Hormone Cafe

Fertility Surgery Explained: PCOS, Endometriosis, Ovarian Cysts & Recovery | Episode 33

In this episode of The Hormone Café, Dr. Sarah Pederson explains how surgery fits into a holistic fertility and women’s health plan. She walks through when surgery is truly helpful, what happens before and during surgery, and how proper recovery—including nutrition and pelvic rehab—can dramatically improve fertility outcomes.

Thyroid Health Explained: Hormones, Metabolism, Fertility & Hashimoto’s | Episode 32

In this episode of The Hormone Café, Dr. Sarah Pederson breaks down the thyroid—why it’s central to metabolism, hormone production, fertility, and energy, and why thyroid testing should always be part of a comprehensive women’s health and fertility workup.
She explains how to properly test the thyroid, interpret results through a fertility-focused lens, recognize autoimmune thyroid disease early, and create a long-term plan that supports both hormone balance and metabolic health.
In This Episode, You’ll Learn:
🦋 Why the Thyroid Is So ImportantThe thyroid:
Regulates metabolism
Supports hormone production
Affects brain function, energy, and body temperature
Directly impacts menstrual cycles and fertility
When thyroid function is off—either too low or too high—it can disrupt the entire endocrine system.
⚠️ Symptoms of Thyroid DysfunctionLow thyroid (hypothyroidism) may cause:
Fatigue
Feeling cold
Brain fog
Low metabolism
Irregular cycles
High thyroid (hyperthyroidism) may cause:
Feeling “amped up”
Anxiety
Blood sugar crashes
Weight changes
Cycle irregularity
Any patient with hormone imbalance or irregular cycles should have their thyroid evaluated.
🧪 What a Comprehensive Thyroid Panel IncludesDr. Sarah emphasizes that checking TSH alone is not enough.
A full thyroid evaluation includes:
TSH
Free & total T4
Free & total T3
Reverse T3 (when indicated)
Thyroid antibodies:
TPO (thyroid peroxidase antibodies)
TG (thyroglobulin antibodies)
🧠 Understanding TSH (and Why “Normal” Isn’t Always Optimal)TSH works inversely:
High TSH → low thyroid hormone
Low TSH → high thyroid hormone
While many labs consider TSH up to 4.5 “normal,” in fertility and women’s health:
Optimal TSH = 5–2.5
Values outside this range may still cause symptoms and fertility challenges.
🔁 Why Thyroid Labs Should Be RecheckedThyroid levels fluctuate with:
Stress
Exercise
Illness
Life changes
If an abnormal result appears:
Repeat testing to confirm trends
Avoid treating based on a single lab value
🧬 Why Thyroid Antibodies MatterPositive antibodies indicate autoimmune thyroid disease:
Hashimoto’s (underactive thyroid)
Graves’ disease (overactive thyroid)
You can have:
Normal TSH and T4
But elevated antibodies
If untreated, antibodies can:
Progress to thyroid dysfunction
Increase miscarriage risk
Disrupt fertility and hormone balance
🦴 Hypothyroidism & Subclinical HypothyroidismHypothyroidism:
High TSH
Low thyroid hormone
Subclinical hypothyroidism:
High TSH
Normal T4
First-line support includes:
Nutrition optimization
Correcting nutrient deficiencies
Monitoring response before medication
🥗 Nutrients Essential for Thyroid FunctionKey thyroid-building nutrients:
Iodine
Selenium
Zinc
Magnesium
Vitamin D
If deficient, restoring these nutrients alone may normalize thyroid function.
💊 When Thyroid Medication Is NeededIf nutrition alone isn’t enough, medication may be indicated:
Most commonly levothyroxine (T4)
Important considerations:
Take on an empty stomach
Avoid food/drinks for 30 minutes
Absorption is sensitive to fillers and brands
Sometimes changing the brand (Synthroid, Tirosint) works better than changing the dose.
🔄 Thyroid Medication Is Not Always PermanentIn many cases:
Thyroid medication is temporary
As blood sugar, stress, and sex hormones normalize, thyroid function may improve
Medication can often be tapered
The goal is lowest effective dose for the shortest necessary time.
🔥 Hyperthyroidism & Why Imaging MattersHyperthyroidism:
Low TSH
Normal or high T4
Evaluation includes:
Thyroid antibody testing
Thyroid ultrasound
Dr. Sarah shares a case where hyperthyroidism and nodules revealed thyroid cancer—highlighting why imaging can be critical.
🧬 Hashimoto’s Thyroiditis: A Long-Term StrategyHashimoto’s is an autoimmune condition where the body attacks the thyroid.
Goals of care:
Reduce antibodies
Calm inflammation
Prevent flares
Support fertility and energy
Antibody levels can range from mild to very high (hundreds).
🌿 Nutrition for Hashimoto’sFoundational strategies include:
Anti-inflammatory diet
Low added sugar
Whole, unprocessed carbohydrates
Adequate protein and fats
Key food sources:
Selenium: Brazil nuts
Iodine: seaweed, kelp, iodized salt
Magnesium: leafy greens, seeds, whole grains
🚫 Gluten & Dairy: Individualized, Not UniversalSome patients benefit from a trial of gluten/dairy-free—but only if:
Antibodies are very high
Changes are measured
Highly processed gluten-free foods can worsen inflammation and blood sugar.
If antibodies don’t improve, restriction is unnecessary.
💊 Other Tools to Lower AntibodiesWhen needed:
Anti-inflammatory supplements (quercetin, turmeric)
Low-dose naltrexone
Short-term low-dose steroids
Thyroid medication
Progress is always monitored with repeat labs.
🧠 Preventing Hashimoto’s FlaresTriggers include:
Stress
Travel
Poor sleep
Dietary changes
Long-term success comes from:
Consistent nutrition
Stress management
Regular monitoring
Proactive flare prevention
🌸 T3 vs. T4 in FertilityDuring pregnancy and conception:
T4 is preferred
T3 does not cross the placenta
Low T3 is best addressed by:
Improving T4 → T3 conversion
Reducing stress
Optimizing nutrition
T3 may be appropriate later in life when fertility is no longer a goal.
Key Takeaways:
Thyroid health is foundational to hormones and fertility
TSH alone is not enough
Thyroid antibodies must be checked
Nutrition is first-line therapy
Medication can be temporary
Hashimoto’s can improve—and even go into remission
Long-term management prevents flares
Resources & Next Steps:
If you’re struggling with fatigue, brain fog, irregular cycles, or unexplained fertility challenges, a comprehensive thyroid evaluation can be transformative.
📍 Westminster, Colorado🌐 Learn more or schedule: verafertility.com📧 Follow along: @verafertility

