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Simple Solutions for Hormonal Imbalance in Women

Written by Dr. Michael Ruscio, DC on January 14, 2021

Written by Dr. Michael Ruscio, DC on January 14, 2021 — Reviewed by Heidi Turner

Addressing PMS, Perimenopause, and Menopause Naturally

• Signs and Symptoms|
• Normal Hormone Levels|
• Menstruation|
• Perimenopause|
• Menopause|
• Hormone Imbalance|
• Estrogen|
• Progesterone|
• Androgens|
• Thyroid|
• Causes|
• Gut-Hormone Connection|
• Stress-Hormone Connection|
• Rebalancing Hormones|
• Digestion, Blood Sugar, Gut Health|
• Stress|
• Herbs|
• Bottom Line|

If you’re a woman with hormonal trouble, you’re not alone. It’s estimated that 80% of women will have some form of hormonal imbalance at some point in their lives [1]. Hormonal imbalance in women can include garden variety women’s health problems like PMS, to more serious conditions like PCOS (polycystic ovarian syndrome) or endometriosis. 

In this article, let’s explore the symptoms of hormonal imbalance, the causes and consequences of hormonal imbalance in women, and how to restore balance.

Signs and Symptoms of Hormonal Imbalance

Hormonal imbalance isn’t just about periods and PMS. The most common symptoms are those having to do with the menstrual cycle, fertility, or menopause. These include mood swings or irritability, cramps, digestive symptoms like constipation or diarrhea, cravings, difficulty getting pregnant, hot flashes, or insomnia. But hormones are also a possible culprit for many other symptoms and conditions, including thyroid disorders.

If you are experiencing many of these signs and symptoms together, chances are you have some kind of hormonal imbalance.

What Are Normal Hormone Levels for Women?

If we’re going to discuss hormonal imbalance, we have to start with some idea of what’s normal. Your normal sex hormone levels depend on which stage of life or what phase of your menstrual cycle you are in. There are three main hormonal states throughout a woman’s life:

• Reproductive phase
• Perimenopause phase
• Menopause phase

Each of these stages has normal levels of various hormones, which fluctuate from time to time. Let’s consider each stage and what normal levels of hormones look like in each stage.

Menstruation (Reproductive) Phase

Around the age of 12, women begin having monthly periods, indicating that their bodies can bear children. These periods, called menstruation, reflect a normal monthly fluctuation of hormones, including estrogen, progesterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). 

Under the direction of the pituitary gland, these hormones rise and fall throughout each month. This triggers the ovaries to release an egg (ovulation), followed approximately 14 days later by a period, or a pregnancy. 

Menstruation generally continues monthly throughout the reproductive years of a woman’s life unless she becomes pregnant or experiences high levels of stress or severe nutritional deficiencies.

Normal serum lab reference range levels of estrogen can vary widely during the phases of your monthly cycle, from 15 to 350 pg/mL [2]. Progesterone levels also vary during each monthly cycle, between 0.89 ng/mL and 24 ng/mL [3].

Perimenopause Phase

Sometime around the late 30s to early 40s, these monthly hormone cycles begin to wane. Menstrual cycles may become slightly shorter or longer, and premenstrual symptoms may intensify. These changes happen as levels of estrogen and progesterone begin to decrease. Many perimenopause symptoms are a result of changing ratios of estrogen and progesterone. Perimenopause continues until you begin to skip periods.

Normal reference ranges for estrogen and progesterone during perimenopause are similar to those during the menstruation phase of life but may be more erratic or less consistent. Perimenopause typically begins in the late 30s or early 40s and continues until approximately age 50 or 55, when menopause begins.

Menopause Phase

Once you begin to skip periods or experience much greater lengths of time between cycles, you are going through the menopause phase. Menopause is complete when your periods cease for 12 months [4].

Completing the process of menopause often comes with a number of symptoms, including frequent hot flashes, night sweats, vaginal dryness, weight gain around the middle, and increased mood swings [5].

Once menopause is completed, estrogen and progesterone levels are far lower than they were during your menstruation phase of life. The normal serum reference range for estrogen post menopause is less than 10 pg/mL [2] and less than or equal to 0.20 ng/mL for progesterone [3].

Hormone Imbalance in Women

Sex hormone imbalances can be a result of deficiencies or excesses of particular hormones or the wrong ratios of certain hormones. 

Estrogen

Estrogen is responsible for your female sex characteristics and your reproductive function [6]. It influences your uterine lining, ovulation, menstruation [7], and breastfeeding [4].

Estrogen also plays other important roles in women’s health. Estrogen: 

• Decreases stress [5] 
• Regulates cholesterol and triglycerides, so reduces cardiovascular disease risk [5] 
• Supports bone health [5]
• Increases leptin, the hormone that provides a feeling of satiety [4]
• May regulate intestinal permeability [8, 9].

