Balancing Act: How To Navigate The Highs and Lows of Female Hormones

Men and women are different, and sometimes these differences are amusing. C’mon, ladies: Who hasn’t joked about a lovable man in her life who refuses to ask for directions or who inexplicably lost the drive to make sane wardrobe choices after a certain age? But when men turn the tables, their humor is frequently hormone-related, from endless PMS jokes to the occasional whispered reference to “a roller-coaster ride.” (Yes, we heard you.)

But is hormone humor doing women a disservice? To help answer this question, we must understand how many of the physical and emotional symptoms attributed to hormones are deserved (as well as which are normal and which aren’t). From your first mood swing to your last hot flash, we’ll walk through the various life stages to see how hormones affect our bodies, minds and emotions—and find out who gets the last laugh.

What’s normal: Women entering their reproductive years experience significant hormonal variations. Margery Gass, M.D., executive director of the North American Menopause Society, likens this ebb and flow to a musical crescendo. “For a woman to be cycling normally and fertile, her hormones are playing an intricate symphony each month: Certain ones go up, other ones go down, there’s a peak in the middle, they drop at the end, and then you have a period. So there’s a pattern that is fairly predictable,” Gass says.

Even when things go normally, there are side effects to deal with, such as premenstrual syndrome (PMS). About 60 percent of women experience PMS, according to Scott Isaacs, M.D., an endocrinologist and author. In his book Hormonal Balance, Isaacs explains how progesterone, which teams with estrogen to regulate fertility and menstruation, figures in. “The high progesterone levels just prior to menstruation are responsible for fluid retention,
food cravings, mood swings and premenstrual syndrome,” Isaacs writes.

What you can do: To manage PMS, Isaacs suggests dietary changes such as cutting back on or eliminating caffeine; eating small, frequent meals; avoiding excess fat, salt and prepared foods; and limiting fiber if you have bloating issues as it tends to exacerbate the sensation. He also recommends losing weight if necessary.

“Obesity contributes to fluid retention by increasing pressure inside the abdomen, making it harder for blood to return to the heart,” Isaacs says. One activity that helps is exercise, yet women often feel lethargic during their period. “Progesterone tends to make you sleepy, reducing your activity level. But working your muscles reduces fluid retention by forcing blood into the heart,” he writes.

What’s abnormal: Other PMS symptoms could be a sign of an androgen disorder. Although they are typically considered “male” hormones, androgens (such as testosterone) play an important role in hormonal balance for women. According to Isaacs, excess androgens, or hyperandrogenism, is the most common hormonal disorder in young women, and polycystic ovary syndrome (PCOS) is the most common cause.

“We see PCOS in about 10 percent of women, with symptoms beginning around the time that a girl has her first period,” Isaacs says. PCOS symptoms include irregular, heavy or painful menstrual cycles, deepening of the voice, and facial hair growth. Insulin resistance, which occurs when the body produces insulin but doesn’t use it correctly, may be a factor. “It’s known that insulin resistance is the underlying cause of PCOS because insulin stimulates the body to produce excess androgen hormone,” Isaacs says.

What you can do: Fortunately, PCOS and insulin resistance usually can be addressed with the same medications. “Treatments for insulin resistance almost always improve androgen levels and symptoms of androgen excess,” Isaacs writes. Your doctor may prescribe anti-androgen medications (such as certain types of birth control pills) or insulin resistance medications, many of which are also prescribed for diabetes.

What’s normal: Beyond backaches and morning sickness, hormones also run high during pregnancy. For example, prolactin (produced by the pituitary gland) stimulates milk production during and after pregnancy to make breastfeeding possible, and it can have other effects.

“High prolactin can suppress estrogen after pregnancy, and it’s probably one of the reasons women who are breastfeeding don’t always have a menstrual cycle,” Isaacs says. Hormonal shifts during pregnancy can have beneficial as well as unwelcomed mental and physical side effects. Hormones can give your skin that “pregnancy glow,” but can also leave you feeling forgetful or preoccupied with “baby on the brain.” Your hair may thicken and your nails grow stronger, yet constipation and hemorrhoids can be a problem. You can thank hormones (at least in part) for all of it.

What you can do: Exercising, eating a high fiber diet and making sure you’re fully hydrated can combat both constipation and hemorrhoids. Fight forgetfulness and stay on track with handy reminder lists that travel with you each day.

What’s abnormal: Losing the pregnancy weight can be difficult, but some women who have trouble may have a thyroid disorder: postpartum hypothyroidism. “There’s a gradual revolution back to normal hormone levels, and there’s certainly an increased risk for hypothyroidism during pregnancy and for up to one year after having a baby,” Isaacs says.

What you can do: Although postpartum hypothyroidism normally resolves itself, it may do so only after a new mom has gained significant weight. “It can also be misdiagnosed as postpartum depression, so it’s definitely something to watch out for,” Isaacs says.

What’s normal: “Perimenopause is in some ways like puberty in reverse: Hormones have gone out of their normal pattern, and that can cause emotional and psychological stress similar to PMS,” Gass says. “If a woman begins having hot flashes and night sweats but they go away quickly, chances are her ovaries have started producing hormones again. This fluctuation can be challenging.”

What you can do: To alleviate perimenopause symptoms, the North American Menopause Society says short-term hormone therapy (HT) is one option, at least for women who begin HT close to menopause. HT’s benefits decrease as women age, and long-term use may raise breast cancer and stroke risk for some women. Because every woman and her symptoms are unique, HT is something you must decide for yourself, Gass says.

“Women should seek help when the symptoms are bothering them. That is the indication for hormone therapy. Moderate to severe hot flashes or symptomatic vaginal problems are valid reasons to seek help and therapy; hormones if that’s right for you, and other therapies if that’s not right for you,” she says.

What’s abnormal: Hypothyroidism, a condition in which the body produces too little thyroid hormone, can be mistaken for menopause because early symptoms may be similar (weight gain, hair loss, mood swings, dry skin and depression) and because thyroid problems often increase with age.

What you can do: If testing reveals a potential thyroid problem, a thyroid hormone medication may be prescribed, along with a combination of diet and exercise, and periodic blood testing. See your doctor to know for sure.

After menopause, which becomes official one full year after a woman’s final period, hormones return to a natural low point, as they were prepuberty, Gass says. And while there are still plenty of issues to contend with—including bone health—she emphasizes not waiting until this stage to start considering healthy habits.

“Yes, osteoporosis is one of those things that seems to get worse with aging, but a lot of things that get worse with aging are things we should be paying attention to before we get there,” Gass says. “You don’t want to wait until you’re 55 or 60 to start getting your weight in line. And the same thing goes for heart health and bone health. You want to be living a healthy lifestyle your entire life, and then menopause will not be a big health issue for you. You’ll just keep doing the healthy things you’ve been doing.”

Scientists in a recent study believe they’ve found a way to predict the timing of menopause. That means women who want to have children could more accurately manage their biological clocks. Although not all experts agree we’re there yet, the idea is intriguing. But could the saying “Just because you can doesn’t mean you should” hold true here?

Ceylon Rowland, M.D., a board-certified gynecologist at Gwinnett Medical Center, says the ability to predict menopause may be closer than we think, but that doesn’t necessarily make it a good idea. According to Dr. Rowland, the genetic timing of a woman’s eggs is not the only issue in pregnancy. If a woman were to know that menopause would occur later than usual, say, age 57, she might wait to have children only to discover fertility issues or experience pregnancy complications related to chronic medical conditions.

“Most health professionals would counsel women that unless you have a compelling reason, it’s probably better to get pregnant sooner rather than later,” Dr. Rowland says. “It’s really helpful information to have, but the whole phenomenon of delaying childbearing has a number of concerns.”

Consult an Expert
Schedule an appointment with an expert Gwinnett Physicians Group OB/GYN today to discuss questions you have about hormones. Call 678-312-7500 or go online to


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