Hormone Balance Protocol
Sara Gottfried's three-step approach fixes food and lifestyle first, then layers in targeted botanicals and supplements. Only then, with a physician, does it consider bioidentical hormone therapy. Cortisol, thyroid and sex hormones work as a network, and in her clinical experience this order resolves most perimenopausal symptoms before any prescription is needed.
Get the right bloodwork Cortisol (and its daily rhythm), a full thyroid panel (TSH, free T3, free T4, antibodies), sex hormones (estradiol, progesterone, testosterone), and consider a stool/microbiome test and a CGM
Knowing and monitoring your numbers changes how you take care of yourself, so start here.
Eat for your hormones Protein at each meal, plenty of cruciferous vegetables (broccoli, cauliflower, Brussels sprouts) for estrogen metabolism, fiber for the gut, and less sugar, alcohol and processed dairy
Her food-first philosophy resolves most symptoms before any supplement or hormone.
Dial down the stress load Paced breathing: 5 second inhale, 10 second hold, 5 second exhale, 20 min twice daily; protect sleep; limit caffeine and alcohol
Cortisol dysregulation drives many perimenopausal symptoms. Gottfried recommends paced breathing for hot flashes specifically as her own clinical practice, an expert opinion rather than a settled finding; the most rigorous RCT (Sood et al., Menopause 2013) found paced breathing performed no better than usual breathing for hot-flash frequency or severity.
Add omega-3 fatty acids A daily EPA/DHA omega-3, ideally dosed to your omega-3 index (an OmegaQuant-style test)
Anti-inflammatory and supportive of mood and hormone health.
Take ashwagandha Ashwagandha (for example KSM-66, about 300 to 600mg) for cortisol and sleep
An adaptogen that blunts the cortisol response and supports sleep.
Add rhodiola rosea Rhodiola rosea for stress resilience and fatigue
An adaptogen Gottfried pairs with ashwagandha for the cortisol response.
Add phosphatidylserine About 400mg phosphatidylserine to blunt an elevated cortisol response
Shown to reduce the cortisol response, particularly under stress.
Cover magnesium Magnesium (such as glycinate) daily for sleep, stress and PMS
Commonly low, with a broad role in sleep and hormonal symptoms.
Match botanicals to your symptoms Chasteberry (Vitex) for PMS and progesterone support, and maca for libido; trial targeted to symptoms for 4 to 6 weeks
Her step-two botanicals, used before any hormone therapy.
Support healthy estrogen clearance DIM (diindolylmethane), or simply more cruciferous vegetables, to support healthy estrogen metabolism
Helps the body process and clear estrogen metabolites.
Discuss bioidentical hormones with a physician If symptoms persist after food, lifestyle and botanicals (give it 4 to 6 weeks), discuss bioidentical hormone therapy with a qualified clinician; this is individualised and prescription-only
Her third and final step: hormones are a medical decision, not a supplement.
This protocol works from your actual levels. Testing partner coming soon.
- Female hormone blood panel
We may earn a referral fee if you book testing through a future partner link; it will never affect which tests are listed here. This is not medical advice or a diagnosis.
Cortisol, thyroid and the sex hormones (estrogen, progesterone, testosterone) work as a network, and the gut (the estrobolome) helps clear estrogen.
View sources
Huberman Lab: Dr. Sara Gottfried on female hormone health
Gottfried: balance your hormones naturally
Not medical advice. This page is for education only and is not a substitute for professional medical care. Consult a qualified clinician before changing your health routine.
Independent curation. YourProtocol is an independent platform. This protocol is based on the publicly available work of Sara Gottfried and is not created, reviewed, endorsed by, or affiliated with Sara Gottfried or Author, The Hormone Cure.
Is this for you
- Women in perimenopause or menopause
- Anyone with cortisol, sleep or cycle symptoms
- People who want to try food and lifestyle before hormones
- Those who like to test and track their numbers
Cautions
- Paced breathing for hot flashes is Gottfried's own stated clinical recommendation, not an established finding: the most rigorous randomized trial (Sood et al., Menopause 2013) found paced breathing performed no better than usual breathing for hot-flash frequency or severity. Treat it as a low-cost, low-risk expert-opinion option, not a proven fix
- Hormone-active botanicals such as chasteberry (vitex) and DIM can interact with hormonal contraception, HRT and other medications and are not advised in pregnancy or with hormone-sensitive conditions; confirm with your physician before use
- Gottfried has no current standalone supplement line; she recommends reputable third-party-tested brands and tailors botanicals to the individual, so treat these as generic recommendations
- This is education based on Gottfried's published work, not medical advice; hormone therapy (HRT and bioidentical hormones) is prescription-only and belongs with a qualified clinician
- Talk to a clinician before adding botanicals or adaptogens, especially if pregnant, breastfeeding, on hormonal birth control, on thyroid medication, or taking other prescriptions (chasteberry, ashwagandha and DIM can interact)
- Change one thing at a time and give hormones 4 to 6 weeks to reach a new equilibrium
- Supplement doses are general ranges from her public work; individualise them with testing and professional guidance
- Educational only, not medical advice
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