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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78 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:

    Hi
    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
    https://wholehealthchicago.com/4594/temperature-test-for-hypothyroidism/

  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:

    Hello,
    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:

    Hello,
    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 and adding more hormones simply increases these. 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:

    Hello,

    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.

    Thanks!

  21. Dr. R says:

    Jeanine. You can google the Institute for Functional Medicine for other like-minded physicians in your area.

    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. You can google the Institute for Functional Medicine for other like-minded physicians in your area.

    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.

    Best,
    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.

  32. nicole says:

    Hi! I’m a 40 yr old woman…just had my thyroid;most of my parathyroid removed but they think they left enough good tissue and sum of my lymph nodes on the left side of my neck removed.lymph nodes are sent off to see if cancer spread to there and if so I will go on radioactive iodine to treat,but they think I will b ok not need this..my question is…it is 10 days since my surgery and I am a mess hormonally!!Just sobbing non stop last 2 days and breasts feel like as if I was a pregnant lady overdue for nursing.im childless but that’s how I can describe the pain ugh! My surgeons are men and very clinical…dont feel comfortable or like they can understand a woman’s needs truly cuz this is what I was so afraid of happening!! I’ve battled depression twice before..once on prozac and last time on my own.Both times do to life events around and to me.I can’t go thru that again!!I know surgeons increased my Synthroid to double they said they automatically do that…is this y? Too much maybe? Or since thyroid removed not enuff?? A couple times I took a double dose of my Synthroid during the summer by accident and I felt like I had severe palpatations etc…weird all day but not like this.Now that it’s double 150 mg. .I don’t have palpatations etc.im crying and sore breasts beyond…I have appt to see Dr in a week time…like to b prepared before going in…help!!..thanxs☺

  33. Dr E says:

    Hi Nicole
    This sounds very much like you’re experiencing a deficiency of progesterone. This will cause your estrogen to go too high (breast tenderness) and likely throw off your serotonin.
    Talk to your doctor about giving you progesterone and possibly a temporary antidepressant (Prozac, etc)

  34. Michelle says:

    Dr.E
    I am 49 years old and began shaking inside and unable to get warm. Anxiety and depression then hit me very hard. I do have a prolactin secreting tumor that was discovered a year ago, but I can not tolerate the meds to shrink it. My period has stopped for 1 1/2 years…all tests except for protactin are within normal range. I’m not tolerating antidepressants well, they increase my anxiety horribly. My life has been taken from me. I used to laugh, now I cry and cry often. I can’t seem to tolerate even the slightest bit of stress without a full blown anxiety attack. Doc wants me on klonopin, but I’m afraid I’ll become addicted. Could I be experiencing menopause along with high prolactin levels causing anxiety? I’m desperate and my endo and GP can’t find a reason for my symptoms. My psychiatrist can’t find a med that works either, they all cause EXTREME anxiety.

  35. Dr E says:

    Hi Michelle
    I would suggest the supplement Theanine, up to four a day, as needed for anxiety.
    I would also suggest starting bioidentical hormones (estradiol/estriol/progesterone). I think the anxiety is due to the drop in your sex hormones. Lab tests are frequently not all that helpful when it comes to sex hormones so “normal” is pretty meaningless especially since you feel so poorly

  36. Marsha says:

    My hormones used to be perfect. I had 5 babies (c-section) and got a tubel ligation on the last one. I started having what I believe to be major hormone upset right after tubal that I never had on other babies (But also had some major stress..so?) Dr. Put me on birth control and I mostly feel OK. I have been on birth control for 6 years with ups and downs but OK. I know birth control is not best, but I have tried to go off and I’m a mess. I also fear that the tubal ligation destroyed my natural ability to regulate hormones. What to do? I live in a small remote town with old school doctors.

  37. Dr E says:

    Hi Marsha
    “Mostly feel okay” is a definite plus considering what you’ve been through. Despite what you feel, the tubal ligation actually may not be responsible for your symptoms and what you’re feeling are the natural changes within a woman’s body.
    I would stick with the birth control until your doctor suggests you can taper off

  38. Denise says:

    Hi, I’m 58 years old still having my period . So my doctor described to me progesterone 10 days. Then I’m going to take a low-dose birth-control pill trying to get my hormones regulated. But I’m just so confused about going on progesterone for 10 days and of course I’m having anxiety to even take the pill and I know I need to.. can you help me .

