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Are my Hormones 'Out-of-Whack'?...Understanding Female Hormonal Imbalance

Not uncommonly,  patients present with irregularities in their menstrual period, irritability or mood swings, bloating, fluid retention or weight gain, hot flashes, or decreased libido…wondering if their ‘hormones are out of balance’?  Unfortunately, there’s not always an easy answer to that question, but as Gynecologists, it does cause us to consider two common ‘hormonal’ conditions that could explain such symptoms:  Polycystic Ovarian Syndrome, and the Perimenopause.

Polycystic Ovarian Syndrome is characterized by menstrual irregularities (chronic anovulation) and signs of androgen excess (hair growth, acne), and is the most common ‘hormonal abnormality’ affecting reproductive aged women.  Nearly 1 in 15 women are affected, half of those women being overweight or obese.  Many women with PCOS have had a long history of irregular menstrual periods, dating as far back as they can remember.  The irregularities can vary between skipped periods to frequent periods, flow may be light to heavy, and short or prolonged in duration.  Some women describe light cramping/a sensation of pelvic ‘fullness’ or bloating (like their period is ‘about to start’), in the months of skipped periods.  Others describe a feeling of emotional ‘tension’, while in wait for that unknown date when their period will start.  Though the cause of PCOS is unknown, genetic inheritance may play a role.

Perimenopause, (‘around’ menopause) is the naturally occurring transition toward menopause, leading to cessation of the menstrual cycle.  The age of this transition varies among women, usually occurring in the late 40’s, lasting a few (or maybe several) years until the actual menopausal transition is complete.   During this time of transition, many women will experience at least some of these symptoms, some will experience symptoms starting as early as their late 30’s.  Common symptoms of the perimenopause include heavy or irregular menstrual periods, mood swings/irritability, hot flashes, vaginal dryness, and decreased libido.

Do I need my ‘hormones checked’?

The diagnoses of PCOS and the Perimenopause are based on clinical symptoms, a laboratory ‘blood test’ is rarely necessary to make the diagnosis.  Though it’s tempting to want to have ‘blood tests’ drawn to ‘see what’s going on’, even in regular menstrual cycles hormonal values fluctuate daily, making one isolated evaluation of little value.  Hormonal blood tests are sometimes used in confirming the diagnosis of PCOS (evaluating estrogen to androgen ratios), but are not necessary.  An FSH value (the stimulator for ovarian estrogen production) is sometimes used to confirm a diagnosis of menopause (the absence of menstrual periods for 1 year, with hot flashes), though these values can also fluctuate, and are of little value in ‘predicting’ the onset of menopause for those women experiencing perimenopausal symptoms.   The blood tests that are of value are:  1) a pregnancy test, and 2) a check of Thyroid hormones, to rule out conditions that could mimic these Perimenopausal or PCOS symptoms.


So you’re right, your hormones may be ‘out of balance’.  Speak with your health care provider to understand more about the evaluation and treatment of female hormonal imbalance caused by PCOS and the Perimenopause.


Suzanne Hall, MD

Eastside Gynecology Obstetrics

Offices located in Roseville, Grosse Pointe, Macomb and Rochester, MI

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