Dr. Serena Goldstein, ND
Subheadline
A comprehensive review of hormonal changes, mood, metabolism, and integrative strategies to support women’s health at every life stage.
Short Description
This article explores hormonal changes across the female lifespan—from menarche through perimenopause and menopause—and their impact on mood, metabolism, and overall health. It outlines integrative strategies including lifestyle, nutrition, laboratory assessment, and targeted therapies to support hormone balance and long-term wellness.
INTRO
In women’s health, the word ‘hormones’ seems to be a catchall phrase at any age when concerns typically related to mood and aesthetics go awry, especially around the 1930s when hormone replacement therapy was gaining popularity. Furthermore, as hormones shift from menses, to perimenopause, to menopause, the amount of information and resources have grown significantly. Therapies that focus on the whole person can truly address symptoms and prevention, and can be blended accordingly (i.e. natural and conventional), yet the acknowledgment of the mental/emotional, and often life changes, have also come into awareness as women too can go through their own epiphanies, which were often thought to be limited to men in their ‘mid-life crisis.’ We are also in the age of the informed patient, so she is discussing her own ideas, research, and what she envisions of ‘health’, and is also asking care to expand beyond hormones for not only a more optimized health, but also prevention.
HORMONES
Around menarche, anywhere from age 9 to 15, estrogen and progesterone increase to begin signaling to the body that menses, and therefore her reproductive years, can begin. For the next perhaps three plus decades, there are at least four hormones in flux every month (estrogen, progesterone, luteinizing hormone (LH), and follicle stimulating hormone (FSH)), with testosterone remaining fairly steady. As responsibilities tend to mount, so too may stress – whether from academia, work, relationships, poor food choices, poor sleep quality, and a more sedentary lifestyle (or too much strenuous exercise without the right support) – all of these can affect hormone production and elimination, as well the health of other organ systems.
SYMPTOMS
Estrogen – which helps with bone density, mood, energy, libido, healthy menses, weight management, glucose metabolism, healthy skin and hair, brain health, and heart health – is best when balanced depending on her age and where she is in her cycle. Too high has been linked to hormone-sensitive cancers, reproductive pathologies (i.e. uterine fibroids), hot flashes (in peri and/or menopausal women), mood swings, irregular and/or painful and/or heavy menses, poor sleep, and weight gain, while lower levels may have some similar symptoms, as well as vaginal dryness, and low libido.1 Normal progesterone levels (depending on her stage) help alleviate many of these symptoms, while elevated levels can contribute to breast tenderness, fatigue, and water retention. Conversely, low progesterone may be a factor in irregular menses, bone health, mood concerns, and issues in maintaining a healthy pregnancy. Testosterone is another major player for hormonal health as it is involved in metabolism, promoting healthy insulin (blood sugar) levels, libido, bone health, and cognition (e.g. brain fog). Levels tend to decline slowly around her 20’s (except if she has Polycystic Ovarian Syndrome [PCOS] – that has higher levels), and especially around menopause.2 However, higher levels can contribute to acne, weight gain, and excess hair growth.
MOOD
With these three hormones crossing the blood brain barrier (BBB), amongst some others, each has an effect on mood. Progesterone crosses the blood brain barrier and therefore it affects mood and general neurological health, promoting GABA (gamma amino-butyric acid), a calming neurotransmitter; whereas noradrenaline and nicotine can inhibit its production.3 While we do need stress to get things done, constant bursts of noradrenaline (part of our ‘fight or flight’ response), as well as now the uptick in vaping may further contribute to hormone imbalances. Testosterone has been associated with increased dopamine levels (our reward neurotransmitter), in part through conversion to dihydrotestosterone via the 5-alpha reductase enzyme to mitigate to anxiety.4 Estrogen – mainly estradiol (E2) – helps increase serotonin, our ‘happy hormone,’ via receptor sensitivity and number. Interestingly, only 1-10% of serotonin is found in the central nervous system, whereas the other 90+% is found in the gastrointestinal tract (e.g. motility), immune tissues, and regulating vasculature.5 Progesterone further helps inhibit indoleamine-2,-3-dioxygenase (IDO) and tryptophan-2,-3 dioxygenase (TDO), two enzymes that can catabolize tryptophan into inflammatory metabolites such as kynurine and impeding the production of serotonin and melatonin.6 From premenopausal concerns like PMS (premenstrual syndrome) to natural hormone shifts in peri- to menopause and afterwards, any sort of shift in hormones can affect her mood (and sleep).