  39. Dr E says:

    Hi Denise
    Overall late life menopause is associated with better health but your doctor’s approach is the usual one. If you have a naturopath in your area, several herbs are available. Also Chinese medicine (acupuncture/herbs) can help

  40. Melissa says:

    Hi Dr. E I’m sending this message in the hope that you could assist me. In September 2015 I had a tubal ligation and an endometrial ablation. Soon after this procedure, my body started with the most bizarre occurances. I Googled the symptoms and came across many blogs that mentioned that TL can result in the onset of early menopausal symptoms. Since than it’s been an uphill journey with fighting many different symptoms from day to day and week to week. I had the procedure done because I was suffering from iron deficiency aneamia which initself had horrendous side effects, however this was corrected before I had the TL procedure done, with intravenous venofir iron transfers. My GYNOB suggested the procedure instead of a hysterectomy. I went along with this as I thought it would be less I facile, however to my dismay, I think it was the worst thing I could have done to my body as it certainly has ENT my hormones into hormone turmoil. I’m 47, and have had numerous tests from estradiol, to DHEA, cortisol (urine of a 24 hour period), LH FSH and a myriad of other tests – needless to say all came back – as you’ve guessed, normal. I have to ask how is this possible. I still have a regular period with the odd month being 24 days compared to my usual 28 days. But have as yet have to have a hot flush and night sweat. My thyroid is absolutely fine. I did a vitamin D test and that was in the low range 24. I’ve managed to get that up to 36. So here I am with my latest symptom, a formication kind of crawly skin which I’ve read is very common during the perimenopause/menopause stage for a lot of women. I’ve suffered with high estrogen all my life so I’ve opted not to use HRT as this would just make the high levels of estrogen worse. I had the Nirena inserted, worse mistake as it did NOT agree with me. Had to have that taken out after two weeks suffering Edema, nausea and some other horrid side effects. I’ve never used the BCP ad that too never agreed with me. So I’m guessing these symptoms are perimenopause even though my lab results show normal ranges with every test. What to do about the symptoms ? Currently I’m using ever possible supplement to get me through a day, week and month the best I can. So is it possible to be in perimenopause even though these tests come back normal and is it possible that I can be super sensitive to hormonal changes. I definitely don’t the same person I was before the op. A healthy avid gym goer who worked out 2 times a week and with high impact excercise, now I can barely walk on the treadmill for 1/2 an hour without feeling exhausted. This is not who I was prior to the op. Something horribly went wrong. Please HELP ! TIA 🙂

  41. Melissa says:

    Sorry meant to say warm greetings from sunny South Africa ?? Melissa

  42. Dr E says:

    Hi Melissa
    You’re navigating the Sturm and Drang of perimenopause. You might start with an Indole-3-Carbinol/IM product like this one
    https://www.orthomolecularproducts.com/estrodim/
    Likely something similar is available in South Africa. If not effective, try to find someone who prescribes bio-identical hormones and start with a low dose of estradiol/estriol/progesterone. Lab tests are generally not useful. Trying to measure constantly shifting hormones only leads to confusion

  43. Naomi says:

    Hi, I am 31 years old. Last year June (9 months ago)when I got my period my breast hurt like I needed to nurse they were swollen,tender and sore and that lasted for 4 weeks then went away and since then comes back about a week before every period and last about 7-9 days. I can recall having body aches for a couple months before that June and fatigue the past couple years. (The fatigue seems to have gotten better the past couple months). I also get anxiety that goes up and down. I do not take any medications. I drink less caffeine than I ever have before. I have stoped using hormone disrupting products that I know of and used a lot of ( plastic water bottles,makeup, body care, hair care.) the past couple of months. How do I find out what hormones are out of balance?