Many common hormonal imbalances are caused by “estrogen dominance,” which is an excess of estrogen relative to progesterone. This includes perimenopause symptoms such as headaches, mood swings, and increased bloating, reproductive cancers, infertility, and PCOS [10]. A woman can have both low estrogen levels and estrogen dominance. 

Estrogen deficiency can cause symptoms too. Mood-related premenstrual symptoms are often the result of fluctuating estrogen levels [7]. As you enter perimenopause and menopause, estrogen levels fall, leading to common menopausal symptoms [5]. Low levels of estrogen are also linked to increased abdominal fat, obesity, and metabolic syndromes [11].

Progesterone

Progesterone is a counterbalance to estrogen and also plays a key role in menstruation. It helps prepare the lining of your uterus to support a fertilized egg each month. If no egg arrives, progesterone levels fall, triggering a menstrual period [12]. Progesterone also helps balance your nervous system [12].

As women begin to ovulate less frequently and transition to perimenopause, progesterone levels begin to fall. This natural decrease of progesterone is one of the causes of perimenopause symptoms such as irritability, mood swings, and insomnia [13, 14]. It is also one of the causes of estrogen dominance.

Androgens (‘Male’ Hormones)

Though androgens are generally thought of as male hormones, women need them too, though in smaller amounts. The androgen hormones testosterone and DHEA (the precursor to testosterone) are responsible for sex drive, motivation, and play a role in female fertility [12]. Low levels of androgens can cause low libido. 

Excess androgen levels can cause excess unwanted hair growth, acne, oily hair, menstrual irregularities, male characteristics (like a deep voice), and polycystic ovarian syndrome (PCOS) [15]. Keeping testosterone levels balanced is just as important for women as for men.

Thyroid Hormones

Though not sex hormones, thyroid hormones are worth mentioning, because the vast majority of thyroid patients are women [16, 17]. Thyroid hormones are used by every cell in the body. They not only help regulate body temperature, energy production, digestive function, body weight, and nervous system function, but thyroid hormones have a direct effect on fertility [4]. An underactive thyroid gland (hypothyroidism) or overactive thyroid (hyperthyroidism) can cause symptoms, including insomnia, depression and anxiety, weight gain, and digestive symptoms. 

Causes of Hormonal Imbalance in Women

The two most common causes of hormonal imbalance in women are gut imbalances and stress. Let’s explore how gut conditions and stress can affect hormones.

The Gut-Hormone Connection

If you’ve experienced an increase in symptoms like constipation or diarrhea with the shifting tides of the menstrual cycle, you’re not alone. Research suggests that gut health affects hormonal health and vice versa.

The three primary sex hormones — estrogen, progesterone, and testosterone — are all made from dietary cholesterol, a dietary fat [6, 12, 15]. If your fat digestion is compromised by gut inflammation, poor gallbladder, or pancreatic function, or if you eat a diet too low in fat, you may have trouble producing enough hormones.  

Epidemiological studies show that twice as many women as men have IBS in the West, which suggests sex hormones play a role in digestive health [18]. Researchers have proposed that levels of estrogen and progesterone impact gut motility [19], abdominal pain or bloating [20] and may be an underlying cause of IBS [18].

Estrogen and progesterone levels have also been implicated in fluctuating levels of intestinal permeability (leaky gut) [8, 9] and gut bacteria populations [21, 22, 23, 24] at different stages of the menstrual cycle or pregnancy.

There is some early evidence to suggest that the gut microbiome plays a key role in the detoxification and metabolism of hormones, particularly estrogen [24, 25]. Gut bacteria produce an enzyme called beta-glucoronidase, which breaks estrogens down into their active forms [24]. Gut dysbiosis may impair this normal process, and lead to estrogen dominance, or other estrogen-related conditions. 

Additionally, hormone-related health conditions such as PCOS, obesity, endometriosis, cardiovascular disease, and breast cancer are associated with low bacterial diversity in the digestive tract [26]. All of this strongly suggests that there is a two-way relationship between gut and hormone health and that improving gut health can improve your hormone symptoms.

The Stress-Hormone Connection

Hormones are quite sensitive to the effects of stress. If your body were an orchestra, the hypothalamus and pituitary gland (two small endocrine organs near the brain), would be the conductor, telling all your various parts what to do and when. Constant stress can derail sex hormone levels by disrupting the function of the hypothalamus and the pituitary gland, thereby disrupting your digestion and sex hormone production [27].

