Belly Fat

The average person adds one to two pounds around the middle every year from age 35 to 55, for a total of 20 to 40 pounds of belly fat. Even if with regular exercise and eating well, most individuals cannot lose weight and keep it off. For many, the problem is an underlying hormone imbalance.

The most important hormone imbalance is estrogen dominance, when your body has too much estrogen in relation to progesterone. While estrogen dominance can be triggered by many factors, the most common cause is too little progesterone to balance or oppose normal estrogen production.

Progesterone production begins to decline in women in their thirties and by age forty has decreased fifty percent. After age fifty it can be close to zero. In men, progesterone levels start to fall in their forties. This significant decrease in progesterone production causes estrogen dominance. Excess fat gets stored around the waists, hips and thighs in women, and spare tires and man boobs in men. Fat cells produce even more estrogen and this leads to even greater estrogen dominance. In addition, your thyroid gland function can be impaired causing your metabolism to slow down or your pancreas to release extra insulin, the fat storage hormone.

  • Treatment

Bioidentical Hormone Replacement Therapy (BHRT) is critical to balance your hormones. Dr. De Monte determines your hormone levels through laboratory testing. If you are estrogen dominant, progesterone is often prescribed. Progesterone helps your body burn fat and counteracts the weight gaining properties of estrogen. For many people, however, it is more complicated and additional treatment is required to address thyroid and adrenal gland function, and insulin and cortisol levels. Environmental estrogens will also need to be reviewed. Diet and exercise are important, but if your body is compromised by estrogen dominance, belly fat will be nearly impossible to lose.


Most people who experience bloating describe a sensation of fullness or tightness within the abdominal area that ranges from mild discomfort to severe pain. Mild bloating can often be the result of lifestyle factors such as stress and diet, but when the condition is chronic it can result from an underlying hormone imbalance. During perimenopause and menopause many women experience severe bloating that is heightened by water retention, intestinal gas and decreased bile production. In addition, hormonal imbalance is why many women experience bloating as a symptom of premenstrual syndrome (PMS).

The hormones progesterone and estrogen play significant roles in fluid retention. Women tend to retain more water than usual when estrogen levels are elevated and progesterone levels decline. This is why bloating is common in the days leading up to a menstrual cycle when estrogen production increases. During menopause, estrogen levels fluctuate erratically and bloating can become chronic. Progesterone is a natural diuretic and when levels are low, women may also experience bloating. Starting in their thirties, progesterone levels begin to decrease significantly creating opportunity for increased bloating.

In a few cases, too little estrogen can contribute to abdominal discomfort. When estrogen levels are low, bile production by the liver decreases. Bile aids in digestion, emulsifies fats and helps cholesterol synthesis. It also acts as a lubricant for our small intestines. With low bile production there is poor lubrication and stool can accumulate within the small intestines causing bloating and constipation.

  • Treatment

The first approach to bloating is to assess your diet and reduce or eliminate foods that are known to cause gas and bloating. Food allergy testing may be necessary to pinpoint sensitivities or intolerances. Additionally, stress reduction and regular exercise have been found to have a positive impact on your digestive health. Sometimes these changes are not enough. If the bloating is caused by fluctuating hormone levels, Dr. De Monte prescribes Bioidentical Hormone Replacement Therapy (BHRT) to restore hormone balance and alleviate the discomfort from bloating.


Hormonal imbalance and depression are closely related, with estimates that 8-15% of menopausal women experience sadness and depression. During premenopause, perimenopause and menopause your body changes interfere with the management of stress and experiencing positive moods. This can lead to feeling even more stress and frustration, resulting in depression.

Hormonal fluctuations also occur before menstruation resulting in PMS and depression. In addition, postpartum depression is common in the months following child birth. This is often caused by a significant drop in progesterone levels. Abnormally low levels of progesterone cause insomnia and contribute to bad moods.

Cortisol is a stress hormone secreted by the adrenal glands that can cause depression if levels rise too high or fall too low. High levels of cortisol can increases agitation, insomnia, sugar cravings and belly fat. Low levels are associated with extreme fatigue, low libido, mood instability and the inability to handle stress.