  44. Dr E says:

    Hi Naomi
    You can order a comprehensive hormone profile from Genova Labs http://www.gdx.net
    You receive a kit containing several small plastic vials, collect some saliva every three days and mail them back to lab. You receive a graph showing where your hormones are during a single month. If your doctor orders this test and you send a copy of your insurance card, the cost is reduced considerably.
    Your symptoms sound like “estrogen dominance”. You can try applying 1/2 tsp of over the counter progesterone cream (sold as Progonal) during the second half of your cycle (ovulation to flow). That might help

  45. Krisya says:

    Hi, I’m 52 years old and just started taking bio identical hormones. I feel very pms’y since taking them. Is there a “getting use to” period that my doctor never told me about?
    And my other question is: is there a right time to start taking hrt? Should I have started right when I stopped having periods?? That was 8 months ago. Did I wait too long?

  46. Dr E says:

    Patients generally start BHRT when they have symptoms so you started at the right time. If you feel physical PMS symptoms, generally the progesterone component needs to be increased slightly. Talk you the doctor who prescribed it

  47. Maria says:

    I suffered a concussion in Dec had a ct xrays mri of brain, no real issues bit i have been feeling very sad,anxious,irritable for no reason,brain fog,confusion,enhanced libido, dizzy,vivid dream, non stop period that is very light most days My Dr has ordered blood work to check hormone levels. Is there a better time to test than others and what exactly should be tested? He ordered esttadiol,prolactin,progesterone,tsh,cbc,cmp,epinephrine.I thank you for your time!

  48. Dr. R says:

    Hi Maria. In addition to the blood work ordered which is fine, I’m sure your doctor told you that it is normal to have the symptoms you’ve described after a head injury. Usually the symptoms subside over a number of weeks. Take it easy for a while so that you can heal. Consult with your doctor if symptoms persist.

  49. Jane says:

    Hi, Dr E.
    I’m a 20 year old girl. I had eating disorder about three years ago and I lost about 10kg per month. That time, I ate only a meal per day with less amount of food.And I exercise almost everyday under the hot sun despite having small amount of food. Besides, my exam was coming that time. I’m need to do revison so I drank coffee(without any sugar and milk) to stay awake. I felt so stressed out until I burst into tears that time. I have no idea what’s wrong with me . And I also get angered easily.After few months, I hair started failing and thinning. I lost about 4/5 of my hair. My hair used to be a lot. After that incident, (about 6months later), I started eating normally, I thought that my hair will grow back but my hair doesn’t. My mum brought me to clinic and the doctor said, it a normal hormone imbalance. But till now, it’s still thin and falling and some tiny bald spots as well. What should I do and why isn’t my hair grow back?

  50. Dr E says:

    Hi Jane
    I suspect it’s a combination of adrenal, thyroid and ovarian exhaustion, all three of which can be repaired. Get a full thyroid profile (T3 T4 TSH reverse T3 and thyroid antibodies) and do the “basal temperature thyroid test” described online. If thyroid numbers are low, or your basals are low, start a small dose of Nature-Throid (32 mg). Test your adrenal glands and your sex hormones for a full month using the tests from Genova Lab http://www.gdx.net . A good herbalist or naturopath should be able to help with this

  51. Nichole says:

    Hello Dr!!
    My name is Nichole and I’m 29 yrs old. Since about the age of 26 I’ve had horrid bloating (where I look 6 months pregnant), ache (hormonal), absolutely 0 sex drive, no appetite at all and no energy at all as well as abdominal pains when the bloating is most severe and I can’t forget the consipation. I’ve been on the pill since I was 17 and I was always on the same one (before and after the birth of my son) with absolutely no negative symptoms. Once all these negative side effects started I stopped the pill for about 6 months and the bloating and acne was even worse. I’ve been bouncing from pill to pill since trying to find something that relieves my symptoms and so far I’ve had no luck with any of them other than the acne. I’m at my wits end with how miserable I am. I’ve begged my Dr for a hysterectomy I want relief so badly but due to my age she won’t do it. Please help!

