Sherrie Koenigseder, MSN, APRN, NP-C

04/01/2026

03/28/2026

New storage for our supplements and healthcare products.

03/28/2026

🔥 Calling all Nurse Practitioners ready to level up their practice!

The Digestive and Liver Center of Central Florida is offering a 12-Month Gastroenterology Fellowship designed to provide advanced, hands-on training in GI and hepatology.

This full-time program includes:

✔ Immersive GI and liver training
✔ Outpatient and inpatient rotations
✔ Hands-on endoscopy and procedures
✔ Comprehensive didactic education
✔ Competitive salary and benefits

Whether you're a new grad or early in your career, this is an incredible opportunity to gain specialized skills and work alongside experienced GI providers.

📩 Apply by sending your resume to: GIFellowship@dlcfl.com
📱 Or DM: 407-963-5596
🌐 Learn more: dlcfl.com

Take the next step in your NP career and expand your clinical expertise in gastroenterology.

03/27/2026

Now inside Navarre Primary Care

2D/3D/4D ultrasound boutique in Navarre, FL. All ultrasounds are non-diagnostic. Owned and operated by an American Registry of Diagnostic Medical Sonography registered sonographer.

03/27/2026

2D/3D/4D ultrasound boutique in Navarre, FL. All ultrasounds are non-diagnostic. Owned and operated by an American Registry of Diagnostic Medical Sonography registered sonographer.

03/24/2026

Progesterone is not just for periods.

It helps with:
✔ Sleep
✔ Anxiety
✔ Mood
✔ Brain health

03/24/2026

🌙 Menopause: The New Hormonal Baseline

Menopause is defined as: 👉 12 months without a menstrual cycle

Average age: ~51

🔄 What’s Happening Hormone-Wise:
Estrogen ↓ significantly and stays low
Progesterone ↓ (no ovulation)
Testosterone gradually declines
👉 Hormones are now low but stable

🧠 What These Hormones Used to Do

Estrogen:
Brain function (memory, focus)
Skin elasticity
Vaginal/urinary tissue health
Bone density
Heart protection

Progesterone:
Sleep
Calm mood
Anxiety control

⚠️ What Happens When They’re Low

🧠 Brain & Mood:
Brain fog
Memory issues
Anxiety or depression
Loss of motivation

😴 Sleep:
Insomnia
Night waking

🔥 Vasomotor Symptoms:
Hot flashes
Night sweats

❤️ Metabolism & Body:
Weight gain (especially central)
Insulin resistance
Loss of muscle mass

🦴 Long-Term Health Effects:
Bone loss → osteoporosis
Increased cardiovascular risk

🌸 Genitourinary Syndrome of Menopause (GSM):
Vaginal dryness
Pain with in*******se
Recurrent UTIs
Urinary urgency

🔄 Key Difference from Perimenopause
Phase
Hormones
Pattern
Symptoms
Perimenopause
Fluctuating
Chaotic
Unpredictable
Menopause
Low
Stable
Persistent

💡 Clinical Insight
👉 Many women feel better emotionally once they reach menopause
because the hormonal “rollercoaster” stops.

BUT…
👉 Long-term health risks increase due to low estrogen

🧠 How I Explain This to Patients:
“Menopause isn’t your body failing—it’s a new hormonal baseline. The goal is to support your body so you can feel like yourself again.”

03/24/2026

🌿 Perimenopause: The Transition Phase (What’s Changing & Why You Feel “Off”)

Perimenopause can start as early as the mid-30s (most commonly 40s) and can last 4–10 years before menopause.

👉 This is not a sudden change—it’s a hormonal rollercoaster.

🔄 What’s Happening Hormone-Wise:
Progesterone ↓ first (early change)
Estrogen = fluctuating (highs and lows)

Ovulation becomes inconsistent
👉 Cycles may still happen—but they are less predictable and less balanced

🧠 Key Hormone Changes Explained

1. Progesterone Drops First

Why: Less consistent ovulation
What progesterone normally does:
Calms the brain (GABA support)
Helps sleep
Balances estrogen

When it drops → symptoms:
Anxiety
Poor sleep
Irritability
Feeling overwhelmed
Shorter cycles

2. Estrogen Becomes Erratic (Not Just Low!)

Important: Estrogen doesn’t just decline—it spikes and crashes

What estrogen does:
Supports serotonin (mood)
Maintains skin, joints, brain function
Regulates temperature

Fluctuations cause:
Mood swings
Breast tenderness
Heavy or irregular periods
Brain fog
Migraines
Hot flashes (from sudden drops)

⚠️ Common Perimenopause Symptoms

🧠 Brain & Mood:
Anxiety (new or worsening)
Depression
Irritability / rage
Brain fog
Feeling “not like yourself”

😴 Sleep:
Trouble falling or staying asleep
Waking at 2–4 AM

🔥 Body:
Hot flashes / night sweats
Weight gain (especially abdomen)
Fatigue

🩸 Cycle Changes:
Heavier or lighter periods
Shorter or longer cycles
Skipped periods

🔄 Why Symptoms Feel So Unpredictable
👉 Because hormones are fluctuating, not steadily declining
One month: high estrogen → heavy period, breast tenderness
Next month: low estrogen → fatigue, depression

💡 Clinical Insight
This is the phase where women are often told:
“Your labs are normal”
“You’re just stressed”

👉 But the issue is hormone instability—not absence

🧠 How I Explain This to Patients:
“Perimenopause is like puberty in reverse—your hormones aren’t gone, they’re just chaotic.”

03/23/2026

🌿 The Menstrual Cycle: Hormones, Phases & Symptoms

💡 Clinical Insights

1. “Hormone imbalance” is often about timing, not just levels

Example: Normal progesterone, but drops too early → PMS

2. Many symptoms are neurotransmitter-driven
Estrogen → serotonin
Progesterone → GABA

👉 This is why patients say:
“I feel like a different person before my period.”

3. Common patterns we see in practice:
Low progesterone → anxiety, insomnia, PMS

Estrogen dominance → heavy periods, breast tenderness, irritability

Anovulatory cycles → no progesterone → chaotic symptoms

How I Explain This to Patients:

“Your cycle isn’t just reproductive—it affects your brain, mood, metabolism, and energy every single month.”

03/23/2026

🌿 The Menstrual Cycle: Hormones, Phases & Symptoms

🌙 4. Luteal Phase (Days 15–28)
Hormones:
Progesterone ↑ (dominant hormone)
Estrogen moderate, then drops

What’s happening:
Body prepares for possible pregnancy

If no pregnancy → hormones fall

🧠 What Progesterone Does:
Calming (acts like a natural anti-anxiety hormone via GABA)
Promotes sleep
Increases body temperature
Slows digestion

⚠️ Early Luteal (First Half)
Symptoms:
Calm, steady mood
Good sleep
Slightly lower energy than ovulation

👉 This can feel like a “grounded” phase.

⚠️ Late Luteal (PMS Phase)
Hormones:
Progesterone ↓
Estrogen ↓

What this drop causes:

Neurotransmitter effects:
↓ Serotonin → mood changes
↓ GABA → anxiety/irritability

Physical effects:
Fluid retention
Breast tenderness
Blood sugar swings

Common symptoms:
Irritability or mood swings
Anxiety or depression
Bloating
Breast tenderness
Sugar/carbohydrate cravings
Fatigue
Poor sleep
Headaches or migraines

👉 This is where PMS or PMDD shows up.

03/23/2026

🌿 The Menstrual Cycle: Hormones, Phases & Symptoms

🔥 3. Ovulation (Around Day 14)
Hormones:
Estrogen peaks
LH surge (Luteinizing Hormone) → triggers ovulation

What’s happening:
Egg is released

What hormones do:
High estrogen → confidence, social drive
Testosterone (small bump) → libido

Common symptoms:
Increased libido
Feeling confident/outgoing
Clear cervical mucus (“egg white”)
Mild pelvic pain (mittelschmerz) in some

👉 This is peak fertility and often peak confidence.

03/23/2026

🌿 The Menstrual Cycle: Hormones, Phases & Symptoms

🌱 2. Follicular Phase (Days 1–13)
Hormones:
Estrogen ↑ (gradually rising)
FSH (Follicle Stimulating Hormone) ↑

What’s happening:
Ovaries mature follicles (eggs)
Uterine lining starts rebuilding

What estrogen does:
Boosts serotonin → improves mood
Increases energy & focus
Supports skin, collagen, and libido

Common symptoms:
Increasing energy
Improved mood
Better focus/productivity
Less appetite (for many)

👉 This is the “get things done” phase.