Abstract

This case report describes the care of a 44-year-old woman who came with a sudden shift in her health, including new abdominal and breast weight gain, mastalgia, extreme fatigue, anxiety, depression, ADHD-related symptoms, digestive upset, insomnia, and an inability to tolerate exercise. Initial laboratory testing showed elevated progesterone metabolites, estrone, estradiol, 2-OH, and 4-OH estrone metabolites, and elevated free DHEA. These findings suggest estrogen dominance or elevated levels of estrogen relative to progesterone, as well as issues with detoxification and adrenal function. The patient's history of celiac disease and Hashimoto’s thyroiditis likely contributed to chronic inflammation and micronutrient depletion. To address the interconnected hormonal imbalances contributing to her symptoms, she was treated with a combination of SAMe, methylated B vitamins, DIM, sulforaphane, calcium-D-glucarate, vitex, green tea extract, and DAO enzyme therapy.

Over the course of twelve months, the patient described a 75-80% improvement in anxiety and depression, increased energy, more manageable menstrual cycles, and a self-reported 80% improvement in digestive symptoms after taking DAO. Follow-up testing found improvement in methylation markers, a shift from the genotoxic 4-OH to the favorable 2-OH estrogen pathway, and a 25% reduction of estradiol into the normal range. The patient lost 15 lbs and reported greater emotional stability and improved day-to-day functioning.

The case demonstrates that personalized, root-cause treatment is key to helping women navigate the complex challenges of perimenopause. Addressing factors like estrogen metabolism, methylation, inflammatory load, detoxification pathways, and histamine clearance can meaningfully improve complex perimenopausal symptoms. This case is novel and adds to existing literature as it addresses the compounding effects of autoimmune diseases such as celiac and hashimoto’s on the perimenopausal transition. Additionally, there are few studies addressing the effects of elevated estrogen levels on histamine metabolism in early-stage perimenopausal women.