Integrative Medicine: What to Know About HRT & Menopause

Find out the benefits of HRT conbined with integrative medicine and how it can transform your menopause experience.

Abstract

Menopause represents a profound biological shift, extending far beyond a simple decline in hormones. While Hormone Replacement Therapy (HRT) is a cornerstone of treatment, it often falls short of resolving persistent symptoms like hot flashes, fatigue, brain fog, weight gain, and mood instability. This is because menopause is not merely a hormonal issue; it is a complex metabolic event rooted in three core biological problems: persistent inflammation (elevated C-reactive protein and oxidative stress), mitochondrial dysfunction (impaired cellular energy production), and localized insulin resistance. These factors prevent HRT from working effectively and contribute to the challenging symptoms many experience. In this educational post, I’ll explore these underlying biological drivers from my perspective as Dr. Alex Jimenez. We will delve into groundbreaking research highlighting the catastrophic decline of NAD+ during this transition and its impact on mitochondrial health. I will outline a comprehensive, evidence-based strategy that goes beyond standard HRT. This integrative approach combines targeted hormonal support with essential nutritional interventions, including key minerals and vitamins like magnesium, potassium, vitamin D3/K2, boron, zinc, taurine, and methylated B vitamins. Furthermore, I will explain how our unique clinical model at Injury Medical Clinic PA in El Paso, Texas, integrates my expertise in chiropractic and functional medicine with the invaluable medical oversight of Dr. Maria Guadalupe Cardenas, MD, our board-certified Medical Director. Together, we provide a multidisciplinary framework to address the neuro-musculoskeletal, hormonal, and metabolic facets of menopausal health, helping you reclaim your vitality and well-being.

Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST
Injury Medical Clinic PA
Dr. Maria Guadalupe Cardenas, MD (Board Certified in Internal Medicine)
Medical Director & Collaborative Physician
NPI #1164426749, Texas MD License #J2933

As a clinician with dual credentials in chiropractic care (DC) and as a Family Nurse Practitioner (APRN, FNP-BC), and with advanced certifications in functional medicine (CFMP, IFMCP), I have dedicated my career to understanding the intricate web of human physiology. My practice, Injury Medical Clinic PA, is built on an integrative model that merges multiple disciplines to achieve comprehensive patient outcomes. A cornerstone of this model is my collaboration with Dr. Maria Guadalupe Cardenas, MD. With over four decades of experience as a board-certified internist, Dr. Cardenas serves as our Medical Director, providing essential medical oversight and clinical wisdom that enriches our patient care protocols. This multidisciplinary partnership allows us to create treatment plans that are holistic and grounded in the highest standards of medical and evidence-based practice.
In my years of clinical observation, particularly through the lens of functional medicine, I have seen countless women navigate the challenging transition of perimenopause and menopause. Many arrive at my clinic feeling frustrated and unheard. They have often been told their symptoms are “just part of aging” or are purely hormonal, yet standard Hormone Replacement Therapy (HRT) has failed to provide complete relief. They still struggle with debilitating fatigue, persistent hot flashes, unexplained weight gain, and a rollercoaster of emotions. The transcript I am about to elaborate on touches upon the very core of this issue—a critical misunderstanding of the menopausal process. It is not just about hormones; it is about biology. Specifically, it is about cellular energy, inflammation, and metabolic health.
In this detailed post, I will expand on these concepts and translate the latest scientific research into a practical, easy-to-understand journey. We will explore why simply “running HRT” is like putting high-performance fuel into an engine that is clogged and misfiring. The fuel is essential, but it cannot fix the underlying mechanical problems. We will uncover the three main biological dysfunctions that sabotage hormonal balance and learn how to address them with a targeted, integrative approach that combines precise hormonal support, chiropractic care for neuro-musculoskeletal integrity, and functional nutrition. My goal is to empower you with the knowledge to move beyond just surviving menopause and truly start thriving.

