In this solo podcast episode, Dr. Tabatha Barber – a triple‑board‑certified OB‑GYN and functional‑medicine physician – explains why women can experience estrogen‑dominance symptoms even when their absolute estrogen levels are low. She describes how, during perimenopause, progesterone is the first hormone to decline and how chronic stress drives a “progesterone steal” that shunts progesterone into cortisol production, leaving estrogen unopposed. Dr. Tabatha walks listeners through the steroidogenic pathway from cholesterol to steroid hormones, highlighting the enzymatic steps that can be modulated by herbs, supplements, and lifestyle changes. She outlines the hallmark symptoms (heavy/irregular periods, mood swings, weight gain, insomnia, anxiety) and emphasizes that these often reflect low progesterone rather than high estrogen. Treatment strategies include bioidentical progesterone replacement, herbal agents such as Estratane Plus that block estrogen synthesis, and liver‑supportive measures (dandelion root, milk thistle, bitter greens). Throughout, she weaves personal motivation from her book Fast to Faith, encourages community engagement via Facebook groups, and calls for broader acceptance of bioidentical progesterone among conventional OB‑GYNs. The episode aims to empower women to understand the root‑cause physiology of their symptoms and to pursue functional‑medicine‑based solutions.
Chapters
Estrogen dominance is just referring to the fact that there is too much estrogen as compared to progesterone in the setting of what is going on. So it's common for women's estrogen levels to start to decline, but they can still have symptoms of estrogen dominance, and the most common symptoms. Are heavy periods, irregular periods, irritability, mood swings, weight gain, weight gain, weight gain, right? Starting to have insomnia, like you can fall asleep, but then you wake up; you can't go back to sleep right away. Your mind is racing. You're feeling anxious, and there's this. Blend where you're starting to have symptoms of low progesterone and they're getting mixed up with symptoms of estrogen dominance. And I want to talk about why this is happening. Hi, I'm Dr. Tabatha, the Gutsy Gynecologist. I'm a triple board-certified OB-GYN and functional medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey, and I'm super excited to share my wisdom and unique perspective as it pertains to women's health. After caring for thousands of women, I've come to realize that your gut health determines your gyn health and your overall health. And it's a super gutsy thing for me to go against conventional gynecology practice to bring you the truth. No more Band-Aid medicine, ladies. We're talking root cause resolution on this show. So if you're struggling with hormone imbalance, weight gain, period issues, anxiety, insomnia, you name it, then you've come to the right place. Place, and I want to be your gutsy gynecologist. So welcome! Hello, hello! I hope you're having an amazing week. I know that I am, and part of the reason is I just keep getting so much good feedback about my book Fast to Faith. It is transforming women's lives, and it's filling my heart, and it's showing me that it was completely worth it to lean in and trust God, have faith that I was doing all of this for a purpose. You know, I really didn't know what the path was or why he was calling me to write Fast to Faith or what, what was going to come of it, but I'm starting to see the fruits of it, and it's absolutely incredible. So thank you for telling me all of your amazing stories of transformation and how you're not only losing weight and like getting rid of your chronic pain and gut issues and feeling amazing, but you're believing in yourself again and you're having hope and you're realizing that you're so much stronger and resilient than you were thinking that you were. So many of us just kind of lose hope. We get caught up in the rat race of life and we get stuck on autopilot and we're just doing the same things we've always done because it's exhausting, right? And so if you haven't read Fast to Faith, you haven't done my online programs, any of that stuff, I would invite you to Just get curious about what if my life were different? What if I felt better? What if I had more energy? What if I had a job I loved? Or what if I was like in a fulfilling relationship? Like, if any of those are issues for you, I would invite you to get curious about how life would look if they were different. Because I promise you, if you can start to envision something better, It can happen. I have a whole section in my book called Future Gazing with God where we help you to see yourself through God's eyes and help you to see the life that he wants for you that's ready and yours for the taking if you'll just lean in and believe it. So, all right, I just want to inspire you and fill you with hope and goodness because I see Women shift every single day. I see the transformations. It's not just a bunch of crazy talk. Like, I actually see the results. So I just want to give a shout out to VW Diva really quick because she left me a review on iTunes. Thank you, thank you, thank you. You guys, when you take 30 seconds to leave the 5-star review