Hormones are our body’s chemical messengers. An example of that would be the thyroid hormone. The thyroid hormone affects our energy and our metabolism.
When we think of hormones, they’re produced by a system, for example, the brain. They are then released to other systems like the thyroid gland that then releases thyroid hormones that travel in the blood and affect our body’s metabolism. Weight gain and weight loss can affect our energy, our sleep, our mood.
The endocrine system refers to that complex communication system between different organs and body parts and the hormones that are released into the blood and then carried downstream to their end site.
When we think of a menstrual cycle, we’re talking about two female sex hormones that are fluctuating and changing, and those are estrogen and progesterone.
With the changes that happen during the menstrual cycle, other hormones are impacted. For example, toward the end of a woman’s menstrual cycle, estrogen and progesterone will precipitously drop right before they get their period. For a lot of women, they can have symptoms of PMS (premenstrual syndrome) and PMDD (premenstrual dysphoric disorder), things like bloating, mood irritability, heightened anxiety.
Other hormones are implicated as well. Hormones like dopamine or feel good hormones can also be lowered. This includes serotonin. It can also affect aldosterone, which is a hormone that causes fluid retention and bloating. A lot of different hormones are related to different times in the menstrual cycle.
During pregnancy, there’s a lot of hormonal change and the female sex hormones can become very, very high. There are also changes in other hormones, like the thyroid hormone. I would say pregnancy is a condition where hormones undergo a great state of flux or change.
When I describe reproductive years, I always tell patients that it’s like a wave of female sex hormones. You get waves of estrogen and progesterone and it’s really nice and predictable.
We then transition to perimenopause. That’s that time sandwich between our reproductive years and menopause. During perimenopause, the female sex hormones, specifically estrogen and progesterone, start to look like a roller-coaster. If you were to plot them, they’re moving in the downward direction.
Once a woman reaches menopause ( the average age is about 51, 52) the hallmark is the lowering of estrogen and progesterone. They get so low, they’re undetected in the blood. So, a significant hormone change happens during perimenopause and menopause
There are a lot of different conditions that can cause imbalances or changes in hormones. There are genetic links, sometimes conditions that our family members have had. But there are also a lot of lifestyle factors, the way we move our body or the lack of movement, the foods we eat.
Maintaining a healthy body weight can really help stabilize and create hormone balance.
A lot of symptoms can come about, depending on what hormones are out of balance.
Hormone imbalance that affects your metabolism can lead to symptoms like weight gain or weight loss. It can also affect mood, irritability, heightened anxiety.
Hormones also impact our sleep, difficulty falling asleep or staying asleep. Those are symptoms that could point at a hormone imbalance.
The first part is identifying what the underlying cause is. There’s a lot of symptom overlap with hormone imbalances. Examples would be hypothyroidism, which is low-thyroid or perimenopause and menopause. We want to identify first what the underlying cause is and then we can figure out the appropriate treatment.
For a condition like underactive thyroid, hypothyroidism, it can be as simple as repleting the thyroid hormone that’s missing in the body.
Bioidentical hormone replacement therapy is when we give a woman estrogen and progesterone to in most cases, to help with transition through perimenopause and menopause. By giving a woman estrogen and progesterone during that transition time, we can help with menopausal symptoms.
It’s not a one-size fits all. When I’m seeing a woman for perimenopausal or menopausal symptoms, I assess her symptoms. How severe are the hot flashes and night sweats, brain fog, mood irritability, sleep troubles? We also look at a patient’s family history, their personal history, what their goals of care are.
Everybody has a different mind frame on hormone replacement therapy and comfort level. We use bioidentical hormonal placement therapy in appropriate conditions.
We also use nutraceuticals. Nutraceuticals are plant-based supplements that often have a very low side effect profile, if at all, but can have significant symptom improvement and can help with hot flashes and night sweats.
There are also non-hormonal pharmaceuticals, which are FDA-approved medications that don’t have hormone modulating activity. They’re not hormones, but they can help with symptoms and adjunct therapy. Things like acupuncture and hypnotherapy can be really helpful for menopausal symptoms.
I encourage all my patients to have an open conversation with their doctors. It usually starts with a primary care doctor. That’s who usually you see most often, and most primary care physicians are very comfortable treating hormone imbalances.
There are a lot of different causes of hormone imbalances. Sometimes we don’t even know the clear answer to that. Sometimes, it could be genetic predisposition, something that we’ve inherited from mom or dad. An example of that would be Hashimoto’s thyroiditis, an autoimmune condition that affects the thyroid and is thought to be genetic. Other things can be environmental exposures. A lot of different conditions can cause hormone imbalances.
We really treat the body as a whole. Often times if you’re just treating one part, you’re missing a whole other piece of valuable information.
We really spend time with our patients, understanding what they’re going through, what their concerns are.
Another important piece is understanding what their day-to-day functioning looks like. How do they eat? How do they move their body? How do they manage stress? How's their sleep. A lot of that will dictate how they feel on a regular basis.
We use a lot of different healing modalities. We do all the routine testing that all your other doctors will do, order all the appropriate imaging studies if necessary. But we spend a lot of time on education, educating our patients, talking about the foods that they’re putting in their body, what they’re exposing their body to in terms of endocrine disruptors. We educate about chemicals and things in the air, things we put in our body, things we’re exposed to that can affect our hormones.
We address day-to-day functioning and how we can make improvements. We have healing modalities as well, including acupuncture and biofeedback. We have an integrative nutritionist here at our center. We really do emphasize the mind, body, spirit, full patient-care model.
Absolutely. I do it on a daily basis. Really, it’s about just assessing what someone’s going through. What are their concerns? What are they feeling? Because I always tell patients, only you know what it feels like to be in your body. I’m here as a guide to help support you and give you the information, the knowledge, and the resources to improve upon that.
There are a lot of consequences to hormone imbalances being left untreated, different things like high blood pressure, increased risk of cardiovascular disease and even cancer risk. It’s important to make sure we’re appropriately identifying, addressing, and treating these hormone imbalances.
Really listen to your body and what your body’s telling you. If something feels off, if you’re not feeling quite yourself, listen to that. I would say have that conversation, talk with your physician, and have it addressed and worked up and just make sure we’re not missing anything.
Lightly edited for clarity.
Watch the San Diego Health video with host Susan Taylor and Dr. Dalhoumi discussing causes and treatments for hormonal issues in women.