Leanne came to us struggling with a cascade of symptoms as she moved deeper into perimenopause at age 51.
Her fatigue was overwhelming.
Hair loss was worsening.
Her nails were thinning and had virtually stopped growing.
Skin flare-ups were becoming frequent (including rosacea).
Brain fog was severe.
Hot flushes struck every day.
And she was experiencing intense pins and needles.
She was genuinely worried she would have to quit working.
Leanne had been on birth control since she was 19.
In 2023, she struggled when doctors had to adjust her hormone prescription due to supply chain issues.
She suspected her current symptoms might be related to the recent shift — moving away from birth control and onto a more dedicated HRT prescription now that she was 51.
But several months had passed, and things still weren’t improving.
She continued to feel that something wasn’t quite right and decided to seek help from us.
Her doctor had been hesitant to make significant changes to her hormone treatment — her aunt had recently been diagnosed with breast cancer.
Her mum had passed away from ovarian cancer at just 38 years of age.
And her dad had died early from a rare cancer.
Leanne was understandably anxious that something serious might be being missed and decided to come see if we could help her.
We decided to run a genetic test along with a comprehensive hormone-endocrine-adrenal test because she felt so uncertain about everything that was happening.
Her extensive testing gave us in-depth information that I thought would really benefit you.
That’s why I wanted to share her journey with you today.
The genetic testing provided valuable insights into her family history concerns.
It helped Leanne determine whether she carried the same gene expressions as her mum, dad, and aunt.
It turned out to be the best decision for Leanne.
We were able to clearly identify that Leanne’s symptoms were driven by a combination of perimenopausal hormonal shifts amplified by specific genetic predispositions affecting oestrogen metabolism, clearance, nutrient conversion, and adrenal/androgen support.
Key Problems and Findings from Testing
From the Hormone-Endocrine-Adrenal Test, we found:
- Very low primary estrogens:
- Oestradiol (E2) at 0.23 ug/gCR (low, ref 0.40-1.80)
- Oestrone (E1) at 0.65 ug/gCR (low, ref 1.20-5.50)
- Oestriol (E3) normal at 0.86 ug/gCR
- Impaired Phase 2 oestrogen methylation/detox:
- Low 2-MeOH Oestrone (0.04 ug/gCR, below ref 0.05-0.75)
- Low 2-MeOH E1/2-OH E1 ratio (0.09, below ref 0.10-0.60)
- Low adrenal androgens:
- Markedly low DHEA production (454.51 ug/gCR, below ref 500-3000)
- Low DHEA-S
- Low androstenedione
- Low etiocholanolone
- Very low DHT
- Suboptimal adrenal cortisol rhythm:
- Flattened diurnal curve with low morning cortisol (AM#1 3.59 ug/gCR, below ref 7-45)
- Low evening (0.95 ug/gCR, below ref 1-7.2)
- Relative progesterone dominance:
- High pregnanediol/oestradiol ratio
- Elevated allopregnanolone
These patterns can be common during the “Low Oestrogen Window” (between 50 and 70), but were exaggerated in Leanne’s case, even though she ate healthily, had a great metabolism, and wasn’t struggling with her weight.
These test results pointed to a number of the metabolic symptoms due to her hormones changing, including:
- Hot flushes
- Brain fog
- Fatigue
- Skin issues (including rosacea flares)
Her low androgens (female testosterone) were contributing to her:
- Hair loss
- Nail thinning
- Low energy
Her impaired methylation added to instability.
Her flattened cortisol worsened overall fatigue and brain fog.
BUT none of these were obvious in her Medicare blood work.
From the Genetic Test
Several variants predisposed Leanne to these inefficiencies:
- Fast COMT:
High COMT activity accelerates clearance of catechol oestrogens and neurotransmitters, potentially reducing oestrogen signalling and contributing to fluctuations/low effective oestrogen in perimenopause. - CBS – Homozygous:
Reduced CBS activity can strain methylation pathways (affecting homocysteine recycling and SAMe availability), indirectly impairing Phase 2 oestrogen methylation and detox. - BCMO1 Heterozygous variants:
Reduced conversion of beta-carotene to active vitamin A (retinol), which supports hormone production, skin/hair health, and adrenal function. This was likely exacerbating hair/nail changes, skin flares (including rosacea), and low androgen support. - Other supportive variants (e.g., CYP1A2 intermediate, APOE ε3/ε4)
Influenced nutrient needs, antioxidant status, and resilience.
