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Out Of Whack Hormones

“My hormones are out of whack!” That’s the single most common sentence I hear from my patients.

It can come from a 25-year-old with irregular periods and industrial-strength PMS whose energy has gone down the tubes. Or from a 45-year-old (on the threshold of pre-menopause) who continues to gain weight even though she’s eating less and exercising more, and who adds that her brain feels like mush and her sex drive is a distant memory.

Many of my current patients have previously seen other doctors and were given prescriptions for hormones to “cure” these ills. Hormones came in the form of birth control pills or hormone replacement therapy (Premarin). Sometimes an antidepressant was thrown in for good measure.

This is definitely and categorically the wrong approach.

Let’s start with a few facts:
• Hormones are immensely powerful molecules The cells in your body have specific receptor sites for each of them. To give you an idea how potent hormones are, current birth control pills and thyroid replacement are both dosed in micrograms (that’s 1/10,000 of a gram). The active ingredient in a birth control pill is invisible to the naked eye.
• Unlike a man’s testosterone, your estrogen and progesterone levels change constantly, and you feel these changes. This continues after menopause even though you may not have enough hormone to trigger a menstrual period.
• Hormones definitely affect how you feel day to day in a variety of ways, and when they’re out of balance, you can feel pretty crummy. However, since imbalance isn’t a disease, your routine blood tests will be normal.
• Sex hormones and stress-buffering serotonin are closely linked, like two cars of a roller coaster. When your estrogen falls (as it does during PMS or pre-menopause/menopause), it pulls feel-good serotonin down with it. This can cause you to cry at a Hallmark commercial or snark at your loved one.
• Imbalance of thyroid and adrenal hormones are often involved too. There’s no actual disease, but rather “fatigue” of these glands. One symptom of thyroid and/or adrenal fatigue is (you guessed it) fatigue.
• Your sex hormones are very much affected by lifestyle choices: primarily diet, exercise, and stress levels.
• Hormone imbalances can be corrected without prescription drugs.

Measuring hormone levels
First let’s discuss a strategy to get your health insurance to pay for as much of this testing as your policy allows. Good hormone testing is pricey. (Those $30 kits that test all your hormones are only moderately accurate, especially when it comes to estrogen and progesterone. If you’re having periods, levels of these hormones change virtually every day, and trying to get an accurate picture with a single day’s result is a waste of your money.)

The best way to get your doctor to sign off on hormone tests is to arrive prepared, knowing what you want, and being able to counter a response like “You don’t need those tests.” This would be your opportunity to say something like (obviously you’ll describe your own symptoms) “I’m miserable and all my other tests are normal. I’m tired and cold, gaining weight, and my periods are a mess. Believe me, women know their hormones.”

Doctors are almost always in a hurry and since your doc’s not paying for the tests, she may capitulate to your request rather than argue. Your doctor can order most of the following tests from whatever lab she regularly uses. The nurse will draw your blood and your doctor will receive the results in a few days.

If you’re a WholeHealth Chicago patient, just contact one of my assistants to schedule a lab-only for drawing blood. This won’t require an appointment with me until after your test results are back.

Thyroid hormone testing  Low levels of thyroid hormone (called hypothyroidism) are extremely common, causing fatigue, puffy facial features, a sense of feeling cold, dry skin and hair, weight gain, and irregular periods. Consider low thyroid especially if thyroid problems run in your family. Ask your doctor for these tests: TSH (thyroid stimulating hormone), free T-3, free T-4.

Adrenal hormone testing  Definitely under-appreciated by many physicians as a cause of chronic symptoms, especially fatigue, “crashing” in the late afternoon, salt cravings, and low blood pressure. Ask your doctor for these tests: DHEA, AM and PM cortisol levels.

Sex hormones testing If you’re in your late thirties, early forties, or beyond AND your periods are becoming irregular, two hormones produced by the pituitary (the master gland) are measured to determine if you’re entering menopause. Ask your doctor for these simple blood tests: FSH (follicle stimulating hormone) and LH (luteinizing hormone).

If you’re menstruating, the best test measures your hormone levels throughout a single cycle. The “Female Hormone Panel” by Genova Diagnostics supplies you with a take-home kit containing ten plastic vials to collect specimens of saliva over a period of one month. When you FedEx the kit back to the lab, they’ll measure your levels of estrogen, progesterone, and testosterone, and graph the results for you. Your doctor can order the kit here.