GUT HEALTH AND STRESS
Serotonin helps regulate urination, cerebrospinal fluid production, and relaxes vascular smooth muscle (i.e. aids in peristalsis).7 Our microbiome is made up of four pounds of gut bacteria, including a portion called the ‘estrobolome’, which helps metabolize estrogen mostly through the enzyme, beta-glucuronidase. Cortisol, our stress hormone made by the adrenal glands, is naturally highest in the morning, and drops steadily in the afternoon to the evening, so melatonin can steadily rise, resulting in good sleep. Elevated, or even dysregulated cortisol, can affect hormone balance as metabolites favor making cortisol from pregnenolone, rather than progesterone and other hormones. Furthermore, stress can contribute to inflammation that may trigger pathogenic bacteria, which can encourage dysbiosis, affecting the estrobolome and compromising gut lining.8 Adrenal health becomes even more important around menopause, as now these are the main organs that produce sex hormones outside of the ovaries, which were once the main source.
THYROID
Thyroid concerns are much more common in women than men, and with imbalanced sex hormone levels, elevated estrogen can create more thyroid binding globulin (TBG), which binds up thyroid hormone (i.e. responsible for metabolism) resulting in less active thyroid hormone. This can lead to weight gain, imbalanced energy levels, and even digestive issues per movement. Furthermore, disproportionate stress levels (especially elevated cortisol), can convert T4 to reverse T3 (rT3), an inactive metabolite (versus T3, the active form).9
RISK FACTORS
An unhealthy diet or perhaps even one that’s consumed ‘on the go’, poor sleep habits, sedentary lifestyle, chronic stress, early family history, and regular use of endocrine disrupting products (xenoestrogens such as BPA, phthalates, etc.) may be implicated to varying degrees on hormonal imbalance outside of what’s occurring biologically. Often, if hormonal imbalances were present as a teen, symptoms may be worse later in life; or when these changes naturally occur, commonly used conventional therapies will mask the issue (birth control, Midol, Tylenol, other medications) rather than addressing the whole person and her lifestyle.
LABS
The gold standard is to test hormones such as estradiol, progesterone, and testosterone, along with FSH, LH, and anti-mullerian hormone (AMH) if they are in peri/menopausal territory. For a more well-rounded assessment, include a CBC, CMP, lipid panel, vitamin D (25-OH), vitamin B12, iron panel, hemoglobin A1c, full thyroid panel (TSH, total T4, free T4, free T3, reverse T3, Anti-TPO, Anti-TG), and high-sensitivity CRP. While bloodwork tests free (active) and bound (inactive) hormones together, urine and saliva tests can be helpful in assessing how much of the active hormone itself is available, especially if bloodwork levels are normal but they still ‘don’t feel good.’ Sometimes these tests can be combined with mapping out a four-point cortisol curve, which can be helpful in observing stress levels upon waking, throughout the day, and before sleep. If there is a strong mood and/or gut symptomatology occurring, consider an organic acids test for inflammatory markers, or a stool test for additional assessment.
LIFESTYLE
When it comes to therapeutic interventions, there’s a balance of alleviating symptoms while also recognizing the importance of a healthful lifestyle, especially given that certain habits can impinge the effectiveness of therapies. Sleep is one of the main aspects affected, so getting to sleep and your head on the pillow preferably before 10:30pm helps with the rise of melatonin at 11pm, as well as proper production of hormones and anti-inflammatory markers throughout the night. A calming routine, including limiting screentime 30 minutes-1 hour before bed, can also help with sleep quality and getting deep, restorative sleep. Journaling, artwork, coloring, gentle movement (i.e. being outside at night, safety permitting), can create mindful moments to help reduce stress levels.
NUTRITION AND EXERCISE
A healthful diet focused on healthy fats (e.g. avocado, nuts, olive oil), quality meats, complex carbohydrates, and predominantly whole foods, can be a great start to modifying the meal plan. In addition, adequate water intake (at least half of body weight in lbs consumed as oz of water) and education around moderated alcohol intake are essential. For additional digestive support, properly chew each bite of food at least 30 times, allow 30 minutes-1 hour for each meal, and aim to consume warmer foods when it’s cool, and lighter foods when it’s warm. Counseling can include creating mindfulness around one meal per day for a week (as a starting goal), as well as getting a water bottle at least 30 ounces in size to reduce the amount of times it needs to be filled up (to encourage water intake). For exercise, anything from gentle movement to cross fit is valid, given their capacity. Weight bearing exercises do help build more muscle, which supports goals around long-term weight loss, mood support, blood sugar regulation, and a more positive self-image, and are especially important around menopause for bone health. It is likely if there is a struggle with weight and/or hormone balance, there may also be an imbalance of either too much or all cardio workouts, which can be replaced with yoga, walking (with or without ankle weights), and/or weight training.
SUPPLEMENTS
Thinking about the foundation, then building more specific choices can be helpful. For starters, a good foundation could include a methylated B-vitamin complex, magnesium (glycinate or other chelated forms are best), vitamin D3/K2 (test vitamin D levels first), and vitamin C (which is involved in a wide range of processes from synthesis of collagen and hormones to iron absorption).10 Seed cycling helps support hormone production for each part of the menstrual cycle, and can be done by alternating fish oil with ground 1-2 tablespoons (TBSP) of pumpkin/chia/flaxseeds in the first half of her cycle (menses) to evening primrose oil with 1-2 TBSP ground sesame/sunflower seeds the second half (ovulation). For menopausal women, beginning on the new moon, and switching on the full moon, is another way to receive benefits. More specifically, blends of vitamins, minerals, and herbs to address her unique symptoms at any stage, while also supporting the liver (has over 500 functions), adrenals, gut, and any general inflammation as needed. Emotionally, hawthorn (berries, leaves, flowers, and seeds) helps support the heart in times of transition, and setting boundaries, with a history of traditional use for heart, digestive, and kidney (where the adrenals reside) tonics.11 Flower essences are also a great option (either as a blend, or single essence depending on her self-expression) taking a few drops on the tongue, or added into a water bottle and sip on throughout the day.
HORMONE REPLACEMENT THERAPY (HRT)
HRT can be a great resource depending on symptoms, with types varying from synthetic to bioidentical, and can be compounded for optimal routes of administration. My experience with HRT is that women either tend to think it will ‘solve everything at once’, refuse to take anything ‘unnatural,’ or express concern about how long they should be on it. Due to how intricately hormones can play a role in a wide variety of conditions and symptoms, it is important to counsel and focus on checking in on what we can relieve, emphasizing the importance of all modalities, and then regularly checking in symptomatically and through labs how they’re doing. Given the recent removal of the black box warning from estrogen, it may help alleviate the propagated fear around HRT, namely estrogen. Though I was taught to do both estrogen and progesterone (testosterone can be administered on its own), I’m sure we will be observing its after effects both clinically and publicly in the coming years.
CONCLUSION
There are many therapies and approaches available to support women through each stage of life; however, what is often overlooked is the lived experience of these transitions—from shifts in mood and perspective to evolving views of the future. As estradiol levels decline, particularly during perimenopause and menopause, many women describe a lifting of the “rose-colored glasses,” prompting greater awareness of long-standing internal cues that may have first emerged in their 30s or 40s. With this shift often comes increased confidence, a stronger sense of self, and greater comfort in setting boundaries. These changes can be powerful allies in implementing sustainable lifestyle modifications, as women navigate new care plans, priorities, and rhythms that align with their individual stage of life and personal timeline.
References:
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https://doi.org/10.3399/bjgp20X709265
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https://pmc.ncbi.nlm.nih.gov/articles/PMC8538505/
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https://doi.org/10.1186/1472-6874-5-12
8) Madison, A., & Kiecolt-Glaser, J. K. Stress, depression, diet, and the gut microbiota: human-bacteria interactions at the core of psychoneuroimmunology and nutrition. Current opinion in behavioral sciences. 2014; 28: 105–110. https://doi.org/10.1016/j.cobeha.2019.01.011
9) Wellwood C, Rardin S. Adrenal and Thyroid Supplementation Outperforms Nutritional Supplementation and Medications for Autoimmune Thyroiditis. Integr Med (Encinitas). 2014;13(3):41-47.
https://pubmed.ncbi.nlm.nih.gov/26770099/
10) Alberts A, Moldoveanu E-T, Niculescu A-G, Grumezescu AM. Vitamin C: A Comprehensive Review of Its Role in Health, Disease Prevention, and Therapeutic Potential. Molecules. 2025; 30(3):748. https://doi.org/10.3390/molecules30030748
11) The benefits of hawthorn for the heart & cardiovascular function. (2023). Gaia Herbs. Retrieved December 1st, 2025. https://www.gaiaherbs.com/blogs/seeds-of-knowledge/benefits-hawthorn
