Sherrie Koenigseder, MSN, APRN, NP-C

12/13/2025

When You Don’t Have Healthy Emotional Boundaries, Your Body Feels It

Many people think boundaries are about being “firm” or “confrontational.”

In reality, healthy boundaries are a form of self-care—and when they’re missing, the body often shows signs long before the mind recognizes the problem.

What are emotional boundaries?
Emotional boundaries define where you end and others begin. They help you:

Protect your time and energy

Say no without guilt

Take responsibility for your own emotions—but not everyone else’s

When boundaries are weak, people often live in a constant state of over-functioning.

Signs You May Not Have Healthy Boundaries

You might struggle with boundaries if you:

Feel responsible for how others feel

Say yes when you want to say no

Avoid conflict at all costs

Feel resentful but don’t express it

Replay conversations in your head later

Feel exhausted even when life “looks fine”

These patterns are common in caregivers, parents, high achievers, and those who learned early in life to keep the peace.

How Lack of Boundaries Affects the Body

Chronic boundary stress keeps the nervous system in a low-grade fight-or-flight state, which can contribute to:

⚠️ Jaw clenching or teeth grinding
⚠️ Neck, shoulder, or back tension
⚠️ Headaches or migraines
⚠️ Fatigue or burnout
⚠️ GI symptoms (bloating, IBS-type symptoms)
⚠️ Sleep disturbances
⚠️ Anxiety or irritability

This isn’t “all in your head.” It’s the body responding to prolonged stress signals.

Why This Happens

Many people were never taught healthy boundaries. Instead, they learned:

Love equals compliance

Saying no causes guilt or rejection

Needs should come last

Being strong means not needing help

The body adapts by staying alert, tense, and controlled—even when rest is needed.

What Healthy Boundaries Actually Look Like

Healthy boundaries sound like:

“I can’t do that right now.”

“Let me think about that and get back to you.”

“That doesn’t work for me.”

“I’m allowed to take care of myself.”

They are calm, respectful, and consistent—not aggressive or selfish.

Healing Starts with Awareness

You don’t fix boundaries overnight. Healing begins with:

Noticing where your body holds tension

Paying attention to resentment as a signal

Practicing small, low-risk boundaries

Learning to tolerate discomfort when others are disappointed

As boundaries improve, many patients notice less tension, better sleep, improved energy, and fewer stress-related symptoms.

Educational content only. Not intended to diagnose or treat medical conditions.

12/11/2025

Please reach out to your FL representative to express support of this bill.

12/11/2025

Please sign and share this petition to help secure patient access to compounded medications.

Stop the SAFE Drugs Act: Protect patient access to life saving GLP-1 treatment

12/09/2025

The Real Signs of Low Ferritin (Low Iron Stores)

Fatigue, hair thinning, brittle nails, headaches, cold intolerance, shortness of breath, or restless legs?
Your ferritin may be low — even if your hemoglobin looks “normal.”

A simple blood test gives you answers. Low ferritin is treatable, and I can help.

How to Improve Ferritin Naturally

✔️ Eat iron-rich foods (spinach, beef, lentils)
✔️ Pair with vitamin C to improve absorption
✔️ Avoid coffee/tea with iron-rich meals
✔️ Consider supplementation if levels are low
✔️ Address heavy periods or gut malabsorption

Your energy can improve dramatically just by correcting iron stores.

12/09/2025

Supplements… Why Are They SO Confusing?

If you feel overwhelmed by supplements…
You’re not alone.
Even providers have to stay on top of constantly changing information.

Here’s the truth ⬇️

🌿 Supplements aren’t ‘one-size-fits-all.’
What your body needs depends on:
• your symptoms
• your bloodwork
• your diet
• your stress level
• your sleep
• your hormones
• your goals

That’s why generic supplement “lists” online often do more harm than good.

✨ These are the MOST common questions I hear:
“Which supplements actually work?”
“Do I really need all of these?”
“How do I know what’s right for me?”
“Can supplements help with weight loss, gut health, inflammation, or menopause?”
“Why do some brands work better than others?”