Women with a history of mood disorders are more likely to experience hormonal depression during menopause. Hysterectomy or surgical menopause also heightens the risk of depression because of the dramatic rather than gradual drop in estrogen. Additional stressors such as the challenges of raising children, difficult work situations, poor diet and smoking, can make menopausal depression more likely.

  • Symptoms

  • Treatment

  • Depressed mood and irritability
  • Loss of interest or pleasure in life
  • Significant loss or increase in appetite
  • Sleep too much or too little
  • Fatigue or loss of energy
  • Feelings of worthlessness
  • Reduced ability to concentrate or think
  • Easily overwhelmed
  • Indecisive
  • Thinking about death or suicide

Balancing your hormones with Bioidentical Hormone Replacement Therapy (BHRT) is a good start to treating depression. Estrogen helps fight depression and promotes sleep by boosting production of serotonin, a hormone in the brain. Estrogen helps you feel good by increasing GABA, the calming brain neurotransmitter, and by raising levels of endorphins. Progesterone helps to balance estrogen, promotes sleep and has a natural calming effect. It also normalizes libido and is a natural antidepressant.

Anti-depressants are the most commonly prescribed drug for women going through life cycles even though the underlying cause of the depression is hormonal. Mild to moderate depression can be treated successfully with lifestyle changes and BHRT. With severe depression, however, the addition of drugs is almost always required.


A significant and common symptom of hormonal imbalance is fatigue. It is especially prevalent in women during perimenopause and menopause. Fatigue is a state of feeling tired and worn out for an extended period of time. You know you are suffering from fatigue when you go to bed exhausted and wake up feeling just as tired. Contrary to popular belief, fatigue is not an inevitable part of aging.

While there are many factors that contribute to fatigue, almost all of them are influenced by hormonal imbalances. Low estrogen levels, often found in menopause, result in insomnia, night sweats, irritability and mood swings that can cause exhaustion. Too little progesterone is also associated with fatigue. Sex drive is reduced and overall outlook is less optimistic.

Severe fatigue could be a sign of burnout of the adrenal glands. The other common cause of hormonal fatigue is low thyroid gland function, particularly low levels of T3 thyroid hormone. In addition, if your blood sugar levels are low (hypoglycemia) or drop too quickly, this results in fatigue. This is caused by excess insulin, often resulting from progesterone hormone deficiency. Other causes of fatigue include anxiety, depression, insomnia and stress.

  • Treatment

The first step is to assess thyroid and adrenal gland function through blood and saliva testing. When inadequacy of these glands is contributing to fatigue, they must be corrected through treatment. In addition, iron deficiency must be ruled out as a significant factor. The main cause is often a hormone imbalance of estrogen or progesterone that can be identified with hormone testing. Dr. De Monte prescribes Bioidentical Hormone Replacement Therapy (BHRT), a customized plan to balance your hormones, to relieve your fatigue and increase energy.

Hair Loss

While it is more common among men, hair loss affects about 20% of women. It is usually the first sign of health problems. When your body goes into crisis mode, hair growth is stunted due to the redirection of energy to other areas of the body. Age, hormone imbalance, emotional stress, medications and hair care products contribute to thinning hair and hair loss. Given the complexity of factors, it is essential to determine the underlying cause before establishing a treatment plan.

  • Hormonal Imbalance

    Hair loss in women is largely attributed to hormonal imbalance. Increased levels of dihydrotestosterone (DHT) are a contributing factor. Researchers believe DHT shrinks the hair follicle and over time the hair becomes thinner, eventually ceasing to grow. Thyroid gland problems and hormonal responses to autoimmune conditions also cause thinning and premature balding in women.

  • Emotional Stress

    When women are stressed, their adrenal glands get overwhelmed due to the increased demand for cortisol, the stress hormone. This results in increased production of adrenaline, testosterone, and DHT. The ensuing hormone imbalance can cause hair loss.

