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Hormonal imbalance: Symptoms, causes, and treatment

Hormonal imbalance: Symptoms, Causes, and treatment

Hormones can be defined as special chemicals in our bodies that get released into the bloodstream. These chemicals send messages to specific organs and tissues to inform them to carry out certain tasks. These particular tasks are designed to ensure all systems run smoothly as required. Our hormones are regulated by a group of glands known as the endocrine system, and the body relies on its signals for a lot of its processes. When there is a hormonal imbalance, this can affect the entire body, including causing fertility issues.

This post will break down key factors that disrupt hormonal health (hormonal imbalance), the causes of hormonal imbalance, signs and symptoms, and how you can work with a healthcare provider to get things back on track.

What is the main cause of hormonal imbalance?
What is the main cause of hormonal imbalance?

What do hormones do to your body?

Hormones play a fundamental role in a child’s growth: they inform the body when it’s time to enter puberty and even control the menstrual cycle. Moreover, they do not shut off after puberty or when menopause begins. They remain active throughout life, dictating vital functions such as:

  • Thirst
  • Hunger
  • Stress response
  • Metabolism
  • Menstrual cycle
  • Sleep
  • Heart rate
  • Mood
  • Getting pregnant

What’s hormone imbalance?

This term, hormone imbalance, refers to too high or too low hormone levels, even though this is an oversimplification of a highly complex hormone regulation process. A chain of events (feedback loop) is involved in producing and releasing hormones, and it all starts in the brain.

For instance, the feedback loop which triggers a menstrual cycle (hypothalamic-pituitary-ovarian axis –HPO) goes like this:

  1. The hypothalamus, which is located close to the brain’s base, controls the production of the gonadotropin-releasing hormone (GnRH).
  2. GnRH makes its way to the pituitary gland (that’s also in the brain) to develop and release the follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
  3. The follicle-stimulating hormone travels through the bloodstream to get to the ovaries and signals a follicle to start its growth.
  4. The developing primary follicle will produce estradiol or E2 and other hormones, stimulating the endometrial lining to start its growth.
  5. The increased levels of estradiol then return to the pituitary gland and decrease the production of the follicle-stimulating hormone.
  6. Once the E2 levels reach their peak and are sustained, they will lead to positive feedback on the pituitary, and an LH surge will occur.
  7. The luteinizing hormone (LH) surge will trigger the final maturation of the egg in the primary follicle, followed by ovulation that occurs within 24 to 48 hours.
  8. Then, progesterone home is secreted from the corpus luteum and prepares the endometrium for implantation.
  9. If the egg is released but fertilization doesn’t occur, the progesterone and E2 levels will drop, allowing the uterus lining to shed as menstruation. This process repeats every other month.

Hormonal changes occur every other day, or from one hour to another, and throughout your cycle. However, sustained lows or highs that do not reflect typical patterns usually have a ripple effect on the other hormones in a feedback loop. For instance, take hypopituitarism, a condition where the pituitary is not able to make some hormones. Suppose the hypopituitarism triggers an FSH or LH deficiency. In that case, the ovaries will not get the message to start the production of E2 or signal follicle growth – all this will disrupt your cycle.

In the long run, hormone regulation happens to be more complex than the balancing act. It is more like a pinball machine with occasional obstacles that shoot the ball in various directions.

What is considered too low or too high for hormone levels?

The best way to measure hormone levels and detect if there is a hormone imbalance is to take a blood test or urine test.

To evaluate the results of a hormone blood test, the expert will need to check the reference ranges. A reference range is the range of values for psychological measurement (which in this case is the hormone levels), a large percentage (95%) of a healthy population. Each test provider uses a specific laboratory to measure the results, and each laboratory has unique reference ranges. If the results are out of range, it means the labels are lower or higher than the average; hence the result will be a hormonal imbalance.

For women, some of the most vital hormones for reproductive health and fertility include thyroid hormones and sex hormones. At Fertility2Family, we suggest measuring three hormones in these two groups: the thyroid-stimulating hormone (TSH), estrogen estradiol (E2), and prolactin.

Here are the standard reference ranges and sex hormones found in people during the reproductive years:

  • TSH: 0.4-4.5 mIU/mL (million international units per millilitre) for all females, but 2.5 mIU/mL is the recommended threshold for women during the first trimester.
  • E2: 22.4-115 pg/mL (picograms per millilitre) for premenopausal women on the 3rd day of the cycle.
  • Prolactin: 3.4-26.7 ng/mL (nanograms per milliliter) for non-pregnant people with ovaries.

The following are the possible reference ranges for the additional hormones we will discuss in the following few sections (these hormones affect people during the reproductive years):

  • Progesterone: <3 nanograms per millilitre for premenopausal mid-cycle people with ovaries.
  • Total testosterone: >0.75 nanograms per millilitre for people with ovaries.

It is crucial to remember that out-of-range hormone levels do not automatically mean that you will have adverse health effects or physical signs. You could be among the 5% of the people outside the calculated reference range – note that the reference range only represents 95% of healthy people. Moreover, all our bodies experience things differently, and that’s why it’s always good to consult with your health care provider about your unique hormone levels.

Ovulating Regularly With PCOS
Image courtesy of The Bright Girl Guide by Demi Spaccavento.

What are the prevalent causes and symptoms of hormonal imbalance regarding sex hormones?

Sex hormones that are often too low or too high are estradiol (produced by fat cells, ovaries, and adrenal glands), testosterone, prolactin, and progesterone. Let us discuss each of them separately:

Estradiol

This hormone is an estrogen and a primary hormone in both reproductive development and health, and it’s produced by the adrenal gland, ovaries, and fat cells. An estrogen hormone imbalance or out of range estrogen levels can be seen when you have the following situations and conditions:

  • Estrogen-producing tumours
  • Menopause 
  • Oophorectomy (ovary removal)
  • Exposure to the endocrine-disrupting chemicals also known as EDSs
  • Functional hypothalamic amenorrhea is caused by malnutrition, extreme weight loss or gain, extreme exercise, and chronic or severe stress.

If the levels of estradiol are too high (>115 pg/mL on 3rd day) or too low (<22.4 pg/mL 3rd day), you will experience the following symptoms:

  • Menstrual migraines
  • Period changes
  • Uterus fibroids
  • Non-cancerous chest or breast lumps
  • Night sweats/ hot flashes
  • Reduced sexual desire
  • Sleeping problems
  • Worsening of PMS (premenstrual syndrome)
  • Dry skin
  • Mood swings
  • Depression or anxiety
  • High estradiol levels can also cause flare-ups for individuals with endometriosis.

Progesterone

The corpus luteum primarily produces this hormone in the ovaries, and it forms after ovulation. Hormone imbalances and Low levels of progesterone can be caused by:

  • Some medications such as hormone replacement therapy or hormonal birth control
  • Anovulation due to hypothalamic amenorrhea, PCOS, or menopause

Whenever the progesterone levels are extremely low (<3 ng/mL mid-cycle), you may experience symptoms like irregular menstrual bleeding caused by anovulation.

Because progesterone is produced after ovulation by the corpus luteum, experts say that their level in the second phase of the cycle (luteal phase) is the key to knowing if ovulation has happened. If a patient has consistent progesterone values under three ng/mL about a week before the next period, it signifies that ovulation isn’t occurring as expected.

Prolactin

Prolactin is a hormone produced by the pituitary gland and can assist you with breast development during puberty and milk production after delivery. High levels of prolactin can be caused by:

  • Blood pressure medications, antipsychotics, or antidepressants
  • Presence of tumours in the pituitary gland
  • Herbs such as red clover, fennel seeds, and fenugreek
  • Hypothyroidism
  • Extreme or excessive stress or exercise
  • Chest irritation (from extra-tight bra, shingles, surgical scars)
  • Nipple stimulation

Whenever prolactin levels are excessively high (26.7 ng/mL), you may experience symptoms like:

  • The production of milk outside pregnancy (galactorrhea)
  • Irregular ovulation, problems getting pregnant, and absent or irregular periods
  • Interference with progesterone and estrogen levels

Testosterone

Also known as the male sex hormone or androgen, the adrenal glands and ovaries produce testosterone. Here are some conditions experienced when one’s testosterone levels are out-of-range:

When the total testosterone levels are high, you are likely to experience symptoms such as:

  • Increased muscle mass
  • Increased acne
  • Balding at the hairline
  • Deepening voice
  • Excess body and facial hair 

Men can have issues with the levels of their sex hormones too. The hormone testosterone is responsible for low or high sex drive in both men and women – and low testosterone in men can cause erectile dysfunction or impaired sperm production.

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What are the cause & symptoms of hormonal imbalance in the thyroid hormones?

This section shall focus on what happens when thyroid-stimulating hormone (TSH) levels are too low or too high.

Thyroid-stimulating hormone

TSH is a hormone produced in the pituitary gland and helps regulate the thyroid. Conditions that occur due to out-of-range TSH levels – hyperthyroidism(overactive thyroid) and hypothyroidism(underactive thyroid)- typically affect one out of eight women. Here are some of the reasons why a thyroid imbalance may happen:

  • Thyroiditis
  • Graves’s disease
  • Over-reactive thyroid nodules
  • Iodine intake
  • Hashimoto’s Disease 
  • EDC’s
  • Non-functioning thyroid gland right from birth

If the levels of TSH are too high (>4.5 mIU/mL) or too low (<0.4 mIU/mL), one is likely to experience symptoms like:

  • Appetite changes
  • Mood changes
  • Energy level fluctuations
  • Unexpected or intentional weight fluctuations
  • Heartbeat rhythm and rate changes
  • Bowel movement changes
  • Nails, hair, or skin changes
  • Increased sensitivity to cold or excessive sweating
  • Impaired memory
  • Increased blood cholesterol levels
  • An enlarged thyroid
  • Hoarse voice
  • Menstrual cycle changes
  • Muscle stiffness, hand tremors, or swelling or pain in the joints

If you have any of these symptoms, be sure to mention them to your health care provider to confirm if out-of-range hormone levels cause the problem.

Can hormonal imbalance have an impact on fertility?

Each time a person’s reproductive hormone levels are too high or too low, they interfere with the standard procedure of hormone regulation, which will also affect the menstrual cycle. Ovulation and period changes can make it difficult for you to conceive, regardless of the reason why they are happening. For conception to occur, the egg needs to be released during ovulation so sperm can fertilize it. However, if the cycle is disrupted, it will become harder to pinpoint your fertile window, and you won’t be able to time your sex or insemination around your fertile days.

What’s the best way to diagnose and treat hormonal imbalance?

Whenever you experience any of the symptoms we mentioned earlier, your healthcare provider should run some tests to determine the cause of the problem. Another hormone test can also give you ideas as it measures up to seven vital sexual reproductive hormones, including TSH and estradiol.

If the results suggest that one of the hormones is too low or too high, you can share the results with your healthcare provider, and they will help you determine the best treatment option. Remember that hormone tests do not diagnose anything on their own. The healthcare provider will likely need to deal with the underlying cause of the problem before addressing the out of range hormone levels.

If the treatment for signs from out of range hormone level is required, the healthcare provider may prescribe or suggest you:

  • Make some lifestyle changes (especially on exercise, stress management and nutrition)
  • Evaluate the current medications to determine if they are causing the problem
  • Control all chronic medical conditions
  • Hyperprolactinemia medications & thyroid medications 
  • Hormone replacement therapy (HRT) or hormonal birth control 
  • Radioactive iodine, beta-blockers, thyroid medications, and surgery

There is little science to back up lifestyle changes beyond nutrition, exercise, and stress management.

When is the most suitable time to test for a hormone imbalance?

The hormone estradiol (E2) should be tested on the third day of the menstrual cycle if you want to get the most clinically reliable results. Medical experts call the 3rd day the baseline since this is when estradiol is more stable before the level starts to rise. Choosing to test on the card day will put you right at the start of the follicular phase, which is an ideal time to acquire a straightforward reading of the baseline levels.

Progesterone testing is essential in the cycle’s luteal phase (second half).

Testosterone, prolactin, and TSH levels are stable throughout the menstrual cycle, so you can test them on any day.

The bottom line of Hormonal imbalances

Whether or not you are experiencing signs related to deficient or excess hormone levels, it is essential to learn more about your body and how you can regulate your hormones. Also, you need to pay attention to what you feel and discuss all your concerns with your healthcare provider. All in all, the more information you have on these essential hormones, the better.