Supplements for Women’s Health: Fertility, Hormones & Vaginal Health — What Actually Helps | Episode 31

In this episode of The Hormone Café, Dr. Sarah Pederson breaks down supplements for women’s health—how to use them strategically for hormone balance, fertility, vaginal health, and metabolism, and why more supplements is almost never better.
She walks through her testing-first, nutrition-forward philosophy, explains why random supplement stacking can backfire, and outlines how to create a personalized supplement plan that actually works—and eventually allows you to come off supplements altogether.
In This Episode, You’ll Learn:
🌱 Dr. Sarah’s Core Supplement PhilosophySupplements should:
Support nutrition, not replace it
Be measured and intentional, not random
Be used in the lowest effective dose
Always have a goal and an exit plan
Taking 20–30 supplements because of TikTok, Instagram, or generic advice often overwhelms digestion, metabolism, and absorption—and can worsen symptoms.
🧪 Why Testing Comes FirstBefore recommending supplements, Dr. Sarah emphasizes testing:
Nutrient status (antioxidants, vitamins, omegas)
Egg quality
Hormone production (estrogen, progesterone, testosterone)
Metabolism and absorption
You should never take supplements that work against your hormone profile.
⚠️ When Supplements Can Make Things WorseDr. Sarah shares examples of supplements that can backfire:
DIM lowering estrogen in someone already estrogen-deficient
Probiotics worsening symptoms when taken blindly
Egg quality supplements used unnecessarily when egg quality is already strong
Without testing, supplements can actively harm progress.
💊 Targeted Supplementation: Less Is MoreExamples of precision-based supplementation:
Low B12 → supplement only B12, not a full B-complex
Low omega-3s → supplement omega-3, then recheck
High omega-6s → adjust diet + omega-3 dose
If levels don’t improve, the issue may be absorption or gut health, not dosage.
🧠 Fat-Soluble vs. Water-Soluble VitaminsWater-soluble (B vitamins, vitamin C):
Excess is usually excreted in urine
Fat-soluble (A, D, E, K):
Stored in the body
Can accumulate to harmful levels
Must be monitored regularly
Taking fat-soluble vitamins long-term without testing can impair metabolism and organ function.
🦠 Absorption, Gut Health & Fillers MatterIf supplements aren’t raising blood levels:
Gut inflammation may be blocking absorption
Microbiome imbalances may interfere
Fillers or capsule materials may cause reactions
Some patients react to:
Microcrystalline cellulose
Silica
Capsule binders
The issue is often the form, not the supplement itself.
🌿 Why One Supplement at a Time Is ImportantStarting multiple supplements simultaneously makes it impossible to identify:
GI reactions
Sensitivities
What’s actually helping
Dr. Sarah recommends introducing supplements one at a time—especially for sensitive patients.
🚫 Never Power Through a Bad ReactionIf a supplement causes:
Stomach pain
Nausea
Fatigue
Feeling “off”
Stop it.
Your body should feel better, not worse. A reaction signals:
Incorrect dose
Poor tolerance
Wrong form
Inappropriate supplement for your physiology
🧬 Egg Quality Supplements: Keep It SimpleFor low egg quality, Dr. Sarah typically recommends:
~3 targeted supplements, not 10
Common options include:
CoQ10 / Ubiquinol
NAC (N-acetylcysteine)
Glutathione
Resveratrol
Alpha-lipoic acid
These work best alongside nutrition and gut optimization—not in isolation.
🌸 Using Supplements to Support Hormone ProductionSupplements should address why hormones are low, not just push levels:
Omega-3s for hormone building blocks
Protein and B vitamins
DHEA for adrenal support (when appropriate)
Vitex or maca in select cases
If a supplement doesn’t change lab values or symptoms, it’s discontinued.
🦠 Probiotics Are Not One-Size-Fits-AllDifferent guts need different species:
Lactobacillus
Bifidobacteria
Saccharomyces boulardii
Akkermansia
Taking the wrong probiotic can worsen overgrowth and symptoms.
🌿 Estrogen Metabolism & Gut SupportFor estrogen dominance:
Address beta-glucuronidase
Increase fiber intake
Use targeted supplements (e.g., calcium D-glucarate when indicated)
Dietary changes are often more powerful than pills.
🔄 Supplements Should Be Temporary Whenever PossibleThe long-term goal:
Restore natural production
Optimize gut health
Improve nutrient absorption
Transition back to food-based support
Supplements are a bridge, not a permanent crutch.
🩺 Short-Term Supplement Use After SurgeryExample: Post-endometriosis surgery:
Omega-3
NAC
Curcumin
Used for ~3 months to reduce inflammation and recurrence—then discontinued.
☕ Alternative Ways to Get AntioxidantsTo reduce pill burden:
Food (greens, berries, protein)
Teas (green tea)
Spices (turmeric)
Powders and tinctures
IV nutrients (vitamin C, glutathione, ALA)
A 360° approach minimizes daily capsule overload.
📊 Measuring Effectiveness MattersSupplements should produce measurable change:
Improved labs
Better symptoms
Objective data (e.g., CGM for blood sugar)
If it’s not working, it’s stopped.
🧾 Why Everyone Needs a Supplement AuditDr. Sarah recommends regularly:
Reviewing all supplements
Measuring what’s actually needed
Eliminating what’s unnecessary
Creating seasonal or short-term plans
The goal is the lowest supplement load possible while maintaining optimal health.
Key Takeaways:
Supplements should be personalized and tested
More is not better
Nutrition comes first
Supplements should improve labs and symptoms
Bad reactions are not normal
Every supplement plan needs a goal and an end point
Resources & Next Steps:
If you’re overwhelmed by supplements, unsure what you actually need, or want a data-driven plan for fertility, hormones, or gut health, a comprehensive supplement audit can make all the difference.
📍 Westminster, Colorado🌐 Learn more or schedule: verafertility.com📧 Follow along: @verafertility

