Healing Hormone Imbalance 101

We hear so much about how hormonal imbalances affect not only our menstrual health, but also our overall health. But what exactly is a hormone? How can these imbalances impact our wellness? In this blog, we will deep dive into the world of hormones, both from western biomedical and Traditional Chinese Medicine (TCM) perspectives. Buckle up, we’re about to learn a lot about how our menstrual cycle operates!

What is a Hormone?

Hormones are like little messengers in your body that keep everything running smoothly. Imagine them as your body's communication experts, each created by special glands, traveling through your bloodstream. Their destination? Various organs and tissues where they have an essential job: to trigger specific physiological and emotional actions and keep things in a happy balance. Hormones are the unsung heroes behind so many of our bodily functions, from how we grow to how we feel. They influence our development, our metabolism (how we process food and energy), our ability to reproduce, and even our moods.

Menstrual Hormones

Hormones play an important role in the menstrual cycle. They can determine whether or not your cycle is smooth as butter, pure torture, or somewhere in between.  

Let's chat about the key hormones in our menstrual cycle: 

• Estrogen: The star hormone produced mainly in the ovaries. It shapes everything from development of secondary sexual characteristics (breasts and pubic hair) to mood, digestion, energy and even joint health! It regulates the menstrual cycle by triggering the Luteinizing Hormone (LH) surge and prepares the uterus for pregnancy by thickening the lining of the uterus and developing its blood supply (like fertilizer). Estrogen is one of the key players that keeps the menstrual cycle in rhythm.
• Progesterone: It’s also produced in the ovaries, but after ovulation. Progesterone is like the nurturing hormone that prepares the uterus to welcome and support a fertilized egg and early pregnancy by maturing and regulating the thickening of the uterine lining. Without progesterone, unregulated growth of the lining of the uterus from estrogen can lead to uterine cancer. Progesterone also regulates the menstrual cycle and affects mood, digestion, energy, and sleep. 
• Follicle-Stimulating Hormone (FSH): Secreted by the pituitary gland, FSH encourages the maturation of follicles (houses for the eggs) in the ovaries. It is the hormone that helps prepare eggs for ovulation and what stimulates cells in the follicles to produce estrogen. 
• Luteinizing Hormone (LH): Also released by the pituitary gland, LH is the trigger for ovulation – it's the cue for an egg to leave the ovary. The LH surge is triggered by estrogen levels and leads to ovulation, which then initiates progesterone production, keeping the harmony in the cycle.

Hormones and the Menstrual Cycle

Picture the menstrual cycle as a beautifully choreographed dance, with our hormones as the dancers. Each step in the cycle is guided by a change in these hormone levels, creating a rhythm that's as unique as each of us.

Menstrual Phase (Beginning of Follicular Phase)

On Day 1 of menses, the start of the follicular phase, FSH sees the stage being cleaned of the flowers thrown during the last performance (menstruation) and empty of other dancers (low levels of estrogen and progesterone). FSH wants to coax their friends onto the dance floor. She starts to dance, slowly at first, but then picking up momentum (stimulating development of follicles/eggs in the ovary).  

Follicular Phase Continued

Following menses, FSH stimulates the development of multiple follicles in the ovary, each producing estrogen. As these follicles grow, they collectively increase estrogen levels until a dominant follicle emerges, suppressing the others. It’s like estrogen sees her friend FSH dancing and joins in, and then estrogen takes center stage. Estrogen is all about growth and preparation, getting the uterus ready for a possible pregnancy by thickening its lining. It's like the body's way of setting up a cozy, welcoming space.

Ovulation

FSH steps back to rest while estrogen picks up intensity until her dance is so exciting that FSH and LH have to jump back in with the same vigorous intensity (known as the LH surge). It's a pivotal moment in our cycle, kind of like the grand reveal. This increase in estrogen not only triggers ovulation, causing the follicle in the ovary to release an egg about 10-12 hours after a surge in LH and FSH hormones, but it causes changes in insulin levels that drive up testosterone levels. This leads to an increased sex drive, feeling more attractive, and a higher pain tolerance. The increase in estrogen also leads to thicker cervical mucus, facilitating sperm entry. The rise in basal body temperature marks ovulation.