  52. Dr E says:

    Hi Nichole
    The bloating sounds more like a condition called Small Intestine Bacterial Overgrowth (SIBO) which I have written about in other Health Tips. Ask your doctor to test you for SIBO or refer you to a gastroenterologist. Some of these symptoms sound like underactive thyroid so testing here is in order. I know you think a hysterectomy will solve a lot but I’d get more tests before considering this option

  53. Sarah says:

    Thank you for the very informative article, Dr. Edelberg. I’m 33 year old and have been suffering from a frozen shoulder since last April (over 1 year now) and recently was diagnosed with a frozen hip too. I’ve been reading about the link between estrogen and adhesive capsulitis and wonder if low estrogen is the source of my issues. My daughter is 20 months old and is still breastfeeding. My period has not returned since her delivery. Adhesive capsulitis is often seen in menopausal women. Do you think my body might think I am in menopause? Can you please suggest what tests I should request my doctor to order? Any light you can shed to help me with this is much appreciated. Many many thanks.

  54. Dr E says:

    Hi Sarah
    I would suggest
    estradiol, progesterone (sex hormones)
    blood count; sed rate; hsCRP (inflammation)
    HbA1c (diabetes)
    T3 T4 TSH (thyroid)

  55. alana says:

    Hi Doctor E!
    Thanks for your informative article. Having my hormones tested for the first time next week. Not sure what to ask for exactly or what to expect. Im 29 years old, I have a 3 year old son, I’m very conscious of my diet, exercise regularly. I have been suffering from reoccurring vaginal bacteria infections, and been on antibiotics 3x in the last 2 years. I refuse to take antibiotics again. I have been having what I think is anxiety or maybe heart papiltations, insomnia, and randomly feeling dizzy like I have no equilibrium,facial hair growth, mood swings, bloating, and the newest annoyence is joint pain. Trying everything and feeling depressed with no positive outcomes.
    My intuition says something hormonally is way off, any advice is greatly appreciated!!!

  56. Dr E says:

    Hi Alana
    When you get your hormones tested, try to get the test that checks levels at least three times during your cycle (using saliva or blood) and let your doctor know if the anxiety, etc is occurring during the week before your period.

  57. yasmin dowell says:

    Hello im 32 year old no kids, was on birth control for about 2 years, had really bad insomnia and anxiety around my cycle, i have stopped the pills but now it has gotten worse, i also had mood swings too. I believe i have a hormone imbalance!! Never had these issues before, also changed pills twice and tried iud

  58. Dr E says:

    Hi Yasmin
    The best natural treatment for this is:
    St. John’s wort 450 mg twice a day every day
    Tryptohan 1,500 mg at bedtime, starting 2 days before expected period and continuing throughout flow
    Progesterone Cream 1/2 tsp twice a day during week before period and again continuing through flow.
    Give this program at least two cycles to take effect

  59. Syd says:

    Hi,
    I am a 20 year old female and i was told by my dr to take my birth control continuously because i have mood issues of increased depression and anxiety around ovulation. Ive been doing it for a couple of months and it seems to be helping. I checked in with my insurance to see if the supply i would need (17 28 day packs per year, skipping placebos) would be covered. They told me that my plan only covers 12 28 day packs per year. Would i be able to pay for my prescription out of pocket for the last 5 refils? Also could i go to my dr and get a prescription for the amount i need and try to get insurance to cover it that way? Would i need a PMDD diagnosis to get it covered? I just want to figure this out before i run out and and back to the crazy mess i was in before. Thanks!

  60. Dr E says:

    This should be covered by your insurance. Your doctor can complete a “prior authorization” form and insurance companies usually allow it. Your doctor also might have plenty of samples in his office and just give you what you need. Lastly, many brands are now VERY low priced generic.

  61. Amy Lyons says:

    I am 43 years old. I have been dealing with weight gain, hair loss, no libido, depression, achy and tired, cry all the time. I have had a lot of blood work done It shows I am not menopausal and thyroid is in balance. My prolactin is low and they detected a gene mutation at my endocrinologist office through the blood work. She increased my vitamin b complex and I have been gluten and dairy free for 8 months Still gaining weight especially andomen, hips and thighs Overall sense of bloating. Ready to loose my mind. Any suggestions.

  62. Yoly says:

    Hi, thank you for the informative article. I’m almost 35.
    I’ve always had a very normal cycle. For years, up until recently I could tell you months in advance when I would PMS and ovulate – down to the exact day. I would have my normal ovulation phase and would feel my sexiest and my libido would go through the roof. I loved it and also loved just knowing when what would happen. Also, during PMS I would have the normal 3-4 days of moodiness, low sex drive, and overall irritability – but again, always expected and it would pass before I knew it. The past year things have gone crazy, I’ve gotten an ultrasound and I’ve had a couple ovarian cysts. Also just found out I have a small fibroid in the inner muscle lining of the uterus. (not in the cervix). I can’t tell anymore when I’ll ovulate (I honestly don’t think I am, not every month anyway). I am moody most of the month, some happy and energetic days… some irritable… some tired. I do workout a lot… Been training for a half marathon – I eat generally well during the week w/ the occasional cheats during the weekend. I drink alcohol maybe once or twice per week. I get enough sleep. I just ordered a blend of Black Cohosh, Shatavari, Chasta Tree Berry, Dong Quai, Ginger Root and Epimedium… hoping this will help. Tomorrow I’m seeing my regular doctor and will order all of the tests you recommended. Hoping to find an answer to the madness so that I can get my sexy back! LOL Any other tips or advise you can give someone with my situation? Thank you!

  63. Dr E says:

    Hi Amy
    1. You need to take “normal” thyroid tests with a grain of salt. Try measuring your basal body temperature (https://wholehealthchicago.com/2012/03/17/temperature-test-for-hypothyroidism/) and if you are below 97.6, ask for a prescription for Armour thyroid
    2. The genetic issue is probably the MTHFR gene. Make sure your B Complex says “Methyl B” or it won’t work.
    3. Raise your stress buffering serotonin with St John’s wort twice a day
    4. Have your doctor test you for SIBO (small intestine bacterial overgrowth) and adrenal exhaustion. Both tests available from Genova Labs

  64. Dr E says:

    Hi Yoly
    This sounds like an imbalance between estrogen and progesterone with too much of the latter. I would suggest St John’s wort 450 mg twice a day (for the moodiness) and a product called Progest-Avail. You’d apply a dropperful on the underside of your forearm from midcycle to start of flow, stopping at flow

  65. Nicole T says:

    Im 37, gaining weight, losing hair and have severly heavy periods. Last month i lost 3-1/2 pints of blood according to my hematologist. Had an iron infusion, my third in the last year and a half. Have had cervical and uterine biopsies. Have had internal and external pelvic ultrasounds. One small cyst. Had thyroid tsh and t4 tested normal. Tried several different birth control pills which did nothing. Help!! My period is lasting 2-3 weeks with a two week break in between. Im tired all the time and cant live a normal life the way i am bleeding.

  66. Dr E says:

    Hi Nicole
    You need to see an endocrinologist who specializes in female hormones. This sounds as if you have PCOS (polycystic ovary syndrome) and there are treatments to control this

  67. June says:

    I’m 25, and I’m experiencing low sex drive, vaginal dryness, and an up & appetite. First I thought it was because I was extremely stressed and felt due to a breakup. I hooked up with someone a few months after just as a distraction and I had none of these issues. Late May is when it started. I can’t even masturbate without the help of a vibrator to get an orgasm off & even then it’s weak. I barely get turned on by another human, even if they’re doing the things I like. I’m curious because I am young so of course I’ve googled the symptoms I’m having ..& things pop up like peri menopause and hormone imbalance. I made a doctors appointment but I’m just nervous that I’ll be like this forever and it’s making me feel crappy. idk what to do or what to think. I’m very scared that my sex life is over

  68. Dr E says:

    Hi June
    The best next step is to have the levels of your sex hormones measured. (estradiol, progesterone, testosterone). If these are normal, then your symptoms are most likely related to the stress from the break up.
    My guess is “stress” and if this is the case, get a referral to a good psychologist to help with the issues you’ve been facing

  69. Amy says:

    My daughter is 19 and has had menstrual problems for 6 years. Hormones checked and within normal limits. Would get her period 2-3 times a month. Went on the pill in September and missed 4 pills in early November. Started taking the pill immediately after 4th miss and has had her period for an entire month. She exercises regularly. Eating is iffy because she is in college so not always as healthy as she would like. Gains weight easily and gains head to toe weight not just one spot. Diagnosed with Anxiety and ADD takes celexa and adderral What can I do to help her. What tests should I look at getting done? Any help would be appreciated.

