When "Normal" Doesn't Feel Normal
For two years, I felt like I was losing my mind. Crushing fatigue no amount of sleep could fix. Weight gain despite eating well and exercising. Brain fog so thick I'd forget what I was saying mid-sentence. Mood swings that swung from rage to tears within minutes.
"You're just stressed," my doctor said. "Get more sleep. Maybe try meditation."
I did all that. Nothing changed. It wasn't until I switched doctors and demanded hormone testing that I finally got answers: hypothyroidism and PCOS. My hormones were completely out of balance—and it explained everything.
"Hormone imbalances are incredibly common but often dismissed or misdiagnosed," explains Dr. Aviva Romm, MD, a Yale-trained physician specializing in women's health and hormones. "Symptoms overlap with so many other conditions, and standard testing doesn't always catch subtle imbalances that still cause significant symptoms."
If you've been told your symptoms are "just stress" or "all in your head," this guide is for you.
What Are Hormones, and Why Do They Matter?
Hormones are chemical messengers produced by glands in your endocrine system. They travel through your bloodstream, regulating everything from metabolism and energy to mood, sleep, reproduction, and digestion.
Key hormone-producing glands:
- Thyroid: Regulates metabolism, energy, body temperature
- Adrenals: Produce cortisol (stress hormone), adrenaline, and some sex hormones
- Pancreas: Regulates blood sugar via insulin
- Ovaries/Testes: Produce estrogen, progesterone, testosterone
- Pituitary: The "master gland" that controls other glands
When these hormones are balanced, you feel energized, sleep well, maintain a stable weight, and have steady moods. When they're out of balance—even slightly—everything can feel off.
Common Signs of Hormone Imbalance
Hormone imbalance symptoms are frustratingly vague and overlap with dozens of other conditions. That's why they're so often dismissed.
Here are the most common signs:
Energy and Metabolism
- Persistent fatigue that doesn't improve with sleep
- Unexplained weight gain or difficulty losing weight despite diet and exercise
- Constant hunger or sugar cravings
- Feeling cold all the time (or unusually heat-sensitive)
- Slow metabolism (constipation, sluggish digestion)
Mood and Mental Health
- Severe mood swings (irritability, anger, sadness)
- Anxiety or panic attacks without obvious triggers
- Depression that doesn't respond to typical treatments
- Brain fog (difficulty concentrating, memory issues)
- Feeling emotionally flat or numb
Sleep
- Insomnia or difficulty staying asleep
- Waking up frequently during the night (especially 2-4 AM)
- Night sweats
- Feeling exhausted despite sleeping 8+ hours
Reproductive and Sexual Health
- Irregular or missing periods
- Very heavy or painful periods
- Low libido
- Vaginal dryness
- Fertility issues
- Severe PMS or PMDD
Skin, Hair, and Body Changes
- Acne (especially along jawline and chin)
- Hair thinning or hair loss
- Excess facial or body hair (hirsutism)
- Dry skin
- Unexplained changes in breast tissue
Important: Having one or two of these symptoms occasionally is normal. But if you have multiple symptoms that persist for months, hormone imbalance could be the culprit.
The Most Common Hormone Imbalances
1. Thyroid Disorders (Hypothyroidism and Hyperthyroidism)
Your thyroid regulates metabolism, energy production, and body temperature. When it's underactive (hypothyroidism) or overactive (hyperthyroidism), everything feels off.
Hypothyroidism (underactive thyroid) symptoms:
- Fatigue, weight gain, feeling cold
- Constipation, dry skin, hair loss
- Depression, brain fog
- Heavy or irregular periods
Hyperthyroidism (overactive thyroid) symptoms:
- Anxiety, irritability, rapid heartbeat
- Unintentional weight loss despite eating normally
- Heat intolerance, sweating
- Insomnia, tremors
Who's at risk: Women, especially over 60; family history of thyroid disease; autoimmune conditions
Testing: TSH, Free T3, Free T4, thyroid antibodies (TPO and TG)
"Standard TSH testing often misses subclinical thyroid issues," Dr. Romm notes. "Ask for a full thyroid panel, including antibodies, especially if you have symptoms but 'normal' TSH."