The Great Misconception: Why HRT Alone Is Not Enough

For decades, the prevailing narrative surrounding menopause has been one of simple hormonal deficiency. The logic seems straightforward: as the ovaries stop producing estrogen and progesterone, replacing these hormones should restore balance and ease symptoms. While Hormone Replacement Therapy (HRT) can be a crucial and life-changing intervention for many, it is not a silver bullet. My clinical experience, supported by a growing body of evidence-based research, reveals a more complex reality. Many women I see in my practice are already on HRT yet continue to feel, in their own words, “like crap.” They are diligent with their prescriptions, but hot flashes persist, fatigue runs bone-deep, and brain fog clouds their daily lives.
This paradox exists because standard HRT primarily addresses the hormonal deficiency, not the underlying biological dysfunctions unfolding at the same time. Menopause is not just a hormonal event; it is a profound metabolic shift that creates a challenging internal environment. Giving hormones to a body struggling with inflammation, mitochondrial decay, and insulin resistance is like planting a beautiful garden in toxic, nutrient-depleted soil. The seeds (hormones) are there, but they cannot sprout and flourish.
To truly understand and effectively manage menopause, we must look beyond the hormones and address three fundamental biological problems:
Uncontrolled Inflammation and Oxidative Stress: HRT does not inherently lower systemic inflammation markers like C-reactive protein (CRP) or quell the storm of oxidative stress.
Mitochondrial Dysfunction and Localized Insulin Resistance: HRT does not rebuild our cellular powerhouses—the mitochondria—or correct the specific insulin resistance that develops in the brain and metabolic tissues.
Accelerated Nutrient Depletion: The tissue repair and metabolic acceleration spurred by HRT can deplete essential minerals and cofactors faster, creating new deficiencies if not properly managed.
Let’s dissect each of these issues to understand why they are the real culprits behind persistent menopausal symptoms and how an integrative approach is necessary to restore true wellness.

Biological Problem #1: The Inflammatory Barrier

One of the most common and frustrating experiences for women on HRT is the persistence of hot flashes. You are faithfully applying your estrogen patch or cream, yet you are still waking up drenched in sweat and experiencing sudden waves of intense heat throughout the day. This isn’t because the estrogen isn’t present; it is because a wall of inflammation is blocking its message.

How Inflammation Sabotages Estrogen’s Vasodilatory Effect

Estrogen plays a critical role in thermoregulation (the body’s ability to maintain a stable core temperature), primarily through its effects on the blood vessels. One key function is promoting the production of nitric oxide (NO), a potent vasodilator. Nitric oxide signals smooth muscle in the arterial walls to relax, allowing blood vessels to widen. This process, known as vasodilation, is essential for dissipating heat and maintaining circulatory health. When estrogen levels are optimal and the body is in a low-inflammatory state, this system works beautifully.
However, the menopausal transition often brings a significant increase in systemic inflammation. Multiple factors drive this, including the natural decline of estrogen (which has anti-inflammatory properties), age-related cellular changes, and lifestyle factors. This pro-inflammatory state is characterized by elevated levels of inflammatory cytokines (like IL-6 and TNF-alpha) and markers such as C-reactive protein (CRP).
Here is the crucial point: inflammation inhibits the nitric oxide pathway. High inflammation and associated oxidative stress (an imbalance between free radicals and antioxidants) damage the delicate inner lining of blood vessels, called the endothelium. This condition, known as endothelial dysfunction, prevents the cells from responding properly to estrogen’s signal. So, even when estrogen hits its receptors on the endothelial cells, the inflamed, dysfunctional machinery cannot produce enough nitric oxide.
The result? The blood vessels remain constricted when they should be dilating. The body’s ability to effectively manage heat is compromised. You take your hormone, but you keep the hot flashes. It is a classic case of cellular miscommunication, where the messenger (estrogen) arrives, but the recipient (the blood vessel) is too “sick” with inflammation to understand and execute the command. This is why just increasing the estrogen dose often fails to resolve the issue and can sometimes lead to other problems, like breast tenderness. The solution isn’t always more hormones; it’s first extinguishing the inflammatory fire.