  • After Pregnancy

    Hair loss after pregnancy is common and occurs when your hormones are out of balance. Many post-partum mothers experience thinning hair and bald patches until their hormone levels return to normal. The hair loss is usually temporary and treatment is often not necessary. After pregnancy hair re-growth naturally takes a few months, but if the hair does not return within a year, further investigation and treatment will be required.

  • Birth Control Pill

    A common side effect of the birth control pill is hair loss. In most cases, birth control causes hormonal fluctuations and increases DHT production. Women are advised to take birth control pills with a low androgenic index and thereby reduce the harmful effects of DHT. This is particularly important for women who have a predisposition to hair loss.

  • Hair Care

    Women use a variety of sprays, gels, chemicals and dyes that can damage their hair follicles and irritate their scalps. If you find that your hair care products are damaging your hair, stop using the products and consider natural alternatives. If your hair does not return within a few months, seek treatment.

  • Treatment

    Hair loss treatment is complex. Initial measurement of hormone levels is required, together with assessment of your history and symptoms. While treatment must encompass many factors including diet and lifestyle, hormonal imbalance is often responsible. Correcting imbalances with Bioidentical Hormone Replacement Therapy (BHRT) can be an effective treatment to restore hair that you’ve lost and prevent further hair loss.

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Hot Flashes and Night Sweats

Hot flashes, sometimes called hot flushes or power surges, are sudden and intense feelings of heat on your face and upper body. They can last from a few seconds to an hour or more. Additional symptoms include sweating, nausea, increased heart rate, headache, anxiety and dizziness. It’s a suffocating feeling often accompanied with a red face.

A night sweat is a hot flash that occurs during the night. It can come on while you are sleeping and wake you up or you might wake up first and then it happens. There is profuse sweating, more than a normal hot flash, which affects your whole body. Your bed sheets and clothing become soaked with sweat and you often have to change both. They can be followed by cold chills. Night sweats can be debilitating, particularly if they occur several times per night and disrupt your sleep.

  • Hormones

  • Treatment

The specific cause for hot flashes and night sweats is often low estrogen and how it affects your hypothalamus. The hypothalamus is the part of the brain that controls body temperature, sleep and appetite. When estrogen levels decrease with menopause, this tricks the hypothalamus into registering that your body is too hot. It then causes hot flashes to try to rid your body of this nonexistent excess heat. For some women, low progesterone but normal estrogen levels can result in hot flashes. Low testosterone levels can also cause hot flashes. Other factors such as your environment, medications and diet may contribute to the frequency and strength of hot flashes.

Hot flashes and night sweats can be a complex challenge due to the many contributing hormonal imbalances. Dr. De Monte prescribes Bioidentical Hormone Replacement Therapy (BHRT) to correct the root problem of hormone imbalance and for many women this is often sufficient. Sometimes progesterone alone will help, but more often it is best combined with estrogen. Some women will require medicines that calm neurotransmitters in the brain. Stress, diet and lifestyle also need to be addressed.


Urinary incontinence is very common, affecting 28% of women in their thirties and 50% of women sixty and over. A cough, sneeze or laugh can result in urine leakage. The focus of traditional treatment is drugs to control bladder function or bladder surgery. Often the medications and surgery do not work because it’s not a bladder problem.

As women age, muscles around the urethra weaken and urine leaks out of the bladder. The tone and strength of these muscles depends upon estrogen. The decline in estrogen during the week before menstruation is sufficient to temporarily weaken the muscles and cause incontinence. The permanent decline in estrogen after menopause or hysterectomy can often result in intermittent incontinence.

  • Treatment

Bioidentical Hormone Replacement Therapy (BHRT) utilizing bioidentical estriol (estrogen) is an ideal treatment. Bioidentical testosterone cream is also highly effective for this problem. Kegel exercises that contract the muscles that stop and start urination should be used along with BHRT to ensure successful treatment.


Hormone imbalances are a major cause of insomnia. During perimenopause and menopause, estrogen production declines causing your sleep to suffer. Hot flashes, night sweats, anxiety and stress can cause sleep interruptions that contribute to and exacerbate insomnia. Adrenal fatigue resulting from stress and hormone imbalances may also worsen insomnia.

