Weight gain, irritability, bloating, fatigue, skin problems – they’re all just a normal part of being a woman. But are they really? Do you really have to accept them as your new “normal”?
The truth is that these frustrating symptoms are common, but that doesn’t mean they’re normal. What many women don’t know is that all these symptoms could have one common root cause: hormone imbalance.
In this article, we’ll discuss the different types of hormone imbalance and how achieving optimal balance can help you be a healthier and more joyful version of yourself.
What are Hormones?
Think of hormones as your body’s chemical messengers. Like little FedEx delivery trucks, your hormones carry signals and information from one group of cells in your body to another.
Your hormones are created and secreted by the glands (ex: thyroid and adrenal glands) that make up your endocrine system. Hormones manage literally hundreds of processes in your body, including:1,2
- Growth and development
- Sexual function
- Homeostasis (internal balance), such as blood pressure and blood sugar levels
- Sleep-wake cycle
As you can see, hormones affect just about everything in your body. That’s why even minor imbalances can leave you feeling off.
Scientists have identified more than 50 hormones in the human body so far. Let’s go over the ones that cause the most hormone-related health problems in women.
Estrogen affects the development of the female reproductive system, your menstrual cycle, fertility and pregnancy, and menopause. But many women don’t realize that estrogen also affects your cardiovascular, central nervous system and bone health.3
Estrogen comes in three main forms – estradiol, estrone, and estriol.
Estradiol is the primary form of estrogen in premenopausal women, with an average level ranging from 15 to 300 pg/mL.
For postmenopausal women, estrone becomes the primary form of estrogen. The average level of estrone for postmenopausal women is 7 to 40 pg/mL, and estradiol drops to less than 15 pg/mL.4
Estriol is the primary form of estrogen during pregnancy, making up more than 90% of estrogen in the urine of pregnant women.5 It helps your uterus grow in preparation for childbirth and breastfeeding. Estriol levels that are too high or low may indicate problems with the fetus or pregnancy. Ranges of normal estriol levels vary between labs.
Your estrogen levels change with age. If you have low estrogen levels, you may experience:6,7
- Hot flashes or night sweats
- Mood swings
- Thinning skin
- Thinning urinary tract that may increase the frequency of urination
- Vaginal dryness
- Menstrual periods that are lighter, infrequent or that stop
Low estrogen levels also put you at a greater risk of developing osteoporosis and heart disease.8
But what if your estrogen levels are too high? Then you might have symptoms of what many people call “estrogen dominance,” such as:9
- Irregular periods, such as light or heavy bleeding
- Breast tenderness
- Weight gain
- Fibrocystic breasts (non-cancerous breast lumps)
- Loss of sex drive
- Fibroids (non-cancerous tumors) in the uterus
- Endometriosis and/or adenomyosis
Estrogen and progesterone (see below) work together to prevent your endometrium, or your uterine lining, from getting too thick. Your body becomes estrogen dominant if it doesn’t produce enough progesterone or has too much estrogen.
Progesterone is released by your ovaries. It plays important roles in maintaining pregnancy, preparing your body for pregnancy, and regulating your menstrual cycle.
Progesterone levels vary based on certain phases of your menstrual cycle and pregnancy. During the pre-ovulation phase and for postmenopausal women, the average progesterone level is less than 1 ng/mL; after ovulation, it rises to 5 to 20 ng/mL.10
Common signs of excess progesterone are:
Symptoms of low progesterone include:
- New or increased migraine headaches14
- Mood swings16
- Difficulty sleeping17
- Irregular or skipped menstrual periods18
- Heavy menstrual bleeding
Learn more about progesterone through my blog “How to Naturally Boost Progesterone Levels.”
Every organ system in your body needs thyroid hormones, including your central nervous system, heart, and metabolism. In the human body, thyroid hormone exists in two main forms, thyroxine (T4) and triiodothyronine (T3).
Euthyroid is a term used to describe an optimally functioning thyroid. Unfortunately, experts estimate that more than 12% of the U.S. population will develop a thyroid condition during their lifetime. And up to 60% of those with a thyroid condition may not even be aware of it!20
Thyroid health is even more critical for women, as we’re 5 to 8 times more likely to develop thyroid problems than men are.21
So what are some signs that your thyroid isn’t functioning well?
Symptoms of an underactive thyroid (hypothyroidism) include:22
- Dry skin
- Weight gain
- Joint pain, stiffness, or swelling
- Thinning hair
- Increased sensitivity to cold
- Enlarged thyroid gland
- Impaired memory
- Puffy face
- Elevated blood cholesterol level
- Irregular menstrual periods or heavier bleeding than normal
If you have an overactive thyroid (hyperthyroidism), you may experience:23
- Mood swings
- Difficulty sleeping
- Muscle weakness
- Frequent urination
- Loss of sex drive
- Nervousness, anxiety, or irritability
- Persistent thirst
A thyroid stimulating hormone (TSH) test can be performed to measure the function of your thyroid. It serves as an “early warning system,” catching any abnormalities before the actual thyroid hormone levels are affected.
Labs generally place TSH values from 0.5 to 5.0 mIU/L in the normal range,24 but from my experience, this range is too broad. Many people begin to experience the early warning signs of low thyroid at ranges higher than 2.5 – 3.0 mIU/L.
Insulin is a peptide hormone produced by your pancreas. It controls the glucose (sugar) levels in your blood and helps store them in your fat and muscle cells and your liver. It also regulates the breakdown of carbohydrates, proteins, and fats in your body.
Insulin resistance isn’t a deficiency. Rather, it means that insulin is being produced, but your body isn’t responding to it. In other words, your cells aren’t taking up the glucose from your blood. As a result, your pancreas is forced to make even more insulin to try to overcome the increasing blood glucose levels. Eventually, your pancreas won’t be able to keep up, and your blood glucose levels will keep rising. This puts you at risk of diseases like type 2 diabetes and prediabetes.
You may have insulin resistance if you experience the following signs and symptoms:25
- Sugar cravings
- A large waist
- Dark skin patches
- High blood pressure
- High fasting blood sugar levels
- Low high-density lipoprotein (“good” cholesterol) levels
- Resistance to weight loss
- Fatigue after eating
- Feeling jittery or shaky
- Increased thirst or appetite
Insulin resistance is a warning sign that your body needs intervention before diabetes develops. I suggest my clients aim for optimal insulin levels between 2-6 mIU/mL.
Cortisol is your body’s primary stress hormone and is secreted by your HPA axis. “HPA” stands for hypothalamic-pituitary-adrenal. The HPA axis is an eloquent set of pathways that connects your central nervous system to the critical glands in your endocrine system. Cortisol is critical to health, and even life. It helps maintain healthy blood sugar levels, inflammation, blood pressure, and muscle strength.26,27
Here are some symptoms that indicate you may have too much cortisol:28
- High blood pressure
- High blood sugar
- Irregular menstrual periods
- Excess hair on your face and chest
- Fatty hump at the base of your neck
- Thin skin that bruises easily
- Pink or purple streaks on your stomach, thighs, or buttocks
If you suspect that you have high levels of cortisol, talk to your healthcare provider about testing for Cushing’s syndrome.
On the other hand, too little cortisol could be a sign of Addison’s disease, also known as primary adrenal insufficiency. Addison disease may cause these symptoms:29
- Weight loss
- Belly pain
- Low blood pressure
- Nausea or vomiting
- Dark patches on your skin
- Decreased armpit and pubic hair
- Low sex drive
- Muscle and joint pain
Cortisol is just one of four hormones secreted by your HPA axis. Your HPA axis tightly controls your stress response and many other processes that maintain balance in your body. When just one part of your HPA axis stops running smoothly, it can affect the rest of the pathway, leading to frustrating symptoms.
You may have heard of “adrenal fatigue,” a phrase used commonly to link chronic stress to low cortisol levels and other symptoms like lack of energy. The theory behind adrenal fatigue is similar to that of insulin resistance — chronic stress overworks your adrenal glands, which eventually “burn out.”
The concept of adrenal fatigue is likely an oversimplification. But it’s well-documented that HPA axis dysfunction, in which your adrenal glands don’t release enough cortisol, exists. And it has detrimental effects on your immune system.31
I recommend a salivary or urine adrenal test to identify HPA axis dysfunction in my patients. I’ve included a simple graphic below that illustrates how different cortisol levels are correlated with HPA axis function.
Luteinizing Hormone and Follicle-Stimulating Hormone
Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) work closely together to regulate the production of estrogen and eggs in women.
Normal LH levels for women are as follows:32
- Weeks 1 and 2 of the menstrual cycle: 1.37 to 9 IU/L
- Week 2, before ovulation: 6.17 to 17.2 IU/L
- Weeks 3 and 4 of the menstrual cycle: 1.09 to 9.2 IU/L
- Postmenopausal women: 19.3 to 100.6 IU/L
Here are the normal FSH levels for women:33
- Before puberty: 0 to 4 IU/L
- During puberty: 0.3 to 10 IU/L
- Menstruating women: 4.5 to 21.5 IU/L
- Postmenopausal women: 25.8 to 134.8 IU/L
Tests that measure LH and FSH levels can be used to determine when ovulation occurs and the reason for irregular or stopped periods.
LH and FSH deficiency may also cause:34
- Low sex drive
- Hot flashes
- Loss of pubic hair
- An inability to produce milk for breastfeeding
Together, LH and FSH are important to monitor for those trying to conceive.
Anti-Mullerian hormone (AMH) blocks FSH, reducing the growing follicles. Without AMH, your follicles may be recruited faster, leading to early exhaustion of your follicle pool.
Normal AMH levels range from 2 to 6.8 ng/mL and shouldn’t change significantly throughout your menstrual cycle.35
Signs and symptoms of low AMH include:
Low AMH levels have also been associated with cardiovascular disease.40
But having high AMH levels isn’t always a good thing. Some women with excess AMH levels may have polycystic ovarian syndrome (PCOS), symptoms of which include:41
- Irregular or stopped periods
- Difficulty getting pregnant
- Weight gain
- Thinning hair on head
- Oily skin or acne
- Excessive hair growth on your face, chest, back, or buttocks
Read more about AMH and its impact on fertility here.
Androgens (testosterone and dihydrotestosterone) are just as important for women although we often think of them for men! Androgens give women the ability to build lean muscle, provide motivation and drive, and are also essential for bone health. They give us that sparkle and gusto we need to thrive! Women’s androgen levels are lower when optimal (15 to 70 ng/dL for women versus 280 to 1,100 ng/dL for men).42
Women with high levels of androgens may experience:43
- Decrease in breast size
- Increase in body hair in a male pattern, such as on your face, chin, abdomen, back
- Irregular or stopped menstrual periods
- Oily skin
- Changes in your body shape
- Deepening of your voice
- Increase in muscle mass
- Thinning of hair on your head
- Enlarged clitoris
Fat cells in your body produce a hormone called leptin, which helps regulate your body weight. It’s also known to help control:44
- Reproductive function
- Fetal growth
- Proinflammatory immune responses
- Formation of new blood vessels (angiogenesis)
- Breakdown of fat
Normal leptin levels for an adult woman is between 0.5 and 15.2 ng/mL.45
Similar to what happens when your body becomes insulin resistant, your body – namely your brainstem on hypothalamus – can stop responding to leptin’s effects. This is known as leptin resistance.
This “lack” of leptin tricks your body into entering starvation mode. You may feel constantly hungry, which leads to weight gain. And because your brain thinks it needs to conserve energy, you may have difficulty losing weight.
Causes of Hormone Imbalance
Many people think of hormones as either having too much or too little. Certainly, there are times or changes in a woman’s life that are associated with dramatic changes in certain hormones, such as menopause.
But what’s missing from this thinking is the numerous other players that are involved in maintaining hormonal balance.
It’s not enough to isolate one hormone or system of your body in an effort to “fix” hormonal imbalance. Your hormones work as an elegant symphony – if one is overproduced or underproduced, your other hormones may try to compensate. This throws everything off balance, resulting in hormone imbalance.
To treat the cause of your hormone imbalance at its root, you also have to look at your:
- Blood sugar levels
- Stress levels
- Gut health
- Liver health
- Sleep quality
- Medical history
- Certain medication use
- Methylation issues
As you can see, there are many factors to consider to achieve hormonal harmony.
Can You Test for Hormone Imbalance?
The simple answer? Yes. Unfortunately, there’s no single test that would help your healthcare provider diagnose a hormonal imbalance. They may order blood tests to check certain hormone levels based on your symptoms and medical history.
But typical hormone tests neglect many root causes of hormonal imbalance, like gut health and inflammation.
Five Tests For Hormonal and Fertility Health
From my experience, the 5 must-have tests for hormonal and fertility health include:
- Cortisol: Abnormal cortisol levels can affect your sleep, blood sugar levels, and energy. One serum blood test for cortisol is not enough. You need a test that will show your cortisol pattern throughout your day. I recommend either a salivary test or urine adrenal test.
- Fasting insulin: Testing your fasting insulin levels lets us know how sensitive your body is to insulin. This is especially important for those with PCOS.
- Methylenetetrahydrofolate reductase (MTHFR) gene mutations: The MTHFR gene provides your body with instructions for making MTHFR, an enzyme that helps convert folic acid into the active L-methylfolate. Adequate folate levels are needed to maintain homeostasis.46 Certain mutations in your MTHFR gene reduces the functionality of your MTHFR enzyme, which in turn affects your hormone function. They can also affect your body’s detoxification pathways, leading to a buildup of toxins. Knowing whether you have an MTHFR mutation can help you understand how well your body detoxifies and handles genes.
- Sex hormone-binding globulin (SHBG): SHBG is a protein made by your liver that binds to estrogen, dihydrotestosterone, and testosterone. While it can bind all 3 hormones, its ability to control testosterone levels is critical, as too little or too much testosterone can cause problems in both men and women. If a total testosterone level test can’t explain your symptoms, an SHBG test may be useful.
- fT4, fT3, and TPO: TSH testing alone is an incomplete way of checking for an underactive or overactive thyroid. In some women, it may lead to a misdiagnosis or delayed diagnosis. To have a more thorough look at your thyroid function, I recommend a complete thyroid panel, which includes levels of TSH, free T4 (fT4), free T3 (fT3), and thyroid peroxidase (TPO) antibodies. Of these, abnormal fT4 and fT3 levels would be the most indicative of a thyroid disorder.
For other tests you can consider, read my blog post “Holistic Approach to Polycystic Ovarian Syndrome.”
Balance Your Hormones and Feel Like Yourself Again
There’s a lot more to hormones than just having too much or too little of something.
Balancing hormones is like conducting a beautiful symphony. This means you don’t want to attempt to “fix” your hormonal imbalances alone. Even natural products like herbs can disrupt this delicate balance.
If you believe your symptoms might be caused by a hormonal imbalance, I can help. As a women’s health specialist, I’ve helped hundreds of women achieve lasting relief from their frustrating symptoms.