Primary Ovarian Insufficiency (POI): Early Menopause, Hormones, Fertility & What to Do | Episode 30

In this episode of The Hormone Café, Dr. Sarah Pederson explains Primary Ovarian Insufficiency (POI)—also known as premature menopause—what it is, how it’s diagnosed, why it happens, and how to support your body hormonally, metabolically, and emotionally if your ovaries stop functioning earlier than expected.
Dr. Sarah walks through real patient examples, the long-term health implications of early estrogen loss, and why hormone support is often essential—not optional—in these cases.
In This Episode, You’ll Learn:
🌱 What Primary Ovarian Insufficiency IsPrimary Ovarian Insufficiency (POI) occurs when:
Ovarian function declines before age 40
Estrogen, progesterone, and testosterone levels are very low
Brain hormones (FSH, LH) are very high
Periods become irregular or stop completely
It may also be called:
Premature menopause
Premature ovarian failure
🔥 How POI Is DiagnosedDiagnosis includes:
Multiple hormone tests over time
Very low estrogen, progesterone, testosterone
Very high FSH and LH (brain signaling distress)
Poor egg quality
Hormones must be tested more than once to identify patterns, not just a single snapshot.
🧠 Why Brain Hormones Are So HighWhen ovaries stop responding, the brain:
Increases FSH and LH dramatically
Works overtime trying to stimulate estrogen production
Contributes to fatigue, brain fog, and exhaustion
Replacing estrogen helps calm this feedback loop.
🩺 Why POI Is Different From Natural MenopauseUnlike menopause in the 50s:
Some ovarian function may remain
Ovulation can occasionally return
Fertility may still be possible with support
This creates opportunities—but also unique medical needs.
🦴 Why Estrogen Replacement Is CriticalEstrogen is not just about cycles—it:
Protects bone density
Protects cardiovascular health
Reduces inflammation
Supports blood vessel growth
Nourishes every cell in the body
Without estrogen, women with POI:
Age more rapidly
Lose bone density earlier
Have increased heart disease risk
💊 Hormone Therapy: Not Optional in POIDr. Sarah explains that in POI:
Estrogen replacement is medically necessary
Goal is to replace ~2 mg/day (what the body would normally make)
Hormones are continued until natural menopause age (~50–51)
This is long-term physiologic replacement, not short-term symptom control.
🌸 How Hormones Are ReplacedTreatment typically includes:
Estrogen (patch or oral)
Progesterone (always required with estrogen)
Testosterone (if low energy, muscle loss, or libido issues)
Doses are:
Personalized
Titrated carefully
Adjusted over time
📊 Ongoing Monitoring Is KeyFollow-up includes:
Hormone levels every 3–6 months
Symptom tracking
Dose adjustments as life demands change
Some days may require more hormone support (stress, workouts, illness).
🔄 Hormone Needs Are DynamicPatients learn to:
Adjust doses during high-stress or high-activity days
Understand how lifestyle affects hormone demand
Become empowered in their own care
🧬 What Causes POI?Potential causes include:
Autoimmune disease (most common)
Autoimmune thyroid disease (Hashimoto’s, Graves)
Celiac disease, lupus, rheumatoid arthritis
Genetic conditions (X chromosome abnormalities)
Childhood infections (e.g., mumps)
Poor ovarian blood flow
Anatomical or vascular differences
Sometimes, no clear cause is found.
🧪 What Else Needs to Be EvaluatedA full POI workup should include:
Autoimmune screening
Thyroid function
Blood sugar and insulin
Lipids and omegas
Bone density (DEXA scan)
Vaginal health and microbiome
🌸 Vaginal Health & EstrogenLow estrogen can cause:
Vaginal dryness
Pain with intercourse
Microbiome imbalances
Support includes:
Daily vaginal estrogen for 1 month
Ongoing use as needed
Periodic “reset” months (e.g., twice yearly)
👶 Fertility With POI: Is Pregnancy Possible?Yes—for some patients:
~5–10% may ovulate spontaneously
Hormone support improves chances
Ovulation medications often required
Estrogen priming may help rejuvenate ovarian function
Each cycle must be closely monitored and adjusted.
❤️ Supporting Blood Flow & InflammationFertility support often includes:
Treating anemia
Improving pelvic blood flow
Pelvic floor physical therapy
Vitamin E for circulation
Reducing inflammation and immune overactivity
🧠 The Emotional Side of POIPOI can feel:
Unfair
Isolating
Overwhelming
Dr. Sarah emphasizes:
Do not compare your journey to others
Focus on learning what your body needs
This diagnosis is not a life sentence
With the right plan, patients can feel excellent, energized, and empowered.
Key Takeaways:
POI is menopause before age 40
Estrogen replacement is essential for long-term health
Hormone therapy is individualized and monitored
Fertility is sometimes still possible
Bone, heart, and vaginal health must be protected
You can feel amazing—even with this diagnosis
Resources & Next Steps:
If you’ve gone long stretches without a period, are experiencing menopausal symptoms in your 30s–40s, or have been diagnosed with POI, comprehensive hormone evaluation is critical.
📍 Westminster, Colorado🌐 Learn more or schedule: verafertility.com📧 Follow along: @verafertility

