Our bodies make three different forms estrogens:

Estrone (E1)
Estradiol (E2)
Estriol (E3)

Estrone is usually considered an unhealthy estrogen.  It is still bioidentical, but you do not want loads of estrone around when you are balancing the hormones.  Estrone is common in young girls when they first get their periods and after menopause.  Estrone metabolites can raise the risk for cancer.  This is why you do not want a high level of estrone, which can also cause moodiness, feeling munchie, puffy and grumpy.  With bioidentical hormone replacement therapy (BHRT), we do not use estrone for the above reasons mentioned.

Estradiol is the strongest of the three bioidentical estrogens.  Estradiol is common in conventional hormone replacement in the form of oral, patches or transdermal.  Premarin and Prempro are not estradiol and are not bioidentical.  Because estradiol is the strongest of the estrogens, it has pros and cons to use.  

Pros of Estradiol:  

Great for keeping bones strong
Eliminating hot flashes and night sweats
Neuroprotective for the brain
Great for short-term memory and memory recall
Helpful for libido and sex drive

Cons of Estradiol: 

Estradiol likes to grow things.   (i.e. grow the lining of uterus, which can cause a risk of uterine cancer)
Can cause spotting, bleeding, periods
Grow breast tissue
Cause breast tenderness
Enlarge breasts which can be a risk factor
Moody (weepy, irritable, anxious) 
Can be similar to a 24/7 feeling of PMS
Weight gain

Many women report gaining on average 6 to 8 lbs when taking conventional estradiol hormone replacement.  It is primarily in the breasts and stomach.
   
So how do we get the positive benefits of estradiol without the negative side effects? The best way to properly balance estradiol is to take estriol with it.

Estriol (E3):
Estriol is the gentlest form of estrogen.  Some people refer to it as the weakest form, but I think that is a misnomer.  When you combine estriol with estradiol you can get the beneficial effects of estradiol and estriol, without the negative side effects of estradiol.

What is pregnenolone? It is a steroid hormone but is not a reproductive hormone like estrogen or testosterone.  Pregnenolone is also made from cholesterol, which makes it a steroid hormone. It is also considered to be a pro-hormone,’ because it can convert into other hormones depending on the needs of the body. Recently, it has been discovered that pregnenolone is also produced in the brain and spinal cord, which makes it very potent on stimulating the central nervous system and having an impact on the brain.
Pregnenolone is helpful for memory. It is stimulating to the brain for memory and learning, but at the same time, it is also neuroprotective.  The brain is very complicated, and pages could be written on the process of memory foundation and degradation. What we are trying to say here is, pregnenolone helps with learning and also preserving memory by protecting brain cells.
Other helpful uses for pregnenolone:

Memory: short-term
Brain fog
Mental energy and mental motivation
Helpful for learning new information
Mood
Focus

Pregnenolone, like most hormones declines with age. However, pregnenolone can also drop in response to high levels of chronic stress.  Whether that stress is mentally induced such as dealing with a family member's illness, PTSD or a stressful high paced life. Or physical stress such as intense daily cardiovascular exercise can diminish levels of pregnenolone.  
This is also known as ‘pregnenolone-steal.’  In times of chronic stress, the body will shunt the production away from the other steroid hormones to produce more cortisol.  For women, the body will shunt production away from progesterone to make more cortisol.  
You can test for pregnenolone levels in the blood, but the lab reference ranges are so vast that most everyone will fall in normal ranges.  Quest has a reference range of 22-237 ng/dL, and LabCorp’s is anything less than 151 ng/dL.
Both are broad reference ranges. I like to see pregnenolone 80-100.  If a pregnenolone blood test is less than 80 ng/ dL, I will treat the patient with pregnenolone.  And after being on the pregnenolone for 1-3 months, I will retest the blood work to see where their levels are and how they are feeling.  
As we all know, too much of a good thing' is not-so-good.  Taking too much pregnenolone can have side effects.  There is not a lot of research on pregnenolone.  There are some animal studies but not any real prolific human studies. For the layperson, there is not a lot of information about pregnenolone online. There are some contradictory statements on dosing, side effects, and safety.

