Wendy and/or David, I am consulting with a client who is 45 years old and had an endometrial ablation in 2017 due to heavy bleeding that began in 2012...baseball sized clots and soaking pads/tampons in an hour. No periods post ablation, but by 2020, was spotting every month. Fast forward to 2024 and she has not had any spotting for almost a year and has started experiencing the dreaded hot flashes and night sweats. Her hormone bloodwork levels are as follows: Prolactin 24.5 (4.8-23.3) Estradiol 235 Estrone 145 Progesterone .2 Testosterone 36 (4-50) Free Testosterone 1.4 (2-6) AM Cortisol 7.2 I'm not really sure what I'm asking here, other than I would really appreciate some insight into your thought process when evaluating whether or not someone is or isn't peri-menopausal/menopausal when they've had an ablation (or hysterectomy for that matter) and you have no idea which phase they are at in their cycle! With all your experience, I remember you saying you can pretty much treat based on symptomology. Women are a mess! Hysterectomies, ablations, and HRT, oh my!! The bloodwork did not include an SHBG value, which I'm assuming is at play due to these testosterone levels. I'm also not sure what to think with this AM cortisol level being on the low end for the morning. If there is cortisol steal going on, there isn't much to steal in the morning! Thyroid levels are great. Fasting glucose is normal, but fasting insulin is a little elevated. She does say her energy level is "low". Any insight and "big picture" observations would be greatly appreciated. I need a glimpse into your brain:) Jami Platt

Wendy said: Yes, trying to figure things out when there is no bleeding pattern to go by adds a layer of complexity, that's for sure! That is a very high estradiol level. So either she was ovulating at the time or she is making excess or she isn't metabolizing/ excreting very well. That progesterone level could be totally normal if it's anytime early in the cycle. Definitely work on the blood sugar because those levels you mention imply instability, which will feel like a flash. And wow, that is a really low am cortisol.....she will need a lot of support with adaptogens, lifestyle change, probably nervines. And the cortisol / adrenal dysfunction is probably impacting her insulin's ability to function correctly, so it's very possible she's eating ok and still has blood sugar issues. Is she sleeping? With that cortisol, I would be surprised if she is, so give her some support there as well. Support liver detoxification as we talked about in class, and be sure she's pooping (or all the metabolized estrogen gets recirculated back to the blood stream, remember?). And of course, give her something directly for the flashes, like siberian rhubarb. Good luck!

Wendy, Thank you for the insight! Very much appreciated:) She claims she is sleeping well. She does have a history of crazy stress, but fortunately many of the circumstances surrounding it have resolved. Jami