On this page patients can Enroll in Naturopathic Care, Refill Hormones, Request a Lab Slip, Report Adverse Reactions, Upload Documents/Labs securely, and Book Naturopathic sessions Online. Please allow 3-5 seconds for the booking widget to appear on the SCHEDULE page. The information below explains each form in steps.


My Naturopathic FAQ page addresses how to schedule your visit, the conditions I treat and specialize in as a Naturopathic Doctor, How to Request a Labslip if you have not been seen recently, and how to request a Hormone Refill (30 Days only) until your hormone testing is finalized.


Naturopathic Medicine, Hormone Management, and Hormone Med Checks are conducted by appointment only. Please visit the SCHEDULE page to receive Naturopathic care. Care is not conducted outside of appointments, except in the event of an adverse reaction there is no charge to receive a substitute hormone, herb, or supplement you cannot take.

To treat yourself to a Holistic Women's Health, Natural Endocrinology, Natural Dermatology, Natural Rheumatology, Natural Cardiology, Natural Gastroenterology, Natural Urology, or BHRT visit please visit my SCHEDULE page and allow 3-5 seconds for the booking widget to load. If you need assistance please call (480) 837-0900.


Naturopathic Doctor's spend a great deal of time with their patients via a detective process to understand the "Root Cause" of symptoms and are quite different than the standard MD version of Endocrinologist, Dermatologist, Rheumatologist, Gastroenterologist, Urologist, and Cardiologist. Naturopathy is a complicated process that uses Functional Medicine, Nutrition, Natural Hormones, Herbal Medicine, Vitamins, and Supplements to address the "Root Cause" of these conditions, rather than just prescribing the antiquated failed "Sick Care" American Medical Model that we use X drug to suppress X symptom. This is why Naturopathic Doctors do not accept insurance and do not run their appointments on a five to ten minute schedule like most doctors that accept insurance. While some patients do receive reimbursement for their visits from their insurance we do not work with any insurance companies as it is too time consuming and the payment system is based on the typical 1-5 minutes an MD spends with a patient not the 30-60 minutes I reserve for each patient.

Instead of handing a patient a prescription after 60 seconds of listening to their symptoms, we are looking at the symptom set as a whole to understand which Functional Medicine systems need to be addressed to reduce inflammation, and aid healing of the affected tissues. Please read the blogs associated with the conditions you seek treatment for to better understand how my medicine is more of a "detective process" and not just a "prescription." This is why the new patient visit is 60 minutes and follow up appointments are 30 minutes. Time is required to solve the symptoms which cannot be conducted outside of a scheduled appointment.


I want every patient enrolling in my practice to be a success story, and only accepting new female patients with Women's Health conditions such as female hormone imbalance, thyroid, breast pain (not breast cancer), Urology, Rheumatology, Psychiatry, Gastroenterology, and Dermatology conditions. Women with these conditions can enroll into my practice. If your health chronic disease health condition is not listed, I can most likely help you with my seventeen years of experience working as a Naturopathic Doctor, but you should call my assistant to first confirm that we will be successful working together. Please ensure your NEW PATIENT PAPERWORK is submitted at least 48 hours prior to your appointment for me to review prior to meeting you! I am very detail oriented and ask a great deal of questions.


Hormones Labs, Functional Medicine Labs, and relevant imaging can be faxed to us at (480) 409-2644 by calling your lab, previous doctor, or by calling your doctor's office and requesting the tests, not the notes are sent to Dr. Sundene. Please do not send your labs by text message as this is not secure, or labs from your patient portal as this is not a normal lab report that any doctor wants or finds useful as oftentimes there is one lab test per page which actually makes it more difficult for me to help you.

Or use the secure document upload form at the top of this page, or mail the labs to our clinic.


I only want the past 1-2 years of your labs, Functional Medicine Labs performed by your previous Naturopath, and anything pertinent that is abnormal related to your chronic disease condition. Providing too much information ie: more than 20 pages will require multiple visits. Please stay problem focused so we can achieve results and I am not wasting your new patient visit sifting through three boxes of chart notes over the past twenty years.

For assistance with scheduling your Naturopathic Hormone visit or for questions if my Women's Health and Hormone practice can be help your specific health chronic health condition if it is not listed as the doctor's specialty, please call (480) 837-0900. We can also obtain copies of your lab reports from Labcorp and Sonora Quest by calling us to request this.


We always refill your bioidentical hormones until you are legally due for a lab and follow-up visit. Please check with your pharmacy first before submitting refill requests. If you need a 30 day courtesy refill of your hormones to ensure your labs are accurate, please submit the REFILL REQUEST form. For accurate hormone testing, I need patients taking the hormones regularly without disruption for at least two weeks prior to the testing for it to be accurate. Do not take any AM hormones or caffeine the morning of your testing. Please stop biotin (hair loss supplement) two weeks prior to having your hormones test as it interferes with thyroid tests and female Hormone tests masking the hormone imbalance and making the labs appear as if they are completely normal, despite the patient exhibiting multiple symptoms.


To request a hormone lab slip please fill out this form: HORMONE LAB SLIP. Please read my NATUROPATHIC HORMONE TESTING page to confirm your testing is performed at the correct time of day and in the proper window with your menstrual cycle.

All lab slips are given directly to the patient at their appointment, or via a portal email. We never send your lab slip to the lab. Please ensure you are at the correct lab that is contracted with your insurance company. While some companies do not care which lab you are at, some policies may deny 100% of your charges should you be at the wrong lab. Labcorp is our preferred lab, due to fewer errors and wait times than Sonora Quest.


EOB's are not bills. Hormone lab testing may look very expensive upon receiving your EOB or "Estimate of Benefits" until your insurance adjusts the lab's bill with their allowed amount. Most of my patients with decent insurance have their labs covered per their insurance plan. Patients with high deductibles usually end up having to pay around $100-200 dollars toward their deductible. I have never seen a patient in my practice receive an actual bill from the lab for $2000 unless the diagnostic codes are missing, or the patient failed to give the lab their insurance card. If none of the labs are covered it is either because #1 The phlebotomist did not enter the diagnostic codes on the lab slip or #2 The patient did not give the lab their insurance card, or #3 The Patient gave the lab their old insurance card that is the wrong card. These are the scenarios that cause mass hysteria in hormone testing that can be avoided by properly educating yourself about the hormone testing process up front.


Hormone patients should check in at the lab no later than 8 am. Hormones must be tested while the patient is fully hydrated with water but fasting (no food, caffeine, or AM hormones) during days 21-23 of the menstrual cycle unless otherwise stated on your lab slip. PM hormones should be taken the night prior.

Please do not get your hormones checked when you are not on the hormones consistently the two weeks prior to testing, or if you have accidentally taken any AM hormones as this will cause erroneous hormone labs and potential hormone safety issues. If you have not performed the hormone testing within the 30 day "courtesy refill" please do not waste your precious lab dollars getting hormones tested when you are not on them. This is an utterly useless waste of everyone's time and taking hormones does not "magically change" hormone numbers. I will just receive totally useless labs that looked exactly as they did prior to treatment. The purpose of the follow up hormone testing is to ensure your hormones are safe for the long run. Patients that perform their labs incorrectly will be legally required to return to the lab at their own expense (as most insurance plans only allow testing every three weeks.) So please read the hormone testing blog to confirm you are doing everything correctly and using your insurance to reduce if not eliminate the cost of your hormone testing.

Our hormone lab results take a minimum of 3 weeks to become final. Sometimes they come in sooner, at which point we will call you. We recommend you wait for the doctor to inform you the labs are final and correct before scheduling a follow up to avoid multiple appointments.

For more information on hormones and Hormone Testing, please visit our Bioidentical Hormone page.


Our clinic uses Fullscript for all prescription grade supplements, vitamins, and herbal medicines the doctor needs to balance your hormones. Once you have set up your account, you can continue to order the supplements and refill them as needed. Patients do not need a prescription to order prescription grade supplements, and we need you to continue taking the supplements to ensure the treatment plan continues to work once the your symptoms are resolved.

While we recommend every patient has an annual hormone check up, this is optional for patients that have resolved their symptoms of hormone imbalance.


Patients should plan to be seen monthly until their symptoms improve. Generally Naturopathic Hormone Doctors need to work with patients monthly until they have improved and then every 3-6 months after that. I always recommend an annual hormone check up to ensure women's hormones are optimal and not just "In the normal range." Especially for women with hypothyroidism, perimenopause, Diabetes, Insulin Resistance, PMS, and menopause.

Existing patients can request a lab slip at any point if they are concerned their hormones are not correct by filling out the lab slip request below.

Visit notes with the doctor are required to get your hormones covered per your plan, if you have not been seen prior to the labs, your labs may be denied without filling out the proper request form so I have documentation for medical necessity.


Please do not listen to the phlebotomist at that lab that says 2-3 days. This is not a simple chem panel and cholesterol check ordered by most doctors. Hormone panels are specialty tests that must be sent out and require two to three weeks for our hormone specialty testing to be complete before scheduling your follow up appointment. The Total Estrogen, which is the most important test I need to help women with female hormone imbalance generally takes 3 full weeks.

To receive Naturopathic service, please book a visit on our SCHEDULE page or call (480) 837-0900 for assistance. We must see you annually at minimum to legally provide any hormones, advice, or medications per Arizona state hormone prescribing laws on thyroid hormones, and female hormones.

I am not legally allowed to prescribe medication by text message. Please do not text me copies of your labs as this is HIPAA compliant and I will immediately delete the text and ask my assistant to call you to schedule a meeting to review the labs.

For more information on how thyroid, adrenal, and female hormones are covered per insurance please visit our Naturopathic Hormone Testing page.

Dr. Nicole Sundene

Female Hormone Specialist

Hormones and Dermatology are very interconnected in my mind as a Women's Health doctor. While many of my patients refer to me as a "Natural Dermatologist," what I am really doing is testing and perfecting hormones and nutrition which then results in perfect glowing skin!

From hormonal acne, and dry menopausal skin to perimenopausal “Allergic Skin” that causes eczema, psoriasis, cystic acne, Seborrheic Dermatitis, Dyshidrotic Eczema, and hives, all of these skin changes in women are actually an important alert that hormone imbalance may be the “Root Cause.”  Women have fluctuating hormones throughout each month and decade of life.

While most people are aware that testosterone causes acne and hypothyroidism causes dry skin, we will discuss hormones and Dermatology in greater depth than that today to understand exactly what is happening to a woman as she move through her teens and twenties and battles hormonal acne as I once did.

I often see my patients experiencing perimenopausal or menopausal skin changes. Many Dermatologists send me their patients when they cannot resolve their patients symptoms with standard treatments or have noticed a hormonal pattern.

Women over forty in perimenopause and menopause often tell me they feel like they “Rapidly aged ten years overnight,” and ask why their skin has suddenly become so thin, saggy, has lost elasticity, and no longer has a healthy glow. We reminisce about the healthy glowing skin they once had when full of hormones during pregnancy as I fill out a lab slip to evaluate the hormones that are "off" with menopause.


As a Naturopathic Hormone Doctor that has treated a lot of women over the years, I do see women's skin changing as they transition through perimenopause and menopause. Generally the skin goes from oily to dry or from already dry to super dry and now having massive issues. Women commonly report new allergic skin conditions they never had before like eczema, psoriasis, hives, seborrheic dermatitis, or dyshidrotic eczema.

While we all tend to associate vaginal dryness with menopause, really the entire body is drying out along with the vagina. So today in this hormone blog I will be discussing exactly what women need to do. 

In my mind as a “Holistic Dermatologist,” the main underlying issue is the change in the woman’s hormones. Especially when new skin condition’s pop up in a women’s forties and fifties the first thing we should be thinking about is hormone imbalance rather than reaching for that easy steroid cream to apply. The steroid cream basically is just slapping a band-aid on the Dermatology issue and not addressing it at the “Root Cause.”

Every woman nearing menopause wants to know why their skin is rapidly aging, thinning, and has lost its turgor and elasticity. So today we will be discussing the link between female hormones and skin aging. 


Estrogen is responsible for helping keep our skin hydrated as well as builds the layer of collagen behind the skin. Loss of estrogen is why women suddenly notice their skin lacks elasticity, and has become very thin. Thin skin is more likely to bruise because there is less cushion to protect the blood vessels below it and with this women notice that cuts take longer to heal. Women that also bruise easily are those that tend to be low in progesterone which we will discuss next. Easy bruising can also be a sign of anemia from heavy bleeding in perimenopause.

Often women cannot rebuild enough iron stores with just food sources when they have had heavy periods prior to menopause. After the ferritin level is above >75 menopausal women generally do not need to supplement with iron as they are no longer losing blood each month.

Estrogen is the last hormone that women lose when women become officially menopausal. Most women in their late thirties and forties are dealing with low progesterone and low or high testosterone impacting their skin. 

The sudden loss of estrogen in menopause though, is when women suddenly notice Hot Flashes along with new Dermatology complaints, or tell me that they have “Aged ten years overnight,” and think to seek me out. As a hormone doctor, I want women to be aware of the shifts to their hormones and skin ahead of time so we can prevent this "rapid aging syndrome" at menopause.

By checking hormones when women turn forty or sooner, we do not need to work to reverse rapidly aged menopausal skin! We can watch for trends and changes and be prepared and treat as needed. Prevention is the queen of Anti-Aging Dermatology!


Progesterone levels are high in pregnancy which causes our capillaries to increase blood flow aka "vasodilation." This is why pregnant women have that amazing glowing skin everyone comments about, “Look at how she is just glowing!” As progesterone levels decline the blood vessels naturally narrow which is why menopausal women suddenly get High Blood Pressure and heart problems like palpitations, and PVC's that they never had before. The arteries of the cardiovascular system have smooth muscle in them that relaxes arteries, stomach, and lungs. When women develop asthma in middle age, they should consider progesterone deficiency as a "Root Cause" since progesterone is a natural bronchodilator.