What I can tell you from my experience with patients, there are relatively little side effects with pregnenolone, as long as you keep the dosage uniquely prescribed for the patient based on their symptoms and the blood work readings.  
Pregnenolone is available over the counter/online without a prescription.  Many pregnenolone doses are just way too high.  I have had new patients walk into my office, and they are on 100mg or more of pregnenolone per day.  There are a few exceptions based on

Painful intercourse is a very common complaint I get from patients going through or have gone through menopause.  They do feel awkward speaking of vaginal dryness, especially with their male gynecologists.  This is one of the most common symptoms of menopause, second to hot flashes and night sweats.
Menopause is an inevitable course of life that all women will go through.  In menopause, the ovaries are going to reduce and ultimately stop making estrogen and progesterone.  The average age of menopause is 51.5 years of age.  Also, commonly some women have had a complete hysterectomy and oophorectomy which is complete removal of the uterus and ovaries.
This can be due to many health conditions such as Endometriosis, heavy/frequent bleeding, or fibroids.  These women will go through what is called, surgical menopause,’ but either way, menopause can have a variety of symptoms.
Unfortunately, dry, painful sex commonly occurs before, during and after menopause.  A female may opt to take hormone replacement during menopause, or she might not choose to take hormones because she may not be a good candidate.
This can be due to personal reasons, health conditions, family history, physician recommendations.  Whether taking hormones or not for menopause, painful dry intercourse is a common symptom.
It should also be noted that perimenopausal women can also have vaginal dryness.  As we get older, our hormones inevitably decline.  Even women as young as the late 30’s to early 40's can have pain with intercourse due to the slight drop in estrogen.
Why is there painful dry intercourse due to menopause?
Estrogen feeds the vaginal cells.  Immature vaginal cells are called Parabasal cells.  Having estrogen in the system will help convert the parabasal cells into mature vaginal cells.
If you have vaginal atrophy, that means you have mainly parabasal cells in your vagina.  If you have ever gotten the full report from your last pap smear, you will notice the report will say there is predominantly parabasal cells.  The lack of estrogen in menopause is the culprit for painful intercourse and/or dryness.
Options for vaginal dryness and painful intercourse:
Personal lubricants are the first line of choice for painful intercourse, which can be helpful.  However, in vaginal atrophy, the walls of the vagina can become narrow.  You still might experience pain even with the lubricant, or the vaginal tissues are very fragile, and the lubricant cannot protect from the tearing.
The next level of treatment is using estrogen topically.  Your ObGyn may give you estradiol or Premarin cream/inserts for vaginal dryness.  The problem with this is estradiol and Premarin are both very strong forms of estrogen.
They usually enter the bloodstream if you use them vaginally.  Estradiol is ‘bioidentical,’ but it is the most potent form of estrogen we make.  So estradiol may not be appropriate for you or intended to be used long term.
Premarin is made from pregnant horse urine and is not bioidentical. The entire ethical implications behind horse/animal treatment and Premarin is a whole other topic itself.
For the appropriate candidate using estriol (E3) vaginally can help hydrate the vaginal cells and make them more resilient to tearing.  Estriol is the most gentle estrogen that our bodies produce.  Estriol is bioidentical and very helpful for skin and mucous membranes like the vagina.
Unfortunately, your conventional doctor or ObGyn is not going to prescribe estriol for you. Now, this is where I am supposed to tell you: this information is intended for information only.  It does not replace medical advice and it just at the disclosure of the reader.
There is a product I like from the company Bezwecken, which is called

As discussed before, fatigue is a broad topic with many multifaceted causes.  I wish there were a magic pill that would help fatigue and was free from side effects or dependency, but there is not.  Fatigue is commonplace, but a complicated symptom to address due to the many contributing factors.  
In our practice, the majority patients complaining about fatigue are relatively healthy and have no disease states, which is why their doctor has a hard time treating them.  Unfortunately, there is no treatment specifically for generalized fatigue.  
In our practice, a typical triad of symptoms we see with almost every patient is the following:

Low energy
Stressed
Weight gain (especially in the stomach)

From our experience treating patients for the last 14 years, we wanted to share some supplements ideas that we have had success with increasing energy. Below is just a summary of some supplement ideas that have helped our patients.  There are many other possibilities, and each practitioner has their preferred options.  This information is not set in stone, but just some simple ideas that might be helpful to you.  Something to also keep in mind, what works for one person, may or may not work from someone else.  
Liver/Insulin/Blood Sugar Support:
Balancing blood sugar and improving insulin status will your energy.   The better interaction between your liver, insulin, blood sugar, and cortisol, the better your energy and metabolism will be.  The KCCP (keto-carb-cycling program) helps to balance the insulin/glucose/cortisol roller coaster.  
Supplements:

Metabolic Xtra
ChromeMate GTF
Lipoic Acid Supreme
Liver GI Detox
Methyl B12 

Adrenal Support:     

Adrenal support can also help improve energy and reduce fatigue over time.  Restoring your adrenals helps to reestablish the stress response and HPA Axis, which is the brain / adrenal connection.  Note: be careful with products containing glandulars, as they are not always needed.  However, they can be helpful in the right situation.

Supplements:

Cortico B5-B6 (Vitamin B5)
Adrenotone

Fatigue and feeling tired is such a big topic.  This episode is the second part of our podcast of ‘Why Am I so Tired All The Time.’ As we discussed, there are many reasons causing fatigue ranging from medication to having too much caffeine.  Below is a list that with many (not all) of the causes of fatigue.  

Medications: such as antidepressant meds, anti-anxiety, heart meds.
Liver – sugar, alcohol and overall number of medications
Excessive amounts of Caffeine
Anemia/low blood iron
Insomnia/lack of sleep
Stress: adrenal and thyroid
Blood sugar/insulin imbalance
Depression / Anxiety
Stress / Cortisol
Thyroid –hypothyroid, Hashimoto’s,

Of course, fatigue is not just as simple as a list.  We believe that fatigue is the interaction between the pancreas, liver, thyroid, adrenal glands, brain and reproductive organs.  
This interaction can also help explain adrenal fatigue or adrenal-dysfunction, which is such a vague term or concept. When you consider the interactions between the adrenals, pancreas, liver, and brain from outside factors, you can get some SERIOUS FATIGUE.  
Fatigue is one of the most common reasons why people visit the doctor.   However, most of the time your conventional doctor cannot help you because the interactions of the organs/glands do not typically show up on a routine blood test.
The stressful American Diet and lifestyle can make these glands and hormones react in a way that can eventually lead you to be tired.  But in most cases, you do not have a disease.  Because these organs are healthy, but behaving in a way that makes you tired.
It is a complicated process to explain.  To keep it simple here is a short list to explain how it works.  
Adrenals:
High stress will cause an increase in cortisol, catecholamines (epinephrine and norepinephrine: aka adrenaline).  This will cause ups and downs in energy, cravings for sugar and belly fat.  Caffeine from coffee and black tea will also falsely increases cortisol and catecholamines (adrenaline) initially but will fall off over time.  
Pancreas:
High glycemic foods and high levels of cortisol will raise your insulin.  Insulin is the only fat storing hormone. Hence, causing weight gain and ups and downs in blood sugar.  Ups and downs in blood sugar cause your energy to crash.

Liver:
The mitochondria in the liver become overwhelmed with high carbohydrate/sugar ingestion.  This high carbohydrate/sugar will cause insulin elevation. Then you will not work as efficiently.  That means the more sugar you eat, the more congested your liver is.  The more congested your liver is, the less efficient it can work.  An overburdened, congested liver will cause a drop in energy.  Leaving you mentally and physically fatigued.  

One of the most common complaints we hear from patients is fatigue or feeling tired all the time. Unfortunately, fatigue is common, but a complicated symptom to treat.  There are many possible reasons someone can be fatigued.  
Conventionally, when you go to your doctor, fatigue is all the same.  There is no differentiation made; however, we see three different patterns of fatigue.  
Snooze Button:
Are you one of those people who keeps pressing the snooze button in the morning. You are so tired and you just can't seem to get out of bed, so you keep pressing snooze.  Every nine minutes, your alarm keeps going off, and before you know it you have stayed in bed for an extra 45 extra minutes.  
Afternoon Crash:
Many patients mention they get really tired in the afternoon, usually between 2:00 to 5:00 pm. We refer to this afternoon drop in energy as the Thanksgiving Effect, which usually happens 30 to 90 minutes after lunchtime.  
Wire and Tired:
In the evening, after a long day, many patients will mention their minds feel wired, but their bodies are exhausted.  They want to sleep, but their racing minds won't let them rest. The stress from the day sets up this vicious cycle of poor sleep at night and fatigue during the day.  Unfortunately, when we need to sleep the most, we often sleep the worst.  
In addition, this the 3 patterns mentioned above, below is a list of other possible causes of fatigue. This is also assuming that an underlying condition or diagnosis such as cancer or an autoimmune disease has already been ruled out by your doctor.  

Medications: such as antidepressant meds, anti-anxiety and beta blockers. 
Excessive amounts of caffeine and/or alcohol.
Liver burden (meds, caffeine, alcohol, high fructose corn syrup)
Iron Deficiency Anemia
Insomnia
Stress: cortisol
Blood sugar/insulin imbalance
Anxiety/ depression
Hypothyroid, Hashimoto’s
Allergies
Autoimmune disease
Cancer

Of course, fatigue is not as simple as a list. Fatigue is very complicated with many contributing factors.
For additional health resources, you can access our Content library and download the Keto Carb Cycling Program, which is intended to help you lose weight and improve your energy throughout the day.  
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