5 signs of hormonal imbalances in women & people with uteruses

Hormones: They’re not just relevant during puberty, folks (although they’re definitely to blame for those zit-riddled middle school picture day photos your parents still keep framed and hanging around the house). Hormones are everywhere, and no matter if you’re in your 20s, 30s, or 40s+, they’re still affecting everything from how you metabolize food to your energy levels and sex drive. 

What are they, though? 

Hormones are chemical messengers that travel in the bloodstream to alert different organs to do different things. Their goal is basically to help the body maintain homeostasis: When things are running smoothly, they’re just one part of the larger picture of what’s going on in your body internally. But when hormones are out of whack – whether due to diet, stress, or illness – the effects can be felt from head to toe. 

One thing that’s especially prone to causing symptoms when hormones are imbalanced is the menstrual cycle. Missed periods, late periods, and ultra-heavy periods can all result from hormonal imbalances. However: It’s important to note that hormonal imbalances are not the ONLY reason your period could change—and, furthermore, a hormonal imbalance is not necessarily a “root cause” or medical condition in and of itself. 

There are lots of reasons your hormone levels might shift or fluctuate over time; some of them are a cause for concern, and some are not. But it’s important to note that, if you notice any of these signs or sudden changes to your period, you should reach out to a healthcare provider or OB/GYN to investigate further. 


What are the key hormones that affect people with uteruses? 

We’ll cover each of these in greater detail below—but, in general, here are the main hormones that play a major role in regulating the overall health of people assigned female at birth (AFAB):

  • Estrogen
  • Progesterone
  • Thyroid hormones (T3, T4)
  • Androgens (including testosterone)
  • Follicle-stimulating hormone (FSH)
  • Luteinizing hormone (LH)

The top 5 signs of hormonal imbalances 

1. Cystic acne

Unless you were one of the blessed few, most of us have dealt with acne in our teenage years that led us to raid the aisles of Target testing every product under the sun. Why all the zits? Much of it has to do with a group of hormones known as androgens. 

Androgens are a family of hormones that are released from the adrenal glands, which sit right on top of the kidneys…hence the name.1 The main precursor androgen is DHEA, which is converted into testosterone and estradiol. Androgens stimulate hair follicles to produce sebum, which is an oily little substance that can get into your pores and be a safe, warm place for acne to develop.2 

During puberty, sex hormones increase around the clock to encourage regular growth and physical development…but, on the flip side, these increased hormones circulating in the blood can also lead to acne. Breakouts during puberty are often found in the “T-zone,” which includes your nose and forehead.  

For most people, the cursed acne of the teenage years will resolve by adulthood. However: Stubborn acne that persists into adulthood or reappears without any other changes to your lifestyle could be a sign of a hormonal imbalance—specifically, an excess of androgens. 


Hormonal acne may look a bit different from the acne you experienced during puberty. For most adults, hormonal acne crops up on the lower part of the face, around the jawline or the bottom of your cheeks. Hormonal acne is also often classified as “cystic” acne: These breakouts are especially large, red, inflamed, and/or painful (as opposed to your standard fare of whiteheads and blackheads). 

As we touched on in our recent deep dive into PCOS, cystic acne along with signs like hirsutism (hair growth on parts of the body where you don’t normally have hair) and weight gain could point to a hormonal imbalance. If you have concerns about chronic cystic acne, talk to your healthcare provider or dermatologist. 


2. Changes to your period or menstrual cycle

If the menstrual cycle is the orchestra, then hormones are the conductor. During the follicular phase of your cycle (the first half), the sex hormone estrogen is secreted. This tells your body to begin building up the endometrium in your uterus to support a potential pregnancy. 

Then, nearly halfway through your cycle, a few more hormones get involved. The ovulatory phase starts with a sudden increase in luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels. About 16 to 32 hours after this surge, your ovaries release an egg. At this point, estrogen levels start to drop. 

If the newly-released egg is not fertilized, another key hormone—progesterone—is released from the corpus luteum and the luteal phase begins. A week or so goes by, you start PMSing, and, ultimately, your period strikes again. No harm, no foul, right? 

Sure—if you have a “normal” hormonal balance!

But estrogen and progesterone don’t always act according to plan. If hormone levels are out of balance, the little messengers that tell our endometrium to thicken, or that set the stage for ovulation, or that trigger the release of an egg from the ovaries, might miss their cue. If your period has suddenly gone missing or your cycle is fluctuating wildly in length, hormonal changes could be to blame. 

Of course, there are lots of different reasons for hormonal imbalance in women (and folks with uteruses) and some are totally normal. For example, as we age, our bodies naturally begin to produce less estrogen and progesterone. This eventually leads to menopause, a.k.a. the cessation of a regular menstrual period.3

Pro tip for folks: Tofu, flaxseed, tempeh, and legumes are all naturally high in estrogen (and just delicious in general). According to ACOG, “It also is important to know that few plant and herbal supplements have been studied for safety or effectiveness. Talk with your ob-gyn about which type of treatment is right for you.”

There are other normal, secondary causes of hormonal imbalance, too. Certain medications interact with processes affecting estrogen/progesterone production and secretion. Hormonal contraceptives, most notably, are designed to affect the levels of estrogen and progesterone in your body in order to prevent pregnancy. That’s why your period on many forms of birth control is technically called breakthrough bleeding, and it might look and feel totally different from your period pre-birth control.  

However, hormone-related period problems could also have to do with lifestyle changes, like an intense exercise regimen or severe diet restriction that sends your body into “conserve resources” mode. They could also point to a medical condition, like primary ovarian insufficiency, polycystic ovary syndrome (PCOS), or another problem in the body. If your period is all over the place, don’t ignore it! Talk to a healthcare provider or OB/GYN to rule out anything serious. 

Important to note here that one of the reasons for a missed or absent period is, of course, pregnancy. Something to keep in the back of your mind, but certainly not the only option.


3. Weight gain or weight loss

Switching gears here, one of the other signs of a potential hormonal imbalance is unintended weight gain or weight loss. Ever feel like no matter what you eat or exercise, the pounds keep adding on? Or, the other way around…you’re eating well and doing the same activities as usual, but suddenly your jeans are sliding right off your hips?

Body-pos culture lets us know that every body is beautiful: What’s normal and healthy for you will look totally different than what’s normal for someone else. At the same time, it’s also critical to check in with yourself – and really listen to your body – if an unusual pattern emerges. 

Sudden weight loss or gain could be a sign of an underlying hormonal imbalance. One of the top culprits here tends to be a little butterfly-fly shaped gland called the thyroid: A little tissue collection located right in the middle of your throat. If you check yourself out in a mirror while swallowing (harder than it sounds), you may be able to see the slight outline of the thyroid moving up and down. 

The thyroid gland produces hormones T3 and T4, which are super important for regulating a ton of processes, from your internal temperature to how you absorb calcium to, yes, things like body weight.4

Folks with a hypoactive, or low thyroid, will often experience unintentional weight gain because there isn’t enough hormone to properly regulate your metabolism.5 In hyperthyroidism, on the other hand, there’s too much thyroid hormone floating around – and folks may experience what’s colloquially referred to as a “high metabolism,” resulting in unintentional weight loss over time (along with a number of other symptoms). 

Hypo- and hyper-thryoidism often run in families and are more common in people AFAB, so if your mother or even relatives like an aunt or sister have it, make sure to bring it up to your healthcare provider at your next appointment. 


4. Low sex drive

First off, it’s totally normal to go through periods of time where you have a low sex drive – and so much of this is affected by other factors in your life, like stress levels or your relationship with your partner. At the same time, a chronically low sex drive over time may also be the result of changes in hormone levels. 

Many hormones contribute to sex drive. Among these, estrogen and the thyroid hormones tend to play the biggest role in the presence (or lack) of sexual desire.6 7

Estrogen regulates sex drive in a couple ways. First, it affects libido, or the desire component of sex drive. It also affects the experience of sex itself. Estrogen is largely responsible for keeping the skin of the vagina elastic, thick, and well-lubricated, which is why some people with uteruses notice vaginal dryness during and after menopause

Low estrogen (whether related to menopause or not) may lead to vaginal dryness, itching, and pain during sex…all of which can affect sex drive. So, whether it’s a sudden disinterest in period sex when you normally love it, or just a disinterest in sex in general…don’t ignore it! And don’t be embarrassed to talk about it with your doctor or OB/GYN. 

The thyroid hormones are also known to affect sex drive: Studies have shown, for instance, that thyroid autoantibodies found in blood tests are linked with sexual dysfunction in women.8 However, the mechanism by which they do so is not as well understood and is most likely the result of multiple complicated processes. 


5. Extreme fatigue

All of us have days when we can’t wait for the sweet release of our pillows and beds, especially after a hard week of work, school, or binging Netflix. Whatever floats your boat. But feeling constantly fatigued, and especially when more hours of sleep doesn’t relieve this feeling, could be a sign of a deeper hormonal imbalance. 

For this one, the thyroid hormones are back in play. T3 and T4 are super important when it comes to maintaining your body’s normal metabolic processes. When this is disrupted, your body has to expend more energy just to keep you going, and this can cause you to feel ultra-fatigued. Low thyroid hormones are commonly to blame for fatigue that isn’t helped by any other medical or lifestyle interventions. 

Other things that come with low thyroid? Sudden weight gain, like we discussed earlier, feeling cold all the time, and chronic muscle aches and malaise.9 If you have one or more of these symptoms, then definitely bring it up with a healthcare provider ASAP. 

In the meantime, here are a couple things you can do to help you sleep more soundly (and keep you from dozing off during that 8:00 a.m. Zoom call). Try sipping soothing caffeine-free teas like chamomile about an hour before bed, reducing nighttime blue light exposure, and optimizing your “sleep hygiene” practices: 

  • Keep your bedroom totally dark to help your body fall and stay asleep
  • Try to wake up at the same time each day to establish & maintain a normal circadian rhythm
  • Eat dinner at least three hours before bed to allow ample time for digestion, which can otherwise disrupt sleep

Extreme fatigue could also be a sign of a different hormone imbalance: Namely, melatonin. Melatonin is a hormone produced by the pineal gland in the brain.10 It’s usually released at night, and is thought to be associated with the sleep-wake cycle. If your body isn’t producing enough melatonin, it can be hard to fall asleep or stay asleep—and that’s part of why over-the-counter melatonin supplements have become so popular. 

For some, melatonin supplements can help the body re-regulate the sleep cycle. However, as always, check in with a healthcare provider before taking anything new (even seemingly harmless stuff like vitamins). Melatonin isn’t the end-all, be-all for insomnia and fatigue, and taking too much can sometimes make sleep problems worse. 


Key takeaways 

  • Hormonal imbalances can manifest in many ways, but for people with uteruses, some of the most common signs include cystic acne, weight gain or loss, menstrual cycle changes, chronic fatigue, and low sex drive. 
  • In women and people AFAB, estrogen, progesterone, and thyroid hormone imbalances are the most commonly associated with the signs and symptoms mentioned above—but there are tons of other hormones that could be involved, including androgens like testosterone, insulin, FSH and LH, and even melatonin
  • A healthy, balanced diet, regular exercise routine, and solid sleep hygiene practices can help with some of the effects of hormonal imbalance, but always speak to a licensed healthcare provider if you’re experiencing any of these symptoms—and remember, your period (and menstrual cycle in general) is a wealth of information!

This article is informational only and is not offered as medical advice, nor does it substitute for a consultation with your physician. If you have any gynecological/medical concerns or conditions, please consult your physician.


© 2021 The Flex Company. All Rights Reserved. 

References (Click to open/close)

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