The term 'hormonal imbalance' gets used a lot when talking about women's health. Here, Jean Hailes endocrinologist (hormone specialist) Dr Rosie Worsley explains this term – what it means, why it's often misused, and what steps you can take if you feel like your hormones are 'out of balance'.
Houston, we have a problem
Fatigue, weight gain, low libido, irritability; if you asked Google, or even one of your girlfriends, what these symptoms add up to, chances are they'd give you the diagnosis of 'hormonal imbalance'. But as Dr Worsley explains, this doesn't really answer your question.
"There is no medical diagnosis for 'hormonal imbalance'," she says. "You can use it in normal conversation and say 'things are out of balance' or 'a particular hormone is out of balance'. But the term 'hormonal imbalance' itself is very imprecise. What hormone are you talking about? What sort of imbalance?
"It ends up being a catch-all type of phrase that often means 'I don't feel well' or 'something doesn't feel right'."
A description, not a diagnosis
Hormones are our body's chemical messengers, carrying important information from one organ to another. The two main female hormones, oestrogen and progesterone, govern the menstrual cycle and fertility, as well as many other processes in the body. Although there are more than 50 different hormones involved in human health, the term 'hormonal imbalance' is usually used when talking about women's health issues, such as premenstrual syndrome (PMS) and menopause.
It's accurate to say that hormones can be out of balance, says Dr Worsley, but the term 'hormonal imbalance' is better used to describe what may be behind a particular symptom of a condition, rather than as a condition itself.
However, even this is not without its problems. "To say that your hormones are 'out of balance' can imply that the scales have been tipped a little too much on one side, so there must be a simple way to put things back into balance, which is not always the case," says Dr Worsley.
"If you're talking about actual hormonal disorders, often you need medication to restore the balance, so to speak."
Real symptoms, root causes
Just because the diagnosis doesn't exist in medicine, that's not to say that the symptoms often attributed to 'hormonal imbalance' aren't real or worthy of medical attention – it's just that hormones aren't always the cause, says Dr Worsley.
"When women come to me worried they have a hormonal imbalance, we take it back to basics," she says. "I ask them what they are feeling, what are they worried about in terms of their health, and work out if their symptoms could be hormone-related or not. And it's not always related to hormones."
Why so tricky?
Hormonal health can be very complex, particularly when it comes to the menstrual cycle or menopause. Dr Worsley explains why.
"There are multiple hormones involved at once; they often have major impacts across multiple body systems and organs, and often affect the symptoms of other conditions as well," she says.
"For example, it could be that asthma, migraines or depression gets worse at certain points in the cycle, so it's about working out what is due to the hormone and what is due to the hormone triggering something else. It can get really complicated."
Dr Worsley says there are "probably a lot of other things going on in the body to do with female hormones that we just don't know about yet."
"One thing we find in women's health is that a lot of these areas aren't well researched, and in medicine we don't understand the actual mechanisms behind a lot of symptoms yet," she says.
Testing, testing, 1, 2, 3 …
If you feel like your hormones are out of balance, you can find out exactly what's happening via a blood test, right? Not always. Current hormone testing for women has its limits. Blood tests show what the levels of hormones are in the blood, and not the body tissues where the symptoms are actually taking place – for example, the brain for mental and emotional symptoms, says Dr Worsley.
"We can diagnose some hormonal conditions such as polycystic ovary syndrome (PCOS), for example, and see if a woman has gone through menopause using blood tests, but in general they won't reflect all the 'hormonal-type' PMS or menopausal symptoms women might be feeling," she says.
An alternative to blood testing is saliva testing, to measure the levels of hormones present in your saliva. This is commonly prescribed through naturopaths and other natural therapists, but isn't recognised as valid by mainstream medicine.
"At this stage, saliva testing hasn't been researched enough, there is not enough evidence to support that it works, so we don't use it in medicine," says Dr Worsley.
So if you have symptoms you think are hormone-related, what do you do?
Dr Worsley says a visit to the GP is warranted for any symptoms that are affecting a woman's quality of life.
"The best resource for women who feel their hormones are 'out of balance' is a GP who has a special interest or extra training in women's health," says Dr Worsley. "Look on the Australasian Menopause Society website for a practitioner in your area – even if you're not going through menopause. Generally, if a doctor has specialist knowledge in menopause, they can apply it to women's hormonal issues."
Dr Worsley also says it's important that 'Dr Google' does not replace your real-life doctor. "There is a whole lot of stuff on the internet which uses the term 'hormone imbalance' as a scientific or medical term, applying it to a whole variety of scenarios and symptoms, and it can be really confusing for women," she says. "When you're reading things online, try to be aware of who is writing it and what their motivation might be. Ask yourself, 'are they trying to market a particular product? Are they selling something?'."
The right advice
Your general health can have a big impact on your hormonal health, so looking after yourself is key, says Dr Worsley. "Have a healthy diet, avoid processed foods, get enough exercise and sleep," she says. "And don't forget to listen to your body. If you feel something's not right – if you think your periods aren't quite right, or you feel like your hormones are 'off'– find some help with it."
"Hormones are complex, so sometimes it's about persisting and making sure you get the right advice. I think the other key thing for women is putting your health first, but also being kind to yourself.
"The message for women is: don't white-knuckle it through life, there are things you can do now. Often something quite simple, can make you feel much, much better."