She may prefer to test your blood for these hormones. This requires returning to the office at least three or four times over a month to have your blood drawn at appropriate intervals.

Remember: if you have chronic symptoms and your doctor tells you everything is fine, the problem is probably a hormone imbalance. But you already knew that, didn’t you?

Drug-free hormone balancing
You yourself can balance your sex hormones–estrogen, progesterone, and testosterone–by making some key lifestyle choices.

Taking these steps will also help you look and feel spectacular (exercise, good foods, and supplements really do work):

  • Exercise every day Walking is fine. Whatever exercise you do, do it outdoors in the sunlight whenever possible.
  • Eat a high-fiber diet including flaxseed, whole bran, beans, seeds, veggies, and fruits. These foods will actually improve your estrogen levels.
  • Dramatically reduce/eliminate the amount of sugar you eat, including all forms of sugar and also high-glycemic foods, which rapidly convert to sugar. These are foods like potato chips and refined white-flour bread, pastries, and pasta.
  • Eat more cruciferous vegetables such as broccoli, Brussels sprouts, and cabbage. These contain a substance called indole-3-carbinol that converts potentially cancer-causing estrogen to a form of estrogen that actually protects your breasts.
  • If you eat a lot of grapefruit, stop doing so and limit yourself to once or twice per month. Research shows grapefruit  blocks estrogen metabolism and actually increases the risk of breast cancer.
  • Choose mostly organic produce, dairy, and meats (and wild-caught fish) to avoid exposure to chemicals, foreign estrogens, and antibiotics.
  • Use filtered water (reverse osmosis) to avoid estrogen in the water.
  • Increase your omega 3 intake by regularly eating cold-water fish and flaxseed oil, or by taking fish oil supplements.

The most useful daily supplements to help you balance your hormones:

If you are menstruating:

If you are in the menopause transition:

Be well,
David Edelberg, MD


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32 comments on “Out Of Whack Hormones
  1. Rick Farmer says:

    Estrogen is a serious issue for women, but there is a lot of publicity lately that it is also a problem for men. Apparently, there are enough estrogen-mimicking chemicals in the environment and the water/food supply that it can create a “feminizing” effect on men. Testosterone supplementation seems to be popular, but I’d like to see some unbiased info on the estrogen-side of that equation for men. Thanks.

  2. Sarah Jamieson says:

    How much to have these tests done with you? Does insurance (Aetna) cover any of them?

  3. Alix Hager says:

    Thank you , thank you, thank you so much for this information! I will be visiting the apothecary shortly. 🙂

  4. Denise says:

    What kind of Doctor are you?
    Would like to know so I know what type of Doctor to contact in my area.

    My GP doesn’t give me the time of day especially if I start talking about hormones & feeling like something is off even though he says my blood test is fine.

  5. Annette says:

    I have been on birth control pretty much continuously since I was 16. I’m now 33 and had a horrible last 6 months when I tried to go off the Pill. My hair thinned, I developed chalazions in my right eye, plus terrible dry eyes, and brain fog. The brain fog was so bad I thought I was going to get fired at work because I’m in a job where you need good memory and to work out complex problems. I gave up and went back on the Pill and all my symptoms disappeared. What can I do? I really want to have kids in the next few years but am too scared to stop taking it again. I also have an underactive thyroid but have been on thyroxine since 18, but I know it’s not the thyroid. Any advice would be much appreciated.

  6. Dr E says:

    I suspect because you’ve been taking BCP your entire life, you’ve really suppressed your ovaries and suddenly stopping the pill placed you in a state of almost menopause. I would suggest working with a local doctor who uses bioidentical hormones and take these in smaller and smaller doses while your own ovaries have a chance to recover. Also, it may be useful to switch from Synthroid tonatural thyroid (Nature-Throid)

  7. Lisa says:

    Hi- I’ve been trying to balance my 47 year old body naturally, and do eat a clean plant based diet and lots of flax and B complex. My energy is still low and it is hard for me to keep my ideal weight and foggy focus as described in your article. I started taking a natural thyroid energy supplement from NOW but I’m also taking St. John’s Wort. Do these two work ok together?

  8. Dr E says:

    The two can indeed be taken together. The symptoms do sound like low thyroid. If your tests are normal, I suggest you do the at-home basal temperature thyroid test and see what the results are for you
    See this link

  9. Lisa says:

    Thank you Dr. E. for your time and knowledge!

