How to Identify if You Have a Hormonal Imbalance
Hormones are your body’s chemical messengers, orchestrating everything from your menstrual cycle to your mood, energy, cycle health, and metabolism. In my sessions I frequently hear clients say they think they have a hormone imbalance when they are describing their symptoms to me - think PMS, mood changes, heavy periods, acne, and fatigue. These symptoms are commonly blamed on hormones! It’s my job to figure out if that is true, and if so, which hormones are signalling that they need support.
The reality is that the term hormone imbalance isn’t specific nor a medical diagnosis, however, it can encompass high or low levels of specific hormones, their fluctuations, or their ratios, manifesting as symptoms that disrupt your wellbeing. Symptoms arise when these interactions falter, influenced by factors like stress, diet, sleep, or health conditions such as PCOS and endometriosis.
The key hormones I commonly see needing support include:
Oestrogen
Progesterone
Testosterone
Cortisol
Thyroid-stimulating hormone (TSH)
Insulin
High Oestrogen
Symptoms can include heavy or painful periods, clotting, cyclical breast tenderness or swelling, fluid retention, premenstrual syndrome (PMS), irritability, headaches. High oestrogen, often relative to progesterone (known as oestrogen dominance), over-stimulates the endometrium, causing heavy bleeding and clotting. I often see high oestrogen levels in women with PCOS, endometriosis, or going through perimenopause.
Test oestrogen on day 2 of your cycle, ideal levels sit between 100 - 200pmol/L
The timing you test your hormones matters. Look at those cyclical fluctuations!
Low Oestrogen
This state can manifest as light or absent periods, fatigue, vaginal dryness, low mood, irregular cycles, hot flushes (common in perimenopause). Low oestrogen, seen in perimenopause, hypothalamic amenorrhoea, or low body fat (from prolonged fasting, undereating and in eating disorders), reduces endometrial growth, leading to light periods or amenorrhoea. It also impacts vaginal tissue and mood regulation, causing dryness and depression.
Test oestrogen on day 2 of your cycle, ideal levels sit between 100 - 200pmol/L. You may benefit from testing fasting insulin also
Low Progesterone
Symptoms of low progesterone include spotting before periods, low mood, irregular or short cycles, PMS, sleep disturbances, acne, recurrent miscarriages. Progesterone stabilises the endometrium and calms the nervous system via GABA receptors. Low levels, common in luteal phase defects, PCOS, or undereating, cause spotting, short cycles, and PMS.
Ensure you are ovulating! This is the only way to make progesterone
Test progesterone 7 days after you ovulate or 7 days before a predicted period. Aim for >35nmol/L
High Testosterone
Elevated testosterone shows up in the body as face or body acne, hair loss (androgenic alopecia), excess hair growth (hirsutism), oily skin, oily hair. High testosterone, prevalent in PCOS and in post-pill states, overstimulates sebaceous glands and hair follicles, causing acne and hirsutism.
Elevated androgens can be suspected from the symptoms listed above
Test testosterone, SHBG, FAI, DHEAS, and androstenedione on any day to confirm elevated androgens
An elevated androgen picture in a PCOS presentation
Low Testosterone
Symptoms may look like low energy, fatigue, low libido, difficulty gaining muscle. Low testosterone is common in perimenopause, chronic stress, or low-calorie diets, reduces energy, libido, and muscle synthesis.
Test testosterone, SHBG, FAI, DHEAS, and androstenedione
In some situations, androgens levels can appear ‘normal’, however SHBG is high. This means that androgens are bound up and unable to exert their effects in the body
High Cortisol
Can appear as anxiety, frequent or loose stools, sleep issues, gut issues (commonly bloating), food cravings, heart palpitations, feeling like you’re in ‘fight or flight.’ High cortisol, driven by chronic stress or HPA axis dysregulation, overstimulates the nervous system and gut motility. This commonly causes anxiety, sleeping issues, and loose bowels. Studies have linked elevated cortisol to anxiety and IBS-symptoms.
Test salivary cortisol levels throughout the day
It may be beneficial to explore thyroid function, as an overactive thyroid can lead to similar symptoms
Elevated DHEAS and cortisol levels on a salivary hormone profile
Low Cortisol
Looks like fatigue, brain fog, feelings of hopelessness, exhaustion not improved by quality by sleep. Low cortisol, often from adrenal fatigue after prolonged stress, impairs energy and cognitive function. Studies have shown that low cortisol levels are common in women with chronic fatigue.
Test salivary cortisol levels throughout the day
Consider exploring thyroid function, as an underactive thyroid can present similarly
High TSH
Hypothyroidism symptoms include fatigue, weight gain, cold intolerance, irregular/heavy periods, low mood, hair loss, brain fog. High TSH indicates low thyroid hormone production (T3, T4), slowing metabolism and affecting ovulation. This state is more common than we realise, especially in women with PCOS and through the perimenopause transition.
Test a full thyroid panel - TSH, T3, T4, thyroid antibodies, rT3
Low TSH
Hyperthyroidism is an overactive thyroid and can look like anxiety, weight loss, rapid heartbeat, irregular/light periods, insomnia, heat intolerance. Low TSH reflects excessive thyroid hormone, accelerating metabolism and disrupting cycles.
Test a full thyroid panel - TSH, T3, T4, thyroid antibodies, rT3.
High Insulin
Elevated insulin levels or insulin resistance can show up with symptoms such as weight gain (especially abdominal), inability to lose weight, sugar cravings, fatigue after meals, acne, irregular cycles, skin tags. This state is a hallmark of PCOS and can increase androgen production and drive oestrogen up.
Test fasting insulin, aiming for <8. Anything over 10 is classified as insulin resistance
It may be helpful to look into your HbA1c levels also
Elevated insulin levels on a fasting blood test - this patient has insulin resistance
Low Insulin
Symptoms include hypoglycaemia, shakiness, dizziness, difficulty concentrating, fatigue, irregular periods. Low insulin is less common than eleated insulin but I see it in my clients who are undereating, overtraining, excessively fasting, or have an eating disorders. It disrupts glucose availability which affecting ovulation and energy levels.
Test fasting insulin and HbA1c
Why Hormone Ratios Matter
It’s important to remember that our hormones don’t act in isolation. Their levels, fluctuations, and ratios - such as oestrogen to progesterone, testosterone to SHBG, or insulin to HbA1c - have the ability to drive symptoms. For example, low progesterone relative to oestrogen can mimic high oestrogen symptoms, even if oestrogen is normal. High insulin can elevate testosterone, causing acne, while low insulin may suppress ovulation and therefore hinder progesterone production.
If you’re experiencing any of the symptoms discussed here, exploring your hormones and their interactions is key to finding solutions to your symptoms.
I often say to my clients - symptoms is your body signalling for support! All symptoms are a sign that something may need to change.
If you have any questions for me about hormonal health or hormone imbalances, feel free to comment below. Please be in touch if you would like individualised support from me at any time in your hormone health journey.
Author
Jaclyn Cave
BHSc (Nat), BComm (Soc)
Masters Women’s Health Medicine (UNSW - completing)