However, when progesterone begins to naturally decline around the age of 35 and dwindles down to zero by forty or fifty, this is when women complain to me that their hair, nails, and skin looks sallow, dull, dry, and lacks any form of that “healthy glow.”

Progesterone is also important for vaginal hydration, dry eyes, and irritable bladder. Painful intercourse described often as “Having sex with sandpaper,” is not just caused by lack of estrogen but also lack of progesterone and testosterone. The 90's method of giving women with hysterectomies estrogen only with the new research we now have on progesterone is simply cruel.

For years doctors have argued that because "she has no uterus, she doesn't need progesterone," this gross scientific misnomer should be drop kicked straight back to the 1900's where it belongs. Estrogen monotherapy should be put out to pasture permanently with "Horsey Hormones" aka Premarin for the safety and sanity of women everywhere. Women need progesterone for their eyes, skin, vaginal health, blood pressure, hormonal acne, weight loss, and mental health. Women without progesterone often have troubled sleep riddled with night sweats, anxiety and insomnia.


Testosterone is oftentimes viewed as the “Most Evil Hormone” in Dermatology for causing Hormonal Acne, Rage, Oily Skin, and Cystic Acne in my PCOS patients. I worked for three Dermatologists over an eight year period that were constantly trying to battle the evil testosterone with spironolactone and birth control pills with some wins and losses because testosterone is not always the cause of the hormonal acne. Testosterone blocking treatments fail when another hormone such as estrogen, progesterone, thyroid hormone, or adrenal hormones like DHEA are out of balance.

While testosterone is sometimes to blame in hormonal acne, women do need some testosterone in their systems as this is the primary reason why “men age better than women.” Because they have testosterone levels of 800 while women are at 8 if not zero in menopause. Plus I see fantastic results treating my Chronic Fatigue, Chronic Pain, Depression, Anxiety, Mental Health, and Osteoporosis patients with testosterone!

Testosterone is why men don't generally get Osteoporosis unless they have low testosterone levels. Ironically, once I began to see benefits on my patients DEXA's and started to look into the research for Osteoporosis and testosterone, the only research study I found of course was done on men with low testosterone. The good news though, is that bone was built from supplementing with testosterone in the study! A minor women's health victory!

Since both my grandma's had severe Osteoporosis I want all women to know this stuff now so they can prevent painful debilitating fractures that may not ever be able to heal in their "Golden Years." I am excited about testosterone not just for avoiding wrinkles but also for bone health. I have seen testosterone build bone in the past decade of my practice faster than in the first half of my career when we just gave women premarin or natural estrogen aka estradiol for their bones.

Today, my patients that use a cocktail of estrogen, progesterone, and testosterone and eat the mineral rich foods on my Osteoporosis blog along with supplements to ingest the correct 1000 mg of calcium I recommend women intake daily for prevention, and combine all of that with weight bearing exercises at least twenty minutes three times a week, are able to reverse their T scores on their DEXA's.

Now I have revealed on my women's health blog that men age better and have better bone density than women, but we will never admit this out loud! This is a 100% private portal page for women on the internet right? 😉  

But I bring this testosterone issue up because if you have ever seen a man wash his face with a bar of dial soap and use no moisturizer afterwards, you know exactly what I am talking about. Men make so much testosterone that their skin is naturally hydrated from within at it’s base and they generally do not need to apply lotion on top. The testosterone stimulates sebaceous gland oil production. Meanwhile women with low testosterone are applying nineteen different products and serums to their skin twice daily.

I just want women educated and understanding why neglecting their hormone imbalance is neglecting their skin, and yet again how unfair it is to be female versus male. Plus now you have medical proof to substantiate to your husband that you do need to buy all of those anti-aging serums and he is totally fine without any!

Testosterone naturally begins to decline around the age of 35. This is when women notice not just dry skin, but that their skin lacks any form of oil or hydration, and their hair is also suddenly dry and coarse. Perimenopause is also when female hair loss begins.

Women generally report lack of stamina, chronic fatigue, depression, and that they are not bouncing back as quickly from their workouts and their muscles and joints feel inflamed and in pain for several days after a workout. Suddenly it becomes exhausting to try to exercise two days in a row if not impossible.

Keep in mind that men with "low testosterone" of 300 complain of joint pain and muscle aches while many of my female patients are at zero. So men are tired and in pain at a level of testosterone 30 times higher than what most women have in menopause, and many of us will never be at that level, nor should we be.

Testosterone helps our joints and muscles heal and repair, so if you notice you are in chronic pain, more tired than normal after a workout this is generally one of the the very first early warning signs of perimenopause for most of my patients, and a sign you need to get on my SCHEDULE to have your hormones checked! Especially if you are having night sweats or beginning to feel overheated at night.

Testosterone has always been the villain in Dermatology because it stimulates the oil glands in our skin causing acne. However, we do need some testosterone as women or our skin looks dry and lacks any form of protective oil that provides shine to our faces. While we don’t need our complexions dripping with visible oil, we do need some oil to prevent rapidly aging skin in menopause!


Hormonal Acne, and Menopausal Hormone changes to the skin require a physician skilled in both Dermatology and Hormones. The first step is for a Female Hormone Specialist (please not your Family Doctor, Endocrinologist, or Obgyn) to check your full set of female hormones, adrenals, and thyroid as these are ALL equally important in my mind. Oftentimes I sadly receive new patients that think that they have “already had all their hormones checked,” only to receive one test or a one page report that they proudly hand me. A TSH is not a full hormone panel, it is not even a full thyroid panel. An FSH/LH to confirm you are menopausal is almost utterly useless. Why????

Occasionally the correct tests are ordered but the doctor ordering the test does not know how to properly interpret them because the hormones fluctuate in different parts of a woman's menstrual cycle and have to be tested at the right time. We also need to look at what is optimal and not just look for things in bold that are clearly abnormal when it comes to chronic skin conditions and Dermatology.

This is where I see a lot of women fail with having their hormones checked with perimenopause, PCOS, and hormonal acne. Testing hormones in the wrong part of the cycle, and/or not testing the correct hormones is totally ineffective for solving women's skin conditions.

Lets instead test all the nutrition and hormonal metrics related to skin health to properly address Dermatology conditions, especially in menopausal women and those with PCOS, thyroid conditions, and perimenopause.

My initial hormone test report is four pages long at minimum. Most insurance covers hormone testing for women unless it is of course government funded. Only the government could care less about your hormones! But they are still very important for proper skin health, which is why I have written this blog about how they impact women during different stages of their lives in my Holistic Dermatology practice.

So if you have not had hormones properly checked, and are struggling with skin rashes, hormonal acne, eczema, or psoriasis, simply visit my SCHEDULE page to treat yourself to a Naturopathic Hormone visit! 

In my experience of fifteen years working as a “Holistic Dermatologist,” very few skin conditions in Women's Health are not hormonal. 

Dr. Nicole Sundene

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Specialist  in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for MenopauseThyroid, Hashimotos, PMS, PerimenopauseAutoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on InstagramTwitter and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!

Dr. Nicole Sundene, NMD

Author of "The Hormonal Acne Diet Program"

Cystic Acne is a form of Hormonal Acne that does not respond to the same treatments I use for my regular acne patients. Topical treatments for cystic acne are generally ineffective because they tend to only aggravate and dry the skin on the surface while failing to address the root cause of the cystic acne forming deep below the layers of skin.

Today I will share "Dr. Nicole’s #1 Cystic Acne Potion Recipe"

I am posting this simple recipe here for someone that might need it, and also as an important reminder to TEST your essential oils on your wrist before applying to your face. The skin is sensitive and inflamed, especially in hormonal acne and cystic acne. So start with 1 drop of thyme per 1 oz of aloe vera. 

Most women use about 2-5 drops of organic thyme or lavender or a mixture of the two. Try one first before the other so we can observe your skin is improving and not aggravated by anything. Allergies are rare with natural medicines but they do happen so it is important to start with a low amount and work up to what is not too strong to smell. This should not sting or burn when you apply it to your skin. It should only soothe it.

Pure lavender can be used undiluted and dabbed on with a q-tip, although I don’t recommend doing this for cystic acne or hormonal acne as oil is the last thing the skin needs and we need to work to make the skin less greasy overall to prevent clogged pores. 

In traditional acne, oil from the sebaceous glands trap dirt and bacteria into the pore causing acne lesions. Cystic acne forms below the layers of the skin and generally topical treatments do not help, except what I will share today.

Aloe vera is an important anti-inflammatory treatment that can also help reduce the scarring associated with cystic acne. Thyme has been researched as an effective acne treatment, as has lavender. I find thyme to be far more effective for my acne patients in my Holistic Dermatology and Hormone practice.

If you have cystic acne it is very important that you work with a skilled hormone doctor that understands this condition and can help diagnose the "Root Cause" of the cystic acne. Oftentimes there are multiple hormone imbalances going on that I find, and not just one. Patients will say "I got my hormones checked," and there is 1-2 tests which is not the 5-7 pages of hormone tests that I generally first order for cystic acne patients to determine the hormone imbalance.

A Naturopathic Hormone Doctor will be able to diagnose the multiple factors impacting the skin for your cystic acne which include: 1) Hormone Imbalance 2) Dietary Triggers 3) Environmental Triggers

Without a proper program to address cystic acne at the root cause, such as "The Hormonal Acne Diet Program," patients generally end up with terrible scarring from having cysts form all over their faces from this form of hormonal acne. Once a cyst forms the sac around it will always continue to fill back up with fluid and recur.

If you have cystic acne and need my help preventing permanent scars on your face, simply pop over to my SCHEDULE page to treat yourself to a Naturopathic visit. I would be happy to help! I will have scars on my face forever, and as a result of that I hope to always work to prevent women from having scarring due to cystic acne.

Dr. Nicole Sundene

Author of "The Hormonal Acne Diet Program"

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause,  Thyroid,  Hashimotos,  PMS, PerimenopauseAutoimmunePostpartumChronic Fatigue, DepressionAnxiety, Food Allergies,  DigestionDermatology, AcnePsoriasis Eczema, and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 23 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease. 

She has been an Herbalist for over 28 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan (not Medicaid) and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on InstagramTwitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!

THANK YOU neighbors for voting me “Best Medical Professional of 2023” on Nextdoor!

This was an awesome email to receive!. Helping women feel AMAZING by solving complex hormone, gynecology, and bladder issues has always been my passion. Those that know me well, know that I also always enjoy a good challenge. I appreciate your votes as a favorite and the referrals I receive from my MD and Naturopathic colleagues on complex women’s health and hormone matters.

One of my greatest joys in life is getting to watch women transform into their BEST version of themselves by testing and perfecting their hormones, nutrition, micronutrients, and macronutrients. This can be very rewarding work.

Reading natural medicine research studies and providing women with the latest Women’s Health news on my blog is also one of my favorite free time activities. Reading research studies, blogging, and drinking herbal tea are my favorite things to do.

So, I am happy to hear my educational posts have helped many women that I have never even met! Many women in our Phoenix/Scottsdale neighborhood also do not have the opportunity to see a women’s health doctor, and I love receiving messages about how my natural remedies have benefited them and changed their lives.

Thank you for making me a favorite and to everyone that shares my natural Women’s Health tips from my blog on their own social media. I love seeing my male friends sharing women’s health tips and also supporting women! Women should not have to be embarrassed or suffer in silence with hormone imbalance, chronic bladder, and gynecological matters.

Times of hormone imbalance in a woman’s life such as Hormonal Weight Gain, Perimenopause, Menopause, Hormonal Acne, PCOS, and PMS can be very challenging without the right education and labs. Visit my blog for important information I think every woman should know as a Women’s Health Doc:

All of my most important tips for women to know are 100% free to read and share with your girlfriends.

If you need my help solving your women’s health issue simply visit my SCHEDULE page to treat yourself to a Naturopathic Women’s Health Visit!

Dr. Nicole Sundene, NMD
Scottsdale Naturopathic Hormones
(480) 837-0900

Dr. Nicole Sundene

Female Hormone Specialist

Hormones actually picked me many years ago! Did you know I was serendipitously selected by life to become a Holistic Hormone Doctor 23 years ago? Be it God, kismet, fate or dumb Luck, my old neighbor in Issaquah, Washington chased me down one rainy morning when she saw I worked at our neighborhood medical clinic and offered me a job working for her Hormone Doctor. She said there was an immediate opening, better pay and it sounded much less stressful than the busy Family Medicine and Dermatology clinic I worked at  for 20 Docs rooming 100 + patients per day. Of course I took the job!

Little did I know  this would be the #1 experience that would shape my future career as a Women’s Health Doctor and I was put in very special training with a genius Female Hormone Specialist that was a Pharmacologist and Internist. Working for the Hormone Doctor every day was a wonderland of fun for me! I left the office giddy with joy every day! The biochemistry nerd in me really enjoyed the hormone and hormone lab lessons on her specialties of Menopause, Perimenopause, Osteoporosis and Chronic Pain. She also taught me everything I know about autoimmune testing and hormones. 

The Female Hormone Specialist also taught me a lot about chronic pain testing for women with Fibromyalgia. It is difficult to find a doctor to take you seriously when you are in severe pain, or struggling with bizarre autoimmune disease symptoms… but she did this with tremendous compassion, kindness and brilliant detective work. Fibro patients need a multitude of proper tests conducted to determine the cause of the pain which requires multiple specialists working together or someone with enough knowledge in Rheumatology, Endocrinology, Neurology, Nutrition and Infectious Disease such as Dr. Panitch.  