2. Polycystic Ovary Syndrome (PCOS)
PCOS affects 1 in 10 women of reproductive age. It's a hormonal disorder involving elevated androgens (male hormones) and insulin resistance.
Common PCOS symptoms:
- Irregular or absent periods
- Acne, especially on jawline
- Excess facial or body hair
- Thinning hair on scalp
- Weight gain, especially around abdomen
- Difficulty losing weight
- Darkened skin patches (acanthosis nigricans)
- Fertility challenges
Testing: Pelvic ultrasound, blood tests for androgens (testosterone, DHEA-S), insulin and glucose levels
Treatment: Birth control pills, metformin, lifestyle changes (diet, exercise, stress management), supplements (inositol, NAC)
3. Estrogen Dominance
Estrogen dominance doesn't necessarily mean high estrogen—it means estrogen is too high relative to progesterone. This imbalance is common in perimenopause and can result from stress, poor liver detoxification, or environmental estrogens.
Symptoms:
- Heavy, painful periods
- Severe PMS (breast tenderness, bloating, mood swings)
- Weight gain (especially hips and thighs)
- Fibroids or endometriosis
- Low libido
- Brain fog, anxiety
Common causes: Chronic stress (lowers progesterone), excess body fat (produces estrogen), liver dysfunction, exposure to xenoestrogens (plastics, pesticides)
Testing: Salivary or urine hormone testing (measures estrogen and progesterone throughout cycle)
4. Adrenal Dysfunction (HPA Axis Dysregulation)
Your adrenal glands produce cortisol, your main stress hormone. Chronic stress can dysregulate cortisol production, leading to persistent fatigue, blood sugar issues, and immune problems.
Symptoms of high cortisol (early stress response):
- Anxiety, insomnia
- Weight gain (especially belly fat)
- High blood pressure
- Sugar cravings
Symptoms of low cortisol (burnout/HPA axis dysfunction):
- Crushing fatigue, especially mornings
- Salt cravings
- Lightheadedness upon standing
- Brain fog, difficulty handling stress
Testing: Salivary cortisol test (4-point test throughout the day)
Treatment: Stress management, sleep prioritization, adaptogenic herbs (ashwagandha, rhodiola), balanced meals
5. Insulin Resistance
Insulin is the hormone that regulates blood sugar. When cells become resistant to insulin, your pancreas produces more and more insulin to compensate, leading to weight gain, inflammation, and eventually type 2 diabetes.
Symptoms:
- Difficulty losing weight (especially abdominal fat)
- Constant hunger or sugar cravings
- Fatigue after meals
- Brain fog
- Darkened skin patches (acanthosis nigricans)
- PCOS symptoms
Testing: Fasting insulin, fasting glucose, HbA1c, oral glucose tolerance test
Treatment: Low-glycemic diet, regular exercise (especially strength training), stress management, adequate sleep
How to Get Diagnosed
Step 1: Track Your Symptoms
Before seeing a doctor, document your symptoms for at least 2-4 weeks:
- Energy levels throughout the day
- Mood changes and triggers
- Sleep quality (how long, how often you wake)
- Menstrual cycle (length, flow, symptoms)
- Digestion (bloating, constipation, etc.)
- Weight changes
- Any other symptoms (skin changes, hair loss, etc.)
This data helps your doctor see patterns and take you seriously.
Step 2: Find the Right Doctor
Not all doctors are well-versed in hormones. Consider seeing:
- Endocrinologist: Specializes in hormone disorders
- Reproductive endocrinologist: Focuses on reproductive hormones (PCOS, fertility)
- Functional medicine doctor: Looks at root causes and runs comprehensive testing
- Integrative or naturopathic doctor: Combines conventional and holistic approaches
Step 3: Request Comprehensive Testing
Standard hormone testing often misses imbalances. Ask for:
Thyroid:
- TSH, Free T3, Free T4, Reverse T3
- Thyroid antibodies (TPO, TG)
Sex hormones:
- Estradiol, progesterone, testosterone, DHEA-S
- FSH and LH (if irregular periods or perimenopause)
Metabolic:
- Fasting insulin and glucose
- HbA1c (average blood sugar over 3 months)
Adrenal:
- Salivary cortisol (4-point test throughout the day)
- DHEA-S
Other:
- Vitamin D, B12, ferritin (iron storage)
- Complete blood count (CBC)
- Comprehensive metabolic panel
"Don't accept 'your labs are normal' if you still have symptoms," Dr. Romm advises. "Ask for a copy of your results and look at the actual numbers. 'Normal range' is often too broad."
Step 4: Advocate for Yourself
If your doctor dismisses your symptoms or refuses testing:
- Bring your symptom tracking data
- Be specific about how symptoms impact your life
- Ask directly: "Could this be hormonal? Can we test for that?"
- If they still won't help, seek a second opinion
You know your body. Trust yourself.
Treatment Options
Hormone imbalance treatment depends on the specific imbalance and its root cause. Here are common approaches:
Lifestyle Interventions (First-Line Treatment)
For many hormone imbalances, lifestyle changes are the foundation:
Sleep: Aim for 7-9 hours. Sleep deprivation worsens all hormone imbalances.
Stress management: Chronic stress disrupts cortisol, which affects all other hormones. Prioritize therapy, meditation, movement, boundaries.
Nutrition:
- Balanced meals with protein, healthy fats, fiber
- Minimize refined sugars and processed foods
- Eat cruciferous vegetables (support estrogen metabolism)
- Include healthy fats (support hormone production)
Movement: Regular, moderate exercise helps insulin sensitivity, cortisol regulation, and mood. Avoid over-exercising (worsens cortisol issues).
Reduce toxins: Minimize plastics, conventional personal care products, pesticides (xenoestrogens)
Medications
For hypothyroidism: Levothyroxine or natural desiccated thyroid For PCOS: Birth control pills, metformin, spironolactone For perimenopause/menopause: Hormone replacement therapy (HRT) For insulin resistance: Metformin
Supplements (Under Medical Guidance)
- Vitamin D: If deficient (very common)
- Magnesium: Supports sleep, stress, blood sugar
- Omega-3s: Anti-inflammatory, supports hormone production
- Inositol: For PCOS and insulin resistance
- Adaptogenic herbs: Ashwagandha, rhodiola (for cortisol balance)
- Vitex (chasteberry): For progesterone support
Always work with a doctor before starting supplements, especially if you have hormone-sensitive conditions or take medications.
Your Hormone Health Action Plan
This week:
- Start tracking symptoms daily (use a journal or app)
- Note patterns in energy, mood, sleep, digestion, and menstrual cycle
- Research doctors in your area who specialize in hormones
This month:
- Schedule appointment with hormone-knowledgeable doctor
- Request comprehensive hormone testing
- Review your diet—are you eating enough protein, healthy fats, fiber?
- Assess your stress levels—what needs to change?
Ongoing:
- Prioritize 7-9 hours of sleep nightly
- Practice stress management daily (even 10 minutes helps)
- Eat balanced meals with protein, fat, and fiber
- Move your body regularly (but don't over-exercise)
- Advocate for yourself with doctors
The Bottom Line
Hormone imbalances are real, common, and treatable. You're not imagining your symptoms. You're not "just stressed." You deserve answers and support.
"The right diagnosis can be life-changing," Dr. Romm says. "I see patients all the time who've been told for years that their symptoms are in their head. Once we identify and address the hormone imbalance, they get their life back."
Start tracking your symptoms. Find a doctor who listens. Don't give up. You deserve to feel like yourself again.
