“I eat like a rabbit, but this belly fat refuses to budge.” I hear some version of that sentence every week. It often comes with a second one: “I started hormones, and I still don’t feel like myself.”
If that sounds like you, the short answer is the order. Hormones added to a body that can’t clear them often work for a while, then fade. The order you do things in matters as much as what you take. Across more than 30 years of clinical practice, I have watched women get better results when they clear first, balance second, and then build the habits that sustain their results. That is the Clear, Balance & Thrive Method.
You may also be forgetting names and walking into rooms with no idea why you went in. (Anybody else’s ability to remember song lyrics from the ’80s exceed their ability to remember why they went upstairs?) Those symptoms connect to the same system, and the same order applies.
If you’d rather watch than read, I’ve covered everything in this short video.
Why aren’t my hormones working?
Getting hormones has never been easier. Since the FDA removed most of the black box warnings from menopausal hormone therapy, women have flooded online hormone programs, and there is almost no barrier left. That can be a good thing. It can also be a bad thing.
“It’s like a vending machine. You fill out an application, some unknown health practitioner whom you never get to meet sends you hormones.”
Women come to me afterward saying something is still not right, and they have no one to ask. Most were started on a standard dose with no testing, on the assumption that it works the same for everyone. After three decades, I can tell you it doesn’t. Everybody absorbs differently, and the dose needs to be customized to you, not one size fits all.
Your hormones also talk to each other, and your gut talks to your hormones. When one is out of sync, it throws the others off. In perimenopause, estrogen fluctuates erratically while progesterone declines or is nearly absent. In menopause, both are low and can still be out of balance. Adding more of one hormone rarely fixes a system that is out of order.
Why does clearing come first?
When women skip the clearing and go straight to hormones, many do well at first. Then the results fade. It’s like building a house on a swamp. Over time, it sinks.
Your liver sorts and packages hormones for disposal. Your gut and your ability to eliminate move them out. When the liver is overburdened, it is not processing hormones and toxins properly. When you are constipated, the toxins and hormone breakdown products cannot be cleared and get reabsorbed.
Reabsorbed estrogen breakdown products can leave you estrogen dominant. That can look like:
- Anxiety, irritability, and impatience
- Insomnia
- Tender or cystic breasts
- Bleeding or spotting
- Weight gain
You can be estrogen dominant even when you are not taking estrogen. After menopause, your body keeps making some estrogen in fat tissue, using hormones from your adrenal glands, and there is little to no progesterone left to balance it.
A body that fails to clear, because of inflammation, constipation, poor gallbladder or bile function, or toxicity, cannot respond properly to hormones, supplements, peptides, or lifestyle measures. You cannot balance hormones in a toxic, inflamed, sluggish body that can’t clear the hormones and toxins.
Clearing first is the heart of the Clear, Balance & Thrive Method. Learn the Method and see how the three steps fit together.
What happened when Jade cleared first?
Jade came to me with terrible migraines, weight gain, anxiety, and mood swings. She had read a book about hormones and was certain she needed them. She worked in health care, ate clean, and exercised. She was very reluctant to start anywhere else.
I told her what I tell many women: doing the method first could save her time and money. She finally agreed.
Her migraines had been daily and debilitating. In less than a month, they came down to two or three times a week. She lost weight, her energy came back, and the fog lifted. She cooked the same way for her whole family, and her husband lost 20 pounds. Her daughters’ belly issues went away too.
She needed no extra testing and no extra supplements. Most of all, she did not need the hormones she came in asking for. She sent me pictures, and she was thrilled.
Jade’s results are hers. Individual results vary, and your starting point is your own.
How can you tell what your hormones are doing?
A routine blood test is a snapshot of one moment. Your hormones are moving all day: some into cells to do their work, some out through urine and stool. I look at hormones three ways, because each one answers a different question.
- Blood is your bank account. It shows what is circulating at that moment, both free hormone and hormone bound to protein.
- Saliva is your savings account. It shows free hormone, the part doing the work, and it is the best test for cortisol.
- The DUTCH test (Dried Urine Test for Comprehensive Hormones) shows what your body does with your hormones: how it breaks them down and disposes of them.