Insomnia in turn causes hormone imbalance and worsens symptoms because your body needs sleep for your hormones to do their job properly. Sleeping less than you need negatively affects a variety of hormones resulting in the disruption of appetite, fertility, mental well being and cardiovascular health.

Poor sleeping habits can aggravate hormonally caused sleep disruption. Recommendations for improvement include a totally dark room, developing a bedtime routine, going to sleep around the same time each night, and removing distractions or anything likely to disturb sleep from your bedroom (for example, a TV or a pet).

  • Treatment

When testing identifies that the cause of your insomnia is hormonal, Dr. De Monte prescribes Bioidentical Hormone Replacement Therapy (BHRT) to balance your hormones and improve insomnia. Progesterone has been found to be particularly effective in promoting feelings of relaxation and an ability to sleep through the night. It is always important to identify and improve other contributing factors such as stress, poor nutrition and lack of exercise.

Low Sex Drive (Libido)

Hormonal imbalances in perimenopause, menopause and postmenopause, commonly result in reduced sexual drive or low libido. It’s the most common sexual complaint, affecting thirty to forty percent of women. Even younger women (premenopausal) have hormonal imbalances that affect their sex life. The prominent imbalances are with progesterone, estrogen and testosterone.

Progesterone production decreases naturally starting in your thirties, hitting an all time low in your fifties. All the while, estrogen production continues. The natural ratio of progesterone to estrogen is upset resulting in estrogen dominance. This effectively causes low libido in women, along with vaginal dryness, vaginal atrophy (a loss of muscle tension) and diminished clitoral sensitivity. Other consequences of estrogen dominance that add to the problem are weight gain, fatigue and mood swings. A deficiency of estrogen is also responsible for similar vaginal problems and low sex drive.

Even though testosterone is mainly associated with men, it is also important for women, as it serves to heighten sexual response and orgasm. Low testosterone can cause a loss of libido. Hormonal imbalance or hysterectomy reduce ovarian function and decrease testosterone production, especially in postmenopause. Similar to testosterone, low levels of DHEA can also reduce sex drive. Other factors include stress, an unhappy relationship and complicating health conditions.

  • Treatment

Maintaining hormonal balance is critical for a healthy sex drive. Dr. De Monte measures your hormone levels and when imbalances are identified, Bioidentical Hormone Replacement Therapy (BHRT) is prescribed to provide hormone equilibrium. In many instances adrenal function also requires treatment. Since stress can interfere significantly with hormone therapy, stress management is critical for hormone balancing.

Memory Loss

Forgetfulness is not just a part of aging, but often a symptom of hormonal imbalance. Occasionally forgetting a word or name is not a great worry, but when memory loss affects your daily life it may be indicative of an underlying problem.

Many women experience difficulty remembering how to do routine tasks such as forgetting where their car is parked, losing their train of thought mid-sentence, or forgetting why they walked into a room. Memory loss, difficulty concentrating and foggy thinking all point to hormonal imbalance.

When your hormones function normally, estrogen helps regulate cortisol hormones that affect the function of neurotransmitters (chemicals used for communication) in your brain. When estrogen levels decline, estrogen can no longer control cortisol. Neurotransmitters begin to malfunction, creating memory lapses. Women often begin to notice memory loss in perimenopause when the production of hormones begins to decrease substantially.

  • Treatment

You are not losing your mind. Your hormones are out of balance, but you do not have to suffer. Short term memory lapses and foggy thinking can often improve with Bioidentical Hormone Replacement Therapy (BHRT). Additional measures include diet, supplementation, memory exercises and activities to optimize brain function.

Mood Swings

Mood swings are a well known menopausal symptom directly related to hormone imbalance. They are usually defined as an inappropriate response to an event, resulting in mood that can change quickly from happy to sad. People become irritable, impatient and angry.