  70. Beth says:

    Hello Dr. E. I just say this exchange between you and Alana, and my health issues almost identically mimic hers, and my question is why do you ask her if her anxiety occurs a week before her menstrual cycle? My moods and depression and anxiety have become unbearable the week before my cycle and I know that my hormones are out of balance but I don’t want to take medication that just masks the symptoms I want to actually address the underlying issue.

    Hi Doctor E!
    Thanks for your informative article. Having my hormones tested for the first time next week. Not sure what to ask for exactly or what to expect. Im 29 years old, I have a 3 year old son, I’m very conscious of my diet, exercise regularly. I have been suffering from reoccurring vaginal bacteria infections, and been on antibiotics 3x in the last 2 years. I refuse to take antibiotics again. I have been having what I think is anxiety or maybe heart papiltations, insomnia, and randomly feeling dizzy like I have no equilibrium,facial hair growth, mood swings, bloating, and the newest annoyence is joint pain. Trying everything and feeling depressed with no positive outcomes.
    My intuition says something hormonally is way off, any advice is greatly appreciated!!!

    Dr E says:

    August 23, 2017 at 8:42 pm

    Hi Alana
    When you get your hormones tested, try to get the test that checks levels at least three times during your cycle (using saliva or blood) and let your doctor know if the anxiety, etc is occurring during the week before your period.

  71. EW says:

    Hello,
    I am a 27 years old female.. my period has always been regular until recently.. in October, my period came twice and i went to see my PCP and he ordered blood work for hormone test and it came back normal LH and FSH.. then i had transvaginal ultrasound and they found one very small cyst on the right ovary and told me to do follow up ultrasound.. then on December 18 i had my follow up ultrasound and the GYN told me that the cysr disappeared by it self and the endomatrunum and ovaries, uterus r all good and that i dont need to follow up… then there month i havent had my menses yet. My last menses was December 27 and it stayed for 4 days.. not heavy and minor cramps… on January 15 me and my partner tired to have intercourse but it wasnt pentrated. However, his penis touched my vagina. Can pregnancy be a possible reason for my missed period? I normally have 26 day cycle and sometimes, it comes every 28 days. This is the first time i missed my period.. i would appreciate your advise

  72. cliffmaurer says:

    Hi there – While women miss a period for a variety of reasons, it’s definitely a good idea to do a pregnancy test. You may also consider letting your doctor know of this missed period so that he or she can follow up with you.
    Best,
    Dr M

  73. Beth says:

    Hello. I’m 43, and I’ve had zero libito and difficulty reaching orgasm for many years (at least 8-10). For the past 6 months I’ve started to have extremely painful periods with light flow. My OB/GYN recently placed me on low dose birth control and my face is puffy, and I can’t control my eating cravings. I work out 5x a week. I’ve always had sleeping problems and I’m freezing cold when I go to sleep and wake up hotter than hell in the middle of the night. None of that has changed since going on the pill, but the period pain is non-existent because I haven’t had my period (although I’m spotting all the time). I’ve been on the pill for 45 days now (and hasn’t been in it for close to 20 years prior). My friend just got the testosterone pellet, and I’m considering stopping the pill, getting hormones tested, and getting the pellet. Is it the miracle I’m hoping for? Is it something you’d prescribe? Any concerns about it? Thank you!