Menopause Explained: Symptoms, Hormones, Sleep, Weight & What to Do About It | Episode 29

In this episode of The Hormone Café, Dr. Sarah Pederson breaks down menopause from start to finish—what it is, when it happens, common symptoms, and how to support your body so you can feel strong, clear-headed, and energized during this transition.
Dr. Sarah explains the difference between perimenopause and menopause, why symptoms happen, and why menopause is a natural life stage—not something to fear or “power through.” Most importantly, she emphasizes that just because menopause is natural does not mean you have to feel miserable.
In This Episode, You’ll Learn:
🌸 What Menopause Actually IsMenopause is defined as:
No menstrual cycle for 12 consecutive months
Ovaries producing very small amounts of estrogen
No ovulation or regular cycling
Perimenopause is the transition phase, where communication between the brain and ovaries becomes erratic before cycles stop completely.
📅 When Menopause Happens
Average age in the U.S.: 51
Normal range: mid-40s to late 50s
Every woman’s timeline is different—and that’s normal.
🔄 Why Symptoms OccurMenopausal symptoms stem largely from:
Rapid drops and fluctuations in estrogen
Loss of hormonal stability
Increased sensitivity to blood sugar, stress, and inflammation
The body is shifting from cyclical hormone production to very low baseline hormone levels.
🔥 Common Menopause SymptomsSymptoms vary widely and may include:
Hot flashes and night sweats
Insomnia and poor sleep quality
Hair thinning, brittle nails, thin skin
Brain fog and memory issues
Mood changes, irritability, anxiety
Fatigue and low energy
Metabolic slowdown and weight gain
Some women have many symptoms; others have very few.
✨ Menopause Is Natural — Suffering Is Not RequiredDr. Sarah emphasizes:
Menopause does not need to be “fixed”
Debilitating symptoms should be addressed
You deserve to feel great at every stage of life
Do not dismiss symptoms as “just menopause.”
😴 Insomnia & Night Sweats: The Big DriversPoor sleep is one of the most disruptive menopausal symptoms and is often driven by:
Blood sugar instability
High cortisol (stress hormone)
Hormonal fluctuations
Thyroid dysfunction
Good sleep should happen 5–6 nights per week. Anything less needs support.
🩸 Blood Sugar & Metabolism Matter More Than EverHormonal transitions amplify blood sugar swings.Key goals:
Avoid lows (50s) and highs (>140)
Aim for a stable glucose curve
Average glucose under ~100
Dr. Sarah often uses continuous glucose monitoring (CGM) to personalize nutrition.
🥩 Protein First in MenopauseMany women in menopause need:
More protein
Fewer carbohydrates
Careful timing of meals
Carbohydrate spikes can worsen:
Anxiety
Mood swings
Insomnia
⚡ Cortisol, Anxiety & the “Tired but Wired” FeelingHigh nighttime cortisol can:
Prevent melatonin production
Suppress estrogen
Cause middle-of-the-night awakenings
Support includes:
Strict bedtime routines
No blue light 90 minutes before bed
Journaling, calming rituals, nervous system regulation
🌡️ Thyroid & ThermoregulationThyroid dysfunction can worsen:
Hot flashes
Cold intolerance
Temperature swings
Optimizing thyroid function is essential for symptom control.
💊 Bioidentical Hormones — Used CorrectlyHormone therapy can be:
Life-changing
Restorative
Protective
But must be:
Personalized
Properly dosed
Monitored carefully
Hormones alone are not enough without addressing nutrition, gut, thyroid, and metabolism.
🥦 Nutrition Still Comes FirstKey principles:
Stable blood sugar
Adequate protein
High-quality fats
No artificial sweeteners (stevia, monk fruit, erythritol, etc.)
Dr. Sarah recommends a primal-style diet during menopause.
⏰ Intermittent Fasting — Use CarefullyUnlike cycling women, menopause may benefit from fasting—but timing matters:
Do not skip breakfast
Cortisol is highest in the morning
Better to shorten or skip dinner instead
Fasting windows should support metabolism, not stress it.
🏋️ Exercise for Hormone Support & Bone HealthEssential components:
Weight-bearing exercise (especially with low estrogen)
Resistance training for muscle mass
Moderate cardio for heart health
Overtraining can worsen:
Weight gain
Fatigue
Hormonal imbalance
🧠 Brain Fog & Estrogen MetabolismBrain fog can result from:
Poor estrogen clearance
Imbalanced estrogen ratios (E1, E2, E3)
Gut, liver, or kidney dysfunction
Daily bowel movements, hydration, and detox pathways matter.
💧 Hydration & Hormone ClearanceAdequate water intake supports:
Kidney function
Estrogen metabolism
Reduced brain fog
📊 A Whole-Body ApproachTrue menopausal support evaluates:
Hormones
Blood sugar
Sleep
Cortisol
Thyroid
Gut health
Nutrition
Exercise
Everything must work together.
🔁 Lifestyle Changes Are Required — And Worth ItWhat worked in your 20s–40s may no longer work.Menopause requires:
New strategies
Greater precision
More intentional self-care
With the right plan, many women feel better in their 50s and 60s than ever before.
Key Takeaways:
Menopause is a natural transition, not a disease
Symptoms vary widely and are highly individualized
Poor sleep, weight gain, and brain fog are treatable
Blood sugar stability is critical
Hormones work best when paired with nutrition and lifestyle support
You can feel amazing in menopause with the right plan
Resources & Next Steps:
If you’re in perimenopause or menopause and struggling with symptoms, a personalized, whole-body approach can make all the difference.
📍 Westminster, Colorado🌐 Learn more or schedule: verafertility.com📧 Follow along: @verafertility

