The Difference Between Feeling Better and Getting Better

You did everything right.

You pushed past the doctors who told you that you were fine. You found someone who took you seriously. You started hormone therapy. And here you are, weeks or months in, still tired. Still foggy. Still not quite you.

So now what? A higher dose? A different formulation? Maybe. But maybe that's the wrong question.

I learned this in a completely different corner of medicine. I spent years in regenerative medicine, where patients came to me after round after round of steroid injections for joint pain. Steroids do exactly what they're designed to do. They mask the symptom. They quiet the inflammation without ever touching the reason the joint hurt in the first place. The shot wears off. The pain comes back. That's exactly why regenerative treatments like PRP (platelet rich plasma) exist: not to mask the pain, but to address why the joint is failing and help it actually heal.

Feeling better and actually getting better are not the same thing.

That lesson changed the way I practice medicine, and nowhere does it matter more than in midlife women's health. Hormone therapy is one of the most powerful tools we have for perimenopause and menopause, and for many women it is genuinely life changing. But hormones aren't magic. When they don't deliver, adjusting the dose or switching formulations is sometimes exactly what needs to happen. But sometimes we never stop to ask why the hormones aren't working the way we expected them to.

I think of it like a house with a crack in the drywall. You can patch the crack, sand it, and repaint the wall, but if the foundation underneath the house is shifting, that crack is going to come back. You haven't fixed the problem. You've covered it up.

The same thing can happen in medicine. Hormones may absolutely be part of the answer, but they may not be the whole answer. Chronic inflammation, thyroid dysfunction, insulin resistance, nutrient deficiencies, poor sleep, chronic stress, or other underlying issues can all influence how a woman feels and even how well she responds to treatment. Every woman is different, which means the reason she isn't feeling her best is different too.

Hormones may absolutely be part of the answer, but they may not be the whole answer.

This is what functional medicine actually means to me. Not rejecting conventional medicine. Not trading prescriptions for supplements. Just refusing to stop at the first answer. Why are these symptoms happening? Why isn't this treatment working? What else is contributing?

And when you start asking why, you run straight into a phrase most women have already heard: "Your labs were normal." Maybe they were. But normal doesn't always mean optimal. Reference ranges come from large populations across different ages, sexes, and health conditions. They tell us what's statistically common, not what's ideal for the woman sitting in front of me. Not every lab needs to be "optimized," but every lab deserves to be read in the context of the whole patient.

That's why I don't believe in chasing numbers or simply increasing medication doses until someone feels better.

I believe in stepping back, looking at the entire picture, and building a stronger foundation. Sometimes that foundation includes hormone therapy. Sometimes it means improving sleep, treating thyroid disease, correcting nutrient deficiencies, addressing inflammation, or focusing on metabolic health. More often than not, it's a combination of several things working together.

To me, conventional medicine and functional medicine aren't opposing philosophies. They're complementary. One gives us incredible tools to diagnose and treat disease. The other reminds us to ask why disease or dysfunction developed in the first place. When you combine both, that's where I believe we deliver the best care.

Feeling better and actually getting better aren't always the same thing. You deserve both.

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I'm so glad you're here.

Dr. Caravelli

I Thought It Was Anxiety. It Might Have Been Hormones.

I keep hearing women describe themselves with the same word. Just.

I'm just a stay-at-home mom. I'm just an office manager. I'm just helping my husband with the business. I'm just a teacher. I'm just a nurse. It keeps coming up in conversations with women in my own network, and honestly, it makes me a little sad. Every time I hear it, I want to stop them.

Because you are not just anything.

I used to do this too. For years I would say, "Oh, I'm just a family medicine doctor," which sounds ridiculous out loud when I think about the medical school, the residency, and the years of training behind it. Family medicine wasn't something I fell into because I couldn't do anything else. It was a choice, and I loved it. So no, I'm not just a family medicine doctor, and you're not just a stay-at-home mom.

Somewhere along the way, a lot of women start sounding less like themselves. Women who used to be confident become more self-critical. Women who used to trust their judgment start second-guessing themselves. Women who spent decades managing careers, families, and crises suddenly feel less certain than they used to. And I don't think that's an accident.

But I also think something else is happening that we don't talk about enough. Our brains are changing.

For years women were often told they had anxiety or depression when what was really happening underneath was far more complicated. And to be clear, anxiety and depression are real. They deserve treatment. Sometimes medication is life changing. Sometimes therapy is life changing. Sometimes both.

But we now have a growing body of evidence showing that the menopause transition itself is associated with a significantly increased risk of mood symptoms. A 2025 analysis that pooled data from over a million women found that nearly one in three experiences symptoms of depression, anxiety, or insomnia during the menopause transition [1]. And large studies that followed women for more than a decade found that the risk of depressive symptoms climbs during perimenopause, with one study showing the risk more than quadrupled. That makes it one of the highest-risk windows in a woman's life for mood changes [2].

