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Understanding and Navigating Hormonal Imbalances in Women

Managing Female Hormonal Imbalances

Hormonal imbalances in women can significantly affect health, given hormones are the chemical messengers facilitating communication across various body parts. These complex and delicate systems, controlling our biology, can lead to significant health issues if any hormone levels are not in the optimal range.

The term "hormone imbalance" encompasses a wide array of potential abnormalities. It could refer to conditions like an overactive or underactive thyroid due to irregular thyroxine levels or it can refer to diabetes from abnormal insulin levels. More specifically, when addressing female hormone imbalances, the focus is often on the intricate balance of hormones governing fertility and the menstrual cycle, including testosterone. Disruptions in this balance can affect other hormone levels, with most concerns revolving around oestrogen and testosterone levels due to their noticeable symptoms.

For women experiencing hormonal imbalances, One Day Tests provides a Female Hormone Blood Test, offering comprehensive insights into your hormonal health.

Oestrogen and Hormonal Imbalances

Oestrogen, a pivotal hormone, showcases its vast influence throughout life. The physical and mental effects of oestrogen are most notably demonstrated during puberty, when levels first rise, and at menopause, where levels fall. Concerns typically arise from low oestrogen levels, often a result of menopause or an early onset of menopause, characterised as occurring before 45.

Traditionally, symptoms of low oestrogen have been thought of in quite narrow terms as symptoms such as hot flushes, sweats, and menstrual irregularities, but many women experience a wide range of other symptoms such as low mood or anxiety, ‘brain fog’, vaginal dryness and irritation, muscle and joint pains, palpitations, and headaches.

Oestrogen levels can also be tested for with a blood test. Alongside testing for oestrogen, we usually test LH and FSH and would consider testing for other hormones that influence the menstrual cycle such as hormones relating to the thyroid or the hormone prolactin which, if overproduced, reduces oestrogen levels and can cause periods to stop. In perimenopause or menopause, we see lower than expected levels of oestrogen and we usually see higher than expected levels of FSH.

The Role of Testosterone

Contrastingly, concerns with testosterone generally involve elevated levels, leading to symptoms like infrequent periods, reduced fertility, and physical changes such as excess hair growth, weight gain, balding and acne. There are some rare causes of raised testosterone levels in women such as congenital adrenal hyperplasia or even some ovarian tumours, but the most common cause of high testosterone levels in women is Polycystic Ovary Syndrome (PCOS), a condition that necessitates proper management for improved health and fertility. 

Diagnosing and Managing PCOS

PCOS diagnosis hinges on symptom presentation, testosterone levels, and ovarian scans for cysts (not all of these features need to be present to make the diagnosis). Managing PCOS effectively can enhance both overall health and fertility, with lifestyle adjustments being the initial focus. This includes dietary changes to mitigate diabetes risk and regular exercise to maintain a healthy weight.

These hormones, and other hormones that may impact fertility and general well-being such as thyroxine, thyroid stimulating hormone, and prolactin, the hormone involved in milk production, can all be tested for with simple blood tests.

To diagnose PCOS we usually check testosterone levels and another test called Sex Hormone Binding Globulin (SHBG). Using the results of these two tests we can calculate the ‘Free Androgen Index’ which tells us how much biologically active testosterone there is.

We also usually check for Luteinising Hormone (LH) and Follicle Stimulating Hormone (FSH) which are two hormones produced by the brain that help to regulate the menstrual cycle. The ratio of these two hormones can be skewed in PCOS. Particularly after PCOS is diagnosed, we check blood sugar levels because PCOS can increase the risk of diabetes.

Medical Treatments for PCOS

Managing Polycystic Ovary Syndrome (PCOS) typically begins with adopting lifestyle changes aimed at overall health improvement.

A balanced diet, particularly one that minimises sugary foods to reduce diabetes risk, combined with regular physical activity, plays a crucial role in reaching a healthy weight. For numerous women, these lifestyle adjustments can effectively normalise menstrual cycles.

Beyond lifestyle interventions, a spectrum of medical treatments is available to address PCOS symptoms:

  • Treatments targeting acne and options for managing excess hair growth are part of the therapeutic arsenal, although availability through the NHS may vary.

  • The contraceptive pill is often recommended for managing both acne and excess hair growth, in addition to regulating menstrual cycles.

  • Metformin, a medication commonly prescribed for diabetes, has been found to encourage ovulation for those aspiring to conceive.

  • Aldosterone antagonists, like spironolactone, are employed to mitigate testosterone's effects, with a crucial emphasis on weighing their risks and benefits with a healthcare provider.

Addressing Low Oestrogen

For low oestrogen, Hormone Replacement Therapy (HRT) is a primary recommendation, especially for women undergoing menopause before 50. For those unable or unwilling to undergo HRT, lifestyle adjustments and certain supplements like black cohosh and isoflavones might offer relief. Other medications, each with their advantages and disadvantages, can also be beneficial.

For women who opt out of HRT or are unable to pursue it due to certain health conditions, such as a history of breast cancer, various alternatives exist. Modifying lifestyle habits can significantly impact overall well-being. Avoiding triggers like spicy foods, alcohol, smoking, and caffeine is advised as they can exacerbate hot flushes, while engaging in regular physical activity can alleviate them. 

Supplements such as black cohosh and isoflavones have shown promise in offering relief. Additionally, a variety of medications, including certain antidepressants, the blood pressure medication clonidine, or gabapentin, have been identified as potentially helpful in managing hot flushes. Each option comes with its own set of advantages and drawbacks.

The Importance of Hormonal Testing

Testing hormone levels is crucial for identifying and understanding symptoms, leading to effective treatment strategies. Although hormone levels fluctuate significantly, once an imbalance is detected, solutions are generally available to alleviate symptoms and improve quality of life.

Hormones intricately influence our health and well-being. Recognising and treating hormonal imbalances is not only a step towards better health but also towards reclaiming one's sense of self.

Test for Hormonal Imbalances

Frequently Asked Questions

What hormones are we referring to when we talk about hormone imbalance?

‘Hormone imbalance’ can refer to abnormal levels of any hormone but generally, when talking about female hormone imbalance, we mean testosterone and oestrogen.

Can you “cure” hormone imbalance?

It is probably better to think about ‘managing’ hormone imbalance than ‘curing’ it. In some rare cases, such as when a hormone imbalance is due to a hormone-secreting tumour, it could be cured but more common causes of hormone imbalance such as polycystic ovary syndrome and early menopause need a more sustained and holistic approach.

What are the signs of hormonal imbalance?

This depends on the exact problem but high levels of testosterone often cause symptoms such as acne, excess hair growth, weight gain and irregular periods. Low oestrogen levels typically cause symptoms such as hot flushes and sweats but many women experience a wide range of other symptoms such as mood changes, palpitations, muscle aches and joint pains, ‘brain fog’, or vaginal dryness and irritation.

Does exercise affect hormone imbalance?

Exercise is generally beneficial for hormone balance. For example, exercise should be part of the lifestyle changes needed to manage PCOS, and many women find that regular exercise improves menopausal symptoms. Apart from any hormonal benefits, exercise has numerous physical and mental health benefits and everybody should be seeking to include regular exercise in their daily life.

Are there any supplements you can take to help?

In general, the evidence around supplements is variable. Many supplements such as evening primrose oil and St John’s Wort are marketed as being beneficial for menopause. The National Institute for Health and Care Excellence (NICE) suggest that black cohosh and isoflavones may be of benefit. 

How long does it take to balance hormones?

This depends on the cause and the choices you make concerning treatment. For example, if oestrogen levels are low, this can be quite quickly corrected with hormone replacement therapy, but if you decide you don’t want to take HRT, you may never rebalance the hormones but you may be able to manage the symptoms with lifestyle and/or other medications. 

Can it be caused by stress?

Stress can have a big impact on hormone levels. The mechanisms behind this are complex, but stress alters other hormone levels in the body that in turn impact other hormones involved in the menstrual cycle. It is quite common for women to have menstrual disturbances (such as missed periods) as a result of stress, although we usually exclude other potential physical causes of problems before blaming stress levels.

Many women also experience anxiety as a symptom of perimenopause or menopause.

Is there any food you should/should not eat when trying to balance hormones?

The most important thing is to maintain an overall healthy and balanced diet. If your hormone imbalance is related to PCOS, avoiding sugary foods is particularly important as it is associated with a higher risk of diabetes. Women with low oestrogen levels may find that spicy foods, caffeine and alcohol make hot flushes worse.

What is PCOS? And how is it linked?

Polycystic Ovary Syndrome (PCOS) is diagnosed when a combination of features are present. These include symptoms such as weight gain, acne, excess hair growth and irregular periods, hormone imbalance in the form of raised testosterone levels, and the appearance of multiple cysts on the ovaries on a scan. Not all of these features need to be present to make the diagnosis so it is technically possible to have PCOS without actually having cysts on the ovaries.

Why would a woman have high testosterone?

The most common cause of high testosterone is PCOS. Other rarer causes include a condition called Congenital Adrenal Hyperplasia can cause raised testosterone and some rare ovarian tumours may also raise levels. Of course, any woman taking testosterone supplements (such as for bodybuilding) will also have high levels. 

Why would a woman have high/ low oestrogen levels?

It is unusual for high oestrogen levels to be a cause for concern in women. If levels are high, it is usually due to medication (such as hormone replacement therapy) although your levels may be higher if you are overweight or have liver disease. Low oestrogen levels are usually caused by perimenopause/menopause, or sometimes following medical treatments such as chemotherapy or hysterectomy. You should also note that oestrogen levels may appear to be low if you are taking a combined oral contraceptive. Checking hormone levels is usually best done when you are not on the combined pill.

Can hormone imbalance be prevented?

Your best way to prevent hormone imbalance is to maintain a healthy lifestyle with a balanced diet and regular exercise although, in many cases, genetic factors will play a big factor so management usually starts once the imbalance has been identified.

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