A guide to demystifying hormonal imbalance

Hormones are chemicals that travel around your body, sending messages and signals to various organs and body parts to regulate their function.

What causes hormonal imbalance and how do you fix it? This depends on which hormone(s) are imbalanced and what the underlying cause is. There are medications available to treat imbalances of hormones such as thyroxine, estrogen, progesterone and testosterone 23 17. But some medications themselves can actually cause a hormonal imbalance, in which case the doctor who prescribed it may be able to adjust your dosage or offer an alternative option. In some cases, lifestyle interventions, such as improving diet or stress levels, are helpful for correcting a hormonal imbalance, particularly in cases of hypothalamic amenorrhea5. In rare cases, a hormonal imbalance might be due to a tumour, in which case surgery and/or medication can normalise your hormone levels. It’s important to note that the root cause of some imbalances, such as menopause or PCOS, cannot be fixed but there are medications and other treatment options available to help manage the symptoms.

Orgasms from masturbation and sex are thought to temporarily change hormones such as adrenaline, prolactin and oxytocin. However, there is very little evidence to support it and any hormonal changes were shown to be short-lived. There is also no evidence to show that they will actually cause a hormonal imbalance.

Hypothyroidism, or an underactive thyroid, is one of the most common causes of feeling cold. It’s caused by your thyroid not producing enough hormones and leads to your body struggling to maintain its temperature3. Feeling cold, coupled with irregular or absent periods, can also be a sign of hypothalamic amenorrhea, which can be caused by not eating enough, over- exercising or feeling stressed5. Iron-deficiency anaemia is also a common cause of feeling cold and can be caused by an iron-deficient diet, heavy periods or a problem with your digestive system28. Finally, feeling cold can also be due to a problem with your blood circulation. This is because less blood is pumped to your extremities which can make you feel cold, particularly in your hands and feet. Problems with circulation are usually caused by an underlying condition, such as diabetes, Raynaud’s disease or atherosclerosis.

Treatment for hormonal acne depends on its severity and what your preferences are. Your doctor may prescribe a benzoyl peroxide cream (which may contain an antibacterial medication) as a first line treatment. This can be enough to get rid of mild acne in many people, however, your acne may come back if the hormonal imbalance causing it is not addressed. If topical creams don’t work then your doctor may suggest a combined oral contraceptive pill that contains an anti-androgen medication (which may be called Co-cyprindiol, Clairette or Dianette) instead, which is useful in many people with PCOS who have acne due to excess androgens in their body. Other anti-androgen medications, such as Spironolactone, may be offered to you and can help with clearing up acne. People with severe acne are sometimes prescribed Isotretinoin (sometimes called Roaccutane) as a treatment. However, this will not treat the underlying hormonal cause of acne, which again means that if your hormonal imbalance is still present when you stop taking the medication, your acne may return. It’s important to know that many oral medications for acne either do not allow you to get pregnant or can cause severe birth defects so it’s important to take precautions when on these types of medication. Your doctor at Hertility will go through your medical history to see what you have already tried and what might be the best prescription or treatment option for you. Regardless of which treatment you end up opting for, you will also receive general skincare advice about which products you should avoid to reduce the occurence of flare ups.

Doctors in the UK are advised to investigate heavy periods (heavy menstrual bleeding or menorrhagia) based on whether they have a substantial impact on your quality of life as opposed to how much blood you lose. That being said, many people with heavy periods need to change their period products very frequently (every 1-2 hours), need to use 2 period products at a time (i.e. a tampon with a pad), and often bleed onto their clothes and bedsheets or bleed for more than a week. Periods vary substantially from one person to another, and at least 50% of people will have heavy periods without any particular reason. However, in some cases, heavy periods can be due to an underlying condition. Blood clotting disorders, such as Von Willebrand’s disease, can be the cause of heavy periods, particularly if your periods have always been heavy since going through puberty. Pre-existing conditions, such as hypothyroidism, diabetes and liver or kidney disease can also be the cause of heavy periods. Women with fibroids, polyps, endometriosis and adenomyosis also often have heavy periods which may get worse as time goes on. If your periods are heavy, a doctor will check your virtual health assessment answers and blood test results to rule out any common causes, and may also refer you for a further pelvic ultrasound or a procedure known as a hysteroscopy (which involves examining your uterus with a small telescopy) to see whether they are being caused by problems such as fibroids or polyps.

Many women with PCOS have issues with their metabolism which means they have trouble processing the food and drink they consume to make energy. The impaired metabolism that many women with PCOS have can lead to a higher risk of conditions such as diabetes, hypertension and heart disease. People with metabolic issues often have what is known as central adiposity. This is when you have fat tissue that is not evenly distributed but accumulates around your abdomen. PCOS belly refers to this central adiposity, and is especially common in women of South Asian origin8. It can be easily assessed by measuring the circumference of your waist and hips and calculating the ratio between the two numbers; according to WHO, a normal waist to hip ratio is less than 0.85.

Unfortunately there are no blood tests currently available that can accurately diagnose endometriosis. Your doctor may suggest that you have endometriosis based on the symptoms you indicated in our virtual health assessment. If this is the case, you will be invited to have a pelvic ultrasound at one of our clinics. Depending on the doctor, they may first choose to do a clinical - examination by inspecting and pressing down on your abdomen to check for signs of endometriosis. They will then image your uterus via a pelvic ultrasound, and possibly also refer you for an MRI. Not all types of endometriosis can be found via imaging techniques, so as a final investigation, you may be referred for a laparoscopy. This is a keyhole surgery where a small telescope is inserted into an incision in your abdomen to look at your internal organs and tissue. Small tissue samples may be taken during the laparoscopy so they can be checked under a microscope for markers of endometriosis.