Hormonal imbalances: Are your hormones really out of whack or are you just doing too much?

At least once a day, and it’s usually several times, I hear the same concern from women in my office… “My hormones are out of balance.”

When I question why they think this may be, it is always the same host of answers: mood swings, low libido, weight gain, fatigue, apathy. And 99% of the time, it’s at the behest of their significant other that they are inquiring about these “hormonal” concerns. 

Here’s the deal. These women are usually the “ticker keepers” of their family—the cruise directors if you will. They know, juggle and arrange the schedules and tasks of the family and often of their coworkers. They are in the very active phase of parenting, or potentially facing transitions to an empty nest, all with jobs and spouses and parents and siblings and life all around them that puts a significant demand on their time and energy. 

And it blows me away EVERY TIME that someone, that anyone, blames hormones for their exhaustion, their low libido, their moodiness, when we live life at a pace such as this. Women are pulled in a million different directions.

So, when a woman comes concerned her hormones are “out of whack,” of course, as a physician, I do my due diligence to make sure there is not in fact some endocrinological abnormality. But I also don’t ignore the reality of the world we live in.

Now before I go step on my soapbox, let’s review the “hormonal” things we can fix.

Hormonal symptoms we can fix

Thyroid problems

Hypothyroidism and hyperthyroidism are common endocrine problems. Up to 15% of women will have an abnormality in their thyroid function. Your thyroid helps to regulate your body’s metabolism. When it’s not functioning properly, things can feel pretty bad.

Common symptoms can include weight changes, skin and hair changes, constipation, diarrhea and menstrual abnormalities. Thyroid stimulating hormones (TSH) and the thyroid hormones (T3/T4) are tests we draw often, and honestly it’s usually normal. However, this is always important to rule in or out.

Premenstrual Syndrome or Premenstrual Dysphoric Disorder 

As we move through our 40’s, we experience more significant amplitude changes in levels of estrogen and progesterone throughout our cycles. This can mean increased moodiness or sadness in the days between ovulation and your period. And if PMS and PMDD are significant contributors to your mood, then we can fix that!

Hot flashes and night sweats

Yes, these can appear years before menopause. And yes, they are horrible. But yes, they are fixable! But you know what I don’t need to fix them? Meaningless lab work. An astute gynecologist does not need to get bloodwork to verify a woman is in peri-menopause or menopause. In fact, that lab work (often an FSH level) is often not reliable. I have seen women with “menopausal levels” of FSH continue to ovulate (and in one case get pregnant). So, P.S. do not take this one to the bank for contraception needs. 

Vaginal dryness

The sneaky symptom of menopause that no one talks about, but everyone has. There is an effective and safe fix for most every woman. If your libido is tanked because sex is painful due to lack of lubrication, you are my favorite patient, because this is fish-in-a-barrel easy.

So, are your hormones really out of whack?

But sister, let me tell you… if your periods are still clockwork, your hormones are doing just fine. Your thyroid is likely functioning normally, and your estrogen and progesterone are fluctuating just as nature intended them.

I always remind women who come in having had “hormone testing” done somewhere else that spot-checked levels of estrogen, progesterone, testosterone are irrelevant without the context of the menstrual cycle timing. It is normal, for example, to have a low progesterone before ovulation. That is not “estrogen dominance,” it’s just the normal follicular phase. 

There is a whole industry out there trying to demonize normal hormonal fluctuations, and many practitioners who peddle and profit from these hormonal treatments have little knowledge about said hormonal patterns.

Now to be clear, I am not opposed to hormone replacement therapy. I will do it myself if I have symptoms that it will control. But hormones are not magic. They’re not a fountain of youth.

At 42, I should not be expected to feel and act like I’m 22. I sleep a lot less, work a lot harder and have a lot more responsibility than I did 20 years ago. Jacking my testosterone levels to that of a teenage boy might make me feel great and super productive for a bit. But is that what we need? Do we need to have the energy of a teenager, or do we need to adjust our expectations of what women “should” be doing in our middle ages?

Don’t get me wrong, I’m not saying that in our 40s we are old and shriveled and useless. I frankly am healthier and more active (although undoubtedly achier) at 40 than I was at 20, and I know many of my patients, friends and partners are in the same boat. Maturity and experience have taught most of us to fuel our body with better foods, drink more water and exercise more consistently than we did 20 years ago. So, I think the goal should be to feel the best that we can feel with reasonable expectations of where we are and how we take care of ourselves. 

But there’s the crux of the issue, right? Are you taking care of yourself? Or are you spending every waking moment doing for others? For our society, our families, or coworkers—and even ourselves—to expect us to give nonstop in service of others without missing a beat, that is what is out of balance.

If you are experiencing uncomfortable or worrying symptoms, talk to your OB/GYN. Don’t have an OB/GYN you can trust? Find one today.