Integrative Chiropractic and Medical Management of Inflammation

At Injury Medical Clinic PA, our approach to taming inflammation is multifaceted, leveraging the strengths of both functional medicine and chiropractic care under the guidance of Dr. Cardenas’s medical expertise.
Medical and Functional Diagnostics: We begin with comprehensive lab testing that goes beyond standard panels. Dr. Cardenas and I often order markers like hs-CRP (high-sensitivity C-reactive protein), homocysteine, and lipid peroxides to quantify inflammation and oxidative stress. This gives us a baseline and allows us to track progress objectively.
Targeted Anti-Inflammatory Nutrition: We guide patients through dietary modifications designed to reduce the inflammatory load. This typically involves removing pro-inflammatory foods like processed sugars, industrial seed oils (e.g., soybean, corn oil), and refined carbohydrates while emphasizing a diet rich in phytonutrients from colorful vegetables, healthy fats (like omega-3s from fish, avocados, and olive oil), and clean protein.
Chiropractic Care and the Nervous System: Chronic musculoskeletal stress and spinal misalignments can act as a significant source of systemic inflammation. As a chiropractor, I utilize precise spinal adjustments to restore proper joint mechanics and reduce nerve irritation. This is not just about alleviating back or neck pain. By optimizing nervous system function, particularly the autonomic nervous system, we can help shift the body from a chronic “fight-or-flight” (sympathetic) state to a “rest-and-digest” (parasympathetic) state. The parasympathetic nervous system plays a key role in downregulating inflammation through pathways like the cholinergic anti-inflammatory pathway. Correcting spinal dysfunction can therefore be a powerful tool in lowering the body’s overall inflammatory burden, allowing hormones like estrogen to work more effectively.
Supplementation: Based on lab results and clinical presentation, we may recommend powerful anti-inflammatory agents such as high-dose omega-3 fatty acids, curcumin (from turmeric), and resveratrol, which help to quell the inflammatory cascade at a cellular level.
By addressing inflammation first, we create a receptive internal environment. We are not just adding estrogen; we are ensuring the body can hear its message loud and clear. This is the first critical step toward resolving persistent symptoms like hot flashes and improving overall cardiovascular health.

Biological Problem #2: The Energy Crisis—Mitochondrial Collapse and Insulin Resistance

If inflammation is the static interfering with hormonal signals, then mitochondrial dysfunction is the power failure shutting down the entire system. This is arguably the most profound and least-appreciated aspect of the menopausal transition. The pervasive fatigue, brain fog, depression, anxiety, and stubborn weight gain are not just “side effects” of hormonal decline; they are direct consequences of a cellular energy crisis.

Mitochondria: The Powerhouses of Your Cells

To grasp the magnitude of this problem, we need a quick biology refresher. Every one of your trillions of cells contains tiny organelles called mitochondria. Their primary job is to take the fuel from the food you eat—glucose (from carbohydrates) and fatty acids (from fats)—and convert it into adenosine triphosphate (ATP) through a process called cellular respiration.
ATP is the universal energy currency of the body.
Every single biological process requires ATP. Thinking, moving, breathing, pumping your heart, synthesizing hormones and neurotransmitters, regulating your body temperature, repairing tissues—it all runs on ATP. When your mitochondria are robust and efficient, you feel vibrant, sharp, and resilient. When they are dysfunctional, your body’s systems begin to fail.