and write Like VW Diva, she wrote one sentence. We need this data and her advocacy. Thank you! Exclamation point. Like that's all it takes for iTunes to know that you guys care about your bodies and that you care about living your best lives, and that pushes us up so that more women can find this information. So use your voice. Use your voice. Tell people what you like, and so that we can share it with each other and we can lift each other up. I appreciate all of you that have left reviews. It just, it helps further the mission. This is not about me, honestly. Like, I'm the vessel. God is using my voice. to do amazing, incredible things, but I need your help. I want to create a sisterhood. I've been focused on growing this sisterhood of women who are really supporting each other and having each other's backs and lifting each other up and showing each other there's a better way to live, right? So join the Facebook group. We have 2 groups, actually— Achieve the Body You Deserve After 40 and Fast to Faith. Just join us in there. We would love to love on you. Okay, here we go. I got a question this week that I've been receiving it a few times, and I realize this answer is not easily found. I talk about this when I talk about estrogen dominance inside of other episodes, but I want to answer this question directly. Can I have estrogen dominance when I have lower Estrogen levels, and they're not actually elevated. Okay, the answer is absolutely. You can have estrogen dominance even without having high estrogen levels. You're probably thinking, okay, how does that work? What do you mean? So estrogen dominance is just referring to the fact that there is too much estrogen. As compared to progesterone in the setting of what is going on. So it's common for women's estrogen levels to start to decline, but they can still have symptoms of estrogen dominance. And the most common symptoms are heavy periods, irregular periods, irritability, mood swings, weight gain. Weight gain, weight gain, right? Starting to have insomnia, like you can fall asleep, but then you wake up, you can't go back to sleep right away. Your mind is racing, you're feeling anxious. And there's this blend where you're starting to have symptoms of low progesterone and they're getting mixed up with symptoms of estrogen dominance. And I want to talk about why this is happening. Okay. So hopefully you've listened to my other episodes where I talk about the menstrual cycle and how that works. Every month you have a nice rise in estrogen that slowly comes up, slowly comes down. You release luteinizing hormone, it triggers ovulation. You have another rise in estrogen, and the ovulation triggers progesterone to be produced. Testosterone is being produced during this half, you know, the mid-half of the month, so that you have desire. You can like get pregnant if you so desire. And then everything slowly declines, and that triggers bleeding or your period. So in the second half, especially when estrogen and progesterone are supposed to increase together, Kind of like a double roller coaster at Cedar Point or somewhere. If you guys have ever ridden the Iron Dragon or any of those double roller coasters, they're supposed to go up together. They're supposed to come down together. They're supposed to ride the same track alongside each other. That's what I think of estrogen and progesterone. They need to stay on that same track pathway next to each other in parallel. And when they don't, Then you start to have too much estrogen as compared to progesterone. And this happens naturally in our 40s because progesterone is actually the first hormone typically to not be sustained and produced enough. And I want to share my screen and show you why progesterone is the first hormone to decline. And it's becoming more and more common the busier and crazier women's lives get. When we, you know, pre-World War II stayed home, ran the family, and that was our major focus, you didn't have this. But now that we're trying to do all the things, we're, you know, having careers, We're trying to be, you know, in shape and go out with our girlfriends and like conquer the world and do all these things and run our kids to 50 different games and practices and all this stuff. Like, we are very, very busy. We are stressed like we've never been stressed before as a species, as women. So I am sharing my screen. With you if you're watching on YouTube. If you're listening on the podcast, it might be worth jumping over to The Gutsy Gynecologist on YouTube to see this. So this image is from my book Fast to Faith, and this is the steroidogenic pathway. This is what you learn when you take biochemistry in college. So if you look far to the right, You see cholesterol listed. Cholesterol is the main ingredient to make all of our steroid hormones. Wow. So, steroid hormones have a cholesterol base, and we care about steroid hormones because they make us who we are. Steroid hormones include testosterone, DHEA, all of our estrogens, And our progesterone, it makes our cortisol, our stress hormone, aldosterone, our blood pressure hormone. So this is really an important pathway to understand. I don't expect you to study it and memorize it like I had to do in biochemistry. We had to not only know every step in these pathways, but all these enzymes in these colored boxes, those enzymes correlate with how you get from one Step to the next, like cortisol to cortisone uses 21 hydroxylase. And so there are medications, there are herbs, there are sometimes lifestyle interventions that can block those pathways or enhance those pathways so that things go in a certain direction or not. So. What I want you to understand about this pathway is cholesterol gets made into pregnenolone. That can go on to make DHEA, or it can go down to make progesterone. Progesterone is our natural anti-anxiety calming hormone. It helps us sleep. It helps us deal with life. It helps prepare the lining of the uterus for implantation of an egg, and it sustains a pregnancy. It's progestational. We love progesterone. It makes us feel good. But if you notice, progesterone then can go on to be made 17-hydroxyprogesterone, and then it can go down to be made into cortisol. So if you are living a busy, busy life and you are making too much cortisol because you are Stressing your body too much, and I'm not talking about feeling mentally stressed. You can handle all this stuff. I know you. You you're a badass, but your physiology is making too much cortisol to handle it, and that is stealing your progesterone to make cortisol. It's called progesterone steal, and that is the major driver of having low progesterone. After 40, that will send you into early menopause more than anything is this cortisol steal that's happening that's continuously robbing your progesterone. And so your estrogens, they're over here being made, and your progesterone is being used for cortisol. And so you get out of this balance and you get into a state of what feels like estrogen. Estrogen dominance, even if your estrogen levels aren't outright crazy high on their own, because progesterone keeps estrogen in check. Progesterone keeps estrogen from overgrowing things. So I hope that answers your question. It's probably the most common scenario that I see for women in their 40s is this. Picture of estrogen dominance and this low progesterone or progesterone deficiency. And it causes a slew of symptoms. And it's a roller coaster because although progesterone is just declining steadily and every month you're just struggling to make it, estrogen is a little more erratic. And sometimes your ovaries will try to overcompensate because they're trying to say, Make progesterone. And so your estrogen levels can get far up again before they come back down. So estrogen is really erratic in your 40s, made worse when you're making excess cortisol to handle all your stressful daily lives. So I hope that makes sense. Women often use progesterone replacement for years. Before they ever need any kind of estrogen support. Sometimes we actually actively try to bring that estrogen level down to meet that progesterone level, and we do that with supplements. There are amazing herbs that actually block some of those pathways that I showed you, all those colored arrows, so that your estrogen can be metabolized more efficiently and be removed from your body so that you get out of this estrogen-dominant, progesterone-deficient state. It's kind of like you help meet the two in the middle. So I love Estratane Plus. It's one of my favorite supplements to help get rid of your excess estrogen. And sometimes you need to do extra liver support, like drinking dandelion root tea or taking milk thistle or getting more bitter greens like arugula and beets and those types of things that can really help you get your hormones back into balance, especially through perimenopause. So hopefully that answered your question. Hopefully that blew somebody's mind. I know it blew my mind when I first really understood what the heck is happening. And I just want to say one last thing. I'm so appreciative that there are conventional OB-GYNs out in social media really advocating for hormone replacement therapy. They're, they're showing that the WHI was a total disaster and that we were misled, and they're debunking those myths the way I have been. But there is a missing piece. A lot of conventional OB-GYNs still don't understand bioidentical progesterone, and that can be a huge missing piece for a lot of women during perimenopause. So although these other people on social media, they're really pushing the idea of feeling better with estrogen, they're still a little confused about the fact that progestins do not act the same in your body as progesterone, and that progesterone does more than just prevent your uterus from hyperplasia and cancer. There are so many other benefits. So I hope that this understanding helps to show you that replacing your progesterone can be really beneficial. And get rid of some of those estrogen dominant symptoms, and hopefully help you avoid the results of estrogen dominance, like unnecessary surgeries and procedures and medications that happen. And I talk about extensively in my estrogen dominance episodes. So I hope that was helpful. Let me know what else you have questions about, what else you want to hear about. I'm here to. Serve you. I love you. Have an amazing week. There's no reason not to have a great day on purpose.