Thankfully Dr. Panitch taught me a great deal about Menopause, Perimenopause and Osteoporosis, at the same time I also worked for 3 Dermatologists. While I loved helping them with their skin surgeries we would often see patients with chronic skin problems such as acne, psoriasis, eczema, dermatitis and MRSA struggle to get better. When I asked the Hormone Doctor about these patients she explained how a lot of chronic disease skin issues are actually hormone problems in disguise. Which makes a lot of sense when we see women get dry skin with menopause or thyroid disease, and oily skin with PCOS, Perimenopause and PMS. “Until we treat the cause of the Hormone Imbalance topical agents will continue to fail” is the take home message from my acne rant that prefaces the latest Natural Medicine research for Acne on my latest blog about “Hormonal Acne."

The #1 clue a symptom is related to hormone imbalance is fluctuation. Women who have fluctuating symptoms throughout the month or that begin with menopause, pregnancy or postpartum should be aware of how hormones can adversely impact their skin. There is way more to acne than just testosterone. Estrogen and progesterone are often to blame as well as many other hormones.

To properly balance hormones we need to use natural medicine to treat the root cause of the hormone imbalance. While we sometimes need bioidentical hormones or thyroid hormones, oftentimes from a Functional Medicine standpoint the cause of the hormone imbalance is something we address with herbs. Patients that like to drink tea, take herbal capsules, tinctures or supplements and improve their nutrition are perfect candidates for Naturopathy.

Patients that do not like those above things should stick with their MD's as it is difficult for me to help them as a Naturopath when they can't take herbs or make nutritional changes specific to what their body needs. Women are very unique as I discuss further in my Snowflake blog.

Today I wanted to share a picture of my favorite room, the "Herb Room" and remind you to drink more iced herbal tea to stay hydrated in the heat.

Teas are perfect for those of us in the Arizona heat that need to be taking in more water. I love to use ginger, mint and licorice which all contain powerful antioxidants and can help mask the flavor of herbs used for medicine. Patients can enjoy their herbal medicine tea iced for a refreshing change. Simply make your tea as normal, refrigerate and serve over ice!

If you need my help testing and balancing your hormones, or have not been feeling good and want to get to the "Root Cause," simply pop over to my SCHEDULE page to treat yourself to a Naturopathic visit!

Dr. Nicole Sundene, NMD

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Specialist  in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!

Dr. Nicole Sundene

Female Hormone Specialist

Hypothyroidism and thyroid disease are the #1 conditions I treat in my Holistic Women’s Health and Hormone practice. Before I answer a lot of the questions I am commonly asked about hypothyroidism and discuss the best natural and prescription treatments, let me first take a minute to explain the process of how I help my patients with hypothyroidism achieve lasting solutions with natural thyroid hormones, herbs, nutrition and supplements

I wish treating hypothyroidism was as simple as the current medical model that constantly fails women. Women with hypothyroidism are oftentimes frustrated because they are stuck in an antiquated hormone treatment system of:

Take X Thyroid Drug for X Symptoms

Oftentimes my thyroid patients are still complaining of common thyroid symptoms such as weight gain, chronic fatigue, depression, anxiety, cold intolerance, hair loss, heart palpitations, high cholesterol, insomnia, poor libido, dry skin, eczema, psoriasis, acne, and abnormal female hormones. All while their Family Doctor or Endocrinologist is saying the dose is fine. Half the time the dose is not properly tested and that is why it is not correct.

In Naturopathic and Functional Medicine, the body will continue to scream about its thyroid symptoms until we get the dose adjusted properly, changed to natural thyroid hormone and off the synthetic garbage.

After all, the thyroid is the “Mother of the endocrine system,” so we all know that when “Mommy” is not happy that none of the “Children” relying on her in female hormone and adrenal land will be happy! 😉

Here is the exact Holistic Thyroid detective process I perform as a Holistic Thyroid Doctor to fix hypothyroid symptoms: 

#1 Why do you have hypothyroidism in the first place? 

#2 What is the “Root Cause” of your hypothyroidism? Hint: It is different for each thyroid patient!

#3 Are vitamins, minerals, and nutrients the thyroid needs to make T4 and T3 hormones deficient? 

#4 Assess adrenal function for women with chronic fatigue, anxiety and insomnia. 

#5 Teach women my healthy hormone balancing Naturopathic meal plans and recipes my nutritionist designed to specifically help my overweight thyroid patients lose weight and balance female hormones.

#6 Addressing the gut inflammation is oftentimes why my patients have hormone imbalance in the first place, looking at the right nutrition for the individual patient, eliminating food triggers, testing the microbiome, and ruling out dysbiosis is critical for many of my thyroid patients. 

#7 Continue to monitor the thyroid with FREE THYROID LEVELS AND NOT JUST USELESS TSH via blood hormone labs to confirm your thyroid function is OPTIMAL and that you are not running on an “Empty tank of gas” or at the bottom of the “hormonal normal range” which is not optimal, yet many doctors that do not specialize in hormones will decide it is totally fine despite being low and the patient frustrated by multiple annoying symptoms such as weight gain, hair loss, and chronic fatigue.

My TSH RANT: Please be advised if the doctor or Endocrinologist monitoring your thyroid is just checking TSH, or is checking total thyroid hormones and not free levels then they are not educated enough on this topic to be managing your hormones in my opinion. This is the #1 reason why my poor thyroid patients is suffering so badly. Checking TSH is 90's medicine and it is time for a better, modern, educated thyroid doctor!

If I treated my menopause patients this way, people would think I was insane to just check their FSH and not actual female hormones. Let's imagine if I stopped checking estrogen, progesterone, and testosterone levels to adjust menopausal women's bioidentical hormones and instead just adjusted hormones off of FSH or the message the brain is sending to the ovaries to make more hormones. Just as TSH is the message the brain is sending to the thyroid that it needs to make more hormones. Managing thyroid this way is a grave disservice to women everywhere.

We have much more sophisticated better ways to manage hypothyroidism now, thankfully! The only way we can stop this madness is to properly educate women and make sure they know what to expect on their labs tests so they can immediately fire their doctor if there is less than three thyroid tests being monitored.

I digress from my TSH rants, and want to move on to my "Root Cause" rant, because I want to take the time to investigate and understand #1 and #2 on my list, I sadly have seen many of my thyroid patients fail to improve over my seventeen years of experience working as a Naturopathic Hormone Doctor. Sadly then Natural Medicine also fails, and I don’t get to receive the “Joy of Fixing you” because I don't understand why the symptoms are here in the first place.  

The real reason why most women don't feel good on synthetic synthroid and levothyroxine is because...

#1 Levothyroxine is a factory made synthetic compound.

#2 Levothyroxine is the dreadful "T4 monotherapy" that makes most of my thyroid patients fat because it needs to be converted to T3 to actually be useful. The T3 from the thyroid tells every cell in our body to work...somewhat like flipping on a light switch on or off.

#3 Lack of T3 means less collagen production, hair growth, and joint repair. Thyroid hormones set the pace for collagen production, along with metabolism. Therefore it is imperative that the thyroid levels for my chronic pain, autoimmune, Hashimotos, Rheumatoid Arthritis , and Lupus patients are in the optimal range and not just “normal.” Many of my unhappy thyroid patients are "Poor Converters" that are unable to convert the store hormone, T4 (Levothyroxine, Synthroid) to the active hormone that burns fat and gives energy=T3. This is why I firmly believe in natural thyroid hormone for women, and the majority of the women in my hormone practice ~95% are on natural thyroid hormone.

While many women are totally fine with their hypothyroidism utilizing the standard synthetic hormones synthroid and levothyroxine, many women specifically seek me out to fix their hypothyroidism related issues because they have been given these synthetic thyroid hormone replacements, yet still have symptoms and just don’t quite feel right.

I want every woman in my practice to be a success story. So please do treat yourself to a Naturopathic visit with me if you also want real answers, want the right nutrition for your body, want natural hormones, like to use herbal medicine, and want me to fix the underlying digestive and adrenal issues that are most often causing low thyroid function. 

If that sounds like what you need to finally solve the mystery of your frustrating thyroid symptoms then please pop over to my SCHEDULE page and treat yourself to a Naturopathic visit!  I would be happy to help! As a thyroid patients myself, this is of course one of my favorite hormone subjects! Now let me answer the most common questions I am asked about hypothyroidism.


Hypothyroidism is a medical condition characterized by low thyroid hormones in the body affecting vital physiological functions. Thyroid hormones, including T3 and T4, are secreted by a small, butterfly-shaped Thyroid Gland located in the front of the neck. Different factors impair the function of the thyroid gland that results in underactive thyroid or insufficient production of the hormone to meet the daily body requirements. [1, 2]

Remember that a low thyroid hormone level or hypothyroidism negatively affects lung function, metabolism, neurological function, body mass index, heart rate, and gastrointestinal health. It is estimated that about 4.6 percent of the US population, or approximately 10 million Americans have hypothyroidism.


The hypothyroidism symptoms vary among individuals. However, it involves the following signs and symptoms. [1, 2, 3]


Hypothyroidism can occur in any individual, but certain risk factors increase the chances of its development. These risk factors include:

Also, the presence of certain medical conditions increases the risk of hypothyroidism. These conditions include pernicious anemia, Sjogren's syndrome, lupus, diabetes, Turner syndrome, and rheumatoid arthritis. [1, 2, 3]


Different factors significantly impact the function of the thyroid gland and lead to the development of hypothyroidism. [1, 2, 3] These include:

Hashimoto's Thyroiditis is the most common cause of hypothyroidism. It is an autoimmune disease where the body's immune system attacks the thyroid gland. That results in the development of thyroid inflammation and leads to an impaired thyroid hormone level. Hashimoto's disease is the most common thyroid disorder in America, affecting around 14 million people. It is seven times more prevalent in women than men. Individuals with Hashimoto's disease are also at high risk of other autoimmune diseases. [7]


Hypothyroidism is divided into three main types based on the etiology of low thyroid hormone in the body. These include:

Moreover, a rare type of hypothyroidism caused by an abnormal expression of the deiodinase three enzyme in tumor tissues is termed Peripheral or Consumptive hypothyroidism. The elevated concentration of the deiodinase three enzyme inactivates thyroid hormone. 


Subclinical hypothyroidism is an early hypothyroidism form characterized by an abnormal thyroid-stimulating hormone and a normal thyroxine level with minimal or no symptoms. It occurs in about 15% and 8% of women and men respectively over the age of 60 years. Remember that subclinical hypothyroidism shares the same causes, similar symptoms, and treatment options to other hypothyroidism types. [6]

It is important to mention that levothyroxine is indicated during pregnancy or in women who want to conceive. It helps prevention of harmful effects of hypothyroidism both on pregnant women and fetal development.


Untreated hypothyroidism increases the risk of following medical conditions or aggravates their symptoms. [3]


Sometimes the diagnosis of hypothyroidism is difficult due to the number of symptoms confused with other medical conditions. Medical history, family history, physical examination (enlarged thyroid, dry skin, puffy eyes, etc.), medical symptoms, and different blood tests are performed to diagnose hypothyroidism. The blood tests such as thyroid-stimulating hormone tests and evaluating the level of thyroxin level are highly recommended for hypothyroidism diagnosis. Plus, the physician may order a blood test for Hashimoto's disease to confirm the presence of hypothyroidism. Note that high thyroid-stimulating hormone levels and low levels of thyroxine indicate an underactive thyroid or hypothyroidism. [2, 3]


Hypothyroidism treatment involves the restoration of normal thyroid hormone levels in the body. Moreover, the treatment aims must include complete control over the hypothyroid symptoms, normalization of thyroid-stimulating and thyroxine hormone level, avoidance of overtreatment, and prevention of medical complications associated with hypothyroidism. It is important to know that hormone replacement such as armour thyroid or levothyroxine, and cytomel are the primary prescriptions used for hypothyroidism management. [4, 8]


In MD hormone replacement therapy, synthetic thyroid hormone levothyroxine is prescribed to restore normal thyroid hormone levels in the body. The administration of levothyroxine (T4) maintains an optimal level of thyroxine and thyroid-stimulating hormones that prevent or manage hypothyroidism symptoms. Moreover, it regulates the high cholesterol level, metabolic dysfunctions and also helps the management of weight gain. Primarily, hormone replacement therapy is indicated for a lifetime, but the dose may vary with the patient's condition. Sometimes, Liothyronine (T3) combined with Levothyroxine (T4) is given to the patients when they do not feel better with single hormone therapy. At the beginning of therapy, a levothyroxine dose of 50-75 µg/day is indicated to treat mild to moderate hypothyroidism. However, the initial dose of levothyroxine depends on the patient's weight, age, pregnancy status in women, lean body mass, hypothyroidism type, TSH level, and other medical comorbidities. [4, 8]  

Note that all hypothyroid patients respond well to hormone replacement therapy. However, in severe myxedema (life-threatening hypothyroidism), the treatment approaches involve the parenteral administration of levothyroxine (T4), antibiotics, steroids, and optimal oxygen supply. [4, 8]

It is important to know that always consult and take great care about the dosage of thyroid hormone, as a low dose can't benefit the hypothyroidism symptoms. In comparison, the high doses will result in the development of hyperthyroidism. Thus, it is advised to regularly check the thyroid-stimulating hormone and levothyroxine level for the first 6-8 weeks during hormone replacement therapy; after getting stable, check the levels at an interval of 6 months or can be extended up to 12 months. [4, 8]

The clinical benefits of hormone replacement therapy appear within 3-5 days, but the complete restoration takes 4-6 weeks. Moreover, the normal TSH reference level regulation may take several months due to the modulation of the hypothalamic-pituitary axis. Plus, it is recommended not to switches between different brands or generic formulations of levothyroxine to avoid dose fluctuation. [4, 8]

Different thyroids hormone formulations are available in the market for the management of hypothyroidism. The most popular formulation include Armour Thyroid, Nature Thyroid Tablet, NP Thyroid, Synthroid, and Cytomel. These medications are natural thyroids hormone formulation obtained from animal thyroid glands (usually a pig's) intended for hypothyroidism treatment. Side effects involve temporary hair loss due to the drug-body adjustment. Note that regularly confirm the normal thyroid level to avoid the hyperthyroidism symptoms. [4, 8]

The American thyroid association recommended the evaluation of certain situations or conditions that may alter the thyroxine level. Such as examine the patients for gastrointestinal disorders who need a higher dose of levothyroxine. Plus, always talk with a qualified physician about the initiation or discontinuation of other hormone replacement therapies such as androgen and estrogen hormone during TSH level assessment or levothyroxine therapy. Moreover, other medications such as tyrosine kinase inhibitors, phenobarbital, sertraline, phenytoin, carbamazepine, and rifampin may also alter the Thyroxine level. Also, the concomitant use of proton pump inhibitors, sucralfate, and supplements such as calcium, magnesium, etc., interfere with the levothyroxine absorption. Furthermore, consume the levothyroxine before 35-45 min before breakfast or at least 3 hours post-meal at bedtime for optimal absorption.   