The Double Whammy in Menopause: Insulin Resistance and NAD+ Decline

During menopause, mitochondria face a perfect storm of challenges that leads to their decline and dysfunction.
1. Localized Insulin Resistance:
You have likely heard of insulin resistance in the context of type 2 diabetes, where muscle and liver cells stop responding to insulin, leading to high blood sugar. However, in menopause, a very specific and insidious form of insulin resistance develops in two critical areas: the hypothalamus (the brain’s master regulatory center) and metabolic tissues (like muscle).
The Problem of “Fuel Overload“: This localized insulin resistance means that even if there is plenty of glucose in the bloodstream, the mitochondria inside these key cells cannot effectively pull it in and use it for energy. Imagine a power plant (the mitochondrion) surrounded by heaps of coal (glucose) but with a broken conveyor belt, unable to get the fuel to the furnace. Cells are literally soaked in glucose but starving for energy.
The Shift to Visceral Fat Storage: This metabolic gridlock has devastating consequences. Because the body cannot efficiently burn glucose or access stored fat from adipocytes (fat cells) for energy, its default survival mechanism kicks in: it stores any excess energy as fat. Worse, it preferentially stores it as visceral fat—the dangerous, inflammatory fat that wraps around your internal organs. This is why so many women in menopause experience rapid weight gain, particularly around the midsection, even when they have not changed their diet or exercise habits. It is not a simple caloric problem of “eating too much and moving too little.” It is a metabolic problem of dysfunctional fuel partitioning. Your biology is programmed to store, not burn.
2. Catastrophic NAD+ Decline:
The second, and perhaps more fundamental, hit to mitochondrial function comes from the decline of a critical molecule called Nicotinamide Adenine Dinucleotide (NAD+). A groundbreaking 2021 study published in Nature Cell Biology provided definitive proof of something functional medicine practitioners had long observed: NAD+ levels decline catastrophically, and this decline accelerates during menopause (Covarrubias et al., 2021).
NAD+: The Mitochondrial Power Supply: NAD+ is essential for mitochondrial function. It acts as a key electron shuttle in cellular respiration, physically carrying the energy harvested from glucose and fatty acids to the machinery that produces ATP. Think of NAD+ as the fleet of trucks that transports the coal from the yard to the power plant’s furnace.
The Consequences of NAD+ Depletion: Without sufficient NAD+, the entire energy production line grinds to a halt. Even if glucose could get into the cell, the mitochondria lack the essential cofactor to convert it into ATP. This means the mitochondria lose their power supply. The lights go out at the cellular level.

The Clinical Manifestations of an Energy-Starved Brain and Body

This collapse in ATP production, driven by both insulin resistance and NAD+ depletion, is the root cause of the most debilitating symptoms of menopause:
Pervasive Fatigue: This isn’t just feeling tired; it’s profound cellular exhaustion. Your cells lack the ATP to function optimally.
Brain Fog and Cognitive Decline: The brain is the most energy-demanding organ in the body, consuming about 20% of your total ATP production. The prefrontal cortex—the region responsible for executive functions like mood regulation, impulse control, emotional stability, and rational thought—is particularly vulnerable. When it is energy-starved, you experience brain fog, memory lapses, and difficulty concentrating.
Depression, Anxiety, and Irritability: The synthesis and regulation of neurotransmitters like serotonin, dopamine, and GABA are highly energy-dependent processes. An energy-starved prefrontal cortex cannot maintain stable levels of these crucial mood-regulating chemicals. They all crash. This is why you can “take antidepressants like Skittles and still feel like trash.” You are treating a downstream symptom (low serotonin) while ignoring the upstream problem: the neurons have no ATP to synthesize serotonin in the first place. You are not “hormonal” or “crazy”—your brain is neurochemically unstable because its cells lack the fundamental energy required for proper function.
Hot Flashes: As we discussed, the hypothalamus controls thermoregulation. When mitochondria in hypothalamic neurons are energy-starved due to NAD+ decline, the entire system becomes unstable, leading to thermoregulatory collapse. This results in the classic hot flashes and night sweats.
Weight Gain and No Libido: The metabolic shift towards fat storage, driven by mitochondrial dysfunction, explains the stubborn weight gain. Libido, a complex interplay of hormones, neurology, and psychology, is also an energy-intensive process that falters when ATP is scarce.
All of these seemingly disconnected symptoms are anchored to one unifying problem: dying, dysfunctional mitochondria. Period. HRT alone does not rebuild mitochondria or restore NAD+ levels. To solve the energy crisis, we need a targeted strategy to reboot our cellular powerhouses.

Rebooting the Mitochondria: An Integrative Strategy

At our clinic, we rebuild mitochondrial health from the ground up, a process that requires a combination of medical, nutritional, and lifestyle interventions.
Restoring Insulin Sensitivity:
Dietary Intervention: The first step is to manage glucose and insulin levels through a low-glycemic diet. This involves reducing or eliminating refined sugars and processed carbohydrates that cause sharp blood sugar spikes. We emphasize a diet rich in fiber, healthy fats, and quality protein to promote stable blood glucose.
Exercise: Both resistance training and high-intensity interval training (HIIT) are incredibly effective at improving insulin sensitivity in muscle tissue, effectively “re-opening” the door for glucose to enter the cells and be used for energy.
Nutraceuticals: Certain supplements like berberine, alpha-lipoic acid, and chromium can help restore insulin sensitivity at the cellular level, acting on pathways similar to some prescription medications.
Boosting NAD+ Levels:
Precursor Supplementation: We can directly support NAD+ production by supplementing with its precursors, such as Nicotinamide Riboside (NR) or Nicotinamide Mononucleotide (NMN). These molecules provide the raw materials the body needs to synthesize more NAD+. This is a cornerstone of addressing the age-related and menopause-accelerated decline documented in research.
Lifestyle Factors: Caloric restriction, fasting, and intense exercise are also potent natural stimulators of NAD+ production through pathways involving proteins called sirtuins.
Supporting Mitochondrial Structure and Function:
Key Cofactors: We ensure patients have adequate levels of nutrients essential for the electron transport chain (the ATP-producing machinery), such as Coenzyme Q10 (CoQ10), L-carnitine, B vitamins, and magnesium.
Reducing Oxidative Damage: We use antioxidants like PQQ (pyrroloquinoline quinone), which has been shown to protect mitochondria from oxidative stress and even stimulate the growth of new mitochondria (mitochondrial biogenesis).
By implementing this comprehensive mitochondrial rescue plan, we address the root cause of the energy crisis. We are not just masking symptoms; we are restoring your cells’ fundamental ability to produce energy. This allows the fog to lift, the mood to stabilize, and vitality to return.

Biological Problem #3: The Unseen Drain on Essential Nutrients

The third, often-overlooked biological problem in menopause management is the accelerated depletion of key nutrients. Hormone Replacement Therapy, by its very nature, is designed to stimulate cellular activity and tissue repair—processes that were slowed by hormonal decline. When you reintroduce estrogen and other hormones, you are essentially “turning the metabolic engine back on” and asking it to run faster. This is a good thing, but it comes at a cost.
Think of it like a construction project. Before the project starts, the demand for raw materials (bricks, lumber, wiring) is low. Once construction begins, the demand skyrockets. If the supply of these materials doesn’t increase to meet the new demand, the project will quickly stall.
Similarly, when HRT speeds up metabolic processes and tissue repair, it dramatically increases the body’s demand for the raw materials required for these functions. These “raw materials” are the essential minerals, vitamins, and amino acids that act as cofactors in countless enzymatic reactions. If these nutrients are not supplied in adequate amounts, you can develop deficiencies that undermine the benefits of HRT and create a new set of symptoms.