After the grand reveal, FSH and LH fall to the floor with exhaustion and estrogen gradually slows down.  

Luteal Phase

Post-ovulation, we enter the luteal phase. Here, progesterone steps into the spotlight. Its levels rise significantly after ovulation, maintaining the uterine lining and keeping things stable and calm, in case the egg gets fertilized. Think of progesterone as the nurturing hormone, ensuring everything stays just right for a potential pregnancy. Progesterone’s dance builds intensity, the crowd is coming to their feet and preparing flowers for the dancers (luteal/secretory phase).  Estrogen joins in the background, waiting to see if other dancers will join for an encore (pregnancy). If pregnancy does not occur, estrogen and progesterone both grow tired, slow down, and take a bow. The crowd throws their flowers onto the stage and the cleaners prepare to clear the stage again. It's like the curtain call of our hormonal dance, signaling the body to shed the uterine lining, and voilà - we have our period.

So, each phase of our menstrual cycle is ideally a delicate balance of these hormones rising and falling, like dancers moving gracefully in tune with each other. When this rhythm is off we can experience unwanted symptoms, which are just signals that our hormones might be imbalanced. 

What is a Hormone Imbalance?

Sometimes, this dance can get a bit out of sync, leading to hormone imbalances.  Each hormone has its own rhythm and style, contributing to the overall harmony of the dance. However, when there's a hormone imbalance, it's like some dancers are moving too fast or too slow, disrupting the beautiful choreography. This can happen when the levels of these hormones are either too high or too low, or signals to release specific hormones are sent at the wrong time. It's like the music's rhythm is off, and the dance steps don't match the beat.

Hormone imbalances can pop up from various things - it could be due to health conditions, the lifestyle choices we make (like what we eat or how much we exercise), the medications we're on, our sleep quality, our environment, or how we deal with stress.

During natural life transitions, such as puberty, pregnancy, or menopause, it's common for the hormone levels to fluctuate, causing a temporary mismatch in the dance. Menstrual hormone imbalances can particularly throw off the rhythm, leading to symptoms like irregular periods, cramps, acne, sleep and energy issues, or mood swings. It's our body's way of saying, "Hey, something's not quite right here!" It's important to listen to our bodies and understand these signals. Sometimes, the dancers are still in sync, but just not being received well by the crowd, as if the music sounds too loud or the lights too bright for sensitive ears and eyes.

Managing these imbalances is about helping our hormonal dancers find their tempo again, ensuring each one is in sync with the others or toning down the music and lights. Just like a dance, the menstrual cycle requires balance and harmony among all the hormone levels to keep everything flowing smoothly. When these levels are imbalanced, it can throw off the entire routine, affecting not just our periods but also our overall health. 

How Do Menstrual Hormones Affect Metabolism and Digestion

1. Appetite Changes and Menstrual Hormones

• Estrogen and Progesterone Influence: These hormones fluctuate throughout the menstrual cycle and are known to impact appetite. Estrogen, which rises during the first half of the cycle (follicular phase) and peaks just before ovulation, is generally associated with a decrease in appetite. Progesterone, which increases in the second half of the cycle (luteal phase), may stimulate appetite.
• Serotonin Levels: Fluctuations in serotonin levels influenced by hormonal changes can also affect appetite. Lower levels of serotonin during the menstrual cycle may increase carbohydrate cravings. Estrogen tends to increase serotonin levels and progesterone decreases them. 

2. Digestive Changes and Menstrual Hormones

• Gastrointestinal Symptoms: Hormonal changes, particularly the rise in progesterone during the luteal phase, can slow down the digestive process and cause fluctuations in water absorption, leading to symptoms like bloating, diarrhea, and constipation.
• Water Retention and Bloating: A rise in estrogen can also cause the body to retain more water, leading to bloating and discomfort. 
• Additionally, prostaglandins, which are inflammatory substances released around menstruation, cause contractions in the smooth muscle of the bowel and changes in water retention as well, which causes cramping, bloating, and period poop.
• For those with fibroids and/or endometriosis, this inflammation, cramping, and bowel function changes can be even worse.
• It seems like estrogen also has a key relationship with our gut microbiome, but this is not yet well understood.

3. Metabolism

• Ovarian hormones also play a role in insulin and insulin resistance, which determines how well our cells process and metabolize food.
• While the pancreas is the primary source of insulin, the ovaries also produce insulin, which interacts with our sex hormones.
• For those with polycystic ovarian syndrome (PCOS), which typically causes irregular menses and acne, insulin resistance is common. This can lead to difficulty with weight management and type 2 diabetes.

How Do Menstrual Hormones Affect Mood

Estrogen and progesterone have a complex relationship with mood and our cycle.

In the first part of our cycle, the follicular phase, there's a rise in estrogen. This hormone is like a mood booster - it positively affects our emotions, making us feel uplifted and happy. Plus, estrogen has a buddy relationship with serotonin, our brain's "feel good" chemical. So, when estrogen levels are high, so are our serotonin levels, bringing more joy and happiness.  Estrogen also decreases the effects of stress hormones like cortisol and adrenaline leading to less anxiety.

Then comes the second phase, the luteal phase. Here, estrogen levels dip, and progesterone starts to rise. Serotonin decreases with the rise in progesterone, which can lead to feelings of depressed mood and trouble concentrating. Progesterone also promotes the effects of stress hormones like cortisol and adrenaline, leading to more anxiety. While we often think of progesterone as a mellow hormone promoting rest, some studies indicate that higher levels of progesterone, even when cortisol levels are taken out of the picture, lead to more anxiety.

As we approach our period, during the late-luteal phase, both estrogen and progesterone levels drop. This is typically when we experience PMS - that's when we might feel more emotionally unstable or moody. It's like the emotional equivalent of a stormy day. The drop in hormones can also lead to more headaches and fatigue.

It's important to remember that sensitivity to these hormonal changes varies from person to person, with some being more sensitive to these hormonal changes than others. That means that even normal, balanced hormonal fluctuations can cause more symptoms in some people. Understanding this can help us navigate these times with a bit more ease and compassion for ourselves.

How Do Menstrual Hormones Affect Sleep

Menstrual hormones influence sleep patterns, sleep quality, and circadian rhythms throughout the cycle. Studies have shown that women tend to experience more sleep issues than men, starting at puberty, partly due to hormonal changes throughout the menstrual cycle. Many people report a decrease of sleep quality premenstrually and during the period. This could be due to the dip in progesterone levels right before the period, as progesterone has a calming, sedative effect on the body. There is evidence that there are circadian rhythm changes premenstrually, leading to sleep troubles.

There is evidence that people with PCOS (polycystic ovary syndrome) have an increased risk of sleep-disordered breathing, like sleep apnea. However, sleep apnea is often associated with obesity and the insulin resistance in PCOS can lead to difficulty with weight management and obesity. It’s unclear if it’s the hormonal changes themselves or the associated weight changes that correlate PCOS with sleep apnea.

During the premenstrual phase, our body goes through a bunch of hormonal fluctuations. These changes can shake up our sleep patterns and even tweak our circadian rhythm - that's our body's internal clock that tells us when to feel sleepy or awake. It's kind of like having a mini jet lag without going anywhere!

Also, these hormonal shifts can affect the secretion of melatonin, which is our body's natural sleep hormone. Less melatonin can mean more trouble falling asleep and staying asleep. This is why some of us might find ourselves tossing and turning more or feeling less rested during this time. Additionally, the more drastic drop in hormones leading up to menses can lead to hot flashes and night sweats. These night sweats aren’t only for those in menopause and can occur with menstrual hormonal fluctuations. They disrupt sleep and can cause you to wake in a pool of sweat. Having a change of clothes at your bedside and different layers of bedding can help.

How Do Menstrual Hormones Affect Energy

Our monthly cycle can be a bit of a rollercoaster ride for our energy levels! When your period kicks off (day 1 of your cycle), both estrogen and progesterone hit their lowest points. It's like your body's energy battery is running low. Plus, if you're dealing with cramps, it's totally normal to feel like this time is more for cozying up with a hot water bottle rather than running a marathon. Additionally, if you have very heavy periods, you might be getting anemic during your cycles, which also leads to decreased energy. Top that off with the sleep disturbances above and it’s a recipe for feeling tired and sluggish.

As your cycle moves into the follicular phase, that's when estrogen starts to climb back up. You'll probably notice you're feeling a bit brighter and more like your energetic self. And when you're nearing ovulation, estrogen is at its peak and testosterone comes in, too. This is usually when you're feeling great, super energized, and ready to take on the world. Typically, most feel their best in the time after menses and through ovulation.

But post-ovulation, as we head into the luteal phase, things take a bit of a turn. Estrogen starts to do a little dip while progesterone rises. Now, progesterone is a bit of a mellow hormone compared to estrogen, so this shift can make you feel a bit low in energy and mood. You might feel a bit more tired or slow-going, but it's not a stop sign for exercise. In fact, getting active, especially in the morning, can really perk up your mood and energy, just move at a lower intensity than when you’re feeling more energetic. 

The week before your next period can feel a bit like your energy is on a downward slope, as both estrogen and progesterone levels are dropping (unless you're expecting a little one). Even if you're not feeling super energetic, a bit of physical activity can actually be your friend for tackling those PMS symptoms. So keep moving, even if it's just a gentle yoga flow, a brisk walk, or slow paced strength training. Your body will thank you for it!

How Do Menstrual Hormones Affect Focus

Think of your brain as a super-computer that's constantly sending and receiving information. In this brain-computer, there are certain neurons, which are like tiny information processors, and they're particularly important for learning and remembering stuff. These neurons are found in a part of the brain called the hippocampus, which is super crucial for memory and learning.

Now, estrogen, a hormone in our bodies, acts like a manager for these neurons. It especially looks after the tiny structures called spine synapses - these are like little bridges that help pass information from one neuron to another. When you learn something new or remember something, it's these spine synapses that are hard at work, passing the information along.

Here's where it gets interesting: the function and number of these little bridges, or spine synapses, changes with the levels of estrogen. When estrogen levels are high, like during certain times in the menstrual cycle, there are structural changes at the existing bridges and creation of new  bridges. This means more information can be passed along, making learning and memory processes more efficient.

So, in short, estrogen is not just a hormone; it's like a brain-power booster, particularly influencing how well we learn and remember things by managing these tiny but mighty spine synapses in our brain. When estrogen levels go up, our brain's ability to handle memory and learning gets a nice little boost. It’s still unclear if these changes create noticeable differences in our memory as the few studies out there have mixed results, but it’s definitely an area that deserves more exploration and why we need so much more attention on women’s health research.

Hormones From a TCM POV

Throughout life, we experience various reproductive phases, from puberty and menstruation, to pregnancy, and menopause - all driven by our hormones. During these years, many people experience unwanted symptoms when hormones become imbalanced - from menstrual cramps, mood swings, headaches, digestive problems, fibroids, to insomnia. These symptoms are just our body’s signal to us that something needs attention, our body is not functioning the way it should be.

Traditional Chinese Medicine (TCM), understands the natural and necessary fluctuations of hormones throughout monthly menstrual cycles, as well as during bigger transitions that occur during pregnancy, post-partum, and perimenopause. It also recognizes that the painful, difficult symptoms and syndromes need not be a ‘normal’ part of a woman’s life; TCM can support these concerns to effectively and naturally address hormonal imbalances that lead to so many of these symptoms.

Yin, Yang, and the Menstrual Cycle

In TCM, balancing hormones is closely related to the fundamental principles of Yin and Yang – the dynamic and interconnected changing forces in the universe. The body is viewed as a microcosm of this greater process. Yin and Yang, often described as being opposites, are complementary pairs such as masculine/feminine, hot/cold, interior/exterior, sun/moon, day/night, even the seasons or times of day. Winter, water, rest, and feminine energy are Yin, while summer, fire, activity, and masculine energy are Yang. We need the Yin and Yang energies to be abundant enough at the correct times of our cycle to have a smooth period. It’s all about maintaining a balanced dynamic rhythmic flow between these two energies.

In TCM, the theory of Yin and Yang has a significant correlation with the moon’s phases, and also with the monthly, hormonal menstrual and ovarian cycles of our body. Yin and Yang flow between each part of the monthly cycle, changing how one becomes more dominant than the other at any specific time. The two main hormones that affect these cycles are estrogen and progesterone, each of which also controls a different part of the cycle.

Estrogen governs the first part of the cycle, known as the follicular phase, aiding in the nourishment of the ovaries to grow and develop prior to ovulation. This time of the cycle is associated with Yin energy. 

Ovulation is a transition point between Yin and Yang energy. After ovulation, progesterone rules the second half of the cycle, the luteal phase, and is more associated with warmth and Yang. The predominance of Yang energy helps to bring more blood and nutrients to the lining of the uterus to encourage implantation if that were to occur. If you have ever tried to chart your basal body temperature (BBT) after ovulation, it will ideally be higher than during the first part of the cycle. TCM often views ovulation time as requiring more Yang energy to encourage the process.

Just prior to menstrual bleeding, progesterone drops leading to the beginning of menstruation. After which, there is a transition moving from Yang to Yin energy, leading to the beginning of the next menstrual cycle.

Qi and the Menstrual Cycle

Now let’s discuss Qi (pronounced Chi) – as this balance between Yin and Yang shifts, we are able to subtly change the flow of Qi in the body which aids in supporting a healthy menstrual cycle. But what does Qi have to do with Yin and Yang, and what is Qi anyway? Qi is your ‘vital energy’, the life-force that flows through the body and the universe, and Yin and Yang energies generate this power. Qi is also what flows through what TCM calls the meridians - the ‘freeways’ of energy that run throughout the body. These meridians house acupuncture points, the energetic access points of the body.

Qi is responsible for many different aspects of hormonal functioning and TCM has additional definitions of how our organs work in our body and interact with Qi. They are seen as having the functions that we know organs carry out from a Western biomedical understanding, however in addition they are broken down into five “organ-systems” that work with Qi in different ways: these TCM Organs are the Spleen, Liver, Heart, Kidney and Lung.

Liver Qi Stagnation

Imagine you are taking a road trip on the freeway each month, and when you get stuck in a traffic jam, all the cars begin to pile up… This is essentially what happens when Qi cannot flow properly in the meridian pathways; our bodies and emotions literally feel stuck and unable to move forward. This leads to symptoms of irritability, mood swings, acne, irregular cycles, to headaches and cramps; TCM calls this important pattern diagnosis ‘Liver Qi Stagnation.’

Qi is also responsible for how easily blood flows throughout the body, including in the uterus, and it directly affects things like menstrual cramps and clots in the blood. Qi is the energy that is responsible for your circulation, and it must flow properly through all the TCM organs and along the meridians in the body in order to function with the proper balance.

Perhaps the simplest way to look at Liver Qi Stagnation in relation to hormonal balance is to think about circulation and elimination. We know that the liver, from a western biomedical model, plays an important role in processing hormones in the body, especially sex hormones such as estrogen or testosterone and it helps to carry the excess hormones out of the body through the intestines. For instance, if we become constipated due to a lack of fiber in our diet, estrogen cannot be eliminated out of the body, contributing to a condition known as ‘estrogen dominance’, which can also cause stagnating symptoms such as PMS and mood swings, acne, headaches. It’s all about balance, as noted above, estrogen makes so many positive things happen in the body, but when levels get too high, burdensome symptoms arise. There is such a thing as too much of a good thing.

Blood Stasis

If left to its own devices and the warning signals of Qi Stagnation are not attended to, the traffic jam gets worse and Qi Stagnation leads to what TCM calls ‘Blood Stasis.’ The warning signals of Blood Stasis include symptoms like sharp menstrual cramps, spotting, menstrual clots, dark or brown period blood, and an irregular or even absent cycle. Blood Stasis is a major contributing pattern seen in conditions like endometriosis, fibroids, and even breast cancer.

How Long Does it Take to Correct a Hormone Imbalance?

The time it takes to correct a hormone imbalance varies significantly depending on factors such as the underlying cause, the specific hormones involved, and your overall health. It can range from a few weeks to several months or more. You can support hormone imbalances through lifestyle changes, medication, hormone replacement therapy, and hormone balance supplements.

The golden rule of TCM is that it could take at least one month for every year that you have experