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Everything You Should Know About Hormonal Imbalance
A hormonal imbalance can have a wide range of symptoms, from weight gain to fatigue. Treatment can help resolve many of the underlying causes.
Hormones are your body's chemical messengers.
Produced in the endocrine glands, these powerful chemicals travel around your bloodstream, telling tissues and organs what to do. They help control many of your body's major processes, including metabolism and reproduction.
When you have a hormonal imbalance, you have too much or too little of a certain hormone. Even tiny changes can have profound effects throughout your body.
Some hormone levels fluctuate throughout your lifetime and may result from natural aging. However, other changes occur when your endocrine glands produce too much or not enough of certain hormones.
Read on to learn more about hormonal imbalances and how they might affect your health.
Symptoms of hormonal imbalance
Your hormones play an integral role in your overall health. Specific symptoms could indicate a hormonal imbalance. However, the symptoms you might experience depend on which hormones or glands are responsible.
Common hormonal conditions that could cause imbalances may result in symptoms such as:
Keep in mind that these symptoms are nonspecific. Having one or a few of them doesn't necessarily mean that you have a hormonal imbalance.
Some of these symptoms may also reflect other chronic conditions. So, if you notice any notable changes in your body or energy levels, it's a good idea to talk with your doctor.
Symptoms in people who were assigned female at birth (AFAB)
In people with ovaries, the most common consequence of hormonal imbalance is polycystic ovary syndrome (PCOS).
Your hormonal cycle also changes naturally during these stages:
Symptoms of a hormonal imbalance specific to AFAB people include:
heavy or irregular periods, including missed periods, stopped periods, or frequent periods
hirsutism, or excessive hair on the face, chin, or other parts of the body
acne on the face, chest, or upper back
hair loss
hyperpigmentation (darker patches on the skin), especially along neck creases, in the groin, and underneath the breasts
skin tags
vaginal dryness
vaginal atrophy
pain during sex
night sweats
headaches
It's important to note that many of these issues, including hirsutism, can affect people of other sexes, too.
Symptoms in people who were assigned male at birth (AMAB)
Testosterone plays a vital role in development. If you aren't producing enough testosterone, it can cause a variety of symptoms.
Symptoms of hormonal imbalance in AMAB people include:
gynecomastia, or enlarged breast tissue
breast tenderness
erectile dysfunction (ED)
decrease in beard growth and body hair growth
loss of muscle mass
loss of bone mass, otherwise known as osteoporosis
difficulty concentrating
hot flashes
It's important to note that AFAB folks can also experience testosterone imbalances.
Symptoms in children
Children start producing sex hormones during puberty. Many children with delayed puberty will go on to experience typical puberty, but some have a condition called hypogonadism.
Individuals with hypogonadism may experience:
lack of development of muscle mass
a voice that doesn't deepen
body hair that grows sparsely
impaired penis and testicular growth
excessive growth of the arms and legs in relation to the trunk of the body
gynecomastia
menstruation that doesn't begin
breast tissue that isn't developing
the growth rate doesn't increase
Causes of a hormonal imbalance
A hormonal imbalance has many possible causes. They can differ depending on which hormones or glands are affected.
Common causes of hormonal imbalance include:
hormone therapy
medications
cancer treatments such as chemotherapy
tumors, whether cancerous or benign
pituitary tumors
eating disorders
chronic stress
injury or trauma
insulin resistance
While hormonal imbalances may initially cause some of the conditions below, having these conditions can also lead to further hormonal imbalances:
type 1 and type 2 diabetes
diabetes insipidus
hypothyroidism, or an underactive thyroid
hyperthyroidism, or an overactive thyroid
hyperfunctioning thyroid nodules
thyroiditis
hypogonadism
Cushing syndrome, or high levels of cortisol
congenital adrenal hyperplasia, which causes low levels of cortisol and aldosterone
Addison's disease
Causes unique to AFAB people
Many causes of hormonal imbalance in AFAB people are related to reproductive hormones. Common causes include:
menopause
primary ovarian insufficiency, which is also known as premature menopause
pregnancy
breastfeeding
PCOS
hormone medications, such as birth control pills
Tests for hormonal imbalance
There's no single test available to help doctors diagnose a hormonal imbalance. Begin by making an appointment with your doctor for a physical exam.
Be prepared to describe your symptoms and the timeline along which they've occurred. Include all medications, vitamins, and supplements you're currently taking.
Your doctor may ask you questions such as:
How often are you experiencing symptoms?
Does anything help relieve your symptoms?
Have you lost or gained weight recently?
Are you more stressed than usual?
When was your last period?
Are you planning to get pregnant?
Do you have trouble getting or maintaining an erection?