Here’s what I tell my patients at Navarre Primary Care:

1. Quality matters more than quantity
Not all supplements are created equal.
Some contain fillers, poor absorption, or doses too low to make a difference.

(That’s why we stock medical-grade Pure Encapsulations and can special order what you need.)

2. You shouldn’t take everything you see online
More supplements ≠ better results.
Your body needs specific support — not a shopping cart full of trends.

3. The RIGHT supplements can change everything
When matched to your labs + symptoms, they can help with:
• energy
• metabolism
• thyroid support
• gut health
• sleep
• inflammation
• hair loss
• stress response

4. Most people only need 3–5 consistent, strategic supplements
Not 15 bottles collecting dust.

✨ If supplements feel confusing, that’s exactly why I’m here.
I can help you choose only what your body actually needs — nothing extra, nothing wasted.

What are your favorite supplements?

12/08/2025

I had such a wonderful time at the annual Navarre Beach Fire Rescue Christmas party last night! 🎄❤️
The Schaefer family hosted a beautiful dinner, Wesley received his 3rd-year jacket (so proud!), the lifeguards played games and laughed all night, and Santa even arrived on a firetruck 🚒🎅

Grateful for this amazing community and the people who make it so special.

https://www.instagram.com/reel/DR-cIbIkW6q/?igsh=eTlrbXN1OGRnYjI3

12/07/2025

“What happens if I don’t use hormone therapy?”

Not every woman wants to take hormone therapy—and that’s okay. My goal is never to push hormones, but to help you understand both sides of the risk/benefit equation: what happens if you do use HRT, and what happens if you don’t.

Over 5, 10, 15, and 20+ years after menopause, low estrogen levels can affect:

🔹 Your bones
Estrogen is a major protector of bone. Without it, bone loss speeds up and your risk of osteoporosis and fractures (especially spine and hip) goes up over time. In large trials, women on estrogen therapy had fewer fractures while they were on treatment.

🔹 Your heart and blood vessels
After menopause, cholesterol, blood vessel function, and inflammation often change in ways that increase heart disease and stroke risk.
Recent research supports a “window of opportunity”: starting hormone therapy before age 60 or within about 10 years of menopause appears safer and may even support heart health for some women compared with starting much later. Skipping hormones doesn’t guarantee a problem, but it may mean losing a tool that could help certain women when used thoughtfully.

🔹 Metabolism & blood sugar
Estrogen loss is linked with more belly fat and higher insulin resistance. In several studies, women on estrogen therapy had fewer new cases of type 2 diabetes compared with those on placebo. For some women, skipping HRT can slightly increase long-term metabolic risk—especially if other risk factors are present.

🔹 Brain health
This is a complex area, but we do know that starting hormone therapy for the first time after age 65 is not helpful and may increase dementia risk. The best available evidence suggests that if estrogen is going to support brain health, it likely needs to be started earlier, closer to menopause—not decades later.

🔹 Vaginal and urinary health
Low estrogen over time can lead to vaginal dryness, pain with in*******se, recurrent UTIs, urgency, and leakage. This cluster of changes is called genitourinary syndrome of menopause (GSM) and usually gets worse, not better, if nothing is done.
Very low-dose vaginal estrogen (creams, tablets, or rings) is extremely effective and, according to updated FDA guidance, does not carry the same systemic risks that were once feared.

🔹 Day-to-day quality of life
Hot flashes, night sweats, poor sleep, brain fog, and mood changes can last for many years for some women. Hormone therapy remains the most effective treatment for these symptoms. Non-hormonal options can help, but may be less powerful.

💬 So what’s the “right” answer?

Choosing HRT—or choosing not to—is a personal decision that should be based on:

your age and years since your last period

your personal and family history (especially for breast cancer, blood clots, heart disease, stroke)

your current symptoms and your future health goals

The FDA’s July 2025 expert panel and the recent removal of the old black box warnings reflect a growing consensus: for many healthy women in their 40s and 50s, hormone therapy is a reasonable, evidence-based option again, not something automatically off the table.

My job is not to tell you what to do, but to give you accurate, up-to-date information so you can make the choice that feels right for your body and your future.

