From mood swings and low energy to unexplained weight gain, under-the-radar hormonal imbalance can silently wreak havoc on our bodies. Understanding the signs and symptoms of hormone imbalance is crucial — not only because it affects our quality of life in the short term but can also lead to long-term consequences. These imbalances are the unseen puppeteers behind a host of health issues. Today, we’re looking at the typical signs and diving into one of the most common (and commonly missed) culprits behind hormone imbalance: Polycystic Ovary Syndrome (PCOS), a condition that affects 4-20% of women of childbearing age worldwide.
First things first. What are the signs of hormonal imbalance?
We asked Dr. Grayson Woods, a gynecologist and hormone expert in Nashville, TN, to help shed some light on how hormones orchestrate the complex symphony of our bodily functions and what happens when they hit a wrong note. From explaining the science behind hormonal imbalances to identifying the telltale signs of PCOS, she offers insight drawn from years of clinical experience.
According to Dr. Woods, the four most common symptoms she sees in patients with an imbalance are:
- Menstrual changes
- Acne
- Hair loss or hirsutism (an increase in hair growth in areas like the face in women)
- Unexplained weight changes (mostly gain, but sometimes loss)
“With the younger population, say the 18 to 30-year-old range, some of the most common signs of a hormone problem are things like hair falling out or excess hair growth in places like women’s faces,” she tells us. “If you’re noticing dark hair on your upper lip, chin, around the nipple area, or on your abdomen, that would be a very common reason to check hormone levels.”
Though the four symptoms above are the most common in Dr. Woods’s patients, there are a surprising number of signs that can indicate a hormonal imbalance. Your body is a complex system, but if you notice any (or a combination) of these symptoms, it might be time to speak to your doctor to discuss next steps.
- low libido or infertility
- problems with digestion, such as constipation or more frequent bowel movements
- unexplained increased fat and decreased muscle mass
- fatigue, weakness, sleepiness, or sluggishness
- mood swings, depression, or anxiety
- low motivation or apathy
- excessive sweating
- poor sleep patterns, insomnia, or night sweats
- insatiable cravings
- dry skin or brittle nails
- tendency to swell
- pain or stiffness in the joints
- a hump of fat develops between the shoulders
- increased thirst or hunger
- blurred vision
- puffy or rounded face
- purple or pink stretch marks
- hyperpigmentation (sunspots)
- skin tags
- vaginal dryness or atrophy
- pain during sex
- increased headaches
- development of breast tissue in males
- breast tenderness
- erectile dysfunction
- loss of bone mass
- difficulty concentrating
- hot flashes
Additionally, some signs of a hormonal imbalance can even be observed during childhood or around the time that puberty is expected to start, such as:
- lack of development of muscle mass
- the voice doesn’t deepen
- body hair grows sparsely
- impaired penis or testicular growth
- excessive growth of limbs in relation to the trunk
- development of breast tissue in males
- breast tissue does not develop in females
- menstruation does not begin
- the growth rate does not increase
How can we tell the difference between a hormonal imbalance and the natural side effects of aging?
There is, undoubtedly, quite a bit of overlap when it comes to the natural aging process and symptoms of a hormonal imbalance. The difference, it turns out, tends to be the speed at which you begin experiencing them.
“During the normal aging process, the rate you notice signs is going to be slower than when there’s a significant hormone problem, which generally comes with a faster onset,” Dr. Woods explains. “For example, when times are really stressful — even for people who have had COVID infections — we can see significant hair loss. With aging, the signs would be more gradual.”
“When we’re in menopause in our 50s and 60s, we definitely see some darker hairs appearing on the face for some women — that’s normal and different than a 30-year-old who’s suddenly noticing those symptoms,” says Dr. Woods. “Unfortunately, normal age-related weight changes tend to start in our late 30s and early 40s. There’s generally a pound of weight gain per year that tends to stabilize at around 10 to 15 pounds over your normal average weight. Men see a little bit less weight gain with aging. For them, it is more in the range of a pound every two years or so.”
What is the most common culprit of hormonal imbalance?
There are a number of possible reasons for hormonal imbalance, but Polycystic Ovary Syndrome (PCOS) is a common culprit that presents a number of frustrations for both patients and doctors — it tends to be influenced by both genetics and environmental factors, making it challenging to definitively point to a cause.
“The most common cause of a significant hormone imbalance in the younger population (the 18 to 30 range) is PCOS,” says Dr. Woods. “We’re looking for cycle irregularities and hirsutism, and a pelvic ultrasound is one of the assessment tools that we use in addition to bloodwork when we have those signs … We check the ovaries to look for these ‘polycystic’-appearing ovaries, which have that appearance because ovulation comes less frequently. And so we see what we call ‘baby’ eggs — baby follicles that are forming but don’t have the trigger for ovulation just yet,” she explains. “We can also help rule out other problems, such as ovarian cysts and tumors.”
And with PCOS, there’s a serious Catch-22. Excess weight tends to worsen symptoms for people with PCOS. But those who struggle with the condition are faced with higher insulin levels and difficulty processing sugars — making it more challenging to lose weight.
“One of the things I do in my women’s health practice is trying to help folks with that process because it’s hard, but if they can manage with diet and exercise and use programs that are out there to keep their weight in the normal range, that will significantly help improve their symptoms, the acne symptoms, the hair changes, and the menstrual irregularities. Methods that help are generally lower carb and high fiber diets, and of course, regular exercise.”
What are the long-term consequences?
Sometimes, the symptoms of a hormonal imbalance are not quite so obvious. For instance, we might connect a skipped period with a stressful event or blame it on coming off medication. Thyroid problems can be subtle, too. Someone might experience a slightly irregular period, a little hair loss, and some new but relatively mild constipation — those can be the first signs of a thyroid problem.
If left undiagnosed and untreated, the long-term effects of a hormonal imbalance can take their toll on your body. An untreated imbalance can lead to endometrial cancer, uterine cancer, difficulty conceiving, and even infertility. Elevated weight can even present cardiovascular risks. Luckily, there are a variety of treatment options available
“Of course, there are treatments available, both natural and other common medications, like combined birth control bills, the progesterone intrauterine device, and medicines that target hirsutism, such as spironolactone,” says Dr. Woods. “A variety of medicines are now available to help and reverse the course.”
Once treated, most patients will see results in their symptoms within a few months, with fundamental differences in hair growth and weight fluctuations within six months.
What can you do to make sure your hormones are in check, even if you’re not experiencing possible warning signs of imbalance?
The answer to this question is fairly straightforward: Don’t skip that yearly exam, even if everything seems normal.
“Typically, in my practice, starting at 40 years, I start to check basic hormone levels like a thyroid panel. At around 47-50 years, I will start checking other hormone levels for perimenopause and menopause,” says Dr. Woods. “Other basic labs are important too. Again starting at 40, we should investigate a complete blood count and vitamins and minerals like iron and B12. Often, we can get clues from these deficiencies if we’re having problems.”
To find out more, speak to a trusted healthcare provider.
Thanks to Dr. Grayson Woods of Woods Gynecology in Nashville, TN for today’s information.
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