Remember that if the hypothyroidism symptoms do not ease with hormone replacement therapy, one must consider and check for other medical causes instead of increasing the levothyroxine dosage. [4, 8]


Hypothyroidism is rarely treated with surgical procedures. Surgery has opted in case of large goiters that negatively impact the function of trachea-esophageal tracts. [4, 8]

Treatment Concerns:

Medical studies reported that thyroid replacement therapy exacerbates the co-existing adrenal insufficiency condition. So, remember that treat or evaluate the adrenal insufficiently condition before initiation of thyroid replacement treatment. Moreover, it is important to know that adrenal insufficiency can also occur with subclinical hypothyroidism. Plus, always treat or confirm the adrenal insufficiency during severe hypothyroidism (such as during myxedema coma) for rational treatment options. Furthermore, in heart conditions such as coronary artery disease, ischemic heart disease, etc., medical studies suggested that always start with the lower dose of hormones.

Then gradually increase the dosage over time for adjustment with heart conditions. At normal doses, levothyroxine does not cause any severe side effects. But overconsumption of overdosage of thyroid hormone increases the risk of poor muscle coordination, fatigue, insomnia, anxiety, excitability, tremors, feeling hotter than normal, osteoporosis, breathing difficulty, muscle weakness, atrial fibrillation, arrhythmias, heart palpitation, and increased appetite. [4, 5]

Natural remedies for hypothyroidism

Different natural interventions are also used to help the hypothyroidism symptoms. These include diet changes and administration of Supplements. Studies reported that selenium levels decrease during Hashimoto's disease and impair thyroxine levels. Selenium Supplementation helps regulate normal T4 levels and improve hypothyroidism symptoms. Moreover, a sugar-free diet also helps prevent aggravation of hypothyroidism symptoms. Studies showed that sugar consumption increases the risk of inflammation that impairs the conversion of T4 to T3 and thus may aggravate or favor the progression of hypothyroidism.

Further, the supplementation of Vitamin B12 improves certain hypothyroidism symptoms, including tiredness and healthy metabolism. Also, the consumption of probiotics restores healthy gut microbiota and improves gastrointestinal symptoms associated with hypothyroidism. Additionally, the supplementation of Zinc, Iron, Iodine, Vit D3 and Tyrosine combined with Iodine help regulate both the stimulating tissue hormone and thyroxine levels. [9] 

Dr. Nicole Sundene, NMD

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert  in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!


  1. Chaker, L., Bianco, A. C., Jonklaas, J., & Peeters, R. P. (2017). Hypothyroidism. Lancet (London, England), 390(10101), 1550–1562.
  2. Chiovato, L., Magri, F., & Carlé, A. (2019). Hypothyroidism in Context: Where We've Been and Where We're Going. Advances in therapy, 36(Suppl 2), 47–58.
  3. Patil N, Rehman A, Jialal I. Hypothyroidism. [Updated 2021 Jan 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from:
  4. Jonklaas, J., Bianco, A. C., Bauer, A. J., Burman, K. D., Cappola, A. R., Celi, F. S., Cooper, D. S., Kim, B. W., Peeters, R. P., Rosenthal, M. S., Sawka, A. M., & American Thyroid Association Task Force on Thyroid Hormone Replacement (2014). Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid : official journal of the American Thyroid Association, 24(12), 1670–1751.
  5. Qari F. (2014). Hypothyroidism in clinical practice. Journal of family medicine and primary care, 3(2), 98–101.
  6. Gosi SKY, Garla VV. Subclinical Hypothyroidism. [Updated 2021 Jan 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from:
  7. Mincer DL, Jialal I. Hashimoto Thyroiditis. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from:
  8. McAninch, E. A., & Bianco, A. C. (2016). The History and Future of Treatment of Hypothyroidism. Annals of internal medicine, 164(1), 50–56.

Dr. Nicole Sundene, NMD

Female Hormone Specialist
"Why don't I lose weight since I turned forty? What is wrong with my hormones? I still have my period." Mindy, Scottsdale, AZ

Weight loss, especially for women, is a very complicated multifaceted hormonal and nutritional condition in my mind as a Naturopathic Hormone Doctor.  Women in their forties and fifties dealing with perimenopausal and menopausal weight gain definitely need a skilled Naturopathic Hormone Doctor.  

Battling weight gain, especially when you are doing everything right and the needle on the scale is not budging can be very stressful and stress ironically worsens weight gain. 

Sadly, many of my hormone imbalance patients are basically starving themselves on very few calories to maintain their weight because their metabolism simply does not work correctly. Especially when they have a thyroid condition or an autoimmune disease such as Rheumatoid Arthritis and Hashimoto's. We correct the metabolism, and they can eat food again in reasonable amounts. 

I am sure you would not be googling natural solutions to solve hormonal weight gain unless you were not getting lasting solutions to maintain your weight that actually worked as I describe in my story about “Why I Became a Naturopathic Doctor.” 

To quickly summarize the story, I was having depression, anxiety, acne, and stomach aches while gaining weight at 205 pounds on a hamster wheel chasing all my different annoying symptoms with prescription drugs and specialty visits. None of the prescription drugs helped me at all, and actually made me gain more weight, until I met a Naturopathic Doctor that fixed me. This is when the trajectory of my career permanently changed because I realized I did not want to go to school to be a pill pushing MD doctor, I wanted to go to school to provide natural lasting solutions that actually solved women's health challenges!

So, I do understand the frustration of not getting lasting solutions that work for weight loss and having to pay a high amount of money in doctor visits, labs, specialty visits, and prescription drugs. Some patients against my advice are maintaining their weight with expensive semaglutide shots (that I do not recommend.) Let's talk about instead what is healthy for your aging body when dealing with weight loss.

First, I would like to take a minute to explain how I help women actually lose weight for good in my Women’s Health and Hormone practice. What we want to do is achieve lasting solutions so that they do not have to rely on prescription drugs.

Here is what I want to do as your Naturopathic Hormone Doctor to fix your weight: 

#1 Why do you have weight gain in the first place? 

#2 What is the "Root Cause” of your weight gain? 

#3 Comprehensive Female Hormone Labs, Macronutrients, Cholesterol, Chem Panel, CBC, inflammatory markers, vitamins, minerals, macronutrients, etc

#4 Look at other health factors such as Diabetes, Insulin Resistance, Anemia, Hypothyroidism, Hashimotos, and other Hormone and Metabolic issues.

#5 Order Comprehensive Nutrition Testing to understand the right diet for your body specifically.  

#6 Implement my 4 week Vegan or 4 Week Meat- Naturopathic Meal Plans I recommend set at 1500 calories per day to create a gradual calorie deficit over a long period of time. While tedious, especially over 40, the studies show slow and steady weight loss is lasting permanent weight loss. As my patients learn new healthy recipes they enjoy eating, they naturally begin to feel better. Proper nutrition means less expensive supplements and medications!

#7 Make sure you are working out with a trainer that is helping you enforce my plan, and/or a counselor or therapist that is helping with any emotional issues making proper nutrition choices. Some of my patients need weekly appointments. Most need monthly at first.

#8 Continue to fine tune nutrition, and use herbal medicine, vitamins and supplements as well as natural hormones or “BHRT” and Armour Thyroid to help you feel your very best and most energetic.

Without understanding #1 and #2 on my list, I sadly have seen many of my hormonal weight loss patients fail over the years, so I write these blogs so my potential new patients understand if they will be a good fit for my women’s health practice or not. 

I want every single patient in my practice to be a success story. Please do treat yourself to a Naturopathic visit with me if you want want real answers, if you have an inquiring mind that wants to know, if you want the right nutrition for your body, want me to fix the underlying hormone imbalance that is most often causing your female hormonal weight gain then lets really do this! 

While I love helping women with weigh loss, and am a proud “Mother Hen” watching them transform, I also have been doing this job for over seventeen years as a Naturopathic Doctor, and twenty five years total in family medicine and have seen women fail to lose weight because these hormone challenged were never properly tested for and treated.

If the same hormone imbalance or nutritional challenges made every woman fat then we would all have the same pill for that, however I see a variety of different types of female hormone imbalance, thyroid, adrenal, insulin, and inflammatory aka autoimmune weight gain that are all completely different from each other, and required different approaches, different hormones, and different herbs and supplements. That is what is so uniquely amazing about women's health! Just like in my "Female Hormones and Anxiety" blog I talk about how we are somewhat like snowflakes with our mental health. While weight gain symptoms all look the same, the Root cause is not always the same!

So if my investigative Women’s Health Naturopathic Hormone process sounds like exactly what you need to feel like the absolute best version of yourself…. then please visit my SCHEDULE page and let’s get working on your weight loss program now!  

#1 question I am asked as a doctor is: "Why can't I lose weight?"

Weight loss programs that fail to address female hormones in women often fail women!

Oftentimes in Women's Health the "Root Cause" of weight gain is hormone imbalance. We need to first diagnose and treat the hormone imbalance as well as implement my basic Naturopathic hormone balancing weight loss program that is 100% free for women to start below.

One thing that always brings me joy as a Naturopathic Hormone Doctor is helping women identify the specific weaknesses in their hormones and metabolism so we can target the exact nutrition program, macros, and hormone balancing supplements to aid weight loss.

Getting to see women transform to their fittest most beautiful version of themselves is such an amazing reward for doing this job! I often receive new patient referrals from my weight loss success stories as their friends and family have always seen them challenged by being overweight and suddenly like magic change right before their eyes.

The truth though is that it is not magic... it is hormone balancing with a splash of hard work.

When we don't understand women's complex female hormones, thyroid, and adrenal profile, expecting weight loss to happen is somewhat like vacuuming in the dark. While vacuuming in the dark will be somewhat helpful, we are missing things, it is inefficient, time consuming, lacks results, and is frustrating. Vacuuming just like hormone balancing becomes a lot easier when we "flip the lights on" and know exactly the obstacles we are dealing with as well as the areas of greatest concern!

By running a full panel of Naturopathic Hormone Labs women can target their nutrition to their own metabolism and understand exactly what ratio of fats, protein, and carbs will works the best for their specific constitution.

This is when I see "the lights come on" for my hormone weight loss patients and everything becomes much easier and efficient. Hacking macros and hormones with labs makes everything so much easier and my women are no longer "bumbling around in the dark" lacking a clear direction of how to best target their efforts.

Bumbling around in the dark is oftentimes why women fail with their weight loss program because they are busy trying different fad diets, and not gathering the specific information that helps optimize their personal metabolic challenges.

Naturopathy can work very well for weight loss when we can take the time to analyze nutrition, metabolism, hormones, and vitamins that can impact weight.

Female hormones are complex and precisely why weight loss for women can be very tricky when complex hormone imbalance is present. To further confuse matters, women experience hormone imbalance and constantly fluctuating hormones every month with PMS. As well as in their forties and fifties with perimenopause and menopause. Therefore it is important we rule out hormonal causes of weight gain with women first and foremost as this is impacting women monthly, and also in midlife when perimenopausal weight gain begins around forty.

When women cannot lose weight with diet and exercise I recommend we conduct hormone and macronutrient testing to determine the correct macro profile of carbs, fats, protein, and fiber needed. Looking at a full set of female hormones, thyroid, and adrenal tests can diagnose the particular hormone imbalance or imbalances impeding the metabolism.

#2 Question I am asked as a Naturopathic Doctor: "Is my thyroid making me fat?"

As a thyroid specialist, I often see thyroid disease causing weight gain, and weight loss, but in women we MUST address all of the other hormones in the "hormone spider web" for a woman to feel properly balanced, healthy, and fit.

If we have a weakness in one part of the web it will impact the stability of the rest of the web.

The impact of estrogen deficiency that suddenly occurs in Menopause, can impact the rest of the hormone web and cause weakness in the thyroid, which is why it is imperative for women to have their thyroids checked when they are perimenopausal and menopausal in their forties and fifties. Some women will naturally start perimenopause earlier in their thirties.

The average age of menopause is 51, and perimenopause generally starts the ten years prior to menopause. Women that enter menopause at 45 will generally exhibit signs of hormone imbalance earlier, in their thirties. Premature Ovarian Failure occurs when women become menopausal sooner than age forty. POF is common in women with anorexia and low body fat as body fat levels directly increase estrogen levels whether too much body fat or not enough.

Menopause can also impact the adrenal glands in our spider web model. When the ovaries cease to produce estrogen, progesterone and testosterone, the adrenal glands become the sole source of hormone production. The hormones DHEA, and cortisol can begin to become deficient in menopause or sooner if there is "Chronic Stress."

Symptoms of adrenal fatigue can cause insomnia, joint pain, stiffness, moodiness, anxiety, depression, and a general blah unmotivated feeling where my patient has become flat and lost their zest for life.