Additionally, sex hormones, including estrogen, progesterone, and testosterone are partly made by the adrenal glands [5, 12, 15]. Constant stress levels may rob the raw materials your body would use for sex hormones to produce stress hormones.

This is true whether your stress is from external factors, like a job you don’t like, or internal stressors, like frequent blood sugar fluctuations or gut infections and inflammation.

Balancing stress is a key strategy for improving hormonal imbalance.

Rebalancing Female Hormones

Even though your endocrine system is complex, correcting hormonal imbalance is relatively easy. Focus on nudging your hormones into balance by:

• Improving your gut health
• Reducing stress
• Taking well-studied herbal remedies

The conventional medical advice for balancing female hormones is most often birth control pills or hormone replacement therapy (HRT), which can come with unwanted side effects or health risks. Most of this overcomplicates the matter and doesn’t address the real cause of hormonal imbalances. Natural solutions for hormonal imbalance are simple and effective.

Optimize Digestion, Blood Sugar, and Gut Health

Optimizing your digestion, blood sugar, and gut microbiome can pay big dividends for your hormonal health. Here are two ways to support your gut and hormonal health:

1. Optimize Your Diet

Your diet has a huge effect on your blood sugar, inflammation, and gut microbiome. The Paleo Diet [28, 29, 30, 31] or the low FODMAP diet [32, 33] are diets that can reduce gut inflammation, support a healthy microbiome, and improve your hormonal health. The Paleo diet is the simplest place to start. If it doesn’t resolve symptoms, you can try the low FODMAP diet instead. 

And because hormones are built from dietary fats, making sure to include healthy fats, such as olive oil, avocado oil, coconut oil, and butter is important to maintain your hormones.

2. Optimize Your Gut Health With Probiotics and Enzymes

Because your hormones are heavily influenced by your gut health, encouraging healthy digestion is a key strategy to restoring hormonal balance.

Probiotics are powerful agents to reduce gut inflammation and rebalance the gut microbiome. There isn’t yet much research specifically showing improvements to hormonal imbalance by using probiotics, but probiotics were shown in one meta-analysis to improve hormonal and inflammatory markers in women with PCOS [34]. Probiotics have certainly been shown to reduce many of the digestive symptoms women experience with their hormones, such as diarrhea [35, 36, 37], constipation [38, 39], and abdominal pain and bloating [40, 41, 42].

Optimizing your gut health with probiotics is as simple as including one quality probiotic from each of the main categories: Lactobacillus and Bifidobacteria blends, Saccharomyces boulardii (a beneficial yeast), and a soil-based probiotic blend. Research suggests that using multiple types of probiotics together provides better results [39, 43].

And because adequate dietary fat is required to produce hormones, optimizing fat digestion with a digestive enzyme that contains lipase (the enzyme that supports fat digestion) may support hormonal health.

Balance Stress

Getting your stress under control is key to balancing your hormones. Reducing stress can include things like therapy, relaxation techniques, exercise, unplugging periodically, or doing things you love. Find something you love that you can do sustainably, and get committed to it. 

And though it may not seem like blood sugar has anything to do with it, frequently fluctuating blood sugar levels are perceived by your body as stress, as can over exercising. Make sure your eating and exercise habits support your health.

Balancing Hormones with Herbs

Often, all that’s needed to rebalance your hormones are some herbs that have good evidence behind them to gently nudge your endocrine system into balance, along with attention to your diet and your stress. 

For example, a combination of gamma oryzanol, black cohosh, dong quai, licorice root, and trans-resveratrol can balance estrogen levels and has been shown to:

• Improve hot flashes, night sweats, and quality of sleep [44, 45, 46, 47, 48]
• Reduce total cholesterol, triglycerides and increases HDL-cholesterol in menopausal women [44, 49]
• Have cardioprotective benefits [50]
• Reduce pain and improves total well-being [51]
• Improve mood and cognitive function [52]

A combination of licorice root, white peony, and chaste tree berry (vitex) has been shown to:

• Regulate menstrual cycles in women with absent or infrequent periods [53]
• Alleviate PMS symptoms [54, 55]
• Help with the treatment of PMS and PMS mood disorders [56]
• Improve symptoms for women with Polycystic Ovarian Syndrome (PCOS) [57]
• Alleviate menopausal symptoms and hot flashes [45, 58]

Very often, gently encouraging the hormonal system to rebalance with health-affirming action is all that’s needed to improve hormonal imbalance.

The Bottom Line

No woman needs to be a prisoner of hormonal imbalance. Though hormone symptoms can make life miserable, they are relatively easy to rebalance with some simple attention to eating a healthy, anti-inflammatory diet, encouraging a healthy gut microbiome, and managing your stress. You can also nudge your hormones toward health with the tried and tested herbal formulas.

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