"Hormone imbalance" is a broad phrase. Cleveland Clinic defines it as having too much or too little of one or more hormones, and the body makes more than 50 of them.
So the same symptom, such as tiredness or weight gain, can come from very different places: the thyroid, the ovaries, blood sugar, stress hormones, or a normal life stage like perimenopause. That is why the answer usually comes from a provider and a blood test rather than a checklist.
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Common signs of hormone imbalance in women
Cleveland Clinic lists these signs of a sex hormone imbalance in women:
- Acne on the face, chest or upper back
- Hair loss, or extra hair on the face and body
- Heavy or irregular periods
- Hot flashes
- Loss of interest in sex
- Trouble getting pregnant
Imbalances that affect metabolism can show up as fatigue, unexplained weight gain or loss, a slow or fast heartbeat, constipation or diarrhea, higher cholesterol, or trouble tolerating cold or heat. Cleveland Clinic adds an important caution: many of these symptoms can come from conditions that have nothing to do with hormones.
Can hormone imbalance cause weight gain?
Some imbalances can. Cleveland Clinic points to three in particular. An underactive thyroid (hypothyroidism) slows metabolism. Cushing's syndrome, which is rare, comes from too much of the stress hormone cortisol. And during menopause many women gain weight as hormone changes slow metabolism, which Cleveland Clinic describes as a natural, expected part of life.
Polycystic ovary syndrome (PCOS) is another. The Office on Women's Health lists weight gain or difficulty losing weight among its signs and notes that many women with PCOS have insulin resistance. There is more on the midlife side of this in why belly fat gets harder to lose after 40.
Can hormone imbalance cause anxiety, hair loss or migraines?
Anxiety can come from an overactive thyroid, which speeds up metabolism and can cause nervousness, restlessness and irritability. Cleveland Clinic also links anxiety to Cushing's syndrome and to growth hormone deficiency in adults.
Hair loss appears on Cleveland Clinic's list for sex hormone imbalances, and dry, thinning hair is a common sign of an underactive thyroid, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
For migraines, The Menopause Society notes that some women have headaches at certain points in their cycle, and that the estrogen swings of perimenopause may make hormone headaches more frequent.
What causes hormone imbalance in women?
Some changes are part of life. Cleveland Clinic names puberty, pregnancy and menopause as times of large hormone shifts, and lists stress, certain medications and steroid use as common reasons levels change at unexpected times. These are more often temporary.
Longer term causes include:
- Thyroid disease. About 5 in 100 Americans aged 12 and older have an underactive thyroid, women are much more likely than men to have it, and it is more common after 60 (NIDDK).
- PCOS, which affects about 1 in 10 women of childbearing age (Office on Women's Health).
- Diabetes, the most common hormone related condition in the United States (Cleveland Clinic).
- Less often, autoimmune conditions, or growths on a gland that makes hormones.
The labs that answer it
Hormones travel in the blood, so blood tests are the usual starting point, along with your history and an exam. Which tests make sense depends on your symptoms:
- Thyroid. The NIDDK notes that hypothyroidism cannot be diagnosed from symptoms alone, because so many of them overlap with other conditions, so several thyroid blood tests may be used.
- PCOS. There is no single test. Blood tests check androgen levels, the hormones sometimes called male hormones, and also look for thyroid disease, cholesterol problems and diabetes, which can look similar (Office on Women's Health).
- Perimenopause. Hormone tests are often unreliable here, because levels swing from day to day (Cleveland Clinic).
- Cortisol and blood sugar. Some levels change a great deal through the day, so a provider may use other tests, such as a glucose tolerance test (Cleveland Clinic).
One more point. The Menopause Society considers saliva and urine hormone testing unreliable for guiding hormone therapy doses, because of how much levels vary within and between people. If a plan is built on test results, ask which test was used.
Which tests answer which question
- Thyroid
- Several thyroid blood tests. Symptoms alone cannot diagnose it.
- PCOS
- No single test. Blood tests check androgen levels and rule out thyroid disease, cholesterol problems and diabetes.
- Perimenopause
- Usually diagnosed from age, symptoms and cycle history. Hormone tests can mislead because levels swing.
- Cortisol and blood sugar
- Levels change through the day, so other tests, such as a glucose tolerance test, may be used.
When to get checked
Cleveland Clinic advises talking to a provider about any new symptom that persists. It is especially worth asking about labs if:
- Your periods have become irregular, very heavy or have stopped early
- You are tired, gaining or losing weight, or always cold or warm, without a clear reason
- You have new acne, hair loss or extra facial hair
- You are having trouble getting pregnant, where the NIDDK notes thyroid testing is common
Cleveland Clinic also notes that few supplements sold for hormone balance have been shown to work, so check with a provider before you start one.
