Disclaimer: this post (like this entire website) is NOT meant to diagnose you OR to replace your doctor’s advice. Its aim is to help you understand your body better, to know when there is a problem from the first symptoms. I’m not a doctor. I’m someone who has suffered from hormonal imbalances, and this post, along with all the others I create, is the sum of the things I have learned in my own journey – from doctors, books, my own experience, as well as the experiences of other people.

A hormonal imbalance is a common issue that many women face nowadays at least once in their lives. After all, we live busy lives, we have jobs that don’t allow us to take a break in our luteal or menstrual phase, we put a lot of chemicals in our bodies. Then there’s the issue of hormonal contraceptives, that can mess our balance even more. There are a few signs that will tell you your hormones are out of whack. While some doctors are quick to put you on the pill or say it’s just anxiety, know that these imbalances are not normal, and while the pill has its benefits, it is not a long-term solution.

Heavy bleeding

A heavy period is one where you lose more than 80 mL of blood, or that lasts more than 7 days. It’s bad not only because it is a sign of a hormonal imbalance, but also because you can end up severely anaemic. What causes it? It can have several causes such as endometriosis, adenomyosis, thyroid disease, the copper IUD, anovulatory cycles, perimenopause, high estrogen, and more. If you also see large clots (bigger than 2.4 cm) you should see a doctor urgently! Smaller clots may be normal, but they could also be a sign of fibroids, especially if there are a lot of clots. If you feel worried, definitely check with your doctor. You should also seek professional help if your periods go from normal to very heavy.

Light periods

Light periods, up to a point, can be normal. The lowest normal is usually considered 25 mL of blood, the equivalent of 5 normal tampons, spread out through the days of your period. If you see less than that, you might actually be having an anovulatory cycle, also called a breakthrough bleed. Again, using a method such as FAM can help you realize if you ovulate or not.

Late/irregular periods

Amenorrhea, oligomenorrhea (lack of ovulation), or late periods (over 35 days) are all signs that something might be off with your hormones.

Amenorrhea is divided into two categories. The first is primary amenorrhea – when you have never had your period and you are over 16 years old. You should definitely see a doctor in this case. The more common type is secondary amenorrhea – that is you have had your period, but all of a sudden it goes missing. It is considered secondary amenorrhea if you do not have a period for 3 months if your periods were regular before, and 6 months if you have regular periods before. The first step is, of course, to rule out pregnancy. Once that is ruled out, there are several possibilities, which will all be discussed in detail in a separate post. To give you a short overview, here are the most common causes of a missing period:

  • perimenopause/menopause
  • PCOS
  • endometriosis
  • thyroid issues
  • stress/illness
  • low body weight
  • eating too little, or too few carbs and fats
  • exercising too much

The last three comprise what is called hypothalamic amenorrhea. However, HA can happen even if you don’t check all three causes. You might be of normal weight and eat enough, but if you put your body through too much effort, you can still end up with HA.

Early periods

Just like late periods, early periods – more often than 21 days – can also be a sign that there’s an underlying hormonal imbalance. This type of issue is more common during perimenopause when the follicular phase gets shorter. However, a short cycle can as well be caused by a short luteal phase. This is usually caused by low progesterone. If you are trying to get pregnant, you need to address this issue, as it can lead to miscarriages, because your body does not produce enough progesterone to sustain a healthy pregnancy.

The easiest way to figure out what may be the culprit is to use the fertility awareness method (FAM). We will talk about in a future post, but in short, you can know if and when you ovulate by tracking your basal body temperature and your cervical mucus. This method, when done correctly, is much better than ovulation prediction kits, which have a very short window, that is easy to miss, especially if your periods are irregular. By doing this, you will also understand if what your period is an actual period or just anovulatory bleeding (breakthrough bleeding).

Pain

A bit of pain with your period is normal. However, if you are swallowing pill after pill after pill and the pain is still there, you have a problem.

When pain lasts for several days, is severe, is accompanied by nausea, and may even happen outside of your menstrual phase, it is possible you are dealing with an issue such as endometriosis or adenomyosis. While I have never dealt with these issues, I know people who have and I know how debilitating they can be. It can take 5 years or more for a woman to get an endometriosis diagnosis because many doctors dismiss the pain. Also, take note than endo cannot be diagnosed by ultrasound. It can, sadly, only be diagnosed through laparoscopic surgery. Adenomyosis, on the other hand, can be diagnosed with a transvaginal ultrasound.

Mid-cycle pain can be due to ovulation. Normal ovulation pain should not last longer than 1-2 hours and should not require any pain killers.

Cysts might also cause pain. Every woman will have some cysts throughout her life and they should go away without any major symptoms. You might feel some pain when the cyst ruptures, but it should go away quickly. If it doesn’t, it is a medical emergency!

Finally, if your pain is accompanied by other symptoms, such as itching or burning of your vagina, a bad smelling discharge or even a fever, it could be a sign you actually suffer from the pelvic inflammatory disease. While this is not a hormonal imbalance, it is a serious issue and you need to see your doctor.

PMS

Premenstrual syndrome, or PMS, is actually not as normal as you’ve been led to believe. It is one of the reasons why teenagers struggle with more PMS symptoms, which go away as they grow older. Hormonal imbalances are more common in young girls and they are not abnormal, their bodies just take a little longer to adjust to the hormones. If however, you’re an adult and you still struggle with severe PMS – bad, uncontrollable mood swings, weight gain, cystic acne, fatigue, breast tenderness and more – than it’s a sign something is wrong. Potential causes include:

  • too much estrogen
  • low progesterone
  • too much estrogen as compared to progesterone – often called estrogen dominance, which is actually not a medical term. It simply means that, while you have seemingly normal estrogen and/or progesterone, their ratio is not what it is supposed to be
  • stress
  • inflammation

I urge you not to go directly to the contraceptive pill to “heal” these symptoms. You won’t heal them, you will just mask them and they will come back with a vengeance once you quit the pill.

Hair loss

Hair loss is a symptom we women feel hard. We all lose a few hairs here and there, depending on how much we style it, the weather, how much we sleep or drink and more. However, when hair loss becomes significant and especially when you notice it happens in a male-pattern, it is a sign something is wrong. Usually, when testosterone and/or androgens are too high, hair loss will be one of the main symptoms.

Worse symptoms of this type of hormonal imbalance include growing hair in unwanted places such as around your nipples, belly button, on your chest, your back and even your face (hirsutism). Definitely, check with your doctor if you experience these symptoms. Also, remember that some forms of hormonal birth control can actually lead to hirsutism. So if you’ve recently started a new pill and are seeing hairs popping up while you are losing hair from your head, it might be the pill!

Signs of a hormonal imbalance in teenagers

Most teenagers experience some signs of hormonal imbalances. However, you should know that these are actually not worrisome. It takes a few years for a girl’s body to adjust to the hormonal changes. In this time, girls might face acne, PMS, irregular periods, and more. The worst mistake one can make, is to give young girls birth-control pills to regulate their cycles. Here’s an excerpt from the Period Repair Manual:

It takes time for hormones to carve out their “rivers” and that’s why it takes time to establish a healthy menstrual cycle. According to Dr. Jerilynn C Prior, a Canadian endocrinologist with expertise in reproductive hormones, it can take up to twelve years to develop a mature menstrual cycle with healthy regular ovulation and an optimal level of progesterone.

[…]

So what happens if you take hormonal birth control as a teen and hit the pause on that maturation process? You will probably need some time to get things going again, and you may not see regular periods right away when you stop birth control.

References:

Lara Briden, “Period Repair Manual, Second Edition: Natural Treatment for Better Hormones and Better Periods“.

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