We invite you to discover Dr. Kate's Clinical Cases — a library of presentations created by Dr. Kate Placzek to assess patient issues with the aid of neurotransmitter testing. You will find case reviews on conditions including anxiety and depression, ADHD, PTSD, insomnia and many others, highlighting real patients and their results ranging in age from children to postmenopause, as well as a veteran with PTSD.
For Menopause Awareness Month, let us take a closer look at a recent case study of a postmenopausal woman. Guest speaker Dr. Allison Smith joins Dr. Kate Placzek to present a common scenario of mood and vasomotor symptoms in menopause.
Julia's Menopause Case Study
Julia is a 51-year-old newly postmenopausal woman suffering from intense hot flushes and night sweats, as well as anxiety, insomnia, and stress. Dr. Smith presents a breakdown of the patient's self-reported symptoms before going into the details of her test results — highlighting the biochemical factors that explain both her symptoms and her observed results. Finally, she summarises the whole picture and presents a suggested approach to help Julia get back into balance.
Identifying the Symptoms: 8 Hormone Imbalance Categories
A Host of Hormone Imbalance Symptoms
ZRT test reports offer 68 self-reported patient symptoms summarised into 8 hormone imbalance categories. In Julia's case, symptoms she rated as severe included depression, anxiety, and sleep disturbances. Commonly seen in newly menopausal patients, moderate symptoms included hot flushes, night sweats, foggy thinking, vaginal dryness, and mood swings. In addition, she had multiple symptoms rated as mild in severity.
Dr. Smith shows how these self-reported symptoms translate on the test report into 8 hormone imbalance categories — in Julia's case, the main problem categories were estrogen dominance, estrogen/progesterone deficiency symptoms, both high and low cortisol symptoms, low androgen symptoms, and hypometabolism.
Julia had already tried multiple supplements in an attempt to address her symptoms — including magnesium, calcium, selenium, zinc, copper, L-theanine, Rhodiola, vitamin D, fish oil, and probiotics. Dr. Smith wanted to see if there was a better way to focus her supplement regimen based on her actual test results.
If you recognise Julia's symptom picture, our Menopause hormone testing page explains which tests are most relevant to your stage of life and how to interpret your results in context.
What the Tests Revealed
Saliva Hormone Test Results
Julia's test kit included a saliva hormone test as well as dried urinary neurotransmitter testing. Her saliva hormone results showed low estradiol and progesterone, low DHEA, but higher than normal testosterone — which could relate to blood sugar issues in this case. Low estradiol and progesterone levels explained many of her menopause-related symptoms.
Neurotransmitter Test Results
Julia's serotonin levels were at the low end of the optimal range, whereas levels of the serotonin metabolite 5-HIAA were high. Using the neurotransmitter pathway diagrams included in the test report, Dr. Smith shows that this suggests increased serotonin degradation — a common picture in postmenopausal women, because estradiol helps maintain adequate serotonin levels by potentiating its synthesis and preventing its degradation. Estradiol acts as a mild monoamine oxidase (MAO) inhibitor, maintaining enough serotonin for optimal mood and sleep, and mitigates the depressive effects of increased serotonin breakdown. Low serotonin availability also contributes to menopausal symptoms of night sweats, hot flushes, and mood changes.
Julia's glycine and glutamate levels were also below optimal — these amino acids are needed for the production of glutathione, a major antioxidant in the body that normally counteracts oxidative stress. PEA was also lower than normal, contributing to brain fog and mental fatigue, and her DOPAC was higher than normal, indicating increased dopamine degradation with resulting negative effects on mood. Her low norepinephrine levels could also contribute to depression, low blood pressure, and fatigue.
Chronic stress and disrupted cortisol patterns are frequently intertwined with these neurotransmitter imbalances. If you experience persistent fatigue, poor sleep or anxiety alongside menopausal symptoms, our Stress & Adrenal Imbalance testing page explains how a cortisol diurnal profile can reveal whether your adrenal hormones are compounding the problem.
Solutions for Julia
Hormone Therapy Options
To address the hormone deficiency problems, if Julia is a good candidate, a hormone replacement therapy-based approach would involve estradiol and progesterone supplementation. A low dose of estradiol can be given as a patch, with dosage modified depending on her response. Estradiol would help slow serotonin and dopamine breakdown and improve Julia's sleep, while oral progesterone taken at night would promote sleep — due to its metabolism to the neuroactive steroid allopregnanolone — as well as help with estrogen dominance symptoms.
If hormone therapy is not an option, SSRIs can improve serotonin availability and help with mood lability, hot flushes and night sweats (although they will not help with bone loss and vaginal dryness). There are also botanical MAO inhibitors that decrease serotonin breakdown, such as curcumin and passionflower.
Nutritional and Lifestyle Support
For Julia's low glycine and glutamate, Dr. Smith suggests N-acetyl cysteine (NAC) and/or glutathione to support her body's response to oxidative stress. For low PEA, vitamin B6, phenylalanine, and regular exercise can all help. Adrenal adaptogens can assist with low norepinephrine and overall HPA axis support — some, like Ashwagandha, are also effective for sleep issues.
Dr. Smith emphasises the importance of general wellness support: a healthy Mediterranean diet, yoga practice, and biofeedback.
Recommended Follow-Up Testing
Dr. Smith also suggests additional testing for Julia, including a thyroid panel to address the hypometabolism issues, and metabolic syndrome markers like HbA1c and insulin to detect any tendency towards prediabetes. A diurnal epinephrine and norepinephrine test would give more insight into the adrenal connection to Julia's sleep issues than the pooled total level in her current report.
For a comprehensive starting point that covers sex hormones, cortisol and thyroid in a single at-home kit, our Weight Management Profiles is a practical option for women navigating perimenopause or postmenopause who want a broad hormonal overview.
Originally by Margaret Groves, ZRT Laboratory. Reproduced with permission. Last reviewed: May 2026.