And honestly? That makes a lot of sense to me. Because looking back, I knew something wasn't right.

I've always had test anxiety. Always. But I've also spent my entire life taking tests. Medical school exams. Board exams. Recertification exams. Thousands of tests. So imagine my surprise when I found myself standing at the DMV feeling anxious about the vision screening.

The vision screening.

I don't wear glasses. I don't wear contacts. There was absolutely no reason for me to think I wouldn't pass. Yet my heart rate was elevated. I was nervous. I was thinking, "What if I fail?" Which was completely irrational. And also completely unlike me. I've spent over a decade working in urgent care and emergency medicine, and one of the things I always liked about those environments was that I stayed calm when things got chaotic. The more pressure there was, the more focused I became. But somehow a vision test at the DMV had me spiraling.

That wasn't me. Or maybe a better way to say it is that it wasn't the version of me I was used to.

What I didn't appreciate at the time was how much fluctuating hormones can affect the brain. Estrogen doesn't just affect hot flashes. It interacts with serotonin, dopamine, and norepinephrine, the same brain chemicals involved in mood, motivation, resilience, and anxiety [3]. And during perimenopause, hormone levels don't decline in a nice predictable line. They fluctuate, sometimes dramatically. Researchers have actually found that the bigger those estrogen swings are, the more likely women are to experience mood symptoms, and that this holds true whether or not they're having hot flashes at all [4].

For some women, that shows up as irritability. For some it shows up as sadness. For some it shows up as anxiety. For others it shows up as waking up at 3 a.m. replaying every awkward thing they've ever said since middle school.

The point is this.

Before you convince yourself that this is just who you are now. Before you accept the racing thoughts. Before you accept the anxiety. Before you accept feeling unlike yourself. Let's make sure we're looking at the whole picture. Because maybe it is anxiety. Maybe it is depression. Maybe it's hormones. Maybe it's all three. But whatever the answer is, you deserve more than being told to simply live with it.

And please stop saying you're "just" anything. You are not just a mom. You are not just a wife. You are not just an employee. You are not just a caregiver. And you are certainly not just a collection of symptoms.

You deserve to feel like yourself again. And if you don't feel like yourself right now, let's figure out why.

I'm so happy you're here.

Dr. Caravelli

Am I in Perimenopause? Or Is the Internet Just Blaming Hormones for Everything?

Itchy ears. Random chin hairs. Belly fat that won't budge. Anxiety at 3 a.m. Every symptom under the sun is now being blamed on hormones, and some of it really is hormonal. Here's how to tell the difference.

Lately it feels like every time I open Instagram, another symptom is somehow connected to hormones.

Itchy ears? Hormones.
Dry eyes? Hormones.
Anxiety? Hormones.
Bloating? Hormones.
Rage? Hormones.
Waking up at 3 a.m. thinking about something embarrassing you said in 2007? Apparently hormones too.

And it can be hard to know what to believe.

Here's the complicated answer. A lot of what you're seeing online actually can be related to perimenopause. The problem is that perimenopause is not a clean, linear process. It is much more like a roller coaster. Hormones fluctuate wildly. Estrogen goes up, then down, then up again. Progesterone slowly declines. Some months your body feels relatively normal and other months it feels like everything is falling apart for absolutely no reason.

There is even something called a luteal out of phase event, where estrogen suddenly surges unexpectedly. You might notice really sore nipples or breast tenderness that seems to come out of nowhere and lasts for weeks. As frustrating as that is, it can actually be completely normal.

So are all of your symptoms hormonal? Maybe. But maybe not.

This is where I think social media can become dangerous. I worry women start attributing every symptom to perimenopause and end up developing tunnel vision. You do not want to miss thyroid disease, anemia, autoimmune disease, sleep apnea, vitamin deficiencies, or something else entirely because everyone online told you it was "just hormones."

That is why I believe a thorough evaluation matters so much. You deserve a physician who actually has time to sit down, listen, ask questions, and look at the full picture instead of throwing one lab order at you and sending you on your way.

That is also why I use what I call the Axis Precision Health Core Panel, with optional add-on testing depending on symptoms and history. I want patients to understand exactly what we are evaluating and why.

Now let's talk about some of the symptoms that really surprise women.

Yes, itchy ears can absolutely be part of perimenopause. Estrogen receptors exist in the skin, including the ear canal. As estrogen declines, skin becomes thinner and drier. Some women notice itching deep in the ears that seems to come out of nowhere. Sometimes topical treatments like a tiny amount of Flonase on a Q-tip or even estradiol cream applied very carefully to the outer ear canal can help, although obviously you should discuss that with your doctor before trying it.

Vaginal dryness, urinary urgency, recurrent UTIs, and discomfort with intimacy are also incredibly common. The vagina and urinary tract are highly estrogen-sensitive tissues. When estrogen declines, the tissue becomes thinner, drier, and more irritated. Topical vaginal estrogen can be life changing for some women. And something many people do not realize is that even many breast cancer survivors can still safely use vaginal estrogen under the guidance of their physician and oncologist.

You also might notice things that seem completely unrelated. Your underwear suddenly irritates your skin. Your eyes feel dry. Your skin feels thinner. Your hair starts shedding more. Your allergies seem worse. Your joints ache. You wake up exhausted no matter how long you slept.

Hormones influence all of it.

Progesterone, in particular, has a huge effect on the brain and nervous system. It interacts with GABA receptors, which help create that calm, steady feeling. As progesterone declines, women often notice more anxiety, racing thoughts, emotional overwhelm, irritability, or even rage. Sleep can become fragmented too, especially that classic waking up between 2 and 4 a.m. unable to fall back asleep.

And then there are the symptoms women really do not expect.

The sudden belly fat despite eating and exercising the same. That happens partly because declining estrogen changes how and where the body stores fat. Women become more insulin resistant during perimenopause and are more likely to store fat centrally around the abdomen instead of the hips and thighs.

The random chin hairs? Unfortunately also common. As estrogen declines, the balance between estrogen and androgens shifts. Even if testosterone levels are technically normal, the relative change can lead to more facial hair growth.

Hot flashes happen because estrogen helps regulate the brain's temperature center in the hypothalamus. As estrogen fluctuates and declines, the brain becomes much more sensitive to even tiny temperature changes, which can trigger sweating, flushing, and feeling suddenly overheated for no obvious reason.

And yes, even changes in body odor can happen. Hormonal fluctuations can alter sweat production and the bacteria that live on the skin, which can make women suddenly feel like they smell different to themselves.

One of the strangest symptoms I hear about is women suddenly smelling cigarette smoke when nobody is smoking. This is called phantosmia, or phantom smells. Hormonal fluctuations, migraines, sinus inflammation, and neurologic changes can all potentially contribute. It is usually benign, but it is also something that deserves proper medical evaluation because not everything should automatically be blamed on hormones.

That is really the point of all of this.

Perimenopause is real. The symptoms are real. You are not crazy. But you also deserve more than social media soundbites and blanket advice from strangers online.

You deserve someone who can help you sort through what is hormonal, what is not, what deserves further workup, and what options actually exist to help you feel better.

Because the goal here is not just surviving this phase of life. It is feeling like yourself again.

I'm so glad you're here.

Dr. Caravelli

Something Just Doesn't Feel Right Anymore

Something just didn't feel right anymore.

All of a sudden I had two more chin hairs than I've ever noticed, and as a Lebanese-Italian I have had my fair share of mustache and chin hairs. My ear itched, which I didn't even know was a thing until I saw it on my own Instagram feed about perimenopause. (I guess we should be putting Flonase in our ears now? We will revisit this, please don't put Flonase in your ear.) And keep in mind, I'm a family medicine physician. We didn't learn this in school or training.

I started asking around. Talking to colleagues, peers, other physicians. And the honest answer is most of them don't feel comfortable treating perimenopause or menopause either. Not because they don't care. It just wasn't something we were really taught.

We trained during a time when one major study came out and changed everything. The Women's Health Initiative study basically told us hormone therapy increases the risk of cancer. If you use it, keep the dose as low as possible and get women off of it as quickly as possible. So that's what an entire generation of physicians learned.

Now fast forward to where we are today. Social media is everywhere. It's where people are getting their information, but it is really hard to know what to trust. And I say that as a physician who follows other physicians and still finds myself thinking… what is actually right?

You look one direction and peptides are the best thing ever. You look the other direction and peptides are going to give you cancer. The truth is probably somewhere in the middle. Same thing with GLP-1s. They're cheating, they're dangerous, or they're one of the most important tools we've had in treating obesity, which we are finally acknowledging is a disease that deserved treatment all along.

Menopause is no different.

Women have been dealing with this forever, but that doesn't mean we were ever supported through it. I've had this conversation with my own mom. "What are you doing? I went through it and I was fine." My husband said something similar. Women have been going through this for hundreds of years, why is this suddenly such a big deal?

And I get that perspective. I really do.

But I also see what's actually happening in clinic. I hear what women are saying. I feel it myself. So I went back and started learning this in a way I never had before. I spent hours reading, studying, digging into the data. I read a full textbook cover to cover in the last month and a half. I honestly don't think I've ever done that, not even in medical school.

This is not something I stumbled into. This is something I chose to go deep on because it matters. Because women deserve to be treated. That is what this blog is going to be.

Some posts will break down the science. Some will talk about symptoms you didn't even know were related. Some will help you understand what your options actually are. But the goal is simple. You feel seen, you feel heard, and if you didn't know where to start or who to trust, you have a place you can come back to.

I will always do my best to give you evidence-based information, but not the kind that is driven by fear. Because that is exactly what happened for years after the Women's Health Initiative study, and we are still undoing that.

If something feels off, you're not crazy. If you think you could feel better, you're probably right.

And this is where you start. I'm so happy you're here.

Dr. Caravelli