The Non-Negotiable Raw Supplies for Hormonal and Metabolic Function

Based on decades of research and my own extensive clinical practice, there is a core group of nutrients that I consider non-negotiable for any woman navigating perimenopause and menopause, especially if she is on HRT. The body requires these raw supplies to function correctly, from metabolizing hormones to producing energy and maintaining bone density.
Magnesium: This is the master mineral. Magnesium is a cofactor in over 300 enzymatic reactions in the body. It is critical for ATP production, nerve function, muscle relaxation, and blood sugar control. It also plays a vital role in the methylation pathway, which is essential for detoxifying estrogens and preventing the buildup of harmful metabolites. Estrogen itself can increase the cellular uptake and utilization of magnesium, leading to a faster depletion. Symptoms of magnesium deficiency—such as anxiety, muscle cramps, insomnia, and heart palpitations—are incredibly common in menopausal women and are often mistaken for hormonal symptoms. If you feel “jittery” on HRT, it is a good chance you are taking too little magnesium (and taurine) to handle the metabolic shift.
Potassium: This electrolyte works in concert with sodium to maintain fluid balance, nerve transmission, and muscle contractions. It is also crucial for maintaining healthy blood pressure. Menopausal hormonal shifts can affect the body’s regulation of fluids and electrolytes, making adequate potassium intake essential.
Vitamin D3 and Vitamin K2: This pair is well known for its role in bone health, which is paramount because estrogen loss accelerates bone density decline. Vitamin D3 facilitates calcium absorption from the gut. Still, Vitamin K2 directs that calcium into the bones and teeth, preventing it from depositing in soft tissues like arteries and kidneys, where it can cause calcification and cardiovascular disease. Their function extends beyond bones; Vitamin D is technically a pro-hormone that influences immune function, mood, and insulin sensitivity.
Boron: This trace mineral is a hidden gem in hormone metabolism. Boron has been shown to increase the half-life and bioavailability of both estrogen and testosterone by slowing their excretion. It also supports bone health and has anti-inflammatory properties. It is a critical, yet often forgotten, nutrient for optimizing HRT.
Zinc: Zinc is essential for immune function, wound healing, and the production of stomach acid for proper digestion. It is also a key cofactor for the enzymes that produce steroid hormones, including progesterone and testosterone. Zinc deficiency can weaken the immune system, impair skin health, and reduce hormone synthesis.
Taurine: This unique amino acid has powerful benefits for menopausal women. Taurine helps to stabilize cell membranes, acts as an antioxidant within mitochondria, and supports cardiovascular health. Crucially, it helps calm the nervous system by supporting GABA function, which can alleviate the anxiety and “jitteriness” that some women experience as their metabolism shifts on HRT. It works synergistically with magnesium to buffer the excitatory effects of a revitalized metabolism.
Methylated B Vitamins: The B-complex vitamins (B6, B12, Folate) are the spark plugs of our metabolism. They are indispensable for energy production in the mitochondria and for a critical biochemical process called methylation. Methylation is required to synthesize neurotransmitters (serotonin, dopamine), detoxify hormones (especially estrogen), and regulate gene expression. Many individuals have genetic variations (like MTHFR) that impair their ability to convert standard B vitamins into their active, methylated forms. For these individuals, and for most women in menopause, supplementing with pre-activated forms like methylfolate, methylcobalamin (B12), and pyridoxal-5-phosphate (P-5-P, the active form of B6) is non-negotiable. If you experience breast tenderness on HRT, it can be a sign of poor estrogen methylation, often correctable with improved B6 and overall methylation support.
These nutrients are not optional add-ons; they are the fundamental building blocks your body needs to run its new, hormonally supported operating system. Ignoring them is a primary reason why many women fail to achieve the full benefits of HRT.

Aligned & Empowered: Chiropractic Conversations on Women’s Health-Video

The Clinical Playbook: A Practical Guide to Implementation

Understanding the “why” is crucial, but the “how” brings results. Based on the principles we have discussed, here is a practical, evidence-based playbook for navigating menopause. We customize this framework for each patient at our clinic, always under the medical supervision of Dr. Cardenas and me.

Rule #1: The Fourteen-Day Rule for Hormonal Adjustments

This is one of the most important and most frequently violated rules in hormone management. Hormones do not work like aspirin. When you introduce a new hormone or adjust a dose, it takes time for that hormone to distribute throughout the body, saturate the tissues, and achieve a steady state. This process takes approximately two weeks (fourteen days).
If you keep tweaking your dose every three days based on how you feel that particular day, you are chasing a moving target and creating wild fluctuations. You are generating more hormonal chaos, which can actually induce more hot flashes and mood swings than you started with.
The Protocol:
Make one adjustment at a time.
Wait a full fourteen days before assessing the effect and considering another change. Patience is paramount.
Track your symptoms objectively. Use a journal to note the frequency and intensity of hot flashes, sleep quality, mood, and energy levels. This provides data, not just feelings.
Stop messing with doses once your primary symptoms, like hot flash frequency, hit zero or reach a manageable, stable baseline. More is not always better. The goal is to find the lowest effective dose that resolves symptoms.

Standard Dosing Protocols and Formulations

While individual needs vary, a common starting point that is both effective and aligns with physiological principles is as follows:
Transdermal Estradiol: Applied once a day. Using estrogen through the skin (as a patch, gel, or cream) is generally preferred because it bypasses the “first-pass metabolism” in the liver. This avoids the increased risk of blood clots and the elevation of inflammatory markers associated with oral estrogen.
Oral Progesterone: Taken at bedtime only. Micronized oral progesterone has a natural sedative effect that can significantly improve sleep quality. It also protects the uterine lining (in women with a uterus) and has calming, anti-anxiety effects in the brain through its metabolite, allopregnanolone.
DHEA (Dehydroepiandrosterone): Taken in the morning. DHEA is a precursor hormone produced by the adrenal glands that can convert to both estrogen and testosterone. It often helps with energy, mood, and libido. However, it can also convert to androgens that cause side effects.
Troubleshooting DHEA: If you get cranky, irritable, or develop oily skin or acne, the dose may be too high for you, or you may be converting it too readily down the androgen pathway. The simple solution is to cut the DHEA dose in half and reassess.