Nutrition Testing Explained: Antioxidants, Omegas, Mitochondria & Hormone Health | Episode 28

In this episode of The Hormone Café, Dr. Sarah Pederson dives into nutritional status and nutrition testing—why it’s foundational for hormone production, fertility, and overall health, what nutrients are most important to test, and how to turn results into a personalized action plan.
Dr. Sarah explains why even “healthy eaters” can be nutrient deficient, how deficiencies impact ovulation, egg quality, energy, and metabolism, and why targeted testing allows for precise nutrition and supplement support instead of guesswork.
In This Episode, You’ll Learn:
🥗 Why Nutrition Is the Foundation of Hormone HealthHormone production depends entirely on having the right nutritional building blocks.Dr. Sarah explains how proper nutrition supports:
Estrogen, progesterone, and testosterone production
Regular ovulation and healthy cycles
Energy, metabolism, and gut function
Mitochondrial and cellular health
Feeling good, ovulating regularly, and having stable energy all start with nutrition.
🧪 Why We Test Nutrients Instead of GuessingEven with a “clean” diet, it’s hard to know:
If you’re absorbing nutrients
If ratios are correct
If what you’re doing is actually working
Testing provides clarity, direction, and measurable progress.
🧬 The NutrEval: A Comprehensive Nutrition PanelOne of Dr. Sarah’s favorite tests evaluates:
Antioxidant status
Oxidative stress
Mitochondrial function
Omega fatty acid ratios
Toxin exposure
Methylation needs
This gives a full picture of cellular health and hormone-building capacity.
✨ Antioxidants & Egg QualityHigh antioxidant levels are essential for:
Reducing oxidative stress
Protecting egg quality
Preventing chromosomal abnormalities
Key antioxidants evaluated include:
Vitamin A
Vitamin C
Vitamin E
Alpha-lipoic acid
CoQ10
Low antioxidants = increased cellular stress and reduced fertility potential.
⚡ Mitochondrial Health = Energy & HormonesMitochondria are the energy factories of your cells.Poor mitochondrial function can lead to:
Fatigue
Poor hormone production
Brain fog
Metabolic dysfunction
Nutrition testing helps identify where mitochondrial support is needed.
🔥 Omega-3, Omega-6 & Inflammation BalanceDr. Sarah explains why omega balance matters:
Omega-3s are anti-inflammatory and hormone-supportive
Omega-6s are abundant in seed oils and easy to overconsume
Even “healthy” diets can have excess omega-6 due to salad dressings and packaged foods. Testing ensures proper ratios, not just good intentions.
🐟 Why Omega-3s Are Hard to Get from Diet AloneTop omega-3 sources are almost exclusively fish.If fish isn’t eaten 2–3x per week, supplementation is often necessary—and must be measured to ensure it’s working.
☣️ Toxins & Heavy Metals That Impact HormonesNutrition testing also screens for:
Lead
Mercury
Arsenic
Cadmium
These toxins can interfere with estrogen production and overall endocrine function, sometimes requiring detox support or increased antioxidant intake.
🧠 Methylation Support: Are You Using the Right Vitamins?Some bodies require methylated forms of nutrients like:
Folate (methylfolate)
Vitamin B12 (methylcobalamin)
Without proper methylation, vitamins can build up without being utilized—testing identifies what form your body needs.
🥦 Food First, Supplements SecondDr. Sarah emphasizes:
Nutrition should always come first
Supplements should be targeted, not random
High levels don’t need more supplementation
Brightly colored fruits and vegetables provide plant-based antioxidants, while supplements fill only true gaps.
💊 Why Supplements Sometimes “Don’t Work”Low blood levels despite supplementation may indicate:
Poor absorption
Capsule fillers (like microcrystalline cellulose)
Gut or stomach issues
Switching forms (liquid, powder, different capsule) can dramatically improve absorption.
🧂 Minerals Matter More Than You ThinkKey minerals tested include:
Magnesium (sleep, metabolism, hormone balance)
Zinc (ovulation, immunity)
Deficiencies may reflect absorption issues, mineral imbalances, or endocrine dysfunction.
📊 Personalized Plans, Not Supplement OverloadDr. Sarah explains why random supplement stacks:
Overwhelm the gut
Don’t address root causes
Waste time and money
Targeted plans focus only on deficiencies—and are re-tested to ensure improvement.
💉 When IV Nutrition Is HelpfulIn cases of severe deficiency or malabsorption, IV nutrients can:
Rapidly replenish vitamins
Support healing while gut protocols are underway
Fast-track hormone recovery
IVs may include vitamin C, B vitamins, glutathione, and alpha-lipoic acid.
Key Takeaways:
Nutrition is the foundation of hormone production
“Eating healthy” doesn’t guarantee nutrient sufficiency
Antioxidants are critical for egg quality and cellular health
Omega balance directly affects inflammation and estrogen
Supplements should be personalized and measured
If nutrients aren’t absorbing, gut health must be addressed
Resources & Next Steps:
If you’re struggling with hormone imbalance, fatigue, poor ovulation, or fertility challenges, nutrition testing can provide clarity and direction.
📍 Westminster, Colorado🌐 Learn more or schedule: verafertility.com📧 Follow along: @verafertility

