Jessica Grim, Nurse Practitioner

Jessica Grim, Nurse Practitioner Board-certified Nurse Practitioner with over 26 years of medical experience. Video and in person visits available.

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www.SaguaroBeautyandWellness.com

Find your tribe, even in the medical field. It’s a process, so find someone who walks with you through it.
09/08/2026

Find your tribe, even in the medical field. It’s a process, so find someone who walks with you through it.

Something important is happening with testosterone therapy for women.On September 17, 2026, the FDA is holding a public ...
09/03/2026

Something important is happening with testosterone therapy for women.

On September 17, 2026, the FDA is holding a public scientific workshop specifically focused on testosterone use in menopausal women.

This is significant.

The FDA says the meeting will examine the current evidence, unanswered questions, measurement of testosterone levels, potential benefits, long-term safety, and what research may be needed to support future drug development for menopausal women.

For decades, testosterone has been used off-label in women, while the U.S. has had no FDA-approved testosterone product specifically for women.

So why does this matter?

Because women’s testosterone needs and symptoms have often been reduced to a single lab value or dismissed altogether. The FDA is now formally looking at those questions.

September 17 could be an important day for the future of testosterone therapy in women’s health.

And there is a second important piece…

The FDA has opened a public-comment docket:

FDA-2026-N-5479

The public can submit comments concerning the risks and benefits of testosterone use in menopausal women. The FDA says comments are due October 19, 2026.

That is unusually interesting because it means this isn’t just an internal FDA discussion.

Researchers, clinicians, patients, educators and industry are being explicitly invited into the discussion.

I’ll be watching this one closely and I’ll share what comes out of it as we learn more.

Source: U.S. Food & Drug Administration, “Testosterone Use in Menopausal Women,” September 17, 2026.

Progesterone sensitivity has become the new concern for some women. But is it really progesterone sensitivity or really ...
08/30/2026

Progesterone sensitivity has become the new concern for some women. But is it really progesterone sensitivity or really just the chaos of perimenopause?

Dr. Mary Claire Haver made an excellent graphic about hormones. During the perimenopausal transition, which can last up to 10 years in a woman’s life, hormones are chaotic.

We prescribe estradiol and progesterone for symptom support and it often helps significantly.

However, when you are going through the spikes of hormones during this time, it can feel like too much. Because it is…during those short periods of excess.

With my clients, I do a lot of education about adjustments. Sometimes we reduce the dose, then increase, the reduce again. It’s about symptom management during this very unpredictable time.

If a woman isn’t tolerating hormones in full menopause, that makes sense. Fun fact: that’s been rare. I’ve had one person not tolerate one hormone (and that person was on other medications long term that were already providing support - so it made sense to stick with what was right for her).

Look at the graph. That is your body. For up to 10 years.

There are so many ways to support your symptoms during this time. It’s never a static solution. Work with a provider who knows this and adjusts your regimen - then teaches you the signs and symptoms so you can adjust your regimen.

Irritable? Tired? Not getting enough sleep? Hair loss? Anxious? It can all be managed so you feel like yourself as much as possible during this natural transition. Suffering is not necessary.

“Why am I gaining weight when nothingchanged?”This is one of the most common questions I hear from women over 40 and wom...
08/27/2026

“Why am I gaining weight when nothing
changed?”

This is one of the most common questions I hear from women over 40 and women experiencing hormonal changes.

Starting in perimenopause, estrogen levels become much lower. That doesn’t simply mean “you gain weight.” It changes where your body prefers to store fat.

Before menopause, women tend to store more fat around the hips and thighs. As estrogen and
testosterone declines, fat distribution shifts toward the abdomen and more of that fat can become visceral fat, stored deep inside the abdomen around your organs.

At the same time, we gradually lose muscle as we age. So you can step on the scale and see only a small change - or sometimes no change at all - while your body composition has changed significantly.

That’s why I care about more than the number on the scale.

Excess visceral fat is associated with insulin
resistance, type 2 diabetes, cardiovascular disease and other major health risks. The diet, exercise, and health strategy has to change from mid-life on.