Do you have vaginal dryness or pain during sex?
Your doctor may suggest one or more diagnostic tests depending on your symptoms. You can also request that your doctor perform these tests.
A healthcare professional can request a blood test to check your thyroid and estrogen, testosterone, and cortisol levels.
Pelvic exam
If you have a uterus, a doctor may perform an internal exam to feel for any unusual lumps, cysts, or tumors.
If you have testicles, a doctor may check your testicles and scrotum for any lumps or abnormalities.
Ultrasound
An ultrasound machine uses sound waves to look inside your body. Doctors may request an ultrasound to get images of the:
uterus
ovaries
testicles
thyroid
pituitary gland
Additional tests
Sometimes, more advanced tests are required. These can include:
biopsy
MRI
X-ray
thyroid scan
sperm count test (semen analysis)
At-home tests
If you're experiencing symptoms of a hormonal imbalance, you may also consider using a home testing kit. These kits are available for a variety of conditions. However, while still best to talk with a doctor as they may recommend additional testing to determine the cause of a hormone imbalance, at-home tests can provide a starting point.
Home testing kits for menopause measure follicle-stimulating hormone (FSH) in your urine. FSH levels increase when you enter menopause. Levels also rise and fall during a typical menstrual cycle. Other factors, such as the use of hormonal birth control, can also affect your FSH levels.
Note that these kits can indicate that menopause may have started, but they can't tell you conclusively. A healthcare professional's confirmation may be necessary.
Other home testing kits typically use saliva or blood from the fingertip to measure your cortisol levels, key thyroid hormones, and sex hormones such as progesterone and testosterone. Some tests may require a urine sample.
These kits require you to send the sample off to a lab. Your test results are usually available online within 5 to 9 business days.
The company LetsGetChecked provides at-home tests that have been approved by the Food and Drug Administration (FDA). However, many at-home tests have not received FDA approval.
Regardless of which at-home test you choose, it is important to discuss your test results with your healthcare professional. Let them know if you're concerned about certain symptoms or a possible diagnosis.
Treatment options for a hormonal imbalance
Treatment for a hormonal imbalance will depend on what's causing it. Some common treatment options include:
Estrogen therapy
Be sure to discuss the risks and benefits of hormone replacement therapy (HRT) with your doctor. If you don't already have one, you can browse doctors in your area through the Healthline FindCare tool.
Vaginal estrogen
If you're experiencing vaginal dryness or pain during sex, a doctor may also recommend an estrogen cream, tablet, or ring.
This local therapy helps eliminate many of the risks associated with systemic estrogen, or estrogen that travels throughout the bloodstream to the appropriate organ.
Hormonal birth control
Hormonal birth control can help regulate your menstrual cycles. Types of hormonal birth control include the:
birth control pill
birth control patch
birth control shot
vaginal ring
intrauterine device (IUD)
Some types of hormonal birth control may also help improve acne on the face and body.
Anti-androgen medications
Androgens are male sex hormones that are present in people of all genders. High androgen levels can be treated with medication that blocks the effects of androgens.
These effects include:
hair loss
facial hair growth
acne
One androgen closely tied to hair growth and loss is testosterone. A 2020 study found that when not enough testosterone is produced, hair loss and lack of growth are common.
Testosterone therapy
Testosterone supplements can reduce the symptoms of low testosterone. In adolescents with delayed puberty, it stimulates the start of puberty. It's available in many forms, including injections, a patch, and gel.
Testosterone replacement therapy (TRT) has risks, including to your cardiovascular system.
Thyroid hormone therapy
If you have hypothyroidism, the synthetic thyroid hormone levothyroxine (Levoxyl, Synthroid, Unithroid) can bring hormone levels back into balance.
Metformin
Metformin is a type 2 diabetes medication that may help some individuals with PCOS symptoms. The FDA has not approved it to treat PCOS, but it might help lower androgen levels and encourage ovulation. It is often prescribed off-label for this purpose.
Flibanserin (Addyi) and bremelanotide (Vyleesi)
Flibanserin (Addyi) and bremelanotide (Vyleesi) are the only medications that are FDA-approved for the treatment of low sexual desire in premenopausal people. Addyi is a pill, and Vyleesi is a self-administered injectable medication.
These drugs may come with some serious side effects, such as severe nausea and changes in blood pressure. Talk with your doctor to see if either one could be right for you.
Eflornithine (Vaniqa)
This prescription cream is designed specifically for excessive facial hair. Applied topically to the skin, it helps slow new hair growth but does not eliminate existing hair.
Natural remedies and supplements
Many nutritional supplements on the market claim to treat menopause and hormonal imbalance. However, few of them are backed by scientific evidence.
Many of these supplements contain plant-derived hormones, which are sometimes called 'bioidentical' hormones because they chemically resemble the body's natural hormones. However, there's no evidence to suggest that they work better than regular hormone therapy. They are also not regulated by the FDA to the same degree as prescription hormone medications.
Some people find that yoga helps ease symptoms of hormonal imbalance. Yoga is excellent for your strength, flexibility, and balance. It may also aid in weight loss, which can further help regulate your hormones.
You can also make the following lifestyle changes:
Lose weight: If your doctor has recommended it, a reduction in body weight may help regulate menstrual cycles and increase the chances of getting pregnant. Weight loss may also help improve erectile function.
Eat well: A balanced diet is an important part of overall health.
Decrease vaginal discomfort: Use lubes or moisturizers free of parabens, glycerin, and petroleum.
Avoid hot flash triggers when possible: Identify things that commonly trigger your hot flashes, such as warm temperatures, spicy foods, or hot beverages.
Remove unwanted hair: If you have excess facial or body hair, you can use hair removal cream, laser hair removal, or electrolysis.
Hormonal imbalance and acne
The primary cause of acne is excess oil production, which leads to clogged pores. Acne is most common in areas with many oil glands, including the:
face
chest
upper back
shoulders
Acne is often associated with the hormonal changes of puberty. But there's a lifelong relationship between acne and hormones.
Acne and menstruation
The menstrual cycle is one of the most common acne triggers. For many individuals, acne develops the week before they get their period and then clears up.
Dermatologists recommend hormonal testing for people who have acne in combination with other symptoms, such as irregular periods and excess facial or body hair.
Acne and androgens
Androgens contribute to acne by overstimulating the oil glands.
Children of all genders have high levels of androgens during puberty, which is why acne is so common at that time. Androgen levels typically settle down in a person's early 20s.
Hormonal imbalance and weight gain
Hormones play an integral role in metabolism and your body's ability to use energy. The only way to treat weight gain from a hormone disorder is to treat the underlying condition.
Some hormone conditions, such as Cushing syndrome, can increase the risk of becoming overweight or developing obesity. Cushing syndrome causes high levels of cortisol in the blood. This leads to an increase in appetite and fat storage.
Hypothyroidism, if the condition is severe, can also lead to weight gain.
Slight hormone imbalances can happen during menopause. During this transition, many people gain weight because their metabolisms slow down. You may find that you still gain weight even though you're eating and exercising like usual.
Hormonal imbalance and pregnancy
During a typical pregnancy, your body experiences major hormonal changes, which are different from a hormonal imbalance.
Pregnancy and PCOS
Hormonal imbalances such as PCOS are among the leading causes of infertility. With PCOS, the hormonal imbalance interferes with ovulation. While you can't become pregnant if you're not ovulating, irregular ovulation in PCOS can still result in pregnancy.
If you're trying to become pregnant and have PCOS, your doctor may recommend methods to improve your fertility. This may include losing weight, if a doctor recommends it. Prescription medications are also available that can stimulate ovulation and increase your chances of becoming pregnant.
In vitro fertilization (IVF) is also an option if medication doesn't work. As a last resort, surgery can temporarily restore ovulation.
PCOS can cause issues during pregnancy for both you and your baby. There are higher rates of:
gestational diabetes
miscarriage
preeclampsia
cesarean delivery (C-section)
high birth weight
admission to and time spent in the neonatal intensive care unit
Becoming pregnant while living with PCOS does not mean an individual will experience any of the above problems. Talking with your doctor and following their advice is the best way to have a safe pregnancy and delivery.
Pregnancy and hypothyroidism
Babies born to parents with untreated hypothyroidism are more likely to have developmental issues. This includes intellectual and developmental disabilities.
Managing your hypothyroidism along with your doctor's advice can help lessen these risks.
Hormonal imbalance and hair loss
Most hair loss, such as male pattern baldness, is hereditary but may be influenced by a hormone imbalance. Hormonal changes and imbalances can also sometimes cause temporary hair loss.
In AFAB folks, this is often related to:
pregnancy
childbirth
the onset of menopause
An overproduction or underproduction of thyroid hormones can also cause hair loss.
Other complications
Hormone imbalances are associated with many chronic, or long term, health conditions. Without proper treatment, you could be at risk for several serious medical conditions, including:
type 1 and type 2 diabetes
diabetes insipidus
high blood pressure
high cholesterol
heart disease
neuropathy
obesity
sleep apnea
kidney damage
depression and anxiety
endometrial cancer
breast cancer
osteoporosis
loss of muscle mass
urinary incontinence
infertility
sexual dysfunction
goiter
