Case Study: When Hormonal Imbalance Meets Stressful Daily Life

Mary, age 51, experienced high stress levels in her career and personal life, and this coupled with the onset of perimenopause resulted in a number of symptoms, including severe energy loss and mood fluctuations.  A baseline evaluation of hormone levels revealed that she was deficient in vitamin D and had low levels of cortisol and progesterone. Dr. Aidun started Mary on bioidentical hormone replacement therapy coupled with IV therapy for adrenal health.  After four months of treatment, Mary experienced improvement in her energy and mood levels.


At age 51, Mary started her office visit by explaining: “I’ve been a totally different person the past three to four months.

A business manager, mother and wife, Mary was working more than 70 hours a week for over ten years while tending to her family responsibilities. For years she was able to “do it all” efficiently, but she started having difficulty functioning several months before seeking treatment. She became paralyzed by stressful situations, was increasingly irritable and started experiencing excessive emotions and anger outbursts.

Mary noticed physical differences as well, including a decline in energy levels and stamina. She had difficulty falling asleep and was not refreshed when she woke up. For the first time in her adult life, Mary needed to take naps in the afternoon. She also started getting colds every two or three months.

While all this was going on, Mary’s menstruation cycle became less frequent and not as heavy. Her mood would worsen before menses. Though she had no history of depression and no external factors causing depression, she was forced to miss work one day on account of being too “down” to get out of bed. She had decreased energy and severe emotional disturbance for days leading up to her menstrual cycle.

 “How could I manage a large business, and my duties as a mom and a wife feeling like this?”

Mary’s primary care doctor offered her antidepressants and birth control medication to manage her symptoms, but she refused the treatment as she wanted to instead discover the underlying cause of the recent changes to her well-being. That led Mary to undergo a complete hormonal evaluation with Dr. Aidun.

Pre-Treatment Health Evaluation

Mary’s hormonal evaluation included analysis of estrogen, progesterone and testosterone levels, as well as an analysis of her thyroid profile, DHEA, cortisol levels and vitamin D levels. External factors such as sources of stress, diet and micro and macronutrient intake were also evaluated.

The results of Mary’s hormonal evaluation were as follows:

Hormonal levels were tested at day 21 of the menstrual cycle. Mary was deficient of progesterone, cortisol and vitamin D. Her progesterone levels were at 0.5 ng/dl, while ideal levels of the hormone at this point of the cycle range between 1.7-2.7 ng/dl. Progesterone levels are affected by changes in ovulation, and a lack of progesterone is associated with mood changes and anxiety.

Cortisol levels fluctuate throughout the day, but Mary tested low for this hormone in multiple screenings. The AM cortisol level was 8.3 ng/dl, while optimal levels of the hormone range up to 22 ng/dl. Anything below 13 ng/dl is considered low.

Vitamin D levels were at 18 ng/ml, which is low. A normal range of vitamin D is between 30 ng/ml and 100 ng/ml. Vitamin D deficiency is associated with mood fluctuations, reduced bone health and changes in hormone functionality.

Thyroid profile of TSH, T4, T3 and anti-microsomal TPO antibodies were within normal range. Lipid panel, iron levels and testosterone levels were all optimal.

Estradiol levels returned at 131 pg/ml, which falls in the optimal range between 44 and 211 pg/ml. However, estrogen levels fluctuate naturally from hour to hour. Drastic fluctuations contribute to premenstrual depression and moodiness, symptoms experienced by Mary.

Assessment of Results

After reviewing her hormonal levels it was clear that Mary experienced a collision of premenopausal hormonal changes with the effect of chronic stress from environmental factors like work pressure and family obligations.

While it was impossible for Mary to avoid the onset of these changes, there were steps she could take to reduce the symptoms and improve her well-being.

Initial Treatment

To restore hormone imbalance and reverse the effects of perimenopause, Mary began bioidentical hormone replacement therapy (BHRT) with a combination of estradiol and progesterone.  Focus was also applied on adrenal health to repair the physical damage of chronic stress and help her better manage her stress in the future.

Adrenal health was treated with a combination of IV therapy and oral supplements. She was recommended dosages of B vitamins and vitamin C.

Treatment dosage was as follows:

  • Bioidentical hormone replacement therapy: Featuring estradiol and progesterone.
  • IV therapy for adrenal health: Injection of vitamin C and B5 B6, B- Complex, calcium, magnesium and the antioxidant selenium. Treatment was given once a week for one month and then biweekly for three months.
  • Oral supplement use: Phosphatidylserine taken nightly to maintain cortisol levels with Vitamin D supplements.

Along with physical treatment, Mary was given direction on better coping strategies so she could learn to manage her stress and maintain good health at home.

Post-Treatment Follow Up

After one month of treatment, Mary’s mood changes were resolved almost completely, including her premenstrual depression. She experienced a significant improvement in energy, though she still had not regained her former energy levels.

After four months, Mary’s blood work showed improvement in her adrenal health. Her cortisol levels improved from 8.3 ng/dl to 12.4 ng/dl and her vitamin D levels improved from 18 ng/ml to 37.9 ng/ml. Her hormone health also experienced positive changes. Estradiol levels improved from 131 pg/ml, which was considered within the normal range, to 195 pg/ml. Her progesterone levels, which were low at the onset of treatment, increased from 0.5 ng/dl to 5.4 ng/dl.

After four months of treatment, Mary’s energy had returned to nearly normal. Her menstrual cycle remained irregular, which is typical for a woman entering perimenopause, but her perception was of an overall improvement in her health. She felt that her health was back to normal.

From the onset of treatment Mary did not experience another cold or upper respiratory infection, which she complained of contracting frequently prior to treatment.

Post-Follow Up Treatment Plan

Following her four month review, Dr. Aidun recommended that Mary continue with monthly IV therapy for another three months, and then as needed. Bioidentical hormone replacement therapy was continued at the same dosage level for 12 months. Vitamin D dosage was reduced to a maintenance level.


After four months of IV therapy and BHRT, Mary noticed a striking difference in her health, including improvements in her mood and energy levels. After six months, Mary regained hormonal balance and reported normalcy with her mental and physical well-being.

Following her treatment, Mary chose to pursue IV therapy every two to three months, and turns to the therapy to improve her health during stressful periods. Her hormones remain stable with BHRT.

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