Hormone Cafe

Hormone Cafe

By Sarah Pederson

The Hormone Café is your cozy corner for honest conversations about women’s health, fertility, and hormones. Hosted by Dr. Sarah Pederson, holistic OB-GYN and founder of Vera Health and Fertility,

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  1. Number 1: Inflammation & Fertility: Autoimmune, Gut, Endometriosis & More | Episode 35

    In this episode of The Hormone Café, Dr. Sarah Pederson explains how chronic inflammation can quietly interfere with ovulation, implantation, and miscarriage risk. She breaks down the five major sources of inflammation that impact fertility—and exactly how to evaluate and treat each one. Inflammation isn’t just a buzzword. It can directly suppress hormones, impair egg quality, and prevent implantation.

    21min
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  2. Number 2: 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 Important The 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 Dysfunction Low 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 Includes Dr. 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 Rechecked Thyroid 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 Matter Positive 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 Hypothyroidism Hypothyroidism: 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 Function Key thyroid-building nutrients: Iodine Selenium Zinc Magnesium Vitamin D If deficient, restoring these nutrients alone may normalize thyroid function. 💊 When Thyroid Medication Is Needed If 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 Permanent In 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 Matters Hyperthyroidism: 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 Strategy Hashimoto’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’s Foundational 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 Universal Some 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 Antibodies When 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 Flares Triggers 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 Fertility During 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

    24min
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  3. Number 3: 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 Philosophy Supplements 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 First Before 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 Worse Dr. 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 More Examples 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 Vitamins Water-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 Matter If 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 Important Starting 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 Reaction If 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 Simple For 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 Production Supplements 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-All Different guts need different species: Lactobacillus Bifidobacteria Saccharomyces boulardii Akkermansia Taking the wrong probiotic can worsen overgrowth and symptoms. 🌿 Estrogen Metabolism & Gut Support For 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 Possible The 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 Surgery Example: Post-endometriosis surgery: Omega-3 NAC Curcumin Used for ~3 months to reduce inflammation and recurrence—then discontinued. ☕ Alternative Ways to Get Antioxidants To 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 Matters Supplements 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 Audit Dr. 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

    22min
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  4. Number 4: 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 Is Primary 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 Diagnosed Diagnosis 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 High When 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 Menopause Unlike 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 Critical Estrogen 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 POI Dr. 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 Replaced Treatment 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 Key Follow-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 Dynamic Patients 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 Evaluated A 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 & Estrogen Low 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 & Inflammation Fertility 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 POI POI 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

    21min
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  5. Number 5: 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 Is Menopause 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 Occur Menopausal 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 Symptoms Symptoms 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 Required Dr. 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 Drivers Poor 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 Ever Hormonal 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 Menopause Many 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” Feeling High 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 & Thermoregulation Thyroid dysfunction can worsen: Hot flashes Cold intolerance Temperature swings Optimizing thyroid function is essential for symptom control. 💊 Bioidentical Hormones — Used Correctly Hormone 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 First Key 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 Carefully Unlike 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 Health Essential 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 Metabolism Brain 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 Clearance Adequate water intake supports: Kidney function Estrogen metabolism Reduced brain fog 📊 A Whole-Body Approach True menopausal support evaluates: Hormones Blood sugar Sleep Cortisol Thyroid Gut health Nutrition Exercise Everything must work together. 🔁 Lifestyle Changes Are Required — And Worth It What 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

    23min
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