Common signs and symptoms of female hormone imbalance include appetite changes, weight gain (or difficulty with weight loss), pain, low energy, altered digestive function, mood changes, abnormal periods, low sex drive, body temperature fluctuations, fertility issues, and skin/hair changes.
Lifestyle treatments, including diet, restful sleep, herbal supplements, probiotics, exercise, and stress management, are effective ways of balancing female hormones in menstruating and menopausal women.
Combination herbal supplement preparations seem to be more effective when compared to single herbal supplements for balancing hormones.
Good gut health may stabilize your hormone levels and in turn help to reduce symptoms related to hormonal fluctuations.
If you’re struggling with your appetite and energy, unexplained weight gain, mood changes, digestive distress, and low sex drive, you’re not alone. Many women (and men) experience the symptoms of hormonal imbalance at some point in their lives.
There are many different tests, programs, and products promising to teach you how to balance hormones. Since the main contributors to hormone harmony are diet, gut health, and lifestyle, our simple, comprehensive approach is not only effective, but also a cost-efficient way to address hormone imbalances.
We’ll start with the foundation, which is a whole-foods, anti-inflammatory meal plan, followed by probiotics to target gut health. Sleep, stress, and exercise are additional priorities, so we’ll use yoga, meditation, and walking in nature to help target the root causes of your symptoms.
In this article, we’ll break down the signs and symptoms of common female hormonal imbalances along with their causes. We’ll also dive into the best natural remedies and approaches for balancing hormones, and touch on hormone testing.
Female Hormone Imbalance: Signs, Symptoms, and Causes
Female hormonal imbalances likely develop from a combination of factors. Many of these are modifiable, such as diet, metabolic health, smoking, alcohol use, chronic inflammation, hormone replacement (like birth control pills), and stress. Often, hormone imbalances occur as a result of gut health imbalances that you may not be aware of. Other causes can include a past history of trauma or growths that are benign or cancerous.
How to Balance Hormones Naturally
While it may be tempting to jump to the latest fad to regulate your hormones, targeting the gut and getting back to the basic pillars of health can provide much relief for both menstruating and menopausal women. In the clinic, we approach female hormonal imbalance with diet, sleep, exercise, stress reduction, probiotics, and targeted supplementation. Let’s take a look at each of these natural ways to balance hormones.
1. How to Balance Hormones With Diet
A whole-foods, anti-inflammatory diet that includes healthy fat can support healthy hormone production by optimizing digestive health, ensuring sufficient micronutrient levels and regulating blood sugar levels. Of course, the diet needs to be personalized and you should avoid any foods you’re sensitive to, even if they’re considered healthy.
An anti-inflammatory diet significantly limits refined grains, sugar, processed foods, and inflammatory fats and generally includes:
Dairy products (as long as you’re not dairy sensitive)
High quality research has found that women who consume higher amounts of fruits, vegetables, and milk and dairy products may have less pain associated with menstruation [4 Trusted SourcePubMedGo to source]. And a study of 100 nurses with PMS found a significant drop in PMS symptoms when at least four daily servings of refined grains were replaced with whole grains, compared to controls [5 Trusted SourcePubMedGo to source].
While we’ve been told for years that dietary fat is bad for us, it’s actually a critically important nutrient.
One study found a diet high in saturated fats was associated with menstrual pain, while a low-fat diet was associated with significantly less menstrual pain. But this doesn’t equate to avoiding all fats; choosing healthy fats can promote healthy hormone production and alleviate the symptoms associated with hormonal imbalance [4 Trusted SourcePubMedGo to source].
It’s a good idea to include healthy fat with every meal and snack to promote healthy hormone production, balance blood sugar levels, and maintain an optimal omega-3 index (the proportion of EPA and DHA in red blood cells) above 8% . Some great options include:
Olives or extra virgin olive oil
Avocado or avocado oil
Flaxseed or flaxseed oil
Fatty fish (salmon, tuna, mackerel)
A large systematic review found that alcohol intake, especially heavy alcohol intake, increases the risk for PMS [10 Trusted SourcePubMedGo to source]. And too much alcohol may make PMS symptoms worse — as does smoking [3 Trusted SourcePubMedGo to source] — so it’s important to balance the risks versus benefits. While the occasional drink isn’t associated with adverse issues, those consuming more than 25 grams per day (about 1.5 glasses of wine) have increased health risks [11 Trusted SourcePubMedGo to source].
Since women can lose iron with each menstrual cycle and those with heavy cycles are at risk of significant iron loss, consuming iron-rich foods is a good idea to restore iron levels and to prevent anemia. Iron from animal sources is much more easily absorbed, so adding in red meat (especially liver and organ meats) is a great option. Other iron sources include:
Fish and seafood
Legumes (lentils and chickpeas)
Women with PCOS may benefit from zinc supplementation:
Since they tend to have lower circulating zinc levels when compared to healthy controls, zinc supplements may help with hair loss and excessive facial and body hair [18 Trusted SourcePubMedGo to source].
One randomized controlled trial found PCOS patients who took supplemental zinc and magnesium oxide for 12 weeks had significant reductions in markers of inflammation and oxidative stress when compared to placebo [20 Trusted SourcePubMedGo to source].
In most cases, a well-balanced diet will provide adequate levels of micronutrients. If you’re eating a healthy diet, yet struggle with micronutrient deficiency, it may indicate a problem with absorption, which is often caused by poor gut health. Restoring gut health to improve absorption should be prioritized above supplementation.
2. How to Balance Hormones With Sleep
Restful sleep is foundational for overall health, but is also important when you’re experiencing the symptoms of hormonal imbalance. Menopausal symptoms can include restless leg syndrome, hot flashes, night sweats, and breathing disorders, which can significantly impact sleep and quality of life.
A healthy sleep routine is the first place to start, so consider going to bed and waking at the same time each day, and sleeping in a dark, cold, and quiet environment. In addition, limit screen time before bed.
Additional tips for supporting healthy sleep for women with hormone imbalances include:
Yoga: One 2019 randomized controlled trial found yoga three times per week over the course of 10 weeks reduced sleep disturbances and improved overall sleep quality in women with PMS [21 Trusted SourcePubMedGo to source].
Acupuncture: One 2016 systematic review and meta-analysis found acupuncture to decrease sleep disturbances in perimenopausal and postmenopausal women [22 Trusted SourcePubMedGo to source].
Hormone replacement therapy: A 2017 systematic review and meta-analysis found hormone replacement therapy to improve sleep quality in menopausal women with hot flashes and night sweats [23 Trusted SourcePubMedGo to source].
Cognitive behavioral therapy for insomnia(CBT-I): was found in one 2019 systematic review to be effective for menopausal insomnia. This type of therapy involves working with a trained therapist to identify thoughts, feelings, and behaviors leading to insomnia [24 Trusted SourcePubMedGo to source].
3. How to Regulate Hormones With Exercise
As I discuss in my book Healthy Gut, Healthy You, exercise is another pillar of health. Getting outside in nature, preferably with a friend, can improve your internal environment, which will allow for healthy bacteria (i.e. your gut microbiota) to flourish.
It’s important to exercise enough, but not too much. If you’re new to exercise or recovering from burnout try light activities like walking for 30 minutes a few days per week (especially in a forest-like environment). As you get stronger, add more time and experiment with different exercise strategies like weight training, swimming, or biking.
Research has shown that chronic stress can increase uterine contractions, causing pain, and also destabilize your sex hormones, especially if you have poor sleep and a poor diet during the second half of your menstrual cycle [2 Trusted SourcePubMedGo to source, 3 Trusted SourcePubMedGo to source].
Balancing stress is an important lifestyle strategy to improve hormonal balance. Cognitive behavioral therapy (CBT) and coping skills training have been shown to improve PMS symptoms [35 Trusted SourcePubMedGo to source, 36 Trusted SourcePubMedGo to source]. But, simple, free interventions such as deep breathing, mindful movement, and meditation are also very effective ways to manage stress levels.
5. How to Regulate Hormones With Natural Supplements
If you’re wondering how to balance hormones with natural supplements, there are several options. Of course, nutrition and lifestyle strategies are the foundation, but natural supplements can also be very effective for some people.
Many herbal supplements are safe and effective, and while some research suggests a benefit with individual preparations, in our experience in the clinic, combination supplements seem to be the most effective.
Let’s take a look at some of the research on a few popular supplements:
Fenugreek has been found to significantly increase free testosterone levels and estradiol, as well as sexual desire and arousal, when compared to placebo [52 Trusted SourcePubMedGo to source].