If you’re wondering where you fall in this picture—whether you’re in perimenopause, newly menopausal, or 5–10 years past your last period—let’s talk. We can look at your labs, history, and risk factors together and decide if hormone therapy, non-hormonal options, or a mix of both makes the most sense for you.

(Educational only; not individual medical advice. Please discuss your specific situation with your own healthcare provider.)

12/06/2025

“What really happened with that hormone study & the black box warning?”

For the last 20+ years, many women have been told that menopausal hormone therapy (HRT) is “too dangerous” because of one big study. That study was the Women’s Health Initiative (WHI).

Here’s what often gets left out:

The WHI was designed to see if hormones could prevent heart disease and other chronic illnesses in older women (average age 63), not to see if modern HRT is safe for treating hot flashes in women in their 40s and 50s.

It tested one specific pill combination: a high dose of conjugated equine estrogen (similar to Premarin®) plus a synthetic progestin (medroxyprogesterone acetate), taken by mouth. It did not study today’s lower-dose patches, gels, or body-identical (“bioidentical”) hormones.

In those older women, that regimen slightly increased the risk of blood clots, stroke, heart disease, and breast cancer, and slightly reduced fractures and colon cancer. The trial was stopped early, and the headlines were scary.

Based on that older data, the FDA added a black box warning to estrogen products in 2003. That warning didn’t distinguish between:

starting hormones at 50 vs 70

pills vs patches

different kinds of progestogens

short-term symptom relief vs long-term disease prevention

As a result, many women were told “absolutely no hormones,” even when they were younger, healthy, and suffering.

Over the last 20 years, more research and re-analysis have shown:

Age and timing matter. Starting HRT before age 60 or within about 10 years of menopause appears to carry much lower risk and may even support heart and bone health in some women.

Different medications matter. Body-identical estradiol and micronized progesterone, especially in transdermal (patch/gel) form, seem to have a more favorable safety profile than the older oral Premarin® + Provera® combo that WHI used.

We still individualize therapy based on personal and family history—HRT is never “one size fits all.”

In July 2025, the FDA held an expert panel to re-examine all the data on menopause hormone therapy. After that review, in November 2025, the FDA announced that it will remove the old black box warnings about cardiovascular disease, breast cancer, and dementia from estrogen-containing menopause therapies and update labels to better reflect what we now know:

> For many healthy women who start hormones within 10 years of menopause, the benefits for symptom control (and possibly bone and heart health) can outweigh the risks.

The FDA will keep a boxed warning about uterine cancer for estrogen used without progesterone in women who still have a uterus, because unopposed estrogen can overstimulate the uterine lining.

💡 Bottom line:
I’m not saying every woman should use hormone therapy, and I’m not claiming that any one approach is perfectly risk-free. What I am saying is:

The scary headlines from 2002 do not tell the whole story.

Today we have newer, body-identical options and better data about timing and dosing.

If you’re in perimenopause or within 10 years of your final period, you deserve an up-to-date, individualized conversation about whether HRT (including bioidentical options) is right for you.

If you’re confused by all the mixed messages, you’re not alone. This is exactly the kind of discussion we can have together in the office—looking at your unique history, risks, and goals so you can make the choice that feels best for you.

(Educational only—this isn’t personal medical advice. Always talk with your own healthcare provider before starting or stopping hormone therapy.)

12/05/2025

The Link Between Gut Health & Mental Health

Did you know your gut is often called your “second brain”?

That’s because it has its own nervous system and produces many of the same neurotransmitters as your brain.

Here’s how gut health directly affects mental health:

1. Your gut makes most of your serotonin
Low serotonin = low mood, anxiety, poor sleep.

2. Inflammation in the gut creates inflammation in the brain
This can contribute to brain fog, fatigue, depression, and anxiety.

3. Dysbiosis (poor gut bacteria) alters stress response
Making you more reactive, irritable, or overwhelmed.

4. Gut imbalance affects appetite, cravings, and emotional eating
Mood & metabolism are deeply linked.

5. Chronic stress damages the gut
And poor gut health increases stress — creating a cycle.

When you support your gut, you’re not just fixing digestion —
You’re improving your mood, energy, hormones, immunity, and resilience.

