Dr. Amy Nett: And so she’s been postmenopausal for about five to seven years, and then I’m guessing that the sleep issues and hot flashes are a little bit more recent. So looking at her daily free cortisol pattern, it’s low normal on waking, morning it’s in range, afternoon above range, low end of range DHEA-S 61, which I think would probably be about normal for a postmenopausal woman. Mid-normal total DHEA production.
Yeah, and again, for a postmenopausal woman you kind of expect androgens to be on the lower side. So I think that might be normal for her. Melatonin above range 92 and upper limit normal 50. So melatonin’s increased. Don’t know what to make of that. And if she was only off melatonin for a couple days before, I wonder. I don’t know if that could sort of stick around and still be showing up in the test. And then normal metabolized cortisol. So her total cortisol production is normal. But what we’re seeing is some dysregulation in that cortisol curve.
So the low estrogen and low progesterone; I’m guessing that you’re saying those are even below the purple rectangle there that indicates the normal postmenopausal range. So I still think of that then as she has some sort of cause of inflammation. Because I would say when hormone levels are low, even for a postmenopausal range, my question is, what’s going on? Is there some sort of imbalance inflammation that’s causing such low levels? Let me see here. So low normal cortisol on waking, and then afternoon is above range. Okay, so she’s sort of losing. So I’m just trying to picture that. So she’s sort of losing that normal curve. I mean, have you done all the gut testing and stuff on her? And nighttime is normal? Yeah, so it’s just. I’m not sure then that cortisol is causing the sleep issue because waking is often the best way to know what cortisol is throughout the night.
If someone is having sleep issues, I look at the nighttime cortisol and waking cortisol because waking cortisol gives me an indication of what their cortisol was overnight. And if that’s low, then I think sleep is less likely due to a cortisol issue. Sleep is so difficult to treat. I would ask her too what’s causing the sleep issues. Does she have a racing mind? Lots of thoughts? I mean, make sure she’s not complaining of something like waking with heart palpitations. That would be more of a cortisol issue. But looking at this, it doesn’t suggest that cortisol is really the cause of her sleep issues.
And hot flashes I am also not sure. If someone’s been postmenopausal for five to seven years, I would be really reluctant to start bioidentical hormone replacement at that time. It wouldn’t be my preference. So I would think about other symptoms. Start with the gut. Think about metals possibility. If she’s 60 years old, does she have any mercury amalgams? So I might consider metals testing. You could also do functional methylation testing on her; see if that’s contributing, if that’s an issue. Chief complaints: sleep issues and hot flashes. Yeah, check methylation, metals, gut stuff, and see what you find. Because it doesn’t look like cortisone’s causing the sleep issue. Tricky. Let us know what additional testing you get.