Together, these genetic factors amplified the natural perimenopausal drop in ovarian oestrogens and adrenal androgens, making symptoms more severe despite ongoing hormone support.
Her blood & nutrient tests helped finish the puzzle, showing us the key nutrient impairments she was experiencing, including:
- Magnesium deficiency (worsening adrenal depletion).
- Low adrenal/electrolyte stress.
- Deficiencies in sulphur pathways.
- Increasing liver enzymes, indicating methylation issues.
- Low DHEA (mirroring what we found in her Hormone-Endocrine-Adrenal Test).
- Good TSH (even though she was fatigued, foggy, losing hair).
- Low testosterone.
- Elevated cholesterol, indicating methylation issues, oxidative stress, and antioxidant challenges.
Medically, Leanne’s routine blood work looked amazing. On the surface, it appeared she only needed to continue or adjust her HRT.
What we could see, and what was actually happening in her body, was far more nuanced:
- Adrenal Axis Dysfunction, skewing testosterone, androgens, and DHEA levels.
- Hormone Metabolism & Clearance Challenges causing intense symptoms, even though she was taking hormones.
- Methylation & Detoxification Issues, that weren’t “dangerous enough” to flag prominently in standard blood work.
On the surface, her blood work suggested that simply taking oestrogen, progesterone, and/or testosterone would fix things.
But because of these deeper findings, we now understood exactly why the hormones weren’t delivering the desired results.
Leading to her persistent:
- Fatigue
- Brain fog
- Neurological sensations (pins and needles)
- Skin inflammation (rosacea flares)
- Allergies
- Energy crashes
Leanne’s Results
We focused on optimising oestrogen clearance, supporting methylation, gentle phytoestrogen and adrenal restoration, supporting her conversations with her doctor to adjust her HRT prescription, and providing specific nutrient support. With this targeted approach, Leanne transformed quickly.
Within about a week of starting treatment:
- Her energy returned
- Her hair stopped falling out
- Her sleep became so much deeper
Leanne started her plan in November last year, and as of last week, she is so happy to be:
- Completely pain-free.
- Has loads of energy.
- Sleeping through the night.
- Skin completely clear.
- Allergies gone.
- Her hair growing back. (Little short strands sticking out but she’s okay with it!)
- Working out and walking regularly.
- Working full time, confidently.
- Brain fog completely lifted.
She said she has never felt this good in her life.
Leanne’s story shows how sometimes we need to dig deeper with testing, beyond standard blood work. You can uncover hidden drivers and unlock real relief.
HRT and hormone therapy can be wonderful support for women.
But if you are concerned because not all of your symptoms are gone, it’s a good time to start looking deeper into your pathology.
It may be that hormones are not the cause of the problem.
OR the pathways that enable hormones to convert and metabolise may be “down”.
You don’t always have to do extensive testing to get the answers. Leanne chose to do two tests at the same time for genetic reasons.
Often we only need to do one and look deeper at the blood and nutrient work that you do have.
When hormones, genetics, and metabolism align with the right support, even deep lowering hormone challenges can resolve dramatically.
If you would like to look at the different ways to look at testing and what to test, especially during this vulnerable 50 to 70 year old time, I encourage you to watch our upcoming webcast, The Low Oestrogen Window.
You can register to watch it here: https://naturalhormonebalance.co/free-training-low-oestrogen/
If you’re experiencing similar frustrations, understanding the “why” behind your symptoms is often the first step to feeling like yourself again. We start with a Free Introductory Consultation over the phone to get a better idea of what is happening to you.
If that sounds like something you would like to do, can you please organise here: https://calendly.com/nz-naturopathy/intro-consult
We look forward to connecting with you again soon!
Have a great rest of your Sunday.
Warmly,
Tiaan & Carrie
