Hormones: the chemical messengers that are produced by our endocrine glands and that regulate various functions in the body, from ovulation to metabolism, the sleep-wake cycle and the stress response. Understanding this complex network of communication within the body can feel daunting, but when we begin to look closely at the clues the body gives us, we can find great insight in the patterns that arise.
Studies show that 80% of women experience hormone imbalances, but these issues often get overlooked, written off as something that one simply “has to live with,” or medicated - to manage the symptoms without always addressing the underlying imbalance.1 In fact, 70% of women affected by conditions related to hormone imbalances, such as PCOS, are unaware that their hormones are at the root of the problem.1
Common signs of a hormone imbalance include menstrual cycle irregularities presenting as cycles that are shorter than 26 days, longer than 32 days, or absent all together, heavy painful periods, or severe PMS; acne or oily skin; chronic fatigue; sleep disturbances; stubborn weight gain; low libido; and mood swings.
The first step to achieving hormone balance is to learn about the inner workings of the endocrine system - the hormones that regulate the menstrual cycle, as well as some of the other key players. In this simple overview, we’ll take a look at some of these hormones, as well as some of the symptoms that can arise when they are out of balance.
Follicle Stimulating Hormone (FSH)
The follicular phase of the menstrual cycle, which starts on day one of your period and ends with ovulation, is characterized by the sloughing off of the uterine lining, followed by the recruitment of several ovarian follicles - immature eggs that begin to undergo development in preparation for ovulation. This process is initiated by follicle stimulating hormone (FSH). As the follicles mature, they begin to release estrogen, causing the peak in estrogen levels that is seen just before ovulation. One primary follicle will continue to mature into an oocyte, an egg that is ready to be released during ovulation, as the other follicles die off.
FSH is made in the anterior pituitary, a gland within the brain. If FSH levels are abnormal, that can indicate an issue within the pituitary gland itself. Elevated levels of FSH can also indicate a loss of ovarian function, polycystic ovarian syndrome (PCOS), the start of menopause, or even an ovarian tumor. The increase in FSH production is the body’s attempt to stimulate the ovaries under conditions in which the ovaries are not responding to the FSH optimally.
Low levels of FSH can also arise due to dysfunction within the pituitary gland, as well as a result of malnutrition and low body weight. Low FSH can have a downstream effect on estrogen production, which can present with symptoms associated with low estrogen (see below).
The majority of estrogen in the body is produced by the ovaries, with small amounts being produced by the adrenal glands as well. Estrogen is considered to be proliferative – meaning it stimulates cell growth, and is therefore responsible for building up the uterine lining during the first half of the menstrual cycle. Estrogen also stimulates ovulation, protects our bone density, and supports the health of our brain cells for cognitive function. However, because estrogen is so proliferative, unopposed estrogen, meaning high levels of estrogen without the presence of progesterone to balance it out, is associated with estrogen dominant cancers such as breast and endometrial cancer.
In our increasingly toxic world, estrogen dominance has become a more common occurrence, due to our chronic exposure to endocrine disrupting chemicals (EDC’s), which interfere with our hormone production and metabolism.2 Plastics in particular have been shown to contribute to estrogen dominance, which is a driving factor in many common menstrual cycle disorders such as endometriosis, fibroids, and heavy, painful periods.2 Other symptoms associated with excess estrogen include weight gain, PMS, and fibrocystic breasts.
On the other hand, an estrogen deficiency can cause symptoms such as those associated with menopause -- infrequent or absent periods, hot flashes, sleep disturbances, low libido, vaginal dryness and mood swings. In my practice, I often see low levels of estrogen production in women with nutrient deficiencies as a result of disordered eating patterns and/or digestive issues that inhibit the absorption of vitamins and minerals from the diet, as well as chronic stress and burned out adrenal glands.
Luteinizing Hormone (LH)
The rise in estrogen levels that are seen over days ~6-13 of the menstrual cycle stimulates the release of luteinizing hormone (LH) from the pituitary gland, causing what is known as the “LH surge.” This surge of LH is what triggers ovulation, which typically occurs 36-48 hours after the peak of the surge, by stimulating the ovaries to eject the egg that has been forming from the ovary and into the fallopian tube.
If the brain is not producing enough LH due to nutrient deficiencies or a disorder within the pituitary gland itself, ovulation and the subsequent rise in progesterone may not occur, leading to irregular menstruation and symptoms of low progesterone (see below). A disorder within the pituitary gland can also increase LH production, and high levels of LH are often seen in women with PCOS.
Progesterone helps to maintain the uterine lining - if estrogen is laying down the bricks, progesterone is the cement that holds it together. Progesterone also helps to regulate menstrual cycle length, supports sleep quality, and calms the nervous system. Progesterone has an antiproliferative effect on cancer cells – it balances the proliferative effect of estrogen. Regular ovulation, followed by sufficient progesterone production, plays a key role in reducing the risk of breast cancer by ensuring adequate progesterone production during the postovulatory phase of the menstrual cycle.3 Because progesterone doesn’t peak until after ovulation, people with long, irregular cycles are typically exposed to unopposed estrogen for several weeks or even months prior to ovulating, and as a result are 3x as likely to develop endometrial cancer.3
Low progesterone can show up as spotting between periods, irregular cycle length, anxiety and sleep disturbances, particularly in the second half of the menstrual cycle, brain fog, and difficulty achieving pregnancy.
Testosterone is an important hormone that is often overlooked in female bodied folks. It’s produced by the ovaries, and helps with the growth, maintenance and repair of reproductive tissues and bone mass. It’s also important for energy, a balanced mood and neurotransmitter production.
Low testosterone levels can contribute to fatigue, low libido, depression, osteoporosis, memory issues and weight gain.
High testosterone levels are associated with conditions such as polycystic ovarian syndrome, and can show up in the body as acne, male pattern baldness or male pattern facial/body hair growth, irregular menstruation, infertility, high blood pressure and more.
The thyroid regulates cellular metabolism. Every cell in the body has thyroid receptors, making thyroid hormone crucial for the optimal function of every muscle, organ, and cell in your body!
The menstrual cycle is very sensitive to fluctuations in thyroid hormone, and menstrual disorders are common in women with thyroid disease, which is prevalent especially among women. I always recommend routine thyroid screening to my female patients, particularly when issues around menstruation or fertility are present.
Cortisol is our primary stress hormone, produced by the adrenal glands. We need cortisol to wake us up in the morning, keep our hearts pumping, and activate our stress response as a survival mechanism. Historically, we really only needed to activate our “fight or flight” response in the face of a physical threat, such as a predator. These days however, we are constantly under stress with work, student loan debt, social pressure, or say, living through a pandemic. These stressors activate the nervous system in the same way that being chased down by a tiger would, and in this state our bodies are focused on mobilizing resources to help us survive, rather than prioritizing things like regular digestion, having a healthy libido, or ovulating -- in short, anything that goes beyond survival and allows us to really thrive. Elevated cortisol levels can shut down ovulation, to protect our bodies from the added stress of a pregnancy during what is perceived to be a dangerous time. Cortisol can also suppress immune function, disrupt the gut microbiome leading to digestive issues, inhibit thyroid hormones, cause weight gain, and generally increase inflammation, which is a driving factor in nearly all disease processes.
Sometimes, when someone has been running on cortisol for a long time, the adrenals can essentially burn out their ability to produce adequate levels of cortisol, which can lead to symptoms of fatigue, depression, lethargy, burn out and dissociation.4
Insulin is a metabolic hormone produced by the pancreas. After a meal, the pancreas releases insulin to remove glucose from the blood -- some of this glucose is used for energy, while the rest is stored in the liver. When insulin activity is impaired and glucose remains in the blood, leading to elevated blood sugar, we see issues with our sex hormones. This is particularly notable in polycystic ovarian syndrome (PCOS), a common menstrual cycle disorder that has more recently been categorized as a metabolic condition, due to the underlying issues associated with blood sugar regulation and insulin resistance. Other menstrual cycle disorders have been shown to be correlated with insulin resistance and the inflammation that arises from elevated blood sugar.
Our hormones are of vital importance when it comes to menstruation and fertility, as well as the many other functions that allow us to live vibrantly. Having a basic understanding of this process gives one the bodily autonomy to begin to recognize where dysfunction may be present, to make informed decisions about their health, to understand how to best support themselves through diet and lifestyle, and to cultivate hormone balance as a foundation for optimal wellbeing.
- Mullin, Christine. 11 unexpected signs of hormonal imbalance. Expert Insights, Northwell Health. https://www.northwell.edu/obstetrics-and-gynecology/fertility/expert-insights/11-unexpected-signs-of-hormonal-imbalance#:~:text=Statistics%20show%20that%2080%20percent,manifested%20due%20to%20hormonal%20irregularities. 27 Nov 2018.
- Lazúrová Z, Lazúrová I. Environmentálny estrogén bisfenol A a jeho účinky na organizmus človeka [The environmental estrogen bisphenol A and its effects on the human organism]. Vnitr Lek. 2013 Jun;59(6):466-71. Czech. PMID: 23808741.
- Schindler AE. Progestogen deficiency and endometrial cancer risk. Maturitas. 2009 Apr 20;62(4):334-7. doi: 10.1016/j.maturitas.2008.12.018. Epub 2009 Feb 23. PMID: 19231117.
- Fries E, Hesse J, Hellhammer J, Hellhammer DH. A new view on hypocortisolism. Psychoneuroendocrinology. 2005;30(10):1010-1016.