  74. Tamara says:

    Hi, I was on Noromin for a number of years and suddenly developed very dry mouth (occurred just after taking oral typhoid). Once I stopped the Noromin my dry mouth stopped but I developed extremely bad dry eye and eye aches. I have been going to eye specialist and am on steroids (FML for eyes) and cyclosporine for eyes. I then went back on Noromin and it immediately helped my eyes but I couldn’t tolerate dry mouth so i stopped. Then I went on Loette but had very dry mouth immediately so i stopped. Then I went on Loette and was on it for 6 months and again eyes were great, and mouth was fine but over time mouth got extremely dry so had to stop. As soon as I went off it eyes were bad again. Then I was told to try Nuvaring and was only on it three days but after day two eyes were already improving but I couldn’t tolerate the side effects of very bad stomach cramps. As soon as I went off it the eyes got extremely bad again. I have been to so many people now and am very frustrated as I believe it’s clearly related to me having low levels of oestrogen, as every time I go on and off there is improvement. I also get headaches when off the pill and night sweats. I therefore believe that I just need to find a way to get some oestrogen without other significant side effects. I believe low levels of oestrogen even help as the Nuvaring helped in that regard as did Zoely that has very low amounts of oestrogen. The endocronologist suggests to try Mirena as another possibility but I am very hesitant to do so as I couldn’t tolerate Nuvaring and there has been so much bad publicity about Mirena. Yaz is another possibility but likely to have same effects and Noromin gave me some other side effects. It is hard to find someone who is willing to look at this as the eye specialist looks at their own thing and everyone looks at their own thing. But after all my trial and error I have come to the belief that I think it’s the estrogen levels. perhaps it could be related to early menopause (I am 40, still get periods), or low levels of estrogen, or pituitary gland related issues? I am just trying to find someone who can help suggest a way forward. Not sure if you have any thoughts? Also if I were to do the hormone panel tests how long do I need to be off the pill for because if I am off for more than a few days to a week I can barely do anything due to extreme eye aches and very dry eye. I am sure there are others experiencing this but very difficult to find information. Initially it was thought I may have sjrogens, but none of my blood tests suggest this and i have been testing it over past 2 years regularly. Also it appears that I have now established that the dry mouth is only when I am on the contraceptive pills, it goes away immediately when I am off. Any insight/ideas you can provide would be greatly appreciated as I have been battling with this for a number of years now, but feel that I am closer to having worked out the issue, just not sure how to address it.

  75. Dr E says:

    Hi Tamara
    Every single one of the hormones you have listed is synthetic and perhaps the problem is there. Find someone in your area who is familiar with bioidentical hormones. You would receive a prescription that would read:
    estradiol + estriol +progesterone
    It would be in a cream form and you could gradually increase the dose until you obtained symptom relief

  76. Annie says:

    Hi Dr. E,

    I came across this thread and thought maybe you might have some ideas. Just some background. I had a baby 6 months ago. When I first became pregnant even before a test was positive, I felt dizzy like I was walking on a boat. Not full vertigo spinning but more like my equilibrium felt a little off. I could still stand, drive, etc. but I could feel it and it made me highly nervous. Before I knew I was pregnant my dr gave me a CAT scan because I was so nervous about why I felt like this. Everything was negative. A few days later I ended up getting a positive pregnancy test. The feeling finally went away a little halfway through pregnancy but majorly improved after my first trimester. Then I felt great the rest of pregnancy and the first 6 weeks postpartum (I also was breastfeeding) At exactly 6 weeks and 1 day I remember I started to feel foggy, hazy, and the off balance feeling came back. I thought it was maybe diet, water intake, vitamins, etc. My dr and ob both said hormones. I ended up going to a ND who ran tons of bloodwork all which came back normal.

    I gave up breastfeeding at 11 weeks(really sore topic for me) because I hoped it would helped my hormones go back and stop the off balance feeling I had all day long (randomly I would feel like a veil lift and everything felt clear, sharp, and my head felt heavier in a good way like I didn’t feel off balance. This happened during my first trimester too). I did see some improvement but the off balance feeling still remains. Its like walking on a boat feeling I guess. I am now 6 months pp and still have it. I have been put on celexa by my dr thinking it was probably just a mix of anxiety and hormones and low and behold I still feel the same.

    A few weeks ago I noticed a decrease in my dizzy feeling and it was sooo faint for a week, then all of a sudden it went away. I had a full week of feeling on top of the world and I was thrilled to feel normal. At the end of that week I finally got my first postpartum period and felt fine until day 3 of my period when I noticed my bleeding decreased. I noticed the off balance feeling came back. I am now a week later still feeling it with some breaks here or there.

    Could the progesterone from ovulation helped me? What could this be? Is it possible this could be like an estrogen dominance issue? I feel like no one has experienced this. I have found some women experiencing this postpartum on blogs but nothing where I feel like I know whats happening.

  77. Dr E says:

    It could be either the progesterone, celexa or a combination of both but fortunately you seem to be doing better. You may never really know the precise answer

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