Timing matters as much as the test. A DUTCH test done when estrogen is very low will not be accurate. A saliva cortisol test belongs on a typical day, not a quiet day at home, because a typical day is what you are trying to measure.
Test, don’t guess. The goal is to understand what your body is telling you, so you can have a better conversation with your own health care practitioner.
What keeps your results from fading?
Thrive is how you sustain your results and the quality of your life. Information alone does not get you there. You have to act on it, in a routine that fits real life.
These are the three places I see women lose ground:
- Many women do more cardio or yoga and no weights. They lose muscle, and with it bone, and they burn fewer calories. Muscle is the organ of longevity.
- You can lose a lot of bone in perimenopause, years before anyone orders a bone density scan.
- Deep sleep is when your brain does much of its cleanup. In animal research, the brain cleared amyloid, a protein linked to Alzheimer’s disease, twice as fast during sleep. Disrupted sleep cuts that short.
Stress belongs on that list too. Stress comes in three types: physical, chemical, and emotional. Hot flashes, pain, and restless legs are physical. A nutritional deficiency or a hormone imbalance is chemical. Worry is emotional. Each one can push cortisol up. Think of sitting on a tack: your brain can dull the pain, and your cortisol stays up until the tack is gone. When cortisol comes into balance, the other hormones often fall into place.
Where should you start?
There is a clear order. Clear the inflammation and the hormone disruptors. Balance hormones and metabolism. Thrive by building the habits that sustain health, longevity and quality of life.
Clearing starts with food: finding your common food triggers without changing everything overnight, supporting digestion, and getting elimination moving. Not everybody needs hormones, and not everybody wants them. Everybody benefits from the order.
If you are ready to do this in the right order, with me guiding you, Learn the Method. Your body is not betraying you. It needs a new strategy.
Frequently asked questions
Can gut problems make hormone therapy less effective?
They can. When the liver and gut are not clearing hormone breakdown products, those products can be reabsorbed. That can contribute to estrogen dominance symptoms, even while you take hormones.
Do I need hormones to feel better in perimenopause or menopause?
Not everyone needs hormones. Many women feel better by clearing first and building the right habits. Whether hormones are right for you is a decision to make with your own health care practitioner.
When is the best time to test cortisol?
A saliva cortisol test is usually four samples in one day: on waking, around noon, late afternoon, and before bed. Do it on a typical day so the results reflect your real life.
This article is educational and is not a substitute for advice from your own health care provider.
References
- US Food and Drug Administration. HHS advances women’s health, removes misleading FDA warnings on hormone replacement therapy. Published November 10, 2025. Accessed September 23, 2026.
- US Food and Drug Administration. FDA approves labeling changes for menopausal hormone therapy products. Published February 12, 2026. Accessed September 23, 2026.
- Santoro N. Perimenopause: from research to practice. J Womens Health (Larchmt). 2016;25(4):332-339. doi:10.1089/jwh.2015.5556
- Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. Estrogen-gut microbiome axis: physiological and clinical implications. Maturitas. 2017;103:45-53. doi:10.1016/j.maturitas.2017.06.025
- Hu S, Ding Q, Zhang W, Kang M, Ma J, Zhao L. Gut microbial beta-glucuronidase: a vital regulator in female estrogen metabolism. Gut Microbes. 2023;15(1):2236749. doi:10.1080/19490976.2023.2236749
- Simpson ER. Sources of estrogen and their importance. J Steroid Biochem Mol Biol. 2003;86(3-5):225-230. doi:10.1016/S0960-0760(03)00360-1
- Greendale GA, Sowers M, Han W, et al. Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: results from the Study of Women’s Health Across the Nation (SWAN). J Bone Miner Res. 2012;27(1):111-118. doi:10.1002/jbmr.534
- Xie L, Kang H, Xu Q, et al. Sleep drives metabolite clearance from the adult brain. Science. 2013;342(6156):373-377. doi:10.1126/science.1241224
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She is a recognized and award-winning holistic, functional, integrative and anti-aging healthcare practitioner, speaker and author, and has been featured in ABC News, Forbes, WOR Radio and many media outlets to spread the word that you can live younger and healthier at any age.