Phosphatidic acid complex (PAS) has been found to reduce the severity of PMS symptoms, improve depressive symptoms, allow for greater productivity, and decrease relationship disturbance. Overall, PAS could be an effective option for premenstrual dysphoric disorder (PMDD), but more studies need to be completed [53 Trusted SourcePubMedGo to source].
Combination supplements using multiple herbal ingredients in a blend may be the most effective option for both cycling and menopausal women.
One study of pre- and post-menopausal women used a combination of black cohosh, dong quai, milk thistle, red clover, American ginseng, and chaste-tree berry for three months. The treatment group experienced a 73% reduction in hot flashes, 69% reduction in night sweats, and improved sleep quality. In addition, 47% of the women in the treatment group experienced complete cessation of hot flashes compared with 19% in the placebo group [54 Trusted SourcePubMedGo to source].
Probiotics Can Help With Hormone Balance
When it comes to hormone balance, probiotics have been shown to:
Although preliminary, research indicates gut health and hormone health are connected. It’s not yet fully understood, but gut imbalances like bacterial dysbiosis and inflammation can alter your hormones [58 Trusted SourcePubMedGo to source]. Similarly, women often experience IBS-like symptoms (bloating, diarrhea, constipation, and pain) during menstruation, suggesting that IBS could be related to female hormone fluctuations [60 Trusted SourcePubMedGo to source].
Here are some ways gut health imbalances and inflammation can influence hormonal balance:
An imbalanced gut microbiome can affect the estrobolome, or the gut bacteria that metabolize estrogens. The waste products of estrogen are then reabsorbed into the bloodstream leading to symptoms of hormonal imbalance [70 Trusted SourcePubMedGo to source].
While it’s a complex process and the research continues to evolve, the available data indicates that poor gut health may be a root cause of hormonal imbalance. Targeting gut health may stabilize your hormone levels and in turn help to reduce symptoms related to hormonal fluctuations.
The most common methods are serum (considered the gold standard) and 24-hour urine collection, which are good options for measuring hormones in most people. Some evidence suggests they’re not accurate in people undergoing hormone replacement therapy (HRT) .
Saliva is an easy method of testing and may be a better option for those undergoing HRT, but can result in different outcomes than serum testing [77, 78 Trusted SourcePubMedGo to source]. A 2020 literature review found saliva testing to be good for testing fertility, measuring levels of estrogen, and for tracking perimenopausal hormonal changes [79 Trusted SourcePubMedGo to source].
Dried blood spot sampling appears to align with serum levels, but may be better for measuring incoming hormones from HRT [77, 80 Trusted SourcePubMedGo to source].
Dried urine sampling (such as the DUTCH test) may be effective at finding steroid hormones and their metabolites in cycling and menopausal women, whether on or off HRT. In addition, dried urine sampling may allow for taking multiple hormone measurements, which can be useful for analyzing fertility [81 Trusted SourcePubMedGo to source].
When Are Female Hormone Tests Not Useful?
While female hormone testing can provide some insight into your symptoms, there are some instances when testing is not indicated.
Diagnosing menopause: The ovaries change during the transition to menopause, so hormone testing shouldn’t be used to diagnose menopause [79 Trusted SourcePubMedGo to source]. As the authors of one 2007 review explain, “The current standard of care is to individualize hormone therapy based on symptom relief and side effect profile, not on laboratory results [75 Trusted SourcePubMedGo to source].”
Adrenal fatigue: Adrenal fatigue and the corresponding correlation between fatigue and cortisol levels isn’t supported. Cortisol testing is not indicative of hypothalamic-pituitary-adrenal (HPA) axis dysfunction [82 Trusted SourcePubMedGo to source], nor is it a proven measurement of immune dysregulation or other conditions [83 Trusted SourcePubMedGo to source].
Better Gut Health Improves Hormone Balance
Hormonal imbalances can lead to a variety of negative symptoms. Overall, we’ve found targeting the gut along with foundational nutrition and lifestyle changes to have the most powerful impact when it comes to balancing hormones. Try the above strategies and monitor your symptoms. If you’re feeling great, then you’re probably on the right track.
If you continue to struggle with some symptoms of hormone imbalance though, Healthy Gut, Healthy You details our simple step-by-step plan for improving your gut health, which will translate into better hormone balance. If, after working through the foundational steps, you feel you need a more personalized plan, contact us at the Ruscio Institute for Functional Medicine.
The Ruscio Institute has developed a range of high-quality formulations, including Progest-Harmony and Estro-Harmony, to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.
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