Essential Lab Monitoring: Test, Don’t Guess

Objective data is your best friend. We cannot effectively manage what we do not measure.
Baseline Labs: Get a comprehensive lab panel done today, before you start any new hormonal or nutritional protocol. This should include a full hormone panel (Estradiol, Progesterone, FSH, Free and Total Testosterone, DHEA-S), thyroid panel (TSH, Free T3, Free T4), and the key metabolic and inflammatory markers we discussed (hs-CRP, Fasting Insulin, Fasting Glucose, HbA1c).
Follow-up Labs: Repeat the panel six weeks after you start the playbook. This timing allows hormones to reach a steady state and the initial effects of nutritional changes to become apparent.
Interpreting Estradiol Levels:
If your estradiol level is over 100 pg/mL, you are likely taking too much. This can increase the risk of side effects like breast tenderness and is often unnecessary for symptom control. The goal is relief, not hormone levels like a 20-year-old.
If your estradiol level is under 30 pg/mL and you are still symptomatic, you likely have room to bump up the dose gently.
Troubleshooting Common Side Effects:
Chest/Breast Tenderness: This is a classic sign of estrogen excess or, as mentioned, poor estrogen methylation. First, lower the estrogen dose. If it persists, we then investigate B6/methylation support.
Feeling Jittery or Anxious: This is rarely from the estrogen itself. It is a good chance you are either taking too much DHEA or, more commonly, you have too little magnesium and taurine on board to handle the increased metabolic rate and neuronal firing that comes with hormonal restoration.

The Integrative Chiropractic and Medical Framework at Injury Medical Clinic

This entire playbook is embedded within our unique clinical structure at Injury Medical Clinic PA. Drawing on my chiropractic and functional medicine background, my role is to identify and address the foundational pillars of health: the neuro-musculoskeletal system, metabolic function, and nutritional status.
As a chiropractor, I focus on keeping the nervous system—the body’s master control system—free from interference. Spinal health is not just about pain; it is about facilitating optimal communication between the brain and the body. By restoring proper alignment and motion, we can help downregulate the sympathetic “stress” response and reduce a key source of systemic inflammation, creating a more favorable environment for hormones to work.
This is where our collaboration with Dr. Maria Guadalupe Cardenas becomes so vital. As our Medical Director and a highly experienced internist, she provides the essential medical oversight required for any protocol involving prescription hormones like estradiol and progesterone. Dr. Cardenas reviews lab work, consults on dosing strategies, and manages the prescriptive aspects of care, ensuring everything we do is safe, effective, and adheres to the highest medical standards. Her four decades of internal medicine experience provide an invaluable perspective on complex cases and potential comorbidities.
Together, we bridge conventional medicine and functional/chiropractic care. A patient might see me for a chiropractic adjustment to address nerve irritation contributing to her systemic stress load, receive a detailed nutritional plan based on functional medicine principles to rebuild her mitochondria, and have Dr. Cardenas manage and fine-tune her HRT prescription. We also incorporate rehabilitation, personal injury care, and other services as needed, creating a truly holistic and patient-centered experience.
This multidisciplinary setup allows us to treat the whole person. We don’t just chase symptoms or look at a single hormone level in isolation. We are rebuilding the biological foundation of health, brick by brick, so that you can not only get through menopause but emerge on the other side with more energy, clarity, and vitality than you have felt in years. The journey requires a deep understanding of physiology, a commitment to evidence-based protocols, and, most importantly, patience. But the result—reclaiming your life—is worth the effort.

References

Covarrubias, A. J., Kale, A., Perrone, R., López-Domínguez, J. A., Pisco, A. O., Kasler, H. G., Schmidt, M. S., He, Y., Goya, R. G., & Verdin, E. (2021). Senescent cells promote tissue NAD+ decline during aging via the activation of CD38+ macrophages. Nature Cell Biology, 23(11), 1265–1279. [https://doi.org/10.1038/s41556-021-00781-6](https://doi.org/10.1038/s41556-021-00781-6)

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