  10. Barb Zollinger says:

    My daughter was on synthroid then switched to armour natural hormone replacement. Now her husband had her stop that and they are trying other natural things such as kelp and iodine, etc. My question is, wouldn’t a blood test show her levels are good if they are working? Her husband thinks that a blood test won’t be accurate if you are taking natural supplements. We disagree. What do you think?

  11. Dr E says:

    Hi Barb
    The natural supplements won’t interfere with testing but the tests should be TSH, Free T3, Free T$ and thyroid antibodies

  12. Madi says:

    Hi my 15 year old daughter is feeling really depressed And just can’t get excited about anything. She told me she was laying in bed one night and she suddenly just felt off and felt sad all of a sudden. Is this hormonal imbalance? Shes also saying her brain is really foggy and she just feel a weird. She has had irregular periods in the past.

  13. Madi says:

    My daughter is also been very emotional. She told me it seems to get worse around the time of her period ( being emotional and depressed) . Then the days of her period she feels a little better but still not her original self.Then the other days she is feeling numb , depressed, and just off. Its been 2 months of these symptoms.

  14. Dr E says:

    Hi Madi
    For a 15 year old, she might do well on St John’s wort 450 mg twice a day and Progonal Cream, 1/4 tsp twice a day during the week before her expected period

  15. barbara says:

    Hi I had an ovary taken out due to a cyst being on it ever since then I’ve been struggling with weight Dr says my thyroid are fine I have no desire for sex I don’t sleep well and my muscles ache please help me

  16. Dr E says:

    Hi Barbara
    See a local physician experienced in prescribing compounded bioidentical hormones and make sure all three sex hormones (estrogen, progesterone, testosterone) are at good levels. He/she will probably also be familiar with the basal temperature test for hypothyroidism and be willing to prescribe a small dose of Armour thyroid if your basal temperature runs low. Once your hormone levels are restored you should feel better

  17. Whitney says:

    I’m 28 and the past 2 or 3 periods I’ve had have been highly ans unusually emotional. I’ve never been this way before, but now I’ll cry at the drop of a hat at any comment that hits me wrong by my SO. Last night had a full on panic attack. Up until now I’ve always felt pretty normally balanced emotional wise on my cycle. I just feel off. I don’t have children, and periods are always very light but very very painful. And I’m constantly thinking about how I do not have a child yet, even though I really don’t feel in a place or a logical desire to have one yet. Is all of this normal, or is there something wrong that I don’t understand at play? Thank you

  18. Martha says:

    I went to my Gyno, because I thought I was suffering from Endometriosis. My doctor suspected that I had it when I was 16 and put me on birth control due to the irregularity of my periods and family history, but didn’t do any testing. Now I am 25 and I am using the Nexplanon for birth control. I am bleeding on and off throughout the month and having extreme menstrual cramps. When I asked my doctor to do a blood hormone test, she said that because of the Nexplanon, my hormones wouldn’t be accurate. Is this true? We did other blood work (thyroid, blood sugar levels, etc.) and all was normal. My transvaginal ultrasound showed that my ovaries are enlarged and my right one is polycystic, possibly indicating PCOS, so now I really wish I had had the hormone blood work done. The doctor just prescribed me to take Loestrin on top of the Nexplanon to try to get my periods back on track. I am very stressed out, because my husband and I would like to have a baby once I remove the Nexplanon and now I don’t know if I have PCOS, Endometriosis, or worst case scenario-both.

  19. Dr E says:

    Hi Martha
    It seems like everything started going wrong when the Nexplanon was inserted. It does have a lot of side effects associated with it (see link) and adding more hormones simply increases these.http://www.nexplanon.com/en/consumer/
    Since you have been on hormones since age 16, you just might want to stop all hormones and let your body settle itself naturally

  20. Jeanine says:


    Do you know of any doctors in NYC who offer similar knowledge as you? I tried about 6 different birth control pills from ages 16-24, and stopped taking the pill a year ago. I suffered from most of the common side effects (depression, nervousness, mood swings, decreased libido, etc.), and am trying to find the right method for me. I’d like to get my hormone levels tested, but would also like to find an experienced doctor who can help me determine what will be best based on my history.


  21. Dr. R says:

    Jeanine. You might try the Institute for Functional Medicine https://www.functionalmedicine.org/practitioner_search.aspx?id=117
    or American College for Advancement in Medicine
    Good luck.