The adrenals and the thyroid also interact with each other and when the adrenals become fatigued and cease to produce hormones that can impact the thyroid gland and tax it further. And vice versa. This is what is going on behind the scenes with many of my weight gain patient's labs.

It is not just always about the Thyroid! We must address our entire "Metabolic Web of Hormones" as I explain in my video about "Hormones and Metabolism" on my free class page.

Hypothyroidism, Hashimoto's, Insulin Resistance, and Adrenal Fatigue can also cause women to gain weight.

#3 Will testosterone help me lose weight?

Testosterone deficiency occurs for most women around the age of 35, this is why our metabolisms slow down when we lose our lean muscle mass with menopause. Each year our metabolism goes down further as we lose our female hormones. Transitioning through perimenopause and menopause also causes the body to become more inflamed and Insulin Resistant. Insulin is the "Weight Gain Hormone," that causes women to gain weight despite following the same diet and exercise regime in their 20's.

"I am doing everything the same, I am not cheating." I commonly hear women complain as they continue to gain weight and cannot figure out why. Most women that are over-weight have insulin resistance and need supplements to address and correct this blood sugar disorder that is common in women with PCOS.

Sluggish liver can also impact the metabolism, as can inflammation from Food Sensitivities and Food Allergies.

Chronic Fatigue and Chronic Pain can cause women to exercise less resulting in less calories burned on the same diet.

The good news is that by addressing female hormone imbalance, and implementing the following Naturopathic weight loss program I will review today, I do see many cases of stubborn hormonal weight gain finally release!

Usually I treat the hormone imbalance with herbs and supplements. Herbal medicine takes time to work, most women only can lose one pound per week and need to be patient. If you have fifty pounds to lose as a woman, that is a year of hard work you need to mentally commit to doing for long term success to keep the weight off.

With menopause, generally Bioidentical Hormones are needed to reduce the inflammation spike causing weight gain. Women under fifty generally do not need hormones and instead have weight gain issues from excessive amounts of hormones as I discuss more in my "Estrogen Dominance" blog. Much of what I do for women and weight loss does involve making dietary changes and taking supplements.

In order to lose weight, one must follow the basic laws of physiology that you must consume fewer calories than you burn each day. This is especially important to follow if you have a thyroid condition, insulin resistance, or estrogen dominance! Expecting your twenty year old metabolism to burn a ton of calories is not realistic without first fine tuning your hormones and then creating a calorie deficit every day.

You must burn more calories from exercise than you consume. If you are inactive and not exercising this is why it is impossible to lose weight especially when lack of exercise is compounded by hormone imbalance.

Addressing the underlying causes behind poor eating and lifestyle habits with regular weekly counseling is the ONLY way to ensure a healthy and long-term approach to weight loss. Food should be fuel and not a treat. The treat is feeling and looking good from perfect fueling!

I know this very well based on how I used to look and feel before I went to Naturopathic school and how I look and feel now. Many people say I look better today than I did in college! That is because I am on the right fuel for my metabolism and hormones!

Eating wrong and not properly fueling your body is the hard way after living both options!

The best approach to weight loss emphasizes lifestyle changes that incorporate whole foods and activity. Many simple sustainable Naturopathic changes in diet and activity can lead to maintainable, long-term weight loss success.

Physical activity guidelines are recommended to complement the nutrition counseling and make this process easier and more productive.

If you are struggling with Seasonal Depression, or post holiday exhaustion it is imperative you get outside for an hour to get 10,000 lux of natural light every day to ensure your energy, metabolism and mood are optimal for weight loss. Especially for women that crave carbs! Lack of light puts us in a fatigued dormant state that is not conducive to fat burning.

Many of my weight loss patients have underlying mental health issues such as depression, anxiety, and PTSD and are using food for comfort instead of fuel. This can create a vicious mental health loop when choices for emotional reasons are worsening physical health, appearance, and self confidence which then drives more unhealthy food choices as "rewards."

Patients constantly seek instant gratification for emotional reasons to treat their poor mood. These poor fuel choices then cause them to feel more fatigued, lethargic, hopeless and depressed.

Depression, sadness, hopelessness and anger trigger more unhealthy food reward behavior and the vicious cycle continues as a woman continues to gain more and more weight.

By using Naturopathy and hormone balancing we can also treat these underlying mental health issues naturally and work to use new rewards such as jewelry, makeup, concerts, events, and fun trips rather than cookies, cake, and candy.

The interesting thing about women's health is that each woman generally has different hormonal metabolic challenges to address. It is not a one sized fit all program, although I generally need my patients following the basics below.

Please do not sign up for hormone balancing work with me if you are not willing to make at least some baby step changes with your diet. Occasionally I get new patients that seem to think all their problems will be fixed with popping a hormone or applying a cream. This is not realistic and we are working to balance the hormones so your metabolism is running optimally and you are receiving benefits from your efforts with diet and exercise.

Hormone testing is important in women's health since many women with hormone imbalance are starving themselves to death to compensate for their sluggish metabolism. Sadly, I see this happening often, and is why I am writing this blog so women know there is a better way than living on 800 calories a day in starvation!

Once I diagnose the metabolic problem and fine tune their hormones they are then able to eat a normal amount of food each day without gaining weight.

While each woman's metabolism is unique like a snowflake and will require labs to develop a custom tailored dietary macro program, I would like to share the basics for hormone balancing that generally work for most women with hormone imbalance.

#4 What is the best diet to support imbalanced female hormones in weight loss?

The best diet for balanced hormones and weight loss is:

• HIGH in fiber-dense carbohydrates found in whole grains, beans, fresh fruits, and vegetables. Also, it is important to drink plenty of water= 60-80oz daily + 8 oz per "vice" of alcohol or caffeine and more water if you are exercising.

 MODERATE in fish and organic lean meats such as chicken and turkey.

 LOW in red meat, animal fats, hydrogenated oils, full-fat dairy products, pre-packaged, processed, and refined foods, sugar, alcohol, and caffeine.

General Tips
• Set a realistic weight loss goal, usually 1 to 2 pounds per week is recommended.
• Balance food intake with activity. The most successful weight loss programs combine increased activity with decreased caloric intake.

Tips to Increase the Amount of Physical Activity in a Day:
• Try some group activity classes at the local gym, fitness center, or swimming pool.
• Work out with family, friends, or neighbors. Motivation is increased with partners.
• Take a walk at lunchtime.
• Use a bike to run local errands and go for pleasure rides.
• Use the stairs instead of the elevator.
• Walk to the bus stop or work
• Park the car a few blocks away and walk.
• Dance to some favorite music at home or sign-up for a series of classes.

Tips to Reduce the Quantity of Food Eaten:
• Plan and prepare meals ahead of time.
• Identify foods that are often over consumed and set limits, or avoid.
• Identify and limit problem foods.
• Eat small, frequent meals and healthful snacks.
• Eat slowly and savor each mouthful. Allow 20-30 minutes for each meal, rest, set the fork down, and/or converse between bites. Chew the food well.
• Wait 10-15 minutes before taking a second helping.
• Serve food on a smaller plate.
• Drink two glasses of water or a cup of hot tea 30 minutes before meals to reduce appetite.
• Postpone a desired snack for at least 10 minutes. It may be helpful to take a walk, get some fresh air, drink a cup of water or tea, or take a short nap during this time.
• At restaurants eat half of the portion and take the rest home. Prepackage the food to go before starting the meal.
• Nurture with nonfood related activities, such as a hot bubble bath or a massage, developing a hobby, relaxing with a good book, or listening to some music.


Tips to Eliminate Eating Cues that Promote Overeating:
• Designate a specific place in the home to eat, preferably the kitchen or dining room. Eat snacks and meals only when sitting down at this place.
• Avoid watching TV, talking on the phone, reading, or driving while eating. This will help increase the awareness of fullness.
• Do the grocery shopping on a full stomach to decrease impulse buys.
• Create a schedule for eating. Plan meals and snacks at regular intervals, including the types of food to be eaten.
• Carry food to work or when going out, to eliminate long periods without eating.
• To prevent visual food distractions, keep all food stored in the kitchen cupboards or refrigerator, rather than out on the counter.
• Read or listen to motivational books, join a support group, or consider seeing a therapist to help with any emotional issues involving food, eating, and/or weight loss.

Diet, activity, and emotional work can provide feelings of health and wellness, which establish new patterns that support and nurture the body. Food should be eaten for fuel and not just for fun.

When we are on the best fuel we have the best energy and mental health.

Think well! Eat well! Be well! Let's get to work ladies!

If you need my help diagnosing and treating your personal hormone imbalance to determine your personalized weight loss plan, I would be happy to help!

Simply visit my SCHEDULE page to treat yourself to a Naturopathic hormone visit in my Scottsdale clinic or by telemedicine!

Dr. Nicole Sundene

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause,  Thyroid,  Hashimotos,  PMS, PerimenopauseAutoimmunePostpartumChronic Fatigue, DepressionAnxiety, Food Allergies,  DigestionDermatology, AcnePsoriasis Eczema, and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 23 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease. 

She has been an Herbalist for over 28 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan (not Medicaid) and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on InstagramTwitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!

By Dr. Nicole Sundene

Holistic Psychiatry & Hormone Specialist

While I am not a true MD Psychiatrist many of my patients refer to me as their "Natural Psychiatrist" because I am fulfilling the role of prescribing natural medicines, hormones, and nutrition as discussed below with my favorite anxiety herbs to treat my patient's mental health. However, I am not a true Psychiatrist, but simply practice "Holistic Psychiatry," which means together we will look at your anxiety not as a prescription, but as a process to first:

#1 Look for the Root Cause of the anxiety

#2 Test female hormones and balance hormones to optimize mental health

#4 Test nutrition aka vitamin and mineral deficiencies that may be contributing to lack of neurotransmitter production. Neurotransmitters such as serotonin and dopamine are needed to make us feel happy, and like everything is okay, and we can properly focus and get things done as procrastination caused anxiety which then makes anxiety worse.

#5 Work with you weeks in holistic counseling sessions or have you work with your counselor covered by your insurance plan to implement better coping skills and support the process of improving your nutrition, lifestyle, stress, exercise, and supplement routine.

So that is how I treat my Anxiety patients in my Holistic Psychiatry practice. Keep in mind if your mental health disorder is severe such as in bipolar, schizophrenia, or severe suicidal depression I will require you to have a board certified Psychiatrist MD working in conjunction with me, as well as a counselor.

Anxiety disorder in Women's Health is best managed by a Holistic Hormone Doctor that can work to evaluate the root cause of the anxiety. For women hormone imbalance such as PMS, PCOS, Perimenopause, Menopause, Adrenal Fatigue, Hypothyroidism, and Hashimoto's Thyroidtis are often the culprits behind what appears to be a generalized anxiety disorder. Especially when typical anti-depressants or anti-anxiety medications do not help.

While many of my patients are currently feeling anxious and can benefit from a natural anxiety treatment the real clue that the anxiety or depression is caused by hormone imbalance is when women experience fluctuating symptoms.

Anxiety that fluctuates monthly is absolutely hormonal. Women that suddenly develop anxiety later in life such as in their 40's or 50's that have never experienced anxiety before are most likely being triggered by peri-menopausal or menopausal hormone changes that can impact mood. Patients with a family history of thyroid disease that suddenly develop anxiety should also have their hormones checked by a female hormone expert.

While different herbs help patients with their anxiety the real issue with anxiety is that we work to discover the root cause. Some women are just more anxious than others but the real clue that there is an underlying hormone issue is when a woman that has never had anxiety before is suddenly feeling anxious, agitated, angry or impatient. Especially when nothing situational is actually going on to contribute to the anxiety.

As a Naturopathic Doctor I honestly don't really even care WHAT herb we use to treat your anxiety. That is pretty boring to me to just prescribe HERB X for SYMPTOM X. Dr. Google can do that for you....what my Detective brain always wants to know is what is the ROOT CAUSE? Until we understand the root cause the patient will just continue to perseverate with their symptoms and nothing will ever truly fix the problem or provide lasting results.

I have included a brief blurb so that you can get an idea of the herbs that I generally find safe for most women to try for their anxiety. Please always check with your Naturopathic Doctor before combining herbs with prescription drugs. Do not take sedative herbs during pregnancy or breastfeeding. More importantly treat yourself to a Naturopathic consultation to discover the root cause of your anxiety by popping over to my SCHEDULE page.

#1 Passionflower- The intricate purple flower pictured above was shown to be as effective as sedatives in the benzodiazepine (valium) family, the aerial parts of this herb are great for nervous tension and anxiety. In recent research, passion flower extract at 45 drops daily (tincture) was shown to be as effective as oxazepam (similar to valium). This nervine herb is also “antispasmodic” which makes it great for people with constant nervous twitching.

#2 Ashwaganda- This is probably one of my favorite herbs. Unlike most of the herbs on this list that are designed to be taken at night or at least late afternoon, both ashwaganda and schisandra (listed below) are terrific “adaptogenic” herbs that help us tolerate our stressful days that much better. You can make some tea, or grab some capsules of the organic root and take two capsules twice a day.

This herb is specifically intended for those that are exhausted and agitated or debilitated by stress. In ayurvedic medicine ashawganda is a renowned anti-aging and rejuvenating herb.


#3 Schisandra- Referred to as “Chinese Prozac” this herb is commonly unappreciated and underutilized in American herbal practice. Schisandra is a terrific day time adaptogen herb and should be taken as is recommended with Ashwaganda, two capsules with breakfast and lunch, or a cup of tea in the morning and afternoon. The berries can be made in to a nice aperitif for those with a low libido.

#4 California Poppy- The bright orange flowers of the California poppy, leaves and other aerial parts are sedative, anti-spasmodic, and mild pain relievers. This is also a gentle herb used for colic and agitation in children. Do not use this herb or any other sedative herbs in pregnancy.