Midlife is the time to become much more intentional about:

• Strength training
• Adequate protein and fiber together (90+ and 25+ grams)
• Daily movement
• Quality Sleep
• Maintaining muscle while losing fat, when weight loss is appropriate
• Treating hormone symptoms appropriately with hormone and non-hormonal treatments.

And for some women, hormone therapy or anti-obesity medication may be appropriate - but neither should be viewed as a substitute for building and protecting muscle.

Your body isn’t “broken.” It’s responding to a very real physiologic transition. The goal isn’t to fight your body. It’s to understand what’s changing and adjust your care accordingly.

I’m here to help. Consults are always free, available in person, on video, or phone call, where I can help answer your questions, teach you how to talk to your medical team to get help and what to ask for, teach you how to navigate your insurance benefits, find treatments that fit your budget and lifestyle, and explore what options are available to you.

Want to establish care with me? Shoot me a message, text or call 503-559-9505, or use the link in my bio to schedule.

You may be low on vitamin D. It’s more common than you think. Living in an area with low sunlight or long periods withou...
08/24/2026

You may be low on vitamin D. It’s more common than you think.

Living in an area with low sunlight or long periods without sun, a BMI over 30, liver/kidney disease, gastrointestinal issues/diseases, and more are causes of low vitamin D. Have it checked minimum once per year. In February or March, levels are often the lowest. Have a level of low 30s this time of year but don’t take a supplement daily? You are at risk for low vitamin D through the winter.

Here’s an interesting fact: many people in Arizona are found to be low on vitamin d if they spend a majority of their time indoors due to the heat. A study of 637 adults living in southern Arizona found that 25.4% had clinically low vitamin D despite living in an area with abundant year-round sunshine.

Can exercise help with perimenopause and menopausal hormone changes?Yes, but maybe not in the way you’ve been told.Exerc...
08/22/2026

Can exercise help with perimenopause and menopausal hormone changes?

Yes, but maybe not in the way you’ve been told.

Exercise doesn’t stop the hormonal fluctuations of perimenopause or menopause, and it doesn’t replace estrogen.

What it does do is help your body adapt to those changes.

Regular exercise can help:
• Preserve muscle mass
• Protect bone health
• Improve insulin sensitivity
• Reduce abdominal fat
• Support heart health
• Improve sleep
• Reduce anxiety and improve mood
• Increase energy
• Help with brain fog

The most beneficial combination includes:
✓ Strength training 2–3 times per week
âś“ Cardiovascular exercise
âś“ Daily movement
âś“ Prioritizing recovery and sleep

Lifestyle changes are incredibly powerful.

You shouldn’t have to choose between healthy habits or appropriate medical treatment. For many women, the best results come from combining both.

Perimenopause isn’t a failure of willpower. It isn’t caused by laziness or a lack of exercise. It’s a normal biological transition.

I have never been much of a gym person, but I have found other creative ways to exercise that brought me a lot of joy. Horseback riding of course is one of them but for many years I played roller Derby. I certainly enjoyed not only the exercise but the game and the camaraderie. The lifelong friends I made from that are strong, clever women, friends who I am grateful for every day. So get creative and think outside the box!

08/16/2026

Every single day in primary care I still have women sit in front of me who don’t know about what is happening to their body in perimenopause and menopause but are highly symptomatic and having health issues from it.

Every. Day.

I regularly have clients in my private practice who come to me because they were denied hormones by their medical team.

These are the things that must get better, and I won’t be quiet until they do. There is treatment and it can be customized to all women, including but not limited to hormones, medication, cognitive behavioral therapy, diet, exercise, supplements, and more.

If men went through menopause, which 100% of women will, and they experienced the sharp loss of hormones like women do, here is what would biologically happen: their testicles would shrink up and the loss of their essential hormones would cause brain fog, fatigue, pain, osteoporosis, increased cardiovascular disease, increased risk of dementia, and so much more.

Now, men do lose about 1% of their testosterone a year starting in about their mid 30s, so it’s not that they don’t experience the symptoms of loss of their essential hormone. They don’t have the sharp decline like women do, which is a different experience.

