Progesterone supports healthy menstrual cycles and pregnancy. It balances estrogen, decreasing the risk of endometrial and possibly breast cancer. It also supports thyroid function, blood sugar regulation, fluid and mineral balance, and bone building. Progesterone has a calming effect and enhances mood and sleep.² Low progesterone levels can lead to anxiety, depression, irritability, insomnia, weight gain, heavy periods, and decreased libido.
Progesterone levels drop during menopause, leaving estrogen unbalanced. Levels can also decline with chronic stress and elevated cortisol. Cortisol blocks progesterone receptors, which prevents the body from using progesterone effectively. This means hormone imbalances resembling early menopause can occur even in your 20s.
Compounded bioidentical progesterone is the preferred replacement for low levels. Synthetic progestins do not have the same effect as natural progesterone and can stay in the body for months, leading to estrogen imbalance and disruption of the body’s natural production. Progesterone can be compounded as a cream or a slow-release capsule. Oral progesterone may be more effective if insomnia is a primary symptom.
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Testosterone plays an important role in hormonal balance for women. Although only small amounts are needed, it supports bone density and muscle mass, helps regulate body composition, maintains skin elasticity, boosts energy and libido, and contributes to overall well-being.¹ ² Low testosterone levels in women can lead to fatigue, weight gain, anxiety, decreased muscle mass, thinning skin, and reduced libido.³
Testosterone levels naturally decline with age, especially during and after menopause, due in part to ovarian aging.⁴ Chronic stress can also lower testosterone by increasing cortisol, which suppresses sex hormone production.⁵ Additionally, certain medications like oral contraceptives can reduce free testosterone by increasing sex hormone-binding globulin (SHBG).⁶
Elevated testosterone in younger women may signal polycystic ovary syndrome (PCOS), a condition characterized by irregular menstrual cycles, anovulation, infertility, and increased risk of miscarriage. Symptoms of excess testosterone in PCOS include acne, unwanted facial or body hair growth, and weight gain, often related to insulin resistance.⁷ ⁸
When replacement therapy is indicated, testosterone should be prescribed in a bioidentical form and typically administered transdermally as a cream or gel, with application sites rotated to avoid skin irritation. Synthetic and oral testosterone formulations carry greater risks, including potential liver toxicity. Maintaining proper estrogen balance is important, as estrogen supports testosterone’s activity in the brain and other tissues.² ⁹
The thyroid gland is a butterfly-shaped organ located at the front of the neck. Its main role is to produce hormones that regulate metabolism, which is how the body uses energy. Thyroid hormones affect many vital functions including heart rate, breathing, body weight, muscle strength, body temperature, mood, and reproductive health. The two primary hormones it produces are thyroxine (T4) and triiodothyronine (T3). T4 is the inactive form and is converted into the active form, T3, primarily in the liver and kidneys. The hypothalamus and pituitary gland in the brain control thyroid hormone production through a feedback loop involving thyroid-stimulating hormone (TSH).¹
Thyroid disease affects an estimated 20 million people in the United States. Women are five to eight times more likely than men to be diagnosed.² Hypothyroidism, or underactive thyroid, occurs when the body does not make enough thyroid hormone. Common symptoms include fatigue, weight gain, hair thinning, constipation, depression, dry skin, brittle nails, and sensitivity to cold.³ Nutrient deficiencies that may contribute to low thyroid function include iodine, iron, ferritin, selenium, zinc, magnesium, and vitamins A, C, B2, B6, and B12.⁴
Chronic stress can negatively affect thyroid function. Elevated cortisol levels can interfere with the conversion of T4 to active T3.⁵ Hormonal imbalances, especially estrogen dominance where estrogen levels are not adequately balanced by progesterone, can also affect thyroid hormone availability by increasing thyroid-binding globulin (TBG), which binds thyroid hormones and reduces the amount of free, active hormone.⁶
Hashimoto’s thyroiditis is an autoimmune condition and the most common cause of hypothyroidism in the U.S. In this condition, the immune system produces antibodies, most commonly TPO (thyroid peroxidase) and thyroglobulin antibodies (TgAb), that attack and damage the thyroid gland. This leads to decreased hormone production over time.⁷