Bioidentical Hormones Explained: Testosterone, Progesterone, Estrogen & How to Use Them Safely | Episode 27

In this episode of The Hormone Café, Dr. Sarah Pederson breaks down bioidentical hormones—what they actually are, how they differ from synthetic hormones, and how they’re used safely and effectively in clinical practice. She walks through testosterone, progesterone, estrogen, and DHEA, explaining how each hormone functions in the body, the best delivery methods, and why dosing, timing, and personalization matter so much.
Rather than using hormones as a “band-aid,” Dr. Sarah emphasizes a root-cause, physiology-first approach—supporting the body while working toward long-term balance and eventual weaning when appropriate.
In This Episode, You’ll Learn:
🌱 What “Bioidentical” Really MeansBioidentical hormones have the same molecular structure as the hormones your body naturally produces.Dr. Sarah explains the key hormones used in practice:
Testosterone
Progesterone
Estrogen (estradiol, estrone, estriol)
DHEA (adrenal hormone and precursor)
These hormones are used to support—not override—natural physiology.
🔥 Testosterone in Women: Why It MattersTestosterone isn’t just for men. Women need it for:
Libido
Energy and motivation
Muscle mass and recovery
Healing and metabolism
Egg quality and follicle stability
Dr. Sarah explains why daily, low-dose testosterone is preferred over pellets or injections, how it supports fertility, and why the goal is always eventual weaning—not lifelong use.
💊 Best Absorption Methods for Testosterone
Troches (dissolved between cheek and gum)
Topical creams
Oral testosterone is avoided to protect gut and liver health and ensure steady absorption.
🌸 Progesterone: Timing Is EverythingProgesterone is only made after ovulation.Dr. Sarah explains:
Why checking progesterone at the wrong time leads to misdiagnosis
Why progesterone taken too early can inhibit ovulation
The danger of “cycle day 21” testing for everyone
Progesterone should always support the natural cycle—not disrupt it.
🩸 When Progesterone Is HelpfulProgesterone may be used when:
You’re not ovulating at all
You have irregular or absent cycles
You have a luteal phase defect
Progesterone is low after ovulation
Supporting early pregnancy
Dr. Sarah outlines how cyclic progesterone can help retrain the body to ovulate and cycle regularly.
🌙 How Progesterone Is Given
Oral (most common; taken at night due to drowsiness)
Vaginal (more uterine-focused, less blood absorption)
Patch or cream (typically for peri/postmenopause)
Injections (sometimes necessary in pregnancy)
If progesterone makes you feel worse, the dose or delivery method needs adjusting—there’s no “powering through.”
🧠 Estrogen: Not Too High, Not Too LowEstrogen is produced daily and plays a critical role in:
Ovulation
Cycle length
Energy and cognition
Uterine lining health
Pregnancy support
Dr. Sarah explains why estrogen must be tested before and after ovulation and how low estrogen is often misdiagnosed as PCOS.
📈 When & How Bioidentical Estrogen Is UsedEstrogen may be used when levels are truly low and root causes are addressed simultaneously.Delivery options include:
Oral estradiol (micro-dosed and carefully titrated)
Vaginal estrogen (for dryness, UTIs, cervical mucus, microbiome support)
Patches (helpful in perimenopause or when oral estrogen isn’t tolerated)
The goal is always physiologic balance—never excess.
🌊 Perimenopause, Menopause & Hormone SmoothingDuring perimenopause, estrogen can swing dramatically.Low-dose daily estrogen (often via patch) can:
Smooth hormone fluctuations
Reduce brain fog, mood swings, headaches
Improve sleep and energy
Dr. Sarah emphasizes that hormone therapy should always have a plan—support, stabilize, then wean.
🧬 DHEA: The Precursor HormoneDHEA supports:
Estrogen and testosterone production
Adrenal health and stress resilience
Fertility and pregnancy support
It can be used orally or vaginally depending on goals and symptoms.
📊 Root Cause Always Comes FirstHormones are never used in isolation. Dr. Sarah reviews:
Nutrition and adequate calorie intake
Stress and cortisol balance
Thyroid and adrenal health
Gut absorption and metabolism
Hormones support healing—they don’t replace it.
Key Takeaways:
Bioidentical hormones match your body’s natural hormones
Dose, timing, and delivery method matter
Hormones should make you feel better, never worse
Testing must match physiology and cycle timing
Root causes must always be addressed
Every hormone plan needs an end game
Resources & Next Steps:
If you’re struggling with hormone symptoms, fertility challenges, or perimenopause and want a personalized, physiology-based approach, support is available.
📍 Westminster, Colorado🌐 Learn more or schedule: verafertility.com📧 Follow along: @verafertility

Perimenopause Explained: Hormone Roller Coasters, Testing & How to Feel Like Yourself Again | Episode 26

