"Hormonal imbalance" is a phrase used constantly and defined rarely. Hormones work as a system: the cycle, the thyroid, cortisol and insulin all influence one another, which is why the symptoms almost never arrive one at a time. This article covers the signs that come up most often and the causes behind them, and serves as the way into the more precise subjects on this blog — irregular cycles, adult acne, fatigue, the thyroid, PMOS (previously PCOS).
What a hormonal imbalance actually is
The female hormonal system runs on a constant conversation between the brain (the hypothalamus and the pituitary), the ovaries, the thyroid and the adrenal glands. An imbalance simply means that conversation has been disturbed — sometimes briefly, by stress, travel or illness, sometimes for much longer. It is not a diagnosis in itself. It is a pattern, and a pattern always has one or more identifiable causes.
The signs that come up most often
A cycle that becomes irregular or changes length. Fatigue your lifestyle does not explain. Acne appearing or returning in adulthood, usually along the jaw and the lower face. Disturbed sleep, particularly in the second half of the cycle. Weight moving without a change of habits. Diffuse hair loss. Mood swings sharper than they used to be.
No single one of these points to a specific cause. It is their combination, and the way they change over time, that gives a direction.
The most common causes
Chronic stress, through its effect on the hormonal axis in the brain, is among the most underestimated. A thyroid running too fast or too slow — read first through TSH — is another classic. Coming off hormonal contraception usually means two or three cycles of readjustment rather than months, with the contraceptive injection the outlier at five to eight. PMOS (previously PCOS) is a frequent cause of irregular cycles combined with other signs, such as acne and increased hair growth. And a very restrictive diet or very intense training can disturb the balance too, by signalling to the body that there is not enough energy available — the energy deficit matters more than the weight change.
What to do about it
The first useful step is to observe and write it down: cycle length, the symptoms that come with it, when each one started. That information is usually the piece missing from a consultation, and it is exactly what lets a clinician give you a direction rather than start from zero.
An imbalance that persists beyond two or three cycles, or that comes with symptoms getting in the way of your day, deserves to be documented rather than endured in silence.
- Track your cycles and your symptoms for two to three months before any consultation — it is the single most useful thing you can bring to it.
- Note whether the signs started after a specific event: stress, coming off the pill, a change in weight. It narrows things down considerably.
- Do not treat each symptom separately — skin, sleep, weight — without looking at whether they are connected.
- See a professional if the signs persist beyond two or three cycles or get worse, rather than waiting for them to pass on their own.
Reviewed by the OVEA medical committee