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Female Hormones in Mid-Life

Hormones are potent messengers within the body that allow for communication between the brain, glands, and tissues to help the body respond to and thrive in its environment. The human body has many different types of hormones that affect different tissues, but sex hormones (estrogen, progesterone, and testosterone), adrenal hormones, like cortisol, and thyroid hormones are predominantly considered when addressing hormone balance. When any of these hormones are disrupted, we experience a variety of symptoms, including weight loss/gain, changes in energy, mood imbalance, skin breakouts, fertility challenges, sleep disruption, and more.1

A delicate balance

All hormones are in a delicate balance with one another, constantly shifting due to a variety of factors, such as age, inflammation, stress, nutrition, and quality of sleep. When one hormone level goes awry, it has a direct effect on the other hormones.1 Coincidentally, the symptoms of hormone imbalance are less about the overall levels of each individual hormone, but rather, more about their balance with one another. To complicate it even further, everyone is different. Some people are naturally more resilient to hormone imbalance, while others will notice extreme symptoms with the slightest shift.1,2

Symptoms of hormone imbalance

In women, shifting hormones often wreak system-wide havoc during the perimenopausal window. Perimenopause is described as the 5-6 years approaching the onset of menopause, when sex hormone synthesis, particularly progesterone, begins to shift from the ovaries over to the adrenal gland.3

Decreasing progesterone levels occur concomitantly with fluctuating estrogen levels during this transitionary period, contributing to a common dynamic known as estrogen dominance. This can be experienced as intense PMS symptoms, long and heavy menstrual bleeding, weight gain, mood imbalance, insomnia, and irritability.1,3 Other contributors to estrogen dominance for women both in their childbearing years and in menopause include high exposure to estrogenic toxins from the environment, as well as poor metabolism and clearance of estrogens.4,5

The bigger picture

Estrogen dominance is just one example of hormone balance, but plenty of other symptoms can be linked to imbalances, such as hypothyroid or androgen deficiency or excess. The progression toward imbalance can begin in a seemingly unrelated body part or system. Insulin resistance due to a high glycemic diet, for example, is a major source of hormone imbalance. It directly contributes to excess body fat, which itself produces estrogen and contributes to estrogen dominance.2 Furthermore, high insulin levels cause increased testosterone production from the ovaries, lending to Polycystic Ovarian Syndrome (PCOS), which causes a variety of androgenic symptoms, such as facial hair growth, head hair thinning, aggression, and infertility, impacting many women in their childbearing years.6

Along with insulin, cortisol, is another key player in hormone balance. Cortisol is released from the adrenal gland in response to stress. It is often called the “master hormone,” in that it is central to hormone balance and is responsible for priming the receptors of all other hormones. Unabated stress leading to high cortisol release will chronically raise blood sugar.7 Eventually, this can lead to insulin resistance and then downstream hormonal imbalance, such as PCOS.6

What really is at the root of the issue?

Healthy hormone balance is dependent on a variety of factors that are influenced by the choices we make every day, including managing stress and taking in adequate nutrition. Another critical factor for hormone balance is gut health. Microbial imbalance in the gut often leads to system- wide inflammation with multiple consequences, including impacting hormones.8 Furthermore, inefficient hormone metabolism, whether due to genetic variants or toxin exposure, can lead to a back-up of hormones lending to imbalance.9 Pinpointing the root cause (or causes) of hormonal imbalance can feel overwhelming and complicated, but your functional medicine practitioner can work with you to find answers and create a plan that will help.

In part 2 of this blog, we’ll cover lifestyle choices that positively impact sex hormones.

By Lindsey Palmer, PharmD, MBA 

Our Pharmacists at PharmToTable specialize in functional medicine using a lifestyle-based approach. We also have health coaches on our team who can help you start to make changes towards improving your health.  

Book an appointment or schedule a free 15-minute discovery call today!


  1. How Do I Naturally Balance Female Sex Hormones? Dr. Mark Hyman. blog/2015/08/14/how-do-i-naturally-balance-female-sex-hormones/. Published December 19, 2019. Accessed May 20, 2021. 
  2. Gottfried S. The Hormone Reset Diet: Heal Your Metabolism to Lose up to 15 Pounds in 21 Days. Toronto: Collins; 2017. 
  3. Santoro N. Perimenopause: From Research to Practice. J Womens Health (Larchmt). 2016 Apr;25(4):332-9. doi: 10.1089/jwh.2015.5556. Epub 2015 Dec 10. PMID: 26653408; PMCID: PMC4834516. 
  4. Paterni I, Granchi C, Minutolo F. Risks and benefits related to alimentary exposure to xenoestrogens. Crit Rev Food Sci Nutr. 2017 Nov 2;57(16):3384-3404. doi: 10.1080/10408398.2015.1126547. PMID: 26744831; PMCID: PMC6104637. 
  5. Parl FF, Dawling S, Roodi N, Crooke PS. Estrogen metabolism and breast cancer: a risk model. Ann N Y Acad Sci. 2009 Feb;1155:68-75. doi: 10.1111/j.1749-6632.2008.03676.x. PMID: 19250193; PMCID: PMC5539950. 
  6. Dunaif A. Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev. 1997 Dec;18(6):774-800. doi: 10.1210/edrv.18.6.0318. PMID: 9408743. Spencer RL, Deak T. A users guide to HPA axis research. Physiol Behav. 2017 Sep 1;178:43-65. doi: 10.1016/j.physbeh.2016.11.014. Epub 2016 Nov 18. PMID: 27871862; PMCID: PMC5451309. 
  7. Keenan DM, Veldhuis JD, Basu A, Basu R. A novel measure of glucose homeostasis (or loss thereof) comprising the joint dynamics of glucose, insulin, glucagon, and cortisol. Am J Physiol Endocrinol Metab. 2019 Jun 1;316(6):E998-E1011. doi: 10.1152/ ajpendo.00078.2018. Epub 2019 Mar 12. PMID: 30860881; PMCID: PMC6620575. 
  8. Farzi A, Fröhlich EE, Holzer P. Gut Microbiota and the Neuroendocrine System. Neurotherapeutics. 2018 Jan;15(1):5-22. doi: 10.1007/s13311-017-0600-5. PMID: 29380303; PMCID: PMC5794709. 
  9. Tsuchiya Y, Nakajima M, Yokoi T. Cytochrome P450-mediated metabolism of estrogens and its regulation in human. Cancer Lett. 2005 Sep 28;227(2):115-24. doi: 10.1016/ j.canlet.2004.10.007. Epub 2004 Nov 19. PMID: 16112414. 
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