Understanding Hormonal Imbalances
WHAT IS HORMONAL IMBALANCE
Hormonal imbalance happens when you have too much or too little of a hormone in your body. Oftentimes, more than just one hormone is involved because all your hormones interact and affect one another. The most common hormones to become imbalanced are your sex hormones (estrogen, progesterone, testosterone), cortisol, insulin, and thyroid hormones.
COMMON HORMONAL IMBALANCES: SIGNS & SYMPTOMS
High Estrogen - heavy periods, painful periods, cyclical migraines, acne, uterine fibroids, ovarian cysts, endometriosis, fibrocystic breast disease, breast/uterine/ovarian cancers
Low Estrogen - hot flashes, night sweats, mood changes, vaginal dryness, insomnia, poor memory, headache, heart palpitations, low libido, skipped periods or absence of periods, UTIs, vaginal yeast infections
Low Progesterone
1 week before period till the end of period: anxiety, bloating, water retention, insomnia, acne, mood swings, depression, low libido, headaches, inability to concentrate, joint pain, fatigue, worsening of asthma
Infertility, spotting, short menstrual cycles (<21 days)
High Testosterone In Women - acne, hair thinning along part line and front of head, excess facial hair growth, long menstrual cycles (>35 days), lack of period or ovulation, PCOS, infertility
Low Testosterone
In Women - low libido, lack of motivation, decreased bone density, fatigue, muscle weakness, sleep disturbances, weight gain, vaginal dryness, irregular menses
In Men - fatigue, low libido, erectile dysfunction, lack of motivation, depression, irritability, increased abdominal fat, poor cognition, brain fog, exercise intolerance, inability to gain muscle
Functionally High Cortisol - insomnia, feeling ‘wired & tired’, acne, sugar or carb cravings, weight gain around the abdomen, headaches, high blood pressure, heart palpitations, anxiety, irritability
Functionally Low Cortisol - fatigue, inability to cope with stress, mood changes, sleep disturbances, salt & sugar craving, needing stimulants to get through the day, exercise intolerance, chronic pain, poor memory, panic attacks, hypoglycemia
Functionally High Insulin - often asymptomatic, feeling “hangry”, excess sugar & carb cravings, weight gain especially around the waist, fatigue, brain fog, anxiety, excessive thirst or urination, hunger soon after eating, hunger pangs
High TSH (hypothyroid) - fatigue, constipation, depression, weight gain or difficulty losing weight, poor memory, brain fog, hair loss, dry skin, brittle nails, irregular periods, allergies, exercise intolerance, cold intolerance, sleep apnea, dizziness, goiter
Low TSH (hyperthyroid) - fatigue, anxiety, diarrhea, weight loss or difficulty gaining weight, palpitations, high resting heart rate, heat intolerance, fine tremor, thinning hair, brain fog, dyslexia, mood swings, increase appetite, muscle weakness
HOW TO TEST FOR HORMONAL IMBALANCE
As you can see, determining which hormone is the culprit is not always straightforward. Many hormonal imbalances can have overlapping symptoms. Therefore, hormone testing is very important to help get a clear picture of what your hormones are doing and which direction you should go with treatment. Without hormone testing, you only end up guessing and prolonging the time it takes to feel whole again. So let’s review some testing options.
The two best ways to measure sex hormones are through serum and urine testing. I often recommend getting both serum and urine testing done to make sure nothing is missed. The serum tests I recommend vary depending on the symptoms or conditions being managed. Some common labs include estradiol, progesterone, total testosterone, free testosterone, DHT, DHEA-S, prolactin, luteinizing hormone, follicular stimulating hormone. The other method of testing I use is the DUTCH test. This is a urine test that measures estrogens, progesterone, testosterone, DHEA-S, cortisol, and their metabolites. The DUTCH test is very comprehensive as it only assesses the bioavailable forms of each hormone, provides insight as to which enzyme may need support, and reflects hormone levels over a full 24hr day.
Thyroid hormones are best measured with serum testing. If you suspect you have may hypothyroidism, I recommend having your doctor run the minimum 3 tests: TSH, free T4, anti-TPO. For a more comprehensive evaluation, the following tests can be run: TSH, total T4, total T3, free T4, free T3, anti-TPO, anti-TG, reverse T3. If you suspect you may have hyperthyroidism, I recommend having your doctor run the following tests: TSH, free T4, total T3, anti-TSI, anti-TPO.
If you suspect your adrenals may be the problem, always make sure to get screened with an AM cortisol test to rule out serious conditions like Addison’s disease or Cushing’s syndrome. Once the more serious issues are properly evaluated, you can then do functional cortisol testing. The best way to test for this is through a 4-point salivary cortisol test. This test is helpful for tracking the fluctuations in your cortisol throughout the day. Cortisol is supposed to be the high in the morning and lowest at night, which is why you should feel energized after waking and tired at night. A majority of people, however, have a reverse cortisol pattern, which is a reason why you may want to do this test and see if cortisol is to blame.
The last hormone talked about is insulin. Insulin is a simple blood test that should be performed fasting. Fasting insulin is one of the best markers to determine if you have chronically poor blood sugar control. Ideally, I like to see fasting insulin levels less than 3. If your insulin returns out of range, this could indicate insulin resistance, type 2 diabetes, or an insulinoma.
HOW TO HEAL YOUR HORMONES
Limit Alcohol Use - Alcohol is considered an endocrine disruptor, meaning it interferes with how your body uses its own hormones. Alcohol also damages the gut and liver, both of which are key for metabolizing hormones.
Keep Blood Sugar Levels Stable - This can be achieved by adding healthy protein and fats to each meal and snack. Make sure the carbs you do eat are 100% whole grain and as unprocessed as possible. Additionally, try to keep sugar intake under 24g for women and 36g for men.
Avoid Endocrine Disrupting Chemicals - The most notable and commonly used endocrine disrupting chemical is bisphenol A (BPA). BPA is frequently used in plastic products, as are its cousins BPF and BPS. Even if the product says BPA-free, it could still have BPF, BPS, and other nasty chemicals. Therefore, it is wise to limit plastic use as much as possible.
Here are some healthier swaps to reduce your plastic exposure:
Plastic water bottle → Glass or stainless steel water bottle
Paper receipts → Email receipts
Plastic tupperware → Glass tupperware
Tea bags → Loose leaf tea
Plastic grocery bags → Cloth reusable shopping bags
Additionally, other endocrine disrupting chemicals include phthalates, herbicides, pesticides, fungicides, dioxins, polycyclic aromatic hydrocarbons (PAHs), polybrominated biphenyl ethers (PBDEs), organotins, parabens, alkylphenols, heavy metals, etc.
Manage Stress - It is impossible to rid of all stress that you come across in life, but there are healthy ways to help improve your resilience to stress. Adaptogens and nervines are great options to help calm your nervous system and reduce your flight-or-fight response. My favorite adaptogen is Holy Basil, as it is much more gentle than other adaptogens like Ashwagandha or Ginseng. Always talk to your doctor before starting any new supplement. Other ways to improve stress response include meditation, journaling, grounding exercises, restorative yoga, listening to binaural beats, contrast showers, constitutional hydrotherapy, etc.
Get 7-9 hrs of Restful Sleep - So much regeneration happens during sleep, making it a necessity for hormone health. The catch 22 is that hormonal imbalance can affect your quality of sleep, yet lack of restful sleep can affect proper hormone production. It’s very important for your hormone (and overall) health to address the root causes of poor sleep.
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