#5 Hops- No I am not recommending that you drink more beer to calm down. However, the herb commonly used to make beer bitter also works as a sedative. It is extremely bitter though so is best given a small part in your herbal tea formula for insomnia or stress. Do not combine with prescription sleep aids due to an additive effect.

#6 Kava Kava- A well known Polynesian psychotropic sedative, this herb is sedative and “spasmolytic” and thus helpful for chronic pain conditions. Several conflicting studies debate the safety of using this herb with alcohol. Liver damage is thought to occur if used in large doses in conjunction with alcohol. This research however was used to scare many people away from using kava kava for whatever reason.

People need to simply remember that herbs are medicines and that an herb with actions similar to prescription sleep aids and analgesics will of course pack the same side effects. A strong herb demands respect. When used ceremoniously, or occasionally this herb does not run the risks it runs when it is heavily abused.


The best way to safely use kava kava is in an organic tea form. Look for a tea blend that includes kava, or make your own. This herb should not be used in large doses, and large doses should not be used over long term. Do not combine with alcohol, or use during pregnancy or nursing. Chronic abuse will result in a horrible scaly skin rash.

#7 Lavender- Try adding lavender to your favorite baked good recipe. Purple lavender flowers will offer a sophisticated herbal makeover to your favorite shortbread cookies, or white tea cakes.

Lavender is great in your herbal medicine blend, and can also be used to stuff pillows, or as an aromatherapy stress reliever throughout the day. Lavender should not be used in pregnancy due to it’s emmenagogue effect.

#8 Lemon Balm- Also known as “Melissa officinalis” this herbal sedative should not be used by those with hypothyroidism as it inhibits the thyroid and is used to treat hyperthyroidism, however for everyone else it is a common simple herb to grow in your garden and make in to your own calming sedative tincture each summer. Do not use this herb in pregnancy.


I grow lemon balm in my garden and harvest it, rinse it, let it dry and then pack it in a jar with enough room for it to swim around in some vodka. Shake the jar once a day for two weeks. The vodka will extract the constituents and after a few weeks you can strain out the plant part leftovers and put a half a teaspoon of this liquid “anxiety medicine” in a little bit of water when you need something to calm you down.

#9 St. John’s Wort- Although we think depression the second we hear about St. J’s Wort, we also need to address that depression and anxiety tend to walk hand in hand and this herb is not just an anti-depressant it is a mild sedative as well. St. John’s Wort has also been shown to have a lower risk of side effects than conventional anti-depressants and is worth trying for those that don’t quite have severe enough depression to mandate the use of a prescription pharmaceutical, but instead need something to take the edge off and boost the mood a bit.

If you are suffering from anxiety that has a form of depression associated with it, then this would be a great herb to consider in your herbal sedative blend pending that you are not on any anti-depressants or anti-psychotic medications. The condition “serotonin syndrome” may occur from combing this herb with those classes of medications or other herbs and supplements that boost neurotransmitter levels.


This herb should not be used by those on oral contraceptives, or any medications as it increases the cytochrome p450 enzyme system which results in a more rapid detoxification of drugs from the system. The drugs or birth control pills are then rendered useless. Standard dose of St. John’s Wort for those not on any other medications, is 300 mg three times daily of the 0.3% standardized extract.

#10 Red Clover- Not traditionally recognized as a sedative, but as a mineral source and blood thinner, this “cooling” herb calms the system and has a special affinity to the lungs, throat, and salivary glands.

This is a terrific balancing herb to include in your herbal sedative blend as the dried flower blossoms make for a beautiful addition to a glass teapot. Do not use in pregnancy, or if on blood thinning medications.

#11 Catnip- Not just for cats. Catnip is actually a gentle nervine herb for humans. No it won’t make you roll around on the carpet or chase after things (at least not to my current knowledge) but it is still a great mild sedative.

This herb should absolutely NOT be used during pregnancy, as most herbs should never be used during pregnancy without checking with your naturopathic midwife, however it can safely be used in children by making a very weak tea. Be sure to only give your children organic herbs and check with their pediatrician or naturopath prior to use.


#12 Valerian- Definitely one of the more potent herbal sedatives, valerian is also a great pain killer for those with chronic pain. Some people prefer not to use this herb because it can cause quite the herbal hangover the next morning and most complain that it makes them feel really groggy, or desire to sleep through the day.

Look for a tea formula that includes a bit of valerian to avoid the hangover, and if you have severe anxiety, chronic pain, or insomnia talk to your naturopathic doctor about using this at a more therapeutic dose. Always use organic root.

#13 Motherwort- The perfect herb for fried and frazzled mothers; it strengthens a weak heart and is great for nervous palpitations. Motherwort is best taken over a prolonged period of time, and because it is a uterine stimulant, it should not be used in pregnancy.

#14 Skullcap- A bitter, cooling sedative herb that is best used for nervous fear, restless sleep, and is also thought to lower blood pressure. This herb is great for people with the inability to pay attention—huh what was that? And has been used effectively to calm down children with ADHD. Some kids concentrate better when they are sped up, and some do better when they are calmed down.


#15 Chamomile- One of the most common kitchen herbs, chamomile is a great mild sedative and digestive bitter.

Be careful in using chamomile tea if you experience ragweed allergies, formally known as the “asteracea family” and previously recognized as “composite family.” If you have a history of seasonal allergies you should exercise caution.

If not, make your tea up strong, use a heaping tablespoon and not a teaspoon per 8 oz cup of water, and allow to steep 15 minutes covered. If you don’t cover your chamomile tea you will lose the calming essential oils to evaporation. Only elitist herbalists know to do that. Welcome to the club!


Traditional Herbal Sedative Use: Establishing a nighttime or daytime tea ritual is a great way to reduce stress, avoid binge eating, and help those that fight insomnia get to sleep at a decent hour.

Directions: For most of these herbs simply make a tea with about 1 tsp (milder herbs use a tablespoon) to 8 oz cup of boiling water. Allow to steep covered 15 minutes. Or if you aren’t a tea drinker just look for a pre-made organic herbal formula to take in tincture or capsule form, and follow the manufacturer’s recommendations.

Please check with your Naturopathic Doctor before combining any herbal medicines with prescription medications or making any changes to your health care routine or simply treat yourself to a Naturopathic consultation with me by popping over to my SCHEDULE page. I am able to help patients that are not in Arizona via Telemedicine with their anxiety, we can conduct hormone testing and implement naturopathic medicine by phone consult.

Dr. Nicole Sundene

Female Hormone Expert

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert  in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for MenopauseThyroid, Hashimotos, PMS, PerimenopauseAutoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on InstagramTwitter and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!

Dr. Nicole Sundene, NMD

Female Hormone Specialist

"Are you a Natural Psychiatrist? How does my monthly cycle effect my mood? " ~Morgan Scottsdale, AZ

Psychiatry is one of my favorite topics in Women's Health, however I am not a psychiatrist. Many of my patients refer to me as their "Natural Psychiatrist" though because I am working with them as a team with their counselor on managing their hormones, supplements, vitamins, and herbs related to their mental health. So they don't exactly want to be on psychiatric meds or need them, but they need something to improve their mood more than just counseling weekly with their therapist (highly reccomended!)

My mental health patients are generally women that prefer to take natural medicines, and are not in such a severe state that they require psychiatric care. Although I do have many women in my practice that work with me, a psychiatrist, and a counselor due to debilitating mental health challenges.

Many women with hormone imbalance end up sad, angry, depressed, anxious, and/or blah feeling.

Hormones should never be ignored in women with mental health challenges such as anxiety, depression, ADHD, rage, and PTSD.

With Holistic Psychiatry, we are treating your mood disorder such as anxiety, depression, bipolar, rage, ADHD, addictions, PTSD, OCD, and even schizophrenia with natural medicines. We also are more importantly following a detective process that utilizes metrics such as hormone testing, and nutritional testing, to determine if there is a vitamin or mineral deficiency or a hormone imbalance. An easy indicator a woman’s moodiness is caused by hormone imbalance, is seeing fluctuations in the mood during the monthly cycle. You can test this yourself at no charge by downloading a free “Period Tracker App” and rating your mood every day for an entire cycle. 

If the mood is not good the 7 days prior to your period or the first few days of your period then we can work together to change that with Naturopathic Medicine! Also if your mood has suddenly shifted in your thirties, forties or fifties then I can bet your hormones have shifted as well.

Fear not, there IS HOPE! Let me walk you through my process of helping women with their hormones, nutrition, and mental health. First, lets go over what happens in a women's monthly cycle and then in her forties and fifties.

When women are generally happy in the first half of their cycle days 1-14, with day 1 being the first day you start bleeding, and then struggle with anger, agitations, depression, anxiety, hopelessness, rage, crying, and sadness during the PMS window or days 21-28 then you need hormone testing as there is likely a hormone imbalance going on that can be addressed with Naturopathic Medicine. 

Also if you have never experienced anxiety or depression until after having a baby or with your forties or fifties and your mood suddenly shifts, this is a sign you are experiencing hormone imbalance. Common hormone imbalances in the following conditions can be improved for mental health patients with natural hormones or herbs such as Postpartum Depression, Hypothyroidism, Perimenopause, Menopause, or even Hashimotos impacting your mood. 

The #1 Sign that something physical is causing the mental health disorder is when nothing stressful or sad is actually going on yet the patient feels anxious or depressed. When women tell me “My life is great, I love my husband, my kids are great, I love my job...I just don’t know why I feel like this…” This is when I think there is a mental health mystery for me to solve!

As a Naturopathic Doctor and Female Hormone Specialist, I love helping patients with depression and anxiety. Especially since I have battled my own depression and anxiety for over 30 years, and it started in my teen years indicating a strong hormonal link. I was never depressed as a child. I had a very happy childhood and wonderful parents. But suddenly, in my teens my attitude rapidly changed, I was angry at my Mom all the time. I was grouchy, depressed, sad, cried a lot, and constantly had anxiety about everything. 

I had social anxiety and a lot of perfectionism OCD like anxiety about my school work. I was an overachiever that would cry over an A- or a “Chinese F’ as they call it. My older sister got all C's and none of this pressure was pushed upon my by my parents to obsess about my grades. I had enrolled myself into all honor's classes and put this all upon myself.

First, my parents sent me to counseling to no avail, then I tried a lot of different antidepressant medications, I was even sent to a psychiatrist to try to medicate my mood. Many of the antidepressants they gave me just made my mood worse and caused me to gain weight or have an upset stomach, which made my mood even worse because now I was overweight and my stomach hurt!


Hormone testing is the most important thing we do for women with PMS like hormone imbalance. I like to conduct “Biphasic Labs'' which means we test your hormones while you are happy and feeling good during the first half of your cycle, and then, we test them in the PMS window days 21-25 when you are feeling at your worst, so we can capture the hormone imbalance. As I describe in my PMS blog, Jenny's husband called me panicking and wondering if the mental health issue with her stuck on the floor crying was her hormones. He said, "If this could be a hormone problem, sign her up now!"  

So I took her on as a Women's Health emergency, and then emailed him a lab slip while saying, “Take her in NOW to get her hormones drawn.'' Of course, it was the last thing Jenny felt like doing while suffering from a migraine, depression, and anxiety but as a Female Hormone Specialist, I know how important it is to get the PMS labs drawn when the patients are at their worst for me to solve the hormone puzzle. The best thing about getting your labs checked when you are at your best mood is, we can set those aside in the event you need bioidentical hormones someday with menopause, and then I know exactly what numbers I need to have you at, to make you feel your "personal awesome!" For more information about hormone imbalance and the blood hormone testing I conduct via women’s insurance please visit my HORMONE THERAPY page. 

The state of Arizona does not allow Naturopathic Doctors to order labs for Medicaid patients. But most decent insurance plans including Medicare, allow me to check your hormones per your insurance plan reimbursement. So long as you are at the correct lab which is either Labcorp or Sonora Quest. Be sure to call your insurance and find out which lab is contracted with your insurance, otherwise, the testing can be quite expensive! If you do not have insurance I have cash lab options, and the first panel should be around -$500 depending on what is going on, so please do not sign up to work with me if you cannot afford cash labs, or have Medicaid insurance. My ability to help you will be left with just guessing as what happens in prescription psychiatry, and that is my personal pet peeve, and not how I work, I like to rely on metrics and numbers to ensure each woman is in an optimal range for their hormones and vitamins. Any doctor can randomly slap you on different anti-depressants and anti-anxiety drugs and study if you are made better or worse by them. That is not what I do, nor in my alignment with my philosophy on what women with mental health disorders truly need to understand, heal, and restore their mental wellness.

Once I have perfected physical health a lot of mental health and insomnia issues naturally subside.

Vitamin and Mineral Testing for Mental Health

Testing nutritional metrics is extremely important as many vitamins and minerals are the very cofactors, and coenzymes that form the neurotransmitters such as serotonin, dopamine, norepinephrine, and epinephrine that impact our mood. Most of this can easily be done via blood testing through your insurance, although I will say Medicare is the worst at reimbursing for vitamin testing. Basically, the government does not care what your vitamin levels are and they may or may not pay for this part of the testing if you have medicare. If you have a secondary insurance it may be picked up by that, but you still will get the “contracted price” which is generally $20-$50 per vitamin we test, so they usually cover the hormones and then send the patient a bill for the vitamins. Just because I think it is necessary does not always mean the government is going to agree with me. The good news with mental health testing is you are making a one time investment in understanding what your personal weak spots are and once we know what those are the follow up lab testing is never as expensive, as the first panel when I am on a Detective Mission to figure out the ROOT CAUSE of your mental health issue. 

Neurotransmitter Testing for Mental Health

Is neurotransmitter testing really necessary for mental health patients? 

Yes and No. 