This should be a good documentary. https://balancedocuseries.com

Alright, this one got me thinking.This Stanford study showed women on estrogen-only hormone replacement therapy (who all...
08/15/2026

Alright, this one got me thinking.

This Stanford study showed women on estrogen-only hormone replacement therapy (who all had hysterectomies, so progesterone wasn’t addressed) had 35% lower odds of Alzheimer’s disease and 39% lower odds of clinical dementia. That’s huge, especially because women make up 2/3 of those who get Alzheimer’s and dementia.

However, a large cohort study, 2024 JAMA study, and 2025 meta-analysis showed women who had estrogen-positive breast cancer and were prescribed tamoxifen, an estrogen blocker, had up to 7% lower risk of Alzheimer’s and dementia compared to women who never took hormone replacement therapy (HRT).

That is fascinating in the context of the Stanford study because it means we cannot simply say:

“Estrogen deprivation from breast cancer treatment means these women are losing estrogen’s brain protection and therefore have an increased dementia risk.”

The epidemiologic evidence doesn’t support that simple conclusion. Yet we know estrogen is neuro protective and reduces the incidence of these neurological diseases.

There are biologically plausible reasons why. Tamoxifen has estrogen-receptor agonist activity in some tissues including the brain and the central nervous system. The medication greatly reduce estrogen levels in the rest of the body, but they may not completely stop estrogen-related activity in the brain. This may be why there is an improvement in dementia and Alzheimer’s for some of this population.

Exercise is probably the most defensible replacement strategy for estrogen loss and prevention of dementia. This is where I would put considerably more emphasis clinically.

* 150 minutes/week moderate aerobic activity or 75 minutes vigorous
* Resistance training ≥2 days/week
* Avoiding physical inactivity

The more you know!

https://med.stanford.edu/news/all-news/2026/08/study-ties-estrogen-based-menopausal-hormone-therapy-to-lower-al.html

https://www.neurology.org/doi/10.1212/WNL.0000000000218413

The VA’s Dementia Caregiver Video Series offers free, practical guidance for family caregivers navigating the day-to-day...
08/14/2026

The VA’s Dementia Caregiver Video Series offers free, practical guidance for family caregivers navigating the day-to-day challenges of dementia care. It was specifically developed to help bridge gaps in caregiver resources, particularly for Veterans and families living in rural areas.

A useful resource to save and share with a caregiver, family member, and friend who may need it.

https://www.ruralhealth.va.gov/products/dementia-caregiver-videos.asp

You might be surprised to learn that many women begin experiencing perimenopause symptoms in their late 30s or early 40s...
08/13/2026

You might be surprised to learn that many women begin experiencing perimenopause symptoms in their late 30s or early 40s up to their late 40s. Perimenopause can last anywhere from a couple of years to 10 years.

100% of women will go through perimenopause and menopause.

Early signs can include:
• Trouble staying asleep
• Night sweats that come in brief waves
• Heart palpitations
• Anxiety or irritability that feels unlike you
• Brain fog or difficulty concentrating
• Decreased libido
• Joint aches
• Dry eyes, dry skin, or even itchy ears
• Changes in your menstrual cycle
• Weight gain around the abdomen
• Fatigue that doesn’t improve with rest

One of the biggest misconceptions is that a hormone blood test can diagnose perimenopause.

In reality, hormone levels fluctuate dramatically during this transition. A “normal” estrogen or progesterone level does not rule out perimenopause.

Instead, we diagnose perimenopause by listening to your symptoms, reviewing your menstrual history, and looking at the whole picture.

If you’ve been told “your labs are normal” but you don’t feel like yourself, don’t ignore what your body is telling you.

The other important fact I want to point out is that a woman should always get a full medical work up to ensure these symptoms aren’t related to something else, but perimenopause should be considered in this age range always as a possible reason for the symptoms.

For those who find this helpful, there are some great books by Dr. Mary Claire Haver and Dr. Heather Hirsch specifically on perimenopause that can be quite enlightening. They also have great YouTube videos and podcasts. Pick your learning style and see if you learn any information that is helpful so you can ask questions to your provider and know a little more about what your body will go through.

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