The hormone imbalances that occur during life cycles can cause mood swings. When your body is going through undesirable changes, it is very difficult to be patient and reasonable. In addition, if you are suffering from adrenal fatigue or thyroid dysfunction, mood swings can occur or worsen.

Your hormones that regulate emotions can be out of control during menopause. Estrogen levels fluctuate significantly, influencing the production of serotonin, a neurotransmitter in the brain that regulates mood. When estrogen increases, there is a corresponding increase in serotonin that affects emotional sensitivity. Progesterone also plays an important role affecting brain function, producing a sense of calmness. Low progesterone levels increase anxiety, depression and nervousness.

  • Treatment

Dr. De Monte prescribes Bioidentical Hormone Replacement Therapy (BHRT) to normalize your hormone levels. Progesterone is particularly important for balancing estrogen so that serotonin production returns to normal and your moods stabilize. In addition to the sedating and anti-anxiety effect provided by progesterone, it also promotes more restful sleep.

Vaginal Dryness

A primary cause of low libido or sex drive, vaginal dryness affects approximately fifty percent of women forty to sixty years of age. This condition is uncomfortable and irritating making sex painful. As a result, women tend to avoid sex. This can cause relationship problems and unhappiness.

Vaginal dryness causes soreness, itching and burning that make sitting, standing, exercising and urinating painful. Women need vaginal secretions for comfort and sexual health. These secretions also help fight off infection from bacteria. Without vaginal secretions, women are at risk for yeast infections and urinary tract infections.

As estrogen levels decline, the vaginal tissue becomes thinner and dryer. This atrophy makes the vaginal walls susceptible to irritation, making sexual intercourse painful. Risk of infection also increases. Reduced testosterone diminishes vaginal muscle tone and reduces sexual sensitivity. Stress and depression, also symptoms of hormonal imbalance, can make women tense resulting in a loss of interest in sex.

  • Treatment

Vaginal dryness is not an inevitable side effect of aging. Correction of hormone imbalances with Bioidentical Hormone Replacement Therapy (BHRT) can relieve symptoms, including vaginal dryness. Bioidentical estriol is the preferred hormone that targets vaginal tissue when administered vaginally. Dr. De Monte prescribes estriol in suppositories or cream with an applicator.

Weight Gain

It is estimated that ninety percent of women gain weight between the ages of thirty-five to fifty-five. The average gain is two to four pounds per year. This corresponds to perimenopause and menopause during which you can experience significant hormonal imbalances. If your hormones are out of balance, you gain weight and cannot take it off. And if you experience early menopause resulting from surgical hysterectomy, weight gain is faster and more pronounced.

Starting in your thirties, progesterone levels start to decline. By age forty, progesterone production is down fifty percent. By age fifty plus it is often close to zero. These dramatic decreases result in estrogen dominance (too much estrogen relative to progesterone). Estrogen dominance impairs thyroid gland function causing your metabolism to slow down. It increases the hormone cortisol, leading to unstable blood sugar levels and sugar/carbohydrate cravings. Estrogen also causes your body to release insulin, the fat storage hormone. In addition, testosterone levels decrease during menopause leading to a decrease in muscle mass that causes lower metabolism and weight gain.

Irrespective of their age, many women have an underactive thyroid gland resulting in hypothyroidism. The production of thyroid hormones responsible for metabolism is decreased. If the adrenal and liver glands that support the thyroid are also not performing optimally, this can result in impaired thyroid function.

Too much stress prevents weight loss. When you are stressed, your body’s natural response is to release cortisol (stress hormone) from the adrenal glands. Cortisol can essentially trick your body to interpret that you will not be eating again for sometime. Your body responds to this message by going into food storage mode. It’s a genetic predisposition resulting in weight gain.

  • Treatment

Hormonal imbalances and weight gain are closely related. While diet, exercise and lifestyle are important components of an overall strategy to maintain optimal weight, if your hormones are out of balance it is almost impossible to avoid weight gain and achieve permanent weight loss. Addressing adrenal and thyroid gland function is often necessary. Balancing your hormones levels with Bioidentical Hormone Replacement Therapy (BHRT) is critical for successful long-term weight management.