Why HRT Alone Won’t Fix Your Hormones

Many women are told hormone replacement therapy (HRT) is the answer to menopause struggles. Hot flashes? Sleepless nights? Mood swings? Just add hormones.

And yes, HRT can help. But here’s the truth: if your body can’t clear old hormones properly, HRT is like pouring more water into a clogged sink. You don’t fix the clog by turning up the faucet—you fix the drain.

Hormones Need an Exit Door

Hormones are little messengers. Once they’ve done their job, they need to leave the body. That “exit” happens through your liver, bile, gut, and urine.

If your detox pathways are blocked, those hormones get stuck, recycled, or turned into irritating forms that cause symptoms like:

• Bloating

• Breast tenderness

• Chin/jaw acne

• Night sweats

• Mood swings

• Weight that won’t budge

The 3 Phases of Hormone Detox

Phase 1 – Break Down

• Enzymes in the liver (CYP450 family) take your main estrogens (estradiol and estrone) and convert them into “metabolites.”

• These can go down three main paths:

  • 2-OH estrogen → the protective form

  • 4-OH estrogen → potentially damaging if not cleared quickly

  • 16α-OH estrogen → can be very strong and drive symptoms (like heavy breasts, fibroids, stubborn fat)

• Imagine this as the liver opening your mail and sorting it into different piles.

Phase 2 – Neutralize + Package

• These metabolites now need to be “packaged up.” The liver does this by attaching different groups to them (this is called conjugation):

  • Methylation (needs folate, B12, B6, magnesium, choline)

  • Glucuronidation (needs fiber, calcium-D-glucarate, magnesium)

  • Sulfation (needs sulfur foods like broccoli, garlic, eggs)

  • Glutathione conjugation (needs protein, NAC, vitamin C, selenium)

• This is like sealing up the piles of mail into boxes so they can’t leak.

Phase 3 – Eliminate

• Packaged estrogens are sent out through:

  • Bile → stool

  • Kidneys → urine

• This step depends on good bile flow and regular bowel movements. If you’re constipated or bile is sluggish, those estrogens can get “unpackaged” by gut bacteria (beta-glucuronidase enzyme) and recycled back into your body.

The Estrobolome

Your gut bacteria also decide how much estrogen you keep or clear. An enzyme called beta-glucuronidase can “unpack” hormones your liver already boxed up, which in turn, then get reabsorbed and cause estrogen dominance symptoms.

Why Bile Flow Matters

Bile isn’t just for digesting fats—it’s one of the main highways for getting hormones out. Stress, low thyroid, low stomach acid, or losing your gallbladder can all slow bile down. If bile doesn’t flow, hormones don’t go.

HRT Without Detox = More Traffic Jams

HRT adds more hormones into the system. If the exits are blocked, those hormones pile up instead of flowing smoothly. That’s why some women on HRT still feel:

• Puffy, bloated

• Moody or anxious

• Hot and sleepless

The hormones aren’t the problem—it’s the traffic jam.

How to Clear the Clog

1. Support bile flow: eat bitter greens (arugula, dandelion), lemon water, artichokes.

2. Keep bowels moving: aim for at least 1–2 easy bowel movements daily. Exercise, hydration, fiber, and magnesium are your best friends.

3. Feed Phase 2 Detox: protein, cruciferous veggies (broccoli, cauliflower, brussel sprouts), and nutrients like B vitamins, magnesium, NAC.

4. Love your gut: reduce alcohol, add L-glutamine, butyrate, diverse fibers and polyphenols.

The Bottom Line

Every woman’s hormone story is different. Your genetics, stress load, gut health, diet, and even your constitutional type (how your body naturally processes energy and stress) all shape how your detox pathways perform.

That’s why a one-size-fits-all plan doesn’t always work. What your best friend needs to support her liver might be very different from what your body craves. Some women need more methylation support, others need bile flow help, and others need gut balance first.

This is where I come in. In my practice, I look at your unique constitution and your existing “template”—how your body is already trying to adapt—and build a step-by-step plan that’s realistic, rooted in science, and personalized. We can map out:

• Which detox phase needs the most support for you

• What nutrients and herbs your body is likely to respond best to

• Lifestyle shifts that match your energy, stress, and digestion patterns

• How to layer in (or adjust) HRT so it actually works with your system

HRT can be helpful, but it doesn’t fix the root. If your detox pathways are clogged, hormones can’t leave—and symptoms linger.

Once you open the exits and support your liver, gut, and bile, hormones (whether natural or from HRT) can flow in harmony. That’s when your body feels calmer, lighter, and more balanced—without the traffic jam.