This is why it is the 3rd step, I list in my simple 3 step process of addressing the physical causes that impact the mental health of patients with anxiety, depression, and mental health disorders. Because, oftentimes we can determine the cause of the mood disturbance via hormone testing and vitamin and mineral testing. This is the final step I resort to when the above testing is not helpful in revealing any physical causes of depression. 

For a small handful of my patients, I will admit that neurotransmitter testing has been a futile waste of their time and money. But for the majority of my patients that do not improve from balancing hormones and nutrition, the neurotransmitter and adrenal testing can unearth some very important neurotransmitter deficiencies or excesses that we can balance with “Amino Acid Therapy.” By using amino acids targeted to boost specific neurotransmitters that are low we can improve mood via a different pathway that an antidepressant works. 

For instance, low dopamine can be related to depression, low motivation, memory issues, ADHD, addiction,  impulse control disorders, dementia and even schizophrenia. Physical symptoms of low dopamine include Pain muscle cramps and stiffness, tremors, trouble swallowing, back pain, balance problems, and constipation, 

Symptoms of low serotonin include depression, crying, insomnia, carbohydrate cravings, weight gain, nausea, poor self-esteem, anxiety, and poor memory.  When serotonin is low then an anti-depressant is often useless for the patient because the way the antidepressant works is to recycle serotonin so if there are “no pop cans in the recycling program” then there is nothing to recycle. The patient gets no benefit from the antidepressant and gets side effects like dry mouth, sweating, weight gain, poor libido, erectile dysfunction or stomach ache. Neurotransmitter testing is also great for patients that have no triggers for their anxiety or depression yet feel flat, blah, anxious, or stressed and don’t know why. If it isn’t a hormone imbalance like what we often find via insurance-paid labs then we need to look at a neurotransmitter profile. This can be done via simple saliva and urine testing.  

So that is the simple 3 step system I used in my Mental Health Detective process to understand any physical causes that may be contributing to your depression, anxiety, and mental health disorders. 


  1. My favorite and always successful patients are the ones that show up with a pen and paper handy to take notes and want to be a student and learn everything they can about their mental health and how to improve it in every possible way- Mind-Body-Spirit.
  2. Women that enjoy making herbal teas, taking capsules and vitamins, and prefer to support their body in this manner, I specialize in food as medicine. You are my perfect mental health patient!
  3. Women that want to make the diet changes to what I think their brain/body needs.
  4. Women that have a care team that will ensure they are following their plan if they are slipping. 
  5. Women that are also working in conjunction with a counselor or therapist on their issues will always have awesome results! I highly recommend counseling at all times!
  6. Women with inquiring minds that also "Need to Know" what is causing their symptoms. I like patients that are just as involved in helping me solve the riddle as I am.

If you think we would be a good fit working together, pop on over to my SCHEDULE page and book your new patient visit so we can get started helping you feel better immediately. You do not have to live in depression as I did for many years, you do not have to live with anxiety and panic attacks in terror like I did for many years, I am happy to help you with your anxiety or depression. The #1 most important mental health disorder I have learned hormone balancing helps is PTSD, so please share this information with your loved ones struggling with their mental health.

Let's go through this detective process together so we can determine what your individual weak spots are when it comes to your personal mental health so we can strengthen your mood from the inside out! 

Dr. Nicole Sundene, NMD

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert  in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for MenopauseThyroidHashimotosPMS, PerimenopauseAutoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on InstagramTwitter, and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!

By Dr. Nicole Sundene

Scottsdale Naturopathic Doctor

Menopause is a common often frustrating Women's Health condition caused by a woman's permanent cessation of her menstrual period for more than 12 consecutive months. The sudden drop in estrogen, progesterone and testosterone levels from menopause result in hot flashes, night sweats, irritability, insomnia, weight gain, stomach aches, joint pain, hip pain, vaginal dryness, painful intercourse, bladder infections, anxiety, depression, anger, agitation and sadness.

While progesterone and testosterone begin to decline for women around age 35 as seen in Perimenopause, Menopause is primarily associated with the deficiency of the hormone estrogen. Menopause typically occurs between 40 and 50 years of age, with the average age of menopause being 52 years old. As women's estrogen levels drop they notice changes in their body temperature, hair, skin integrity, vision, vaginal dryness, sleep and concentration.

In the United States, studies reported that women at the age of 51 often experience menopause. Further, every year 1.3 million women report menopausal symptoms in the United States. Women with menopause have lost the ability to become pregnant naturally. Early menopause, also known as "Premature Ovarian Failure" occurs when women are in their early 40's or 10 years or more prior to the average age of menopause.

Medical studies report that hormonal disturbances are common in later stages of life. Depletion of estrogen level leads to the high concentration of follicle-stimulating hormone and luteinizing hormone in the body that significantly disrupt the hypothalamic-pituitary-ovarian axis. As a result, endometrial development failures disrupt the regular menstrual cycles and finally develop various menopausal symptoms. Moreover, different surgical procedures such as hysterectomy with bilateral oophorectomy may also cause surgical menopause. Other health conditions such as cancer, cancer treatments such as chemotherapy can cause early menopause and affect a woman's hormone and thyroid. Endometriosis medications such as antiestrogen medication can also lead to the development of premature menopause. [1, 2]

It is important for women not to confuse Perimenopause, Menopause, and Postmenopause. With so many different labels how can the patient even know which one applies to them? Knowing the correct diagnosis when working with your hormone doctor is important as different treatments, herbs and hormones are appropriate for these 3 different stages of a woman's normal life span. Perimenopause generally occurs 10 years prior to menopause or ages 41-51 if we were to predict based upon the average age of menopause and is characterized by irregular periods with heavier or lighter menstrual flow before menopause. Menopause is the complete absence of menstruation and often the most difficult time for women to get adjusted to as their body and brain adjust to their new low hormone levels. This is when women commonly need the most hormonal support as even tapering a patient slowly off BHRT is often more gentle than just the sudden cessation of estrogen. Some of my female patients need bioidentical hormones around menopause for a few years and then discontinue them when no longer needed and some patients will prefer to be on hormones at all times. Once a woman has gone through menopause she then becomes labeled with "Postmenopause."

Signs and Symptoms of Menopause

Menopausal symptoms are divided into the following three main categories. [1, 3]

Vasomotor Symptoms: Studies reported that 75% of menopausal women experience vasomotor symptoms. The vasomotor symptoms include: 

Hot flashes are the prominent symptoms of menopause experienced by almost 85% of menopausal women. A menopausal hot flash episode often remains for at least three to four minutes. Moreover, different factors such as alcohol, emotional stress, and diet may aggravate hot flashes. Studies reported that the average age of menopausal hot flashes is around 5.2 years. 

Note that the intensity and severity of migraine changes over time. Studies also reported that the migraine without aura commonly occurs during menopause. Remember that although migraine with aura is less common in menopausal women and is highly associated with the risk of stroke. [3, 4]

Urogenital Symptoms

Urogenital symptoms occur in approximately 60% of menopausal women. These symptoms include:

Vaginal dryness, pruritus, lichen sclerosis and dyspareunia (painful intercourse) results from vaginal atrophy. In contrast, urethral atrophy leads to urgency, frequent urination, dysuria, and stress incontinence. Women have more bladder infections, more kidney infections, more yeast and vaginal infections with menopause as the vaginal flora is impacted by pH changes and lack of hydration from diminished goblet cells producing mucous that can protect bacteria from adhering to the tissues.  [3]

Psychological Symptoms

Around 45% of menopausal women report psychological symptoms. These symptoms include:

Studies also recommend checking and evaluating weight, blood pressure and overall health at a check up when women become menopausal or begin to notice changes. The Latin rood word for Uterus comes from "Hysteria" and that is how we ended up with the word hysterectomy. Most likely because a doctor made the observation that women go hysterical with menopause. As much as I hate this judgement label, I would agree it is true for some of my patients and have sadly seen many women struggle with menopause and their mood. My great grandmother was "accidentally given a hysterectomy after the birth of her last child" and she suddenly went in to severe depression and hot flashes. Back in 1911 the only cure her doctor was aware of for menopause was to "Drink beer." The church lady was told to illegally brew beer during Prohibition so she had medicine for her menopausal symptoms. She had to shutter her house once a month to make the beer she needed for her hot flashes. Thankfully we have much better treatments for menopause thanks to bioidentical hormones, nutrition and Naturopathy! I do not want any of my patients to feel like they have to break the law to treat their menopause. Brewing beer for menopausal symptoms illegally seems barbaric. I did learn in Naturopathic school at Bastyr University that Hops are a natural phytoestrogen that help with menopausal symptoms. Fortunately we have tinctures and capsules so women do not need to rely on drinking beer!

The key indicator that a woman's depression or anxiety is related to menopause or perimenopause is a sudden onset of anxiety or depression later in life when no previous mental health disorder occurred. Most women with anxiety will have a lifetime pattern that they describe to me as always feeling anxious since childhood, teens or 20's but when women that are 40-50 experience a sudden adverse shift in their mental health we should be extremely concerned about their hormone balance whether we are treating the menopause with hormones or herbs it is vital for it to be addressed and properly diagnosed or women can often feel they are going crazy, "I feel like I am suddenly going crazy!" has been a comment I have heard time and time again as a menopause doctor. I then ask whether they have experienced any mental health disorder previously in their life and when they tell me no, I counsel them that it is their hormones impacting their mental health and they are not crazy.

Nearly every single work day I get a new female patient that is depressed or anxious struggling with their mood and frustrated that they are not getting any results from their anti-depressants or anxiety medications. When we get their hormones properly fine tuned it can help stabilize the patient and oftentimes I have seen patients be able to discontinue the antidepressants whether I taper them off myself, their psychiatrist tapers them off or they just suddenly stop taking it because they tell me they no longer need it. Obviously I do not recommend women suddenly stop their antidepressants but instead gradually taper them down once their treatment is working effectively and they no longer need the anti-depressant or valium, Ritalin, Vyvance, etc. Hormones can impact mood, memory and concentration. It is possible for women to be taken off these common medications once their concentration, peace and sense of joy is restored by addressing the imbalanced endocrine system with Functional Medicine, Bioidentical Hormones and Naturopathy.

Did you know I once had a patient sent to me by a Psychiatrist that was on 5 mental health drugs? She is no longer taking any of those medications thanks to her decision to get her hormones checked and treated. Once we had all her levels adjusted properly she completely returned to normal. All of her symptoms started at 35 and she had never had anxiety or depression before until her hormones began to suddenly shift. The psychiatrist was of course shocked to see how much better she was with the hormones as we worked together to taper her down from everything. It was a very powerful mental health lesson for both of us.

While many Naturopathic Doctors are intimidated by complex patients, my background in prescription family medicine makes me a bit more fearless...especially since I know my treatments are generally harmless compared to the side effects of antidepressants, anti-psychotics and the addiction potential for patients at risk of becoming hooked on benzodiazepines like valium and xanax when really their hormones are just off and not compatible with feeling happy.

Perimenopause which begins as early as 30 for some women that will enter menopause early can be extremely hard on a woman's mental health as they battle estrogen dominance and progesterone deficiency or "Permanent PMS" as I like to call it as my mental health patient nods and says "That is exactly what is wrong with me. It does feel like permanent PMS because I am gaining weight, I am super bloated, I feel agitated, and I am constantly fighting with my husband and crying over nothing!"

Many marriages can be pushed to the brink of marriage counseling when women are struggling with their hormones. In order for men to have more empathy and understanding I would love to perform an experiment where I give someone's husband 6 x 1mg estradiol tablets with no progesterone to oppose it and see how bitchy and evil the husband becomes. So far I have not been able to find any men to participate in my "PMS Experiment" and I won't be holding my breath waiting for someone's husband to volunteer, although I would like to make a a video of a man crying and raging on imbalanced hormones. So that we can have more understanding and support with PMS and PMDD. I believe many marriages could be saved, families could stay together and not be broken with better understanding and more support for women. Many women bring their husbands in to the appointment so they can learn how to keep a period tracker app, know what window in the month is best to be kind, silent, keep things simple, or even better maybe just leave us alone and go on a fishing trip and return when it is all over.