  22. Jane Wolfe says:

    Hi, am on the progesterone pill since July last year , but am having weight gain , mood change and a lot of breakouts on my face , if I want to have a hormone blood test is that going to show in blood test that am on a birth control??

  23. Dr E says:

    Hi Jane
    If you are taking bioidentical progesterone, that will show up on a blood test. Synthetics may not. Here is a quote taken from webmd.com
    However, progesterone can cause many side effects including stomach upset, changes in appetite, weight gain, fluid retention and swelling (edema), fatigue, acne, drowsiness or insomnia, allergic skin rashes, hives, fever, headache, depression, breast discomfort or enlargement, premenstrual syndrome (PMS)-like symptoms, ..

    Maybe you should try something else.

  24. Taylor says:

    Hello Dr.E
    I’ve had a pretty devastating year this past year. I had a baby at 17 and about six month after my hair started thinning and falling out. Thinking it was only postpartum hair loss I didn’t think much of it. Well months went by and my hair was still thinning and falling out. I tried to reach out to my doctor who did blood work and said that my hormones and thyroid were perfectly fine. I informed him that I was on my period the day he took the blood work but he told me it wouldn’t interfere. He then proceeded to tell me that the stress from school work and my daughter could be causing my hair loss. Now it’s been over a year now that my hair is continuously falling out and i have lost about 2/3rds of my hair. Now being 19 you could see why this has devistated me. I have irregular very light periods hot flashes I often feel depressed and my mind gets foggy some days. Now I exercise and eat a pretty healthy diet only drink water. I also tried to reach out bc I was almost positive I had a bacterial infection in my vagina I was having a really strong fishy odor and thick white discharge but when I made an appointment my obgyn decided that even though I have all these symptoms she was ONLY going to do a Pap smear and not test for an infection. I called back a few days later bc I knew something was wrong and she told me my pap was fine. I asked her if she checked for an infection and she said oh no but I’ll send in antibiotics since you have symptoms and If you finish the antibiotics and the symptoms haven’t subsided then call me back and we’ll do more tests. It’s been an entire year I’ve lost all my hair I feel as though I’m going through menopause at the age of 19 and my doctor doesn’t seem to care one bit. I’m devistated and desperate. I just need some help and some advice. I feel like I pay all these medical bills for her to do nothing to try and resolve my problems. Please help me

  25. Lee Ann Hathaway says:

    Dr E my daughter needs help and none has been found. She is 38 and is in pre menopause. She has no children. Her problem is her moods and anger issues. Her GYN NP put her on birth control and said that would control her hormones. It has not helped. The NP (she had an appt recently) said there is nothing else she can do and that my daughter needs to see a Psychiatrist. My daughter does not seem to have these issues until about 2 weeks prior to her period. Once she has started she is better. Because of the way it presents itself I still think it’s hormonal. She works in a stressful insurance call center and cannot be rude and angry to customers. She needs help badly. Does it seem to you that it still could be hormonal and she just needs the right medicine? Also, if you have the name of aGYN in the Indianapolis area it would be appreciated. Thank you for your time.

  26. cliffmaurer says:

    Hi Lee Ann – This definitely deserves some additional investigation, testing and medical opinion. A colleague of mine recommends Health and Wellness of Carmel, just north (I think) of Indianapolis.

    Best of luck to you and your daughter.

    -Dr M

  27. Deb says:

    Madi it has been a year since you posted. Did your daughter get any better. You are describing my daughter. I am afraid she isn’t going to pass school she is depressed and brain fog so bad.

  28. Emma says:

    Hi I have PCOS and Cysts and take the pill Diane 35 and have done for quite a few years. To get an accrate reading of my hormones I would need to go off the pill. How long do I have to wait after I finish the pill to take the tests?

  29. cliffmaurer says:

    Hi Emma – Testing for accurate hormone levels needs to be done at specific times depending upon your history and provisional diagnosis. It’s best to coordinate medication changes (stopping your birth control) with the physician who plans to test your hormones.

    Dr M

  30. Kim says:

    I would like to ask a question regarding hormones but not sure if this is the correct areas. Please advise?

  31. Dr. R says:

    Kim. Yes, this is the place if your question can be answered in a relatively short and concise manner? If it requires a conversation, you’re better off making an appointment with your primary care physician.

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