In this episode of The Hormone Café, Dr. Sarah Pederson breaks down perimenopause—what it is, how to know if you’re in it, and what you can do to feel better during this major hormonal transition. She explains why symptoms can feel extreme and unpredictable, how hormone testing actually works in perimenopause, and why a whole-body, root-cause approach is essential for long-term relief.
Rather than accepting “this is just part of aging,” Dr. Sarah outlines how targeted nutrition, lifestyle support, lab testing, supplements, and — when appropriate — low-dose bioidentical hormone therapy can dramatically improve quality of life.
In This Episode, You’ll Learn:
🌿 What Perimenopause Actually IsPerimenopause is the transition between regular, ovulatory hormone production and menopause.Instead of a smooth decline in estrogen and progesterone, hormone production becomes sporadic and erratic, leading to dramatic highs and lows.This hormonal “roller coaster” is what drives many of the frustrating symptoms women experience.
🔥 Common Symptoms of PerimenopauseDr. Sarah explains that symptoms can vary widely and may include:
Anxiety and mood swings
Depression or irritability
Brain fog and poor concentration
Hot flashes, night sweats, and temperature intolerance
Fatigue and poor sleep
Weight gain despite eating well and exercising
Changes in metabolismPerimenopause is natural — but suffering is not inevitable.
🧪 How to Test for Perimenopause (and Why One Lab Isn’t Enough)Hormone levels fluctuate dramatically in perimenopause. One “normal” lab does not rule it out.Dr. Sarah explains:
Why FSH and LH are key markers
What values typically look like in reproductive years vs. perimenopause vs. menopause
Why testing multiple times, at least two weeks apart, is critical to identify trendsTrending labs over time gives a much clearer picture than a single snapshot.
🩸 When Irregular Bleeding Is a Red FlagNot all irregular cycles require treatment — but certain symptoms do:
Extremely heavy bleeding
Bleeding lasting weeks at a time
Bleeding through clothes or experiencing “waterfall” bleedingThese situations warrant intervention to protect health and improve quality of life.
🥗 Why Nutrition Is Always the FoundationBefore jumping to medication, Dr. Sarah emphasizes:
Eating enough calories to support hormone production
Stabilizing blood sugar to reduce hormone swings
Ensuring adequate protein, healthy fats, and micronutrientsNutrition is the base that allows any other therapy to work effectively.
🧠 Supporting the Entire Endocrine SystemPerimenopause is not just about estrogen and progesterone.Dr. Sarah walks through why it’s essential to assess:
Thyroid function (full thyroid panel, not just TSH)
Adrenal health (DHEA/DHEA-S)
Nutrient status (magnesium, zinc, B vitamins, omega-3s)
Mitochondrial and metabolic health
📈 Why Blood Sugar Matters More Than You ThinkUsing continuous glucose monitoring, Dr. Sarah explains how blood sugar instability can worsen:
Insomnia
Anxiety
Inflammation
Hormone irregularityBalanced glucose = more stable hormones.
🌱 Gut Health, Absorption & Hormone BalanceEven a perfect diet won’t help if nutrients aren’t absorbed.Daily bowel movements, minimal bloating, and proper digestion are essential to hormone production and detoxification.
💊 Supplements: When to Support vs. When to Avoid
High estrogen → support detox pathways (DIM, calcium D-glucarate)
Low hormones → avoid estrogen-lowering supplements
Strategic use of nutrients like DHEA when appropriateSupplement choice must match hormone status.
🧠 Mental Health & Nervous System SupportMood changes during perimenopause are influenced by:
Hormone fluctuations
Life stressors (career changes, aging parents, family transitions)Sarah highlights the importance of therapy, nervous system regulation, and targeted neurotransmitter support when needed.
🌸 Hormone Therapy: When It’s HelpfulHormone replacement therapy can be life-changing for severe symptoms such as:
Debilitating insomnia
Drenching night sweats
Severe brain fogSarah explains:
Why low-dose, bioidentical hormones are used
How therapy is personalized
The importance of monitoring labs and symptoms
Why hormones should support — not override — natural physiology
📊 Discovery, Stabilization & Weaning PhasesHormone therapy is never “one and done.”Treatment includes:
Discovery phase (finding the right dose)
Stabilization phase (feeling great consistently)
Planned weaning into menopauseThe goal is support, not dependence.
Key Takeaways:
Perimenopause can last 5–10 years and looks different for everyone
Hormone swings — not aging — drive many symptoms
One lab test is not enough to diagnose perimenopause
Whole-body evaluation is essential for lasting results
Hormone therapy can be powerful when used thoughtfully
You are not doomed to feel bad — feeling better is possible
Resources & Next Steps:
If you think you may be in perimenopause or you’re experiencing symptoms that are affecting your quality of life, you don’t have to navigate it alone.
📍 Westminster, Colorado🌐 Learn more or schedule: verafertility.com📧 Follow along: @verafertility

Bypassing the Gut: How IV Therapy Supports Egg, Sperm & Implantation Health | Episode 25

