Question from a 40-Year-Old Woman:
“Dr. Sarah, I feel like something is off, but my doctor says my labs are normal. I’m tired all the time, I can’t lose weight like I used to, I am so irritable with my husband and kids, I can’t sleep and my cortisol is high. Could this be my hormones? How do I know if they’re low or unbalanced?” My doctor even told me that my estrogen is high, so I need to lower it.
Answer: If I had a nickel for every time I heard this question, I would own 4 Ferraris! Many women come to me feeling dismissed by traditional doctors, even when they know something is wrong. The truth is, hormone problems don’t always show up on standard lab tests, and many doctors aren’t trained to recognize the early warning signs. Doctors don’t order the right tests and ignore all 3 hormones in women. They also believe that hormones are normal if a woman is still menstruating. This one is a big one! A very common misconception!
When women are starting to get symptoms they can have a normal estradiol level because the ovaries are able to make a little bit every now and then. However, they aren’t consistently making estradiol just because they got a normal once on a lab test! In addition, progesterone and testosterone are completely absent. A FSH (follicle stimulating hormone) and progesterone are two labs virtually never ordered and are the most important. I want to point out that you can’t measure these from a metabolite urine test – no matter how expensive the urine test is! If your ovaries are failing, or fatigued then your FSH will be higher than 9.0 even if your estrogen levels are “normal.”
As a longevity, hormone and peptide specialist, I’ve helped thousands of women navigate their hormones and aging. Let’s break down how to tell if your hormones are low or unbalanced, what causes it and what you can do about it.
Symptoms of Hormone Imbalance or Deficiency: What to Look For
Women’s ovaries start to fail or fatigue around the age of 30 – they were never meant to work for 90 years (the time we are now living until). Women know that they are off because they just don’t feel like themselves anymore and all the things that used to work for them (diet & exercise) no longer do! They see wrinkles, hair loss and their health start to decline. It doesn’t mean they are menopausal – they are 20-30 years away from the period stopping actually. What they are experiencing is just fatiguing ovaries! Just like men don’t make as much testosterone as they age – women don’t make as much progesterone, estradiol and progesterone.
Physical Symptoms
- Weight gain
- Fatigue and low energy
- Irritability, rage, or anxiety
- Sleep disturbances
- Hair thinning or loss
- Dry skin, brittle nails, or wrinkles
- Bloating, leaky gut, or other digestive issues
- Elevated cortisol
- Autoimmunity, or increased immune sensitivity
- Muscle aches and pains
- Joint pain or stiffness
- Not getting results at the gym despite working out all the time
- Dry skin, hair, ears, and vagina – which can cause itching all over!
Emotional & Cognitive Symptoms
- Anxiety, or depression
- Brain fog or forgetfulness
- Lack of mental clarity or ADHD like symptoms
- Irritability and low stress tolerance
- Loss of motivation or drive
- Lack of verve for life
Reproductive & Sexual Symptoms
- Heavy and painful periods
- Low libido or difficulty with arousal
- Vaginal dryness
- Vaginal odor
- Infertility
- Increased PMS symptoms, or PMDD
- Ovarian cysts or uterine fibroids
Conditions linked to low hormones
- Polycystic ovarian syndrome
- Endometriosis
- Any kind of autoimmunity
- High cortisol
- Leaky gut
- Post-birth control syndrome
- Postpartum depression
There are 100s of symptoms because when hormones drop there is a cascade effect. This is because estrogen and progesterone are needed to maintain health and youth! They are needed for every process of the body, so when they decline, you feel it! If any of these most common symptoms sound familiar, your body is sending you a message—it’s time to dig deeper.
What Causes Hormones to DROP and become imbalanced?
Women often ask: Why is this happening to me? There are a lot of misconceptions about what causes it so women often try to change their diet, thinking it is a nutrient deficiency, or they try and fix their thyroid first. These are not root causes, but rather symptoms of low hormones.
Here are the most common reasons hormones become low in women at any age:
Natural Hormonal Decline (Aging)
Hormone levels start to decline in your 30s and 40s, long before menopause because the ovaries were never meant to work that long! Progesterone is often the first to decline, leading to increased anxiety, insomnia, and irritability. Estrogen and testosterone follow, impacting metabolism, skin, energy, and libido.
Post-Birth Control Syndrome
Synthetic hormones from birth control pills can suppress natural hormone production for years after stopping them. Often women are unable to start producing hormones again – even after stopping birth control.
Environmental Toxins & Endocrine Disruptors
Plastics, pesticides, and chemicals in beauty products contain endocrine disruptors that bind to estrogen receptors and then suppress the production of our own estrogen and progesterone. This is how environmental toxins work like birth control and cause infertility. They aren’t estrogen, or don’t act like estrogen in the body. They cause your estrogen and progesterone to be low!
Testing for Hormone Deficiencies or Imbalances: What You Need to Know
Do I need a lab test, or is there another way to know for sure?
Yes! Here are a few ways to assess whether your symptoms are hormone-related:
Symptom-Based Self-Assessment
If you are having any symptoms this is always a better indicator than any lab test! You can see if your symptoms are hormone-related with our Health Quiz.
Lab Testing – while this is an option, there are many downsides and you should never believe a lab test over your own experience.
- DUTCH Test – A urine test that measures hormone metabolites, cortisol patterns, and how your body processes estrogen. The downside: misleading results because it doesn’t give an accurate reflection of hormones in the tissue, or FSH, a very important marker of perimenopause. Women are often told that they have “estrogen dominance” from this test and they are led to believe that they need to lower estrogen, which is misleading and typically not the case.
- Saliva Testing – Measures free (active) hormone levels throughout the day. Some hormones are stored in saliva like progesterone. This also doesn’t take into account hormones that are stored in other tissues, or an FSH and results are very misleading.
- Comprehensive Blood Work – Should include estradiol, progesterone, free & total testosterone, thyroid function, and inflammation markers. FSH, LH and progesterone are typically not done and these are tests that can help diagnose ovarian fatigue, endometriosis, PCOS, or perimenopause. Its important to remember that labs often come back “normal” because optimal reference intervals for all these tests haven’t really been well established by labs.
Who Should You Ask Questions about Hormones?
Unfortunately, not all doctors are trained in hormone optimization. Here’s who can help:
- Traditional OB-GYNs & Endocrinologists – Good for delivering babies and treating pituitary tumors. But diagnosing conditions like perimenopause they are just not familiar with, lack training and often follow outdated guidelines. Their solution is typically birth control.
- Hormone Specialists (Like Inner Balance) – Experts in bioidentical hormone replacement therapy (BHRT) and longevity medicine. Here you can get answers about different formulations, and the risks and benefits of starting.
When Should You See a Specialist?
You don’t need to suffer for years before seeking help. You should consider seeing a specialist if:
- Your symptoms are impacting you.
- Your doctor says your labs are “normal,” but you still feel off.
- You want to optimize your hormones for longevity and disease prevention.
- You’ve tried lifestyle changes and supplements, but they aren’t enough.
Next Steps: Take our Health Quiz
If you’re wondering whether your symptoms are due to hormones, don’t wait for things to get worse. Take our Health Quiz to get personalized insights and learn more about your next steps. You can also follow us on Social Media for the information, success stories and more.
You don’t have to settle for feeling “off.” Bioidentical HRT isn’t just about fixing symptoms—it’s about optimizing your health, longevity, and quality of life. Let’s take control of your hormones at Inner Balance and get you back to feeling your best.