If you’ve been struggling with anxiety, fatigue, or brain fog, please know:
It might not just be “in your head.”
It could be in your gut.

12/04/2025

Such an honor to see Don Self twice this week! If you own a practice and don't use his services, give me a call! He is awesome to work with ❤️

12/04/2025

Perimenopause vs Menopause — What’s the Difference?

So many women tell me:
“I don’t know if I’m in perimenopause or menopause… I just know something is off!”

Let’s break it down simply and clearly:

🔸 PERIMENOPAUSE: “The Hormone Rollercoaster”

This phase usually begins in your late 30s to late 40s and can last 4–10 years.

What happens?
Progesterone drops first
Estrogen fluctuates up and down
Hormones are UNSTABLE — not consistently low

This hormonal chaos can cause:

• Irregular or heavy periods
• PMS worsens
• Anxiety / irritability
• Mood swings
• Trouble sleeping
• Breast tenderness
• Bloating
• Migraines
• Weight gain (especially belly)
• Hot flashes / night sweats (yes, in perimenopause!)

Perimenopause = fluctuating hormones + unpredictable symptoms

You can still get pregnant in this stage.

🔹 MENOPAUSE: “The Hormone Desert”

Menopause is not a feeling — it is a 12-month absence of periods.

At this point, estrogen has dropped and stayed low, not fluctuating anymore.

Symptoms can include:

• Hot flashes
• Night sweats
• Insomnia
• Brain fog
• Memory changes
• Depression or anxiety
• Low libido
• Vaginal dryness / painful in*******se
• Joint pain
• Weight gain
• Hair thinning
• Dry skin
• Recurrent UTIs
• Loss of muscle / bone density

Menopause = consistent low hormones + long-term physical changes

You can’t get pregnant naturally in this stage.

🔄 How Women Transition Between the Two

Here’s the typical pattern:

1. Perimenopause begins — cycles change, symptoms show up

2. Hormones go through high/low fluctuations

3. Progesterone stays low → estrogen becomes “dominant”

4. Eventually, ovaries stop releasing eggs

5. Periods become very infrequent

6. Once you’ve gone 12 months without a period, you’re in menopause

7. Estrogen remains consistently low

And here’s the key truth:

Perimenopause is usually the “messy” phase

Menopause is the “low but stable” phase

Symptoms don’t magically stop in menopause —
they just change.

✨ A Few Important Notes

• Perimenopause symptoms often go undiagnosed
• Women are often told “it’s just stress”
• Symptoms are real, valid, and treatable
• Treatment looks different depending on the phase

You don’t have to suffer through either phase — and you don’t have to guess what’s happening.

❤️ If you're noticing changes in your body, mood, sleep, weight, or energy — you deserve answers.

Hormones don’t just affect reproduction.

They affect your brain, bones, heart, metabolism, and quality of life.

12/04/2025

What Happens to Hormones During Perimenopause?

Perimenopause is not “a switch” — it’s a transition that can last 4–10 years before menopause.

Here’s what happens hormonally:

1. Progesterone drops FIRST

This is the biggest change that starts the chaos.

Progesterone is your calming, sleep-supporting, anxiety-lowering hormone.
It balances estrogen, relaxes muscles, and supports mood and metabolism.

So when progesterone drops, and estrogen stays normal, you get:

• Irritability
• Anxiety
• PMS-type symptoms
• Breast tenderness
• Heavy or irregular cycles
• Sleep disturbances
• Increased bloating + cravings

This is what people mean when they say “estrogen dominance.”
It isn’t that estrogen is too high — it’s that progesterone is too low to keep it in balance.

2. Estrogen fluctuates wildly (not just “low”)

One month high, one month low — leading to:

• Cycle changes
• Weight changes
• Mood swings
• Hot flashes (yes, even in perimenopause)
• Insomnia
• Migraines

Perimenopause is a rollercoaster — but it’s not you “losing your mind”
It’s your hormones restructuring.

Want me to post which symptoms are from low progesterone vs low estrogen? Comment SYMPTOMS!