Treatment for hypothyroidism typically involves hormone replacement. Some patients benefit from natural desiccated thyroid (NDT) medications like Armour Thyroid or NP Thyroid, which provide both T4 and T3. Others may do well with synthetic T4 such as levothyroxine or Synthroid, sometimes combined with synthetic T3 liothyronine or Cytomel, particularly if T4-to-T3 conversion is impaired.⁸ The choice of therapy depends on the patient's specific diagnosis, symptoms, lab values, and individual response. Supporting thyroid health through diet and supplementation of key nutrients may also be helpful in some cases.⁴ ⁹
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Cortisol is a steroid hormone produced by the adrenal glands, which sit on top of the kidneys. Its levels can increase with age.¹ When you experience stress, cortisol rises as part of the fight-or-flight response and typically returns to baseline once the stress passes.² Chronic stress, however, can keep cortisol elevated³. This sustained elevation prioritizes cortisol production over reproductive hormones, causing hormonal imbalances and symptoms like anxiety, depression, fatigue, irritability, mood swings, and brain fog.⁴
The adrenal glands are part of the hypothalamic-pituitary-adrenal (HPA) axis, a system regulating cortisol and many other hormones essential for stress response, mood, metabolism, energy, immune function, and hormone balance.⁵
Cortisol plays critical roles such as reducing inflammation, normalizing blood sugar, supporting metabolism, regulating blood pressure and circadian rhythm.⁶ It peaks in the morning to prepare the body for the day and is lowest at night to support sleep.⁷
Excess cortisol can weaken immunity and reduce reproductive hormones by competing with progesterone receptors, also disrupting blood sugar balance and potentially leading to insulin resistance.⁴ ⁸ Chronic high cortisol may impair thyroid function as well.⁹
Prolonged stress can cause adrenal fatigue, where cortisol production declines, resulting in fatigue, insomnia, low libido, brain fog, and emotional instability.¹⁰
Treating adrenal dysfunction involves stress management and may benefit from supplements and herbal adaptogens like Ashwagandha and Rhodiola to help balance the HPA axis.¹¹
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DHEA (dehydroepiandrosterone) is a hormone produced mainly by the adrenal glands. It is converted in the body into both estrogen and testosterone. DHEA is often called an anti-aging hormone because levels peak in the late twenties and gradually decline thereafter.¹ It supports the immune system, helps decrease allergic reactions, lowers cholesterol and triglycerides, and promotes weight management and mental health. One important function of DHEA is to buffer the hormone system against stress-related hormone imbalances, often referred to as the cortisol “steal” effect.²
Declining DHEA levels are a normal part of aging and menopause. However, chronic stress can cause an accelerated drop in DHEA levels even in young women.³ Since DHEA is a precursor in the hormone synthesis pathway for estrogen and testosterone, low DHEA can contribute to hormone imbalances.
DHEA supplementation is best done with pharmaceutical-grade products and typically does not require a prescription. The replacement dose for women is much lower than for men, as women are more sensitive to DHEA’s effects and require smaller amounts. If low DHEA levels are not corrected, it can make balancing other hormones such as estrogen, progesterone, and testosterone more difficult.⁴
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Estrogen is a chemical messenger with over 400 functions in the body, controlling sexual and reproductive health as well as many non-reproductive roles in the skeletal, cardiovascular, and nervous systems¹. It affects cholesterol levels, blood sugar regulation, muscle and bone mass, circulation, collagen production, skin moisture, and brain function including memory and mood² ³. Estrogen also supports serotonin formation, which helps decrease depression, irritability, anxiety, and pain sensitivity.
There are three types of estrogen: estrone (E1), estradiol (E2), and estriol (E3). Estrone predominates after menopause, estradiol is the most potent form protecting bone, heart, and brain health, and estriol is important during pregnancy and for menopause symptom control⁴.
Menopause generally occurs between ages 45 and 55, though this varies widely and can be unpredictable. During this transition, hormone levels fluctuate causing symptoms like mood swings, weight gain, sleep problems, and vaginal dryness. Early in menopause, progesterone and testosterone tend to decline before estrogen, sometimes leading to relative estrogen dominance⁵ ⁶. This imbalance can contribute to hypothyroidism and increase breast cancer risk.
Bioidentical hormone replacement therapy (BHRT), using hormones chemically identical to those the body produces, is an effective treatment for menopause symptoms and is often preferred over synthetic hormones⁷. Oral estrogen is typically avoided due to increased risks of blood clots, high blood pressure, and liver effects. Transdermal estrogen, such as creams containing estradiol and estriol, bypasses liver metabolism and can provide better results with lower doses⁸.
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