In this episode of The Hormone Café, Dr. Sarah Pederson explains how IV nutrient therapy can support fertility when diet and supplements aren’t enough. She breaks down why nutrient deficiencies persist despite “doing everything right,” how IVs bypass absorption barriers, and how targeted IV formulations can improve egg quality, sperm quality, implantation, and surgical recovery.
In This Episode, You’ll Learn:
💉 Why IV Therapy Matters in Fertility CareDr. Sarah explains why many fertility patients remain deficient in key nutrients despite optimal diet and supplementation:
Poor gut absorption
Digestive inflammation or dysfunction
Liver metabolism limiting nutrient availabilityIV therapy allows nutrients, antioxidants, and hydration to be delivered directly into the bloodstream—bypassing the gut and liver for faster, more effective results.
🧪 Key Nutrients Commonly Low in Fertility PatientsFrequently identified deficiencies include:
Folic acid & B vitamins
Vitamin C and other antioxidants
GlutathioneThese nutrients are essential for:
Cellular energy and metabolism
Egg and sperm quality
Detoxification and inflammation reduction
🥚 Egg Quality IVDesigned to support ovarian health and cellular protection:
High-dose antioxidants to reduce oxidative stress
Supports mitochondrial function and egg integrity
Can be used weekly or monthly depending on fertility goalsSarah explains that while we’re born with all our eggs, egg quality can be supported through targeted antioxidant pathways.
🌱 Implantation & Uterine Blood Flow IVCreated for patients with:
Thin uterine lining
Recurrent miscarriage
Chronic inflammation or endometritisThis IV focuses on:
Improving blood flow to the uterus
Supporting implantation before and after ovulation
Working alongside diet, supplements, and medication—not replacing them
🩺 Pre- & Post-Surgical Recovery IVsDr. Sarah discusses why surgery should be restorative—not depleting:
Surgery places stress on the body and increases dehydration
Nutrients and electrolytes support healing and circulation
IVs help reduce recovery time and support fertility-preserving outcomesThese IVs are now integrated into Vera’s fertility-sparing surgical protocols.
👨 Sperm Quality IVMen benefit from IV therapy too. This IV supports:
Sperm morphology (normal head and tail structure)
Motility and progressive motility
Hydration and reduced sperm agglutination
Blood flow to the testesIdeal for men who have optimized diet and supplements but still have suboptimal semen parameters.
🧠 IV Therapy as an Adjunct—Not a ReplacementDr. Sarah emphasizes:
IVs do not replace good nutrition or supplements
They enhance and accelerate results when absorption is limited
Best used as part of a comprehensive fertility plan
Key Takeaways:
Persistent nutrient deficiencies often stem from absorption issues—not effort
IV therapy delivers targeted nutrients directly into circulation
Antioxidants play a critical role in egg and sperm quality
Blood flow and hydration are essential for implantation and recovery
IV therapy can support fertility at multiple stages for both men and women
Resources & Next Steps:
If you feel like you’re doing “all the right things” but still struggling with egg quality, implantation, recovery, or sperm parameters, IV therapy may be a supportive next step.
📍 Westminster, Colorado🌐 Learn more or schedule: verafertility.com📧 Follow along: @verafertility

Low, Dominant, or Imbalanced? Understanding Estrogen & Progesterone Profiles | Episode 24

In this episode, Dr. Sarah Pederson breaks down the three most common female hormone profiles—low estrogen & progesterone, estrogen dominant, and progesterone dominant/low estrogen—and explains how each one affects mood, energy, cycles, fertility, and overall health. This episode empowers women to understand their symptoms, test hormones properly, and align nutrition, exercise, supplements, and treatment with their unique hormone profile.
In This Episode, You’ll Learn:
🧪 The Three Core Hormone ProfilesDr. Sarah explains how estrogen and progesterone work together—and what happens when they fall out of balance:
Low Estrogen + Low Progesterone (“Low–Low”)
Estrogen Dominant (Relative Low Progesterone)
Progesterone Dominant / Low Estrogen
Each profile presents differently and requires a different approach to treatment, lifestyle, and supplementation.
🩺 Why Proper Hormone Testing Matters
Best timing for hormone labs:
Cycle day 3: Estrogen, progesterone, FSH, LH, testosterone
5–7 days after ovulation (depending on luteal phase length)
Why checking progesterone at the wrong time leads to misdiagnosis
How incorrect supplementation can worsen symptoms instead of helping
🌱 Low Estrogen & Low Progesterone (Low–Low Profile)Common symptoms include:
Depression, brain fog, low stress tolerance, fatigue
Light or skipped periods, long cycles, short luteal phase
Recurrent miscarriage, poor cervical mucus, thin uterine lining
Low libido, vaginal dryness, UTIs, hair thinning, brittle nails
Hot flashes, cold intolerance, poor circulation
Root causes may include:
Chronic stress
Under-eating or poor nutrient absorption
Excessive exercise
Postpartum or breastfeeding states
Perimenopause or ovarian insufficiency
Support strategies:
Adequate calories and protein
Gentle exercise (yoga, Pilates, barre)
Stress reduction and sleep prioritization
Targeted supplements (omega-3s, magnesium, vitex)
⚖️ Estrogen DominanceCommon symptoms include:
Anxiety, irritability, mood swings
Heavy or painful periods, clots, PMS
Breast tenderness, fibroids, endometriosis
Migraines, acne, bloating, weight gain
Poor sleep, constipation, joint inflammation
Key contributors:
High sugar or refined carbohydrate intake
Low protein consumption
Poor liver or gut estrogen metabolism
Support strategies:
Higher protein intake (≈80g/day)
Strength training, HIIT, frequent movement
Fiber-rich diet for estrogen detoxification
Supporting liver and gut health
Reducing alcohol and excess sugar
🌡️ Progesterone Dominant / Low EstrogenCommon symptoms include:
Sedation, brain fog, low motivation
Excessive sleepiness, low blood pressure, dizziness
Weight gain, insulin resistance, cravings
Heat intolerance, nausea, constipation
Vaginal dryness, low libido, breast fullness
Key focus areas:
Supporting ovulation and estrogen production
Balanced, moderate exercise
Stress reduction and adequate sleep
Avoiding progesterone-only supplementation when estrogen is low
🧠 Why Hormone Ratios MatterDr. Sarah emphasizes:
Hormones must be balanced—not treated in isolation
DIM, progesterone, or bioidentical hormones can be harmful if mismatched
Nutrition, exercise, and supplements should support—not fight—your hormone profile
Ongoing lab monitoring ensures treatment is helping, not harming
Key Takeaways:
Most symptoms are clues to your hormone profile—not random
Estrogen and progesterone must be evaluated together
Timing of hormone testing is critical
One-size-fits-all hormone advice often backfires
Aligning lifestyle and treatment with your hormone profile leads to better mood, energy, cycles, and fertility
Resources & Next Steps:
If you suspect hormone imbalance or feel stuck with persistent symptoms, proper hormone testing and individualized care are essential.
📍 Westminster, Colorado🌐 Schedule a consultation: verafertility.com📧 Follow along: @verafertility