by Elizabeth Yuko
We talk about hormones a lot, but do we really know what we’re talking about? Whether we’re referring to an emotional woman as being “hormonal” (hint: Don’t do that), or talking about sex drive or their part in the reproductive process, it’s clear that they play an important role in how our bodies function.
Along the same lines, people seem very concerned by hormonal imbalance. It sounds serious — we need balance, right? — but what does it actually mean? We spoke with several OB-GYNs to find out.
What are hormones?
Before we get into hormonal imbalance, it’s important to talk about what hormones actually are. According to Dr. Patricia Lo, an OB-GYN at MemorialCare Saddleback Medical Center in Laguna Hills, California, hormones are chemical messengers produced by glands in the endocrine system to help coordinate and dictate different body system functions. They also can regulate a whole host of functions, such as metabolism, appetite, sleep, reproductive cycles, sexual function, mood and stress, she tells SheKnows.
How do hormones become imbalanced?
There are many hormones that can affect a person with a uterus’s reproductive function throughout their lifetime — the two primary ones being estrogen and progesterone. The relationships between these hormones are complex, and they naturally fluctuate at different times of our lives, Lo explains, noting that overproduction or underproduction of these hormones can result in hormonal imbalances.
But if you’re picturing a weighing scale with estrogen on one side and progesterone on the other trying to stay balanced, that’s definitely an oversimplification. In fact, Dr. G. Thomas Ruiz, an OB-GYN at Orange Coast Medical Center in Fountain Valley, California, tells SheKnows that he finds the term “hormone imbalance” to be “too generic and technically not accurate.”
He explains that in a normal menstruating person, the first half of the cycle, (called the follicular phase) is dominated by estrogen. Then, the second half of the cycle (called the luteal phase) is dominated by progesterone. “The luteal phase has both estrogen and progesterone,” he notes. “If there is no pregnancy, the egg dies and the corpus luteum stops producing hormones, hormone levels drop to near zero and this triggers a period.”
In addition, Ruiz says that each cycle in itself is unique, with slightly differing hormone levels. People under 40 years of age who ovulate generally have good-quality eggs, making hormone variation from cycle to cycle pretty steady, he explains. However, as the person approaches menopause, the egg quality is less consistent, resulting in more variation in hormone levels, Ruiz says.
“This will lead to perimenopausal vasomotor symptoms or abnormal menses, PMS type symptoms, sleep disturbances and difficulty concentrating,” Ruiz explains. “Generally speaking, one does not need to measure hormone levels because they vary from day to day depending on what day you are in with respect to the cycle.”
Along the same lines, menopause — when a person who menstruates hasn’t had a period for one year — can also be behind hormonal imbalances, Dr. Mary O’Toole, an OB-GYN at Saddleback Medical Center in Laguna Hills, California, tells SheKnows. While the average age for a person to go through menopause is around 51, symptoms may begin as early as 45 or 46, she says.
Polycystic ovarian syndrome
But hormonal imbalances are not limited to those with menopause: They are also related to a condition called polycystic ovarian syndrome.
According to Dr. Yen Tran, an OB-GYN at MemorialCare Medical Group in Fountain Valley, California, when a person has PCOS, their ovaries produce more follicles than usual, which in turn produce higher testosterone levels.
Some of the symptoms associated with a hormonal imbalance because of PCOS include growing hair on the facial area (chin and upper lips), abnormal uterine bleeding or no periods for months or weeks, Tran tells SheKnows. It can also result in obesity, a higher chance of developing diabetes, high blood pressure, infertility and uterine cancer later in life. Treatments for this type of hormonal imbalance include birth control pills, ovarian drilling procedures, laser hair removal (for the unwanted hair) and the drugs spironolactone or metformin, she adds.
“Birth control pills, patches and vaginal rings can help lower testosterone levels and improve excessive hair growth [and] hormonal breakouts,” Lo explains. “Exercise and eating a healthy diet can also help combat insulin resistance associated with PCOS. For women with PCOS who are planning pregnancy, medications such as letrozole or clomiphene citrate may help a woman ovulate.”
Menopause & beyond
People going through menopause transition or menopause may experience symptoms of hormonal imbalance, Lo explains. Estrogen changes during menopause can impact our brain chemicals; for example, decreasing levels of estrogen can trigger hot flashes and night sweats, she says. This can also result in some people experiencing memory problems or feelings of “fogginess” as well as moodiness, feelings of depression, poor sleep quality, decreased sex drive and vaginal dryness, Lo adds.
“The imbalance is going to vary from person to person,” O’Toole explains. “[For] some women, [it] is subtle; for others it can be extreme. The changes that they are experiencing are related to the changes with their estrogen and progesterone.”
According to O’Toole, subtle changes involving these hormones can be detected as early as age 40. “As a woman’s cycle approaches her menses, the estrogen decreases and most of the symptoms of menopause are due to a low estrogen, and this is because as we age, the ovaries release less and less estrogen,” she explains.
Treating hormonal imbalance
When it comes to treating hormonal imbalance, there is no one-size-fits-all option. “In each case, the care and treatment is individual, and this can vary from woman to woman,” O’Toole says, adding that she works with patients to discuss all options, including herbal remedies, acupuncture, hormone replacement and antidepressants.
Hormone therapy can help with treating the symptoms of hormone imbalance, primarily hot flashes and night sweats, Lo explains, noting that there are many well-studied FDA-approved hormone therapy options. When taking hormone therapy, she recommends starting with the lowest dose to prevent side effects.
Ultimately, Lo says it’s best to talk to your OB-GYN about your symptoms to find the best treatment for you, which could include different pills, patches, gels, creams, mists and vaginal rings, among other things.
A healthy diet can also play a role in treating hormonal imbalances, O’Toole says. She recommends getting 1,200 milligrams of calcium and 2,000 IU of vitamin D each day — ideally from your diet. And lastly, she says that counseling can be very helpful for patients whose hormonal imbalance has affected their quality of life.
So, while there’s no quick and easy fix for hormonal imbalance, there are several options out there to discuss with your doctor in order to determine which is best for you.