From acne and menstrual cramps to hot flashes and mood swings, for women, it can feel like we’re victims of hormone imbalance from middle school through middle age. Puberty launches us into a 30-40 year period of cycling and shifting hormone levels, which for some, feels more like a curse than a blessing. If hormones are out of whack, symptoms such as acne, mood swings, painful periods, temperature changes, sleep disturbances and weight gain can take control of our lives. However, if we’re armed with the right knowledge and support, hormones can be magical instead of miserable. This article is dedicated to sharing information that all women deserve to have, so they can take control of their hormone health and live well.
Hormone 101 – What is a hormone?
Hormones are molecules that your endocrine organs produce to send messages around your body. These chemical molecules can only attach to receptors on certain cells, where they attach and direct the cell to act. Think of them as emails looking for the right inbox.
While the word “hormone” is often used to refer to the sex hormones; estrogen, testosterone and progesterone, we also produce hormones that regulate hunger, body temperature, glucose metabolism, blood pressure, circadian rhythm, stress response, and more.
Hormones-secreting endocrine glands are located all over the body and include organs such as adrenals, ovaries, testes, thyroid, pancreas, parathyroid, pineal, pituitary and hypothalamus. While all hormones need to be balanced for good health, for the purpose of this article, we are going to focus on the three major sex hormones; estrogen, testosterone and progesterone.
What are symptoms of hormone imbalance?
Imbalanced hormones or an impaired endocrine system cause any of the following signs or symptoms:
- Weight gain or sudden weight loss
- Muscle weakness
- Hump of fat between the upper shoulder blades
- Acne, dry skin, red or purple stretch marks, or skin tags
- Hair loss or hair growth in unexpected places
- Muscle and aches and stiffness or trigger points
- Joint pain
- Temperature changes or increased sweating
- Constipation or loose stool
- Changes in heart rate
- Frequent urination
- Mood changes including depression, anxiety and panic attacks
- Increased or decreased hunger or thirst
- Changes in sex drive
- Water retention, bloating and puffiness
- Rounded face
What are the most common causes of hormone imbalance?
Hormones are constantly shifting. There are periods of life, when hormone levels change more dramatically such as puberty, pregnancy and menopause, but in reality, our hormones are shifting everyday throughout the monthly menstrual cycle (often referred to as the Infradian rhythm).
This means that there is a constant dance going on between estrogen, progesterone and testosterone as those hormones guide us through our reproductive years. And while we have come to accept hormone symptoms as “normal”, the truth is that if our hormones are balanced, we should not experience symptoms around ovulation, menstruation or menopause.
In fact, those symptoms are a sign that our hormone levels need support. Addressing these common causes of hormone imbalance can turn things around.
Just like we’ve normalized hormone symptoms, we’ve also come to accept stress as a part of life. That doesn’t mean our bodies will perform well under the constant pressure of daily life. Because our hormone levels vary throughout our monthly cycle, stress affects us differently depending on where we are in our cycle or if we are pregnant, in puberty or going through perimenopause and menopause. Research has shown that when we experience stress, there is virtually no change in estrogen, but progesterone and cortisol spike. This response leads to “hormone” symptoms because the balance of estrogen and progesterone is now out of sync.
Stress also downregulates hormone production. Your amazing body has feedback loops that help balance hormones by sensing when there is too much or too little of a hormone so it can produce less or more. Turns out that when your body is producing increased levels of cortisol to respond to stress, there is a downregulation of the precursor hormone to cortisol, called DHEA. DHEA can be converted to cortisol or to estrogen or testosterone. When DHEA, produced in the adrenal glands, is downregulated due to excess cortisol, your body may not produce enough estrogen or testosterone either.
So, what do we do about stress?
If you suspect that chronic or acute stress is a factor in your hormone balance, take steps to reduce cortisol levels. This does not mean that stress triggers go away (you may not be able to quit your job or stop going to school), it means you teach your body to respond differently to those triggers. Here are cortisol-reducing behaviors:
- Avoid overwhelm and take things off your plate if you can. Assess the biggest sources of stress in your life and be honest about whether you can affect them. If so, start purging.
- Resource your body with good sleep, balanced nutrition and regular exercise which will lower overall cortisol production.
- Avoid caffeine; stimulants increase cortisol.
- Practice breathing in and out through your nose for a count of 6 seconds both ways. This practice signals safety to your nervous system which translates to less cortisol.
Assess your self-care practices. What do you do to move your body into a state of “rest and digest” everyday? By creating small habits around self-care and relaxation, you’re giving your body a chance to regulate hormones away from stress response and towards healing and balance.
Nutrition is critical to hormone health. The biggest factors are:
- High-sugar diets which lead to insulin imbalance which increase fat storage, cortisol spikes and estrogen production.
- Low-calorie diets, which reduce hormone production.
- Poor quality food, which causes micronutrient deficiency.
- Eating infrequently, which increases cortisol and fat storage.
- Low fiber diets, which increased risk of excess estrogen (sometimes referred to as estrogen dominance).
Dialing in nutrition is probably the most effective way to balance hormones because it affects sleep, stress, microbiome, metabolism, detox and more. A healthy hormone diet means:
- Eating regular meals that contain healthy fat, vegetables, fiber, adequate protein and slow-burning carbs
- Avoiding refined sugar
- Moderating alcohol
- Avoiding food within 4 hours of bedtime
- Eating breakfast (intermittent fasting is usually not helpful for women in childbearing years)
- Avoiding processed foods
- Avoiding inflammatory foods and food sensitivities
The microbiome (over 100 trillion bacteria, virus, fungi, and protozoa living in your gut) affects countless hormone functions throughout the body and has been referred to as the “neglected endocrine organ”. In fact, the bugs in your gut are affecting everything from your stress response, to metabolism, mood and PMS.
It’s easy to underestimate the power of the microbiome, but consider this example of how essential a healthy microbiome is: some microbes produce a byproduct called beta-glucuronidase, an enzyme that prevents the liver from breaking down estrogen. This leads to a back-up of estrogen in the body and symptoms associated with estrogen dominance. That is just one of the countless ways an imbalanced biome can impact your hormone symptoms.
A healthy microbiome supports balanced hormones. Follow these steps for a better biome:
- Eat a whole food diet with 8 serving of plants each day
- Avoid sugar, which feeds unhealthy microbes
- Avoid alcohol, which feeds unhealthy microbes
- Make sure you’re having at least one healthy bowel movement per day
- Consider probiotics such as Biocodex Florastor Max or Xymogen ProbioMax
- Eat 20g soluble fiber per day to provide food for your healthy microbes
Sleep quality is largely affected not only by the menstrual cycle, but more commonly as our bodies transition through perimenopause and menopause. In the first half of our menstrual cycle (the follicular phase), progesterone and estrogen levels are fairly low until just before ovulation. Sleep is often reported to be better during this phase in comparison to the luteal phase. The luteal phase occurs after ovulation, when body temperature is higher and melatonin production is lower.
Lowest sleep quality is reported just before menses when hormones drop to their lowest levels. Even more interesting is that disruptions in the circadian rhythm and inconsistent sleep are correlated with menstrual problems with increasing evidence pointing to poor sleep quality as a risk factor for developing breast cancer, mood disorders and menstrual disorders.
So, if our fluctuating hormones can reduce our sleep quality and poor sleep quality can negatively impact our hormone balance, where do we break the cycle? The answer is, start with sleep. Reboot your sleep routine by following these steps:
- Go to bed and wake up at the same time every day.
- Keep your bedroom cool and dark
- Use white noise, if needed, to block out disruptive sound
- Do not drink alcohol
- Do not eat within 4 hours of bedtime
- Use 3-6mg time-released melatonin
- Meditate, deep breath or pray before bedtime
- Do directly outside for natural light upon waking each morning or use a natural light bulb to induce wakefulness.
Poor sleep is commonly associated with perimenopause and postmenopause due to decreases in progesterone. If these steps do not lead to significantly better sleep, progesterone therapy can be a safe and effective way to improve sleep and should be discussed with your provider.
In recent years, researchers have discovered that the gut may have more to do with hormones that we once thought. We’ve long known that an imbalanced immune system and increased inflammation can negatively impact hormones due to increased inflammatory molecules that damage hormone-producing glands.
However, newer studies reveal a bidirectional relationship where estrogen-producing sites, found in the gut tissue, can impact the GALT (gut associated lymphoid tissue), therefore impacting overall immunity and inflammatory function. And, any Inflammation in the gut can negatively affect hormone production. Gut symptoms can be a clue to explain why your hormones are out of balance. If you experience symptoms below, your hormones are at risk. Addressing this with a trained healthcare provider can not only improve gut health, but hormone health as well.
- Acid reflux
- Gut pain
Liver function and detox
Before we can understand the importance of the gut, we have to back up and remember that the liver is in charge of metabolizing hormones. As hormones are produced by endocrine glands, they build up in the bloodstream and this excess is referred to as “endotoxins,” or toxins created by your own body.
Your liver metabolizes excess hormones and prepares them to leave the body by attaching them to bile molecules and sending them to your holding tank, the gallbladder. This is where the gut comes in.
Hormone-carrying bile is secreted into the gut where it has two fates; it will either help you absorb dietary fat, in which case the hormone-bile molecule is reabsorbed into your bloodstream. Or bile will attach to soluble fiber in your food and be carried into your colon and then your toilet. The more soluble fiber you eat, the better you excrete excess hormones.
Hormone balance checklist
If you have symptoms of hormone imbalance, focus on this checklist:
- Eat a whole food diet rich in plants and prebiotic fibers
- Avoid toxins and alcohol that reduce digestion, liver and gut function
- Utilize probiotics to support microbiome health
- Eat slowly and in a low-stress environment
- Drink plenty of water
- Avoid food sensitivities that irritate gut-immune function
- Reduce or eliminating refined sugars
- Consume an average of 20 grams of soluble fiber daily
- Get 7-9 hours of good quality sleep
- Exercise for at least 30 minutes 5 days a week
- Create a practice to lower stress response
If you’re already practicing these habits or are interested in balancing hormones with hormone replacement therapy, you can learn more about the safe and effective approach using natural hormones.
About Megan Barnett, MS
Megan Barnett is a functional medicine practitioner in Portland, Oregon. In her clinical practice, she helps patients identify the root cause of their health problems, then designs individualized and evidence-based approaches to alleviate symptoms and help their bodies heal. She has a Bachelor of Science in Dietetics from Kansas State University and a Master of Science in Nutrition and Functional Medicine from University of Western States.