples from their own practice and personal hormone experiences. 18. The pace is practical and reflective, with both women using patient stories, mechanism talk, and testing examples such as serum progesterone, Dutch testing, Mira, and annual DEXA scans. 19. Women in perimenopause who want individualized HRT, hormone testing, and histamine-aware care would likely value this episode. 20. Listeners wanting a simple menopause overview without biochemistry or testing detail could skip it.

As heard by us

A measured take on perimenopause that keeps HRT tied to individual symptoms, follow-up, and real-world judgment.

The episode treats perimenopause as a shifting stretch of hormonal swings and mixed signals, not a neat diagnosis with one clean answer. HRT comes through as something that has to be tailored, with dose and follow-up adjusted to the person rather than handed out as a standard…

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Why you'd press play

If your hormones feel like they changed the rules overnight, start here.

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