In conclusion, its a massive hormone red flag when women suddenly develop anxiety or depression later in life yet also cite no current stressors such as work stress, death, loss, finance, parenting or relational stress yet cannot figure out why they continue to remain unhappy, moody, agitated, on edge and constantly anxious or stressed. We all know when we are going through a tough time that we can expect not to feel fabulous. But if there is no actual trigger for a woman's mental health condition then I need to put on my Detective cap and look for possible hormone, vitamin and nutritional imbalances that can be the actual underlying cause of the moodiness. "Tolle Causam" means "Treat the Cause" and is my favorite Naturopathic Principle because unless we understand the cause we cannot treat the cause. Until we treat the actual cause whether it be with natural medicine or prescription medicine... the patient will fail to improve because we are not addressing the actual problem and simply trying to mask each symptom of hormone imbalance rather than treat it at its source.[3] 

Causes of Hot Flashes during Menopause

Hot flashes are the first thing everyone thinks of when they hear the word menopause. But what actually is causing this hot flash? A hot flash is a feeling of sudden warmth in the upper body parts, experiencing high in the chest, face, and neck region. Sometimes it is accompanied by sweating, followed by chills. Medical research studies are still working to explore the exact mechanism of menopausal hot flashes. Multiple research studies attribute the hot flashes to hormonal changes during menopause. Such as the fluctuations in the estrogen or progesterone level, less estrogen production, and modulation of the thermoregulatory system that results in the development of hot flashes. With less estrogen the hypothalmus that is in charge of setting the body temperature is now telling the body to run hotter. The sudden drop in estrogen triggers the serotonin receptors in the brain to turn the temperature up via vasodilation. As a reflex the woman then becomes too cold and is having hot and cold flashes or hot flashes followed by sudden chills.[3, 5]

Research studies have found a connection between hot flashes estrogen and serotonin and have attributed the hot flashes to the estrogen withdrawal and imbalance between estradiol and follicle-stimulating hormone levels. Recent studies reported the association between hot flashes and a high concentration of serotonin that triggers changes in the set-point temperature. A low estrogen level modulates the activation of serotonin receptors in the hypothalamus that change the set-point temperature sensitivity and results in hot flashes. [3, 5, 6]

Complications of Menopause

Studies reported that women with menopause are at greater risk of developing certain medical conditions. These conditions include heart and blood vessel diseases, urinary incontinence, osteoporosis, sexual problems, and weight gain. [1, 2]

Menopause Diagnosis and Hormone Tests

The diagnosis of menopause involves the evaluation of clinical symptoms and lab tests. Generally, there is no need for lab tests to confirm menopause. However, there is never a more important time for a woman to get her check up and make sure her thyroid, cholesterol and blood chemistry are normal. While not all women require treatment for menopause having the full profile of hormones tested and balanced can help women to feel more optimal. [1, 2]

Menopause Treatment History

Menopausal treatments from opium to acupuncture were used for the management of menopausal symptoms till 1942. Then Wyeth pharmaceutical introduced Premarin containing synthetic estrogen obtained from "Pregnant-Mare urine" for the treatment of menopause. Despite the fact collecting urine from pregnant mares trapped in stalls all day is animal abuse, the sales of Premarin spiked until the 1970s. Reports linking synthetic estrogen with a high risk of breast cancer. During that time, the formulation was modified with the addition of progestin to ensure safety and efficacy. But the 1984 National Institutes of Health assertion backed that estrogen is an effective agent for hot flashes, bone loss prevention, night sweat, and other menopausal symptoms. [7]

Moreover, by the 1990s, the American Heart Association, the American College of Physicians, and the American College of Obstetricians and Gynecologists recommended estrogen for both heart conditions and bone loss. As a result, estrogen use soared up again among menopausal women until the Women’s Health Initiative (WHI) in July 2002. The Women’s Health Initiative (WHI) conducted a study on around 17,000 postmenopausal women. The study revealed that the combination of estrogen and progestin increased death rate in postmenopausal women due to increased risk of blood clotting, heart attack, stroke, breast cancer, and ovarian cancer. This report changed the whole scenario of hormone replacement therapy for more extended periods. Later, multiple research studies confirmed the WHI reports and found a high incidence of heart conditions and cancer with hormone therapy. The risk of these morbidities is prevalent in women older than 60 years. Moreover, women who abruptly stopped the hormone therapy intervention also showed a significant risk of death or comorbidities. Thus, the prescription of hormone therapy depends on the patient medical condition, duration of therapy and previous history. In 2002 we had to call 100's of women to take them off of their Premarin and Prempro without bioidentical hormones as widely available at the time, most patients were transitioned to soy and black cohosh although we have seen advancements in Women's Health since then and have much better natural treatment options for menopause. [7]

How Long Should Women take BHRT Hormones After Menopause?

Hormone experts generally prescribe BHRT hormone therapy for a 3-5 year window after menopause. Once a woman turns 55 her cancer risk is naturally going up which is when I generally taper the hormones down. An irresponsible hormone doctor leaves patients on the same dose, while a responsible hormone doctor will taper the dose down as is considered biologically normal for the woman's age group. Yes, hormones are effective drugs of choice in the treatment of menopausal symptoms, but treatment goals must be safe and realistic as the patient ages.

Do BHRT Hormones Cause Cancer?

It is important to work with an ethical hormone doctor to determine if BHRT is safe. The doctor should first evaluate the patient's entire family history of blood clots, heart disease, stroke, breast cancer, uterine cancer and ovarian cancer risk when considering any hormone use whether natural or synthetic. Women without a family history of reproductive cancer are excellent candidates for BHRT. A good menopause hormone doctor will provide alternative remedies to BHRT when family history of breast cancer exists. The hormone doctor should case by case weigh the benefit-risk ratio of hormone therapy and recommend a symptomatic approach to treat menopausal symptoms. For safety reasons women should not use hormones without a doctor continuously monitoring and checking hormone levels. Hormones should not be given to patients with cancer. After a reproductive cancer an Oncologist would need to approve if BHRT will be safe or harmful for the patient to use. While some cancers are hormone driven, patients that have had cancer will need to follow their Oncologist's instructions. Naturopathy and herbs can still be used even when hormones cannot be used. While BHRT hormones generally do not cause cancer a woman should always get their mammogram, pap smear and pelvic exam every year as a safety measure. Should a woman naturally develop cancer while taking BHRT these important cancer screenings will help Reproductive cancers are generally very slow to grow and thus the hormones would be removed immediately. [7]

Treatment of Menopause

Various treatment interventions help the management of menopausal symptoms and prevent the risk of severe medical conditions. These treatment options include:

Hormone Replacement Therapy

Hormone Replacement Therapy (HRT) encompasses both natural and synthetic hormone therapy for menopause and is considered the most effective approach to treat menopausal symptoms. It helps prevent both vasomotor symptoms, urogenital symptoms, improves lipoproteins level, and reduces the risk of osteoporosis. The hormonal agents include systemic estrogen, estrogen-progestin combination, progestin alone, estrogen-bazedoxifene combination, or progestin combined with oral contraceptives. Although many hormone formulations are currently available, I only prescribe BHRT from a compounding pharmacy or natural estrogen and progesterone from a regular pharmacy. Synthetic preparations are associated with worse side effects than a woman's own natural hormones or "bioidentical."[1-3]

Hormonal replacement therapy helps treat hot flashes, improves sleep disturbance, prevents bone loss, and helps urogenital atrophy. It is important to know that estrogen alone is not recommended in women with a uterus as it can cause uterine hyperplasia and cancer in such women. It is usually recommended for menopausal women with hysterectomy. The combination of estrogen and progesterone were mainly prescribed to menopausal women with an intact uterus. Now with the latest research we know women without a uterus still need progesterone for their mental health, sleep, vaginal lubrication, vision, weight and overall wellness. [1-3]

Whether natural or synthetic, hormones should be used for a short-term duration at their lowest therapeutic doses. Because the long-term use of hormone replacement therapy is associated with a high risk of coronary heart diseases, thromboembolism, breast cancer, stroke, and ovarian cancer. Side effects of hormones involve bleeding between periods, gastrointestinal symptoms, and breast tenderness. [1-3]

Alternative to Oral estrogen

Medical research studies reported the following alternative to oral estrogen formulations. [3, 7]

Localized Estrogen Therapy

Estrogen intended for vaginal administration helps urogenital symptoms, including vaginal dryness, vaginal atrophy, painful intercourse, and other urinary symptoms. Different dosage forms such as creams, rings, and suppositories deliver estrogen to the vaginal tissues. The localized estrogen therapy is associated with a bit of risk of venous thromboembolism. Alternative to vaginal estrogen, hormone-free remedies, including plant oils and lubricant, are also helpful in managing vaginal dryness. [1-3]

Non-Hormonal Treatment

Non-hormonal treatment involves using antidepressants, anti-seizure, and antihypertensive agents for a short duration, usually up to a few months. The antidepressant, including both serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) in low doses, helps the management of both vasomotor (hot flashes) and psychological symptoms (poor mood). Paroxetine is the only FDA-approved SSRI for the treatment of hot flashes. Besides, Gabapentin, an anti-seizure agent, also helps reduction of menopausal hot flashes. Clonidine is an antihypertensive agent that might help both high blood pressure and hot flashes during menopause. [1-3]

Selective Estrogen Receptor Modulators (SERMs)

Selective estrogen receptor agents modulate the estrogen action without interfering with the endometrial growth. These agents include raloxifene, ospemifene, and bazedoxifene that help prevention of osteoporosis and improve lipoprotein level. Also, estrogen combined with these modulators significantly helps vasomotor symptoms and prevent hot flashes. Among these modulators, the ospemifene is highly effective in the management of vaginal dryness. [1-3]


Osteoporosis-specific treatment in menopausal women involves the intervention of the administration of denosumab, bisphosphonates, and supplementation of calcium and vitamin D. Both denosumab and bisphosphonates inhibit the activity of osteoclasts and resorption of bones that increase bone density and prevent the risk of fractures. The supplementation of Vit D and calcium strengthen the bones and improve bone mineralization. [1-3]

Nonprescription Remedies

Complementary and alternative treatments include phytoestrogens, vitamin E, and omega-3 fatty acids. Vitamin E and omega-3 fatty acids have been used to treat the vasomotor symptoms of menopause. They are generally safe; however, studies have shown that they are no better than placebo. [1-3]

Certain plants contain a high concentration of plant-based estrogen, known as a phytoestrogen. These plants include soybeans, whole grains, lentils, legumes, flaxseed, chickpeas, and various fruits and vegetables. They are rich sources of the main types of phytoestrogens, including Isoflavones and Lignans. [1-3]

Role of Bioidentical hormones in the management of menopausal symptoms

Bioidentical hormones are referred to the manmade hormones obtained from plant sources that share a similar chemical structure with the human testosterone, progesterone, and estrogen hormones. Examples of bioidentical hormones include 17 beta-estradiol, estrone, progesterone, and estriol. They are available in different dosage forms, including patches, oral pills, topical gels, vaginal capsules, and topical creams. Bioidentical hormones are either made by pharmaceutical companies or by pharmacies according to a physician's order. They help treat various menopausal symptoms, including hot flashes, mood disturbances, night sweats, sleep problems, low libido, and weight gain.The bioidentical hormones made in a pharmacy, known as compounded bioidentical hormones, are not approved by FDA. They are marketed as safe and effective bioidentical hormones, but they may possess serious health risks. The side effects of bioidentical hormones include fatigue, excessive facial hair growth, bloating, mood swings, and acne. It is important to mention that FDA recommends low doses of hormone replacement therapy for short-term use. 

My hormone philosophy is to use the least amount of bioidentical hormones needed to keep women in a normal physiological range for their age group as some women will continue to make hormones from their adrenal glands and body fat while other women will have zero hormones in their tank and need a little bit of a hormone cream, troche or lozenge containing natural estrogen, progesterone and testosterone to restore skin integrity and aging, improve vaginal dryness, aid with mood, decrease hot flashes and improve sleep at night. It is important to work with a skilled hormone doctor that understands how to properly test bioidentical hormones via blood work (not saliva) and adjust them while also ensuring their safety. Women undergoing treatments for menopause, perimenopause and PMS will need to have their hormones checked and adjusted 1-2 times per year at minimum to ensure they are functioning optimally and that their hormones are at optimal levels. I have seen a lot of careless prescribing of hormones over the years and it is dangerous to not have these levels monitored and adjusted. Women should always be given progesterone with their estrogen regardless of if they have a uterurs because progesterone is also needed for vaginal hydration, mood, sleep and vision. Women will generally feel better on a low dose of combined hormones.

My practice style is to continuously test the hormone levels to ensure they are safe and being metabolized properly as genetics such as COMT mutation can cause estrogen pooling and increased risk of side effects and adverse outcome in women that are not having their hormones regularly checked.

The recommended schedule for hormone testing in menopausal patients is every 3 months the first year that bioidentical hormones are started and then every 6-12 months after that. Hormone testing is covered per the patient's insurance plan and it is imperative the patient goes to the correct lab either Labcorp or Sonora Quest whichever is contracted with the insurance plan is where the blood is drawn for testing. Whether a prescription product from the pharmacy is being used and states no testing is required or whether a compounded pharmacy is being used to make the BHRT the levels should tested as women metabolize hormones very uniquely and high levels of estrogen that women cannot eliminate can cause sudden weight gain.

Natural treatment of menopause

Medical research studies reported a significant positive impact of the following herb on menopausal symptoms. 

Lifestyle modifications:

Various lifestyle interventions can also ease the menopausal signs and symptoms. [3] These include:

Need help with menopause symptoms? Simply pop over to my SCHEDULE page to treat yourself to a Naturopathic visit!

Dr. Nicole Sundene

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert  in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!


  1. Peacock K, Ketvertis KM. Menopause. [Updated 2021 Feb 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from:
  2. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Menopause: Overview. [Updated 2020 Jul 2]. Available from:
  3. Santoro, N., Epperson, C. N., & Mathews, S. B. (2015). Menopausal Symptoms and Their Management. Endocrinology and metabolism clinics of North America, 44(3), 497–515.
  4. Johnson, A., Roberts, L., & Elkins, G. (2019). Complementary and Alternative Medicine for Menopause. Journal of evidence-based integrative medicine, 24, 2515690X19829380.
  5. Bansal, R., & Aggarwal, N. (2019). Menopausal Hot Flashes: A Concise Review. Journal of mid-life health, 10(1), 6–13.
  6. Freedman R. R. (2014). Menopausal hot flashes: mechanisms, endocrinology, treatment. The Journal of steroid biochemistry and molecular biology, 142, 115–120.
  7. Jennifer Wolff, AARP the Magazine, “A Brief History of Treating Menopause;”How estrogen therapy got a bad name — and why doctors now say it shouldn't have”. August/September 2018.

Dr. Nicole Sundene, NMD

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is considered a Female Hormone Expert  in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology , Acne, Psoriasis, Eczema and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 22 years of experience in both Prescription and Natural women's health and hormones she presents to women the best integrated health solutions for their Chronic Disease. She has been an Herbalist for over 27 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter and Facebook for more tips on Women's Health, Female Hormones and Naturopathy!

Location: 14300 N Northsight 
Blvd Ste 124
Scottsdale, AZ 85260
Ph: 480-837-0900
Fax: 480-409-2644
© Copyright 2024 | Scottsdale Naturopathic Hormones 
map-markersmartphone linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram