Dr. Shilpy Bhandari 23 Dec 2020

Hormones are chemical messengers, synthesized by specific organs and carried through the bloodstream to the target organs where they cause changes in structural and functional. Hormones are essential for growth, reproduction, maintaining body temperature, and performing essential body functions. 

Hormones play an important role in maintaining the health of women. Any fluctuations observed in the hormone levels (e.g., estrogen, progesterone, insulin, adrenaline, and testosterone) may negatively impact the mood, sexual desire, fertility, and ovulation in females. Women are more prone to hormonal imbalances than men. The variation in hormone secretion becomes more prominent during menstruation, pregnancy, and menopause.

Here are some of the signs that can help identify hormonal imbalances in women:

  • Irregular menstrual cycle: It includes a menstrual cycle that occurs in less than 21 days or more than 35 days continuously in a row for 3-4 months. The flow is usually heavier or lighter than the normal times. This is mainly due to low estrogen and decreased thyroid hormone production (hypothyroidism) in the body.
  • Mood swings or depression: Reduced levels of estrogen in the body may affect the serotonin concentration (neurotransmitter, also known as happy hormone), resulting in mood swings, anxiety, and depression. Elevated cortisol levels and decreased thyroid production can also lead to depression.
  • Weight gain: The thyroid hormone regulates the basic metabolic rate in the body. Any decrease in thyroid hormone production results in weight gain. An increase in estrogen levels also causes weight gain. Stress can drive an increase in the level of cortisol hormones causing food cravings and a reduction in the action of thyroid hormone, resulting in weight gain.
  • Headaches and migraines: Decreased levels of estrogen in the body can lower the levels of serotonin which causes headaches and migraines.
  • Acne on the face or back: Fluctuation in the levels of testosterone, estrogen, and progesterone can cause overproduction of sebum, responsible for acne formation.
  • Low libido: A drop in the levels of estrogen, progesterone, and testosterone lower libido in females.
  • Memory fog (inability to concentrate or have a sharp memory): Estrogen affects the brain and memory. It has a neuroprotective effect. Inadequate levels of estrogen increase the risk of developing Alzheimer’s disease. An increase in the levels of cortisol hormone in the body during stress or trauma may also result in loss of memory.
  • Dizziness or sleep disorders: Disturbance in sleep or inability to sleep is directly linked to decreased estrogen levels in the body. The presence of mild hypothyroidism is associated with decreased progesterone production resulting in disturbed sleep.
  • Excess hair growth on the face, chin, or other parts of the body: Increased production of testosterone causes excess hair growth on the face, chin, and other parts of the body.
  • Infertility: Polycystic ovary syndrome is a common cause of infertility. Ovaries are sensitive to insulin levels in the body. In case of an imbalance in insulin levels, ovaries try to compensate for the imbalance by increasing the production of estrogen and progesterone, resulting in disturbance in the metabolic process. This may lead to infertility, acne, and facial hair growth.
  • Bowel discomfort: Disturbance in the levels of estrogen and progesterone hormones may lead to bloating, abdominal pain, cramping, backache, constipation, or diarrhea.
  • Menopausal symptoms: Menopausal symptoms such as hot flushes, night sweats, vaginal dryness, and tenderness of breasts may be observed due to low levels of estrogen in the body.

Causes of hormonal imbalance:

Hormonal imbalance may be caused by a combination of several factors:

  • Intake of excess saturated fats, refined sugars, processed foods, and carbohydrates
  • Intake of xenobiotics, antibiotics, and hormones (e.g., estrogen) in food from commercially-available animal products (meat and dairy)
  • Toxicity (Due to exposure to high levels of harmful chemicals, pesticides, toxins, cigarettes, alcohol, and pollution)
  • Lifestyle factors (e.g., poor diet, lack of exercise, sedentary lifestyle, obesity)
  • Intake of birth control pills and hormone replacement therapy
  • Stress, lack of sleep, or inadequate rest
  • Genetic susceptibility
  • Underlying medical conditions (e.g., PCOS, diabetes, hypothyroidism, hyperthyroidism, adrenal fatigue, pituitary tumors)

Factors such as intake of environmental toxins (e.g., pesticides and insecticides), alcohol, xenobiotics, and dairy products with estrogenic substance increase females’ susceptibility to environmental estrogens which increase estrogen levels in the blood. This is also associated with an increased risk of developing breast cancer.

Hormone-led medical conditions and impact:

Below are some hormone-led medical conditions and associated impact:

  • Polycystic Ovarian Syndrome (PCOS): It causes Infertility, weight gain, higher risk for diabetes, acne, and abnormal hair growth.
  • High estrogen: It causes a change in sleep patterns, changes in weight, appetite, and increased stress levels.
  • Low estrogen: It leads to low sex drive, reproductive problems, irregular menstrual cycle, and mood changes. Other symptoms include vaginal dryness, hot flashes, tenderness of the breast, fatigue, and decreased bone density.
  • Hypothyroidism: It results in slow metabolism, weight gain, fatigue, anxiety, and irregular periods.
  • Low testosterone: It causes reduced libido, muscle loss, weight gain, fatigue, mood swings, and depression.
  • Hyperthyroidism: It leads to anxiety, hair loss, weight loss, disturbed sleep, and irregular heartbeats.
  • Diabetes: It results in weight gain, nerve damage, vision loss, fatigue, dry mouth, and skin problems.
  • Adrenal Fatigue: It causes nervousness, fatigue, muscle aches, anxiety, depression, disturbed sleep, weight gain, memory loss, and reproductive problems.


  • Medical history and physical examination: These comprise a discussion with the doctor about the chief complaint, frequency, duration of symptoms, and intake of medications (if any). This helps the doctor understand the condition better.
  • Laboratory investigations: Urine and blood tests are recommended to assess the levels of hormones in the body. Below are some of the blood tests recommended.
    • Complete blood picture
    • Fasting blood sugar, postprandial blood sugar, and HbA1c
    • TSH, free T4, free T3, thyroid peroxidase antibodies
    • FSH, LH, estradiol, progesterone, free testosterone, cortisols
    • 24-hour urine for estrogen metabolism
    • 2-OH:16α-OH estrogen ratios
  • Radiographic examination: Ultrasounds, MRI (Magnetic Resonance Imaging), or CT (Computed tomography) scans of the pelvis may be recommended to check for presence of lesions.
  • Histological examination: PAP smear test may be recommended to rule out the presence of cervical cancer.


General recommendations:

  • Diet modifications:
    • An increase in the intake of supplements such as multivitamins, minerals, probiotics, and omega- 3 fatty acids help in the regulation of hormonal release.
  • Increase in intake of dietary fiber (e.g., flax seeds, the bran layer of grains, beans, and seeds).
  • Inclusion of organic food to avoid intake of xenoestrogens, hormones, and antibiotics.
  • Reduction in intake of processed food, refined sugars, excess of carbohydrates, meat, and dairy products to lower the sugar levels and adverse effects on estrogen and progesterone.
  • Lifestyle changes:
    • Avoid a sedentary lifestyle. Exercise every day
    • Minimize stress
    • Lose weight
    • Take adequate sleep

Specific recommendations:

  • Hormone replacement therapy (e.g., Estrogen/progesterone hormone therapy): In case of deficiency of hormones, the doctor may recommend supplementation of hormones.
  • Hormonal birth control (birth control pill, intrauterine device): It helps to regulate the menstrual cycle.
  • Additional therapy: Testosterone therapy and metformin medication are advised in some to regulate the hormonal imbalance.

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About the Author:
Dr. Shilpy Bhandari is an experienced dental surgeon, with specialization in periodontics and implantology. She received her graduate and postgraduate education from Rajiv Gandhi University of Health Sciences in India. Besides her private practice, she enjoys writing on medical topics. She is also interested in evidence-based academic writing and has published several articles in international journals.


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