This article was last updated on August 6, 2021.
Hormones are special chemicals in the body that, when released into your bloodstream, send messages to tissues and organs telling them to carry out specific tasks and keep things in the body running smoothly. Hormones are regulated by a collection of glands called the endocrine system — and your body relies on their signals for many of its processes.
Hormones play an important role in how you grow as a child: they tell your body when to enter puberty and they even control your menstrual cycle. But they don’t just shut off after you finish puberty or even enter menopause. They remain hard at work for the rest of your life, dictating important functions like:
- Your menstrual cycle
- Stress response
- Heart rate
In this article, we'll break down factors that can disrupt hormonal health (aka "hormonal imbalance"), causes of hormonal imbalance, symptoms and signs of hormonal imbalance, and how you can work with your healthcare provider to get things back on track.
What is a "hormone imbalance"?
“Hormonal imbalance” is commonly used to refer to too low or too high hormone levels, but that term is a bit of an oversimplification of the very complex process of hormone regulation. The production and release of hormones involve a chain of events (called a feedback loop) that begins in the brain.
Reproductive endocrinologist and Modern Fertility medical advisor Dr. Temeka Zore, MD, FACOG explains that the feedback loop that triggers the menstrual cycle, which is "known as the hypothalamic-pituitary-ovarian axis, or HPO for short," goes like this:
- The hypothalamus (located near the base of the brain) controls the production of gonadotropin-releasing hormone (GnRH).
- GnRH travels to the pituitary gland (also in the brain) to produce and release luteinizing hormone (LH) and follicle-stimulating hormone (FSH).
- FSH makes its way through the bloodstream to the ovaries to signal a follicle to start growing.
- The dominant developing follicle will secrete estradiol (E2) and other hormones leading to stimulation of the endometrial lining to start growing.
- Increasing levels of E2 then go back to the pituitary to decrease production of FSH.
- Peak and sustained E2 levels lead to a positive feedback on the pituitary gland and the LH surge (and to a lesser extent, a FSH surge) occur.
- The LH surge leads to final maturation of the egg within the follicle followed by ovulation, which usually occurs within 24-48 hours.
- Progesterone is secreted from the corpus luteum (the leftover cyst that forms from the follicle after ovulation) and prepares the endometrium for implantation.
- If fertilization doesn't take place, then E2 and progesterone levels drop, the lining of the uterus will shed, and the process repeats.
Hormonal changes happen day to day (sometimes hour to hour) and throughout your cycle, but sustained highs or lows that don’t reflect typical patterns have a ripple effect on other hormones in the feedback loop. Take hypopituitarism, for example: a condition where the pituitary isn’t able to make certain hormones. If hypopituitarism causes LH and FSH deficiency, the ovaries won’t get the message to produce E2 and signal follicle growth — disrupting your cycle.
Ultimately, hormone regulation is a little more complicated than a "balancing" act. It’s more like a pinball machine with occasional obstacles that shoot the ball in different directions.
What's considered too high or too low for hormone levels?
Hormone levels are typically measured using blood tests (like the Modern Fertility Hormone Test) or urine tests.
Evaluating the results of hormone blood tests involves what are called "reference ranges." Reference ranges are the range of values for a physiological measurement (in this case, hormone levels) for the middle 95% of the healthy population. Each provider of their test will use a specific lab to measure the results, and each lab has its own reference range. Out-of-range results indicate that levels are higher or lower than "average" (read: "hormonal imbalance").
For people with ovaries, some of the most important hormones to reproductive health and fertility include sex hormones and thyroid hormones. Modern Fertility can measure three hormones in those two groups: the estrogen estradiol (E2), thyroid-stimulating hormone (TSH) (plus fT4 if TSH levels are out of range), and prolactin.
These are the "normal" reference ranges Modern Fertility uses for sex hormones and thyroid hormones in people during their reproductive years:
- E2: 22.4-115 picograms per milliliter (pg/mL) for premenopausal people with ovaries on day 3 of their cycles
- TSH: 0.4-4.5 milli international units per milliliter (mIU/mL) for all people with ovaries (2.5 mIU/mL is recommended for the first trimester of pregnancy)
- Prolactin: 3.4-26.7 nanograms per milliliter (ng/mL) for nonpregnant people with ovaries
These are possible reference ranges for the other hormones we talk about in the next few sections (in people during their reproductive years):
- Progesterone: <3 ng/mL for premenopausal people with ovaries mid-cycle
- Total testosterone: >0.75 ng/dL for people with ovaries
It's important to note here that an out-of-range hormone doesn't automatically mean you'll have physical signs or adverse health effects. You might just be one of the 5% of people who are statistically outside the calculated reference range (remember, it only represents the middle 95% of healthy people). All of our bodies experience things differently — that's why it's always a good idea to talk to your healthcare provider about your unique levels.
What are the common causes and symptoms of "hormonal imbalance" in sex hormones?
Estradiol, an estrogen and a key hormone in both reproductive health and development, is produced by the ovaries, adrenal gland, and fat cells. Out-of-range estradiol levels (aka "estrogen imbalance") can be seen in the following conditions and situations:
- Estrogen-producing tumors
- Oophorectomy (removal of the ovaries)
- Functional hypothalamic amenorrhea due to causes such as extreme exercise, malnutrition, extreme weight gain or loss, and chronic, severe stress
- Exposure to endocrine-disrupting chemicals (EDCs)
When estradiol levels are too high (>115 pg/mL on day 3) or too low (<22.4 pg/mL on day 3), common symptoms can include:
- Period changes
- Non-cancerous breast/chest lumps
- Uterus fibroids
- Menstrual migraines
- Worsening of premenstrual syndrome
- Hot flashes and/or night sweats
- Sleeping issues
- Decreased sexual desire
- Mood swings
- Anxiety or depression
- Dry skin
High levels of estradiol can also lead to flare-ups for those with endometriosis.
Progesterone is mainly produced by the corpus luteum in the ovaries, which forms after ovulation. Low progesterone levels can be caused by:
- Certain medications (like hormonal birth control or hormone replacement therapy)
- Anovulation due to causes like PCOS, hypothalamic amenorrhea, or menopause
When progesterone levels are too low (<3 ng/mL mid-cycle), symptoms can include:
- Irregular menstrual bleeding from anovulation
Since progesterone is produced by the corpus luteum after ovulation, Dr. Zore says that progesterone levels in the second part of the cycle (in the luteal phase) are key to understanding if ovulation has actually happened. "If a patient has consistent progesterone values under 3 ng/mL approximately one week before their next period is expected, it implies ovulation is not occurring," explains Dr. Zore.
Prolactin is produced by the pituitary gland to help with breast development in puberty and milk production after giving birth. High prolactin levels can be caused by:
- Tumors in the pituitary gland (like a prolactinoma)
- Antidepressants, antipsychotics, or blood pressure medications
- Some herbs (fenugreek, fennel seeds, and red clover)
- Chest irritation (e.g., from surgical scars, shingles, a too-tight bra)
- Excessive or extreme stress or exercise
- Nipple stimulation
When prolactin levels are too high (26.7 ng/mL), symptoms can include:
- Irregular ovulation, absent or irregular periods, and trouble getting pregnant
- Milk production outside of pregnancy (galactorrhea)
- Interference with estrogen and progesterone levels
Testosterone, which is known as a "male" sex hormone (or androgen), is also produced by the ovaries and adrenal glands. Out-of-range testosterone levels can be seen in the following conditions:
- Polycystic ovary syndrome (PCOS)
- Over-exposure to EDCs
- Testosterone-secreting ovarian tumors
- Congenital adrenal hyperplasia
When total testosterone levels are too high (>.75 ng/dL), symptoms can include:
- Increased acne
- Excess facial and body hair (hirsutism)
- Balding at the front of the hairline
- Increased muscle mass
- Deepening voice
People with sperm can have issues with their sex hormone levels too. Testosterone is responsible for high or low sex drive in all people — and low testosterone in those with sperm can lead to erectile dysfunction and impaired sperm production.
What are the causes and symptoms of "hormonal imbalance" in thyroid hormones?
In this section, we'll focus on what happens when thyroid-stimulating hormone (TSH) levels are too high or too low.
Thyroid-stimulating hormone (TSH)
Thyroid-stimulating hormone (TSH) is produced by the pituitary gland to regulate the thyroid. Conditions caused by out-of-range TSH levels — hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid) — occur in about 1 in 8 people with ovaries. Here are a few reasons this "thyroid imbalance" might happen:
- Graves’ disease
- Hashimoto’s disease
- Overactive thyroid nodules
- Non-functioning thyroid gland at birth
- Iodine intake
When TSH levels are too low (<0.4 mIU/mL) or too high (>4.5 mIU/mL), symptoms can include:
- Unintentional or unexpected weight fluctuations
- Changes in the rate and rhythm of heartbeat
- Changes in energy level
- Changes in appetite
- Changes in mood
- Changes in the menstrual cycle
- Changes in the skin, hair, or nails
- Changes in bowel movements
- Elevated blood cholesterol level
- Hand tremors, muscle aches/stiffness, or pain/swelling in the joints
- Sweating or increased sensitivity to cold
- Voice hoarseness
- Impaired memory
- An enlarged thyroid (or goiter)
If you have any of the above symptoms, consider bringing them up with your healthcare provider to see if out-of-range hormone levels may play a role.
Can a "hormonal imbalance" impact your fertility?
When reproductive hormone levels are out of range, that can disrupt the standard process of hormone regulation and impact your menstrual cycle. Period and ovulation changes, no matter why they're happening, can make it harder to get pregnant. Conception requires an egg to be released during ovulation before fertilization by sperm — cycle disruptions can make it harder to pinpoint ovulation and time sex or insemination around the days you're most likely to get pregnant.
How can you diagnose and treat "hormonal imbalance"?
If you experience any of the symptoms we listed earlier, your healthcare provider can run tests to help you figure out the cause. The Modern Fertility Hormone Test can give you a leg up on the conversation by measuring up to seven important reproductive hormones, including estradiol (an estrogen) and TSH (depending on your birth control).
If your results suggest any hormone levels are too high or too low, you can use those levels to start a conversation with your healthcare provider about treatment options. (It's important to note, though, that the Modern Fertility Hormone Test can't diagnose anything on its own.) In many cases, your healthcare provider will treat the underlying cause before addressing hormone levels.
If treatment for symptoms from "abnormal" hormone levels is needed, your healthcare provider may suggest or prescribe:
- Evaluating your current medications to see if they may be contributing
- Lifestyle changes (stress management, nutrition, exercise)
- Making sure any chronic medical conditions are controlled
- Hormonal birth control or hormone replacement therapy (HRT)
- Hyperprolactinemia medications or thyroid medications (or adjustments to medications you're already on)
- Radioactive iodine, thyroid medications, beta-blockers, and surgery
As for lifestyle changes beyond stress management, nutrition, and exercise? Dr. Zore explains that other modifications have very little science to back them up.
When is the best time to test for “hormonal imbalance”?
Estradiol (E2) needs to be tested on day 3 of the menstrual cycle to get the most clinically meaningful results. Doctors call day 3 the “baseline” because that’s when E2 is most stable, before levels begin to rise. Aiming to test on day 3 (for most people) puts you right at the beginning of the follicular phase and is the best time to get a clear read of these baseline levels.
Progesterone testing is most valuable in the luteal phase (second half) of the cycle.
Prolactin, testosterone, and TSH levels are more stable throughout the menstrual cycle and can be tested any day of the month.
The bottom line: The more info you have, the better
Whether or not you're experiencing symptoms that might be related to excess or deficient hormone levels, learning more about your body (which you can do through the Modern Fertility Hormone Test!) and how hormone regulation works are great first steps. Paying attention to what you're feeling and discussing any concerns you might have with your healthcare provider is always important. At the end of the day, the more information you have, the better.
This article was reviewed by Dr. Temeka Zore, a Modern Fertility medical advisor and reproductive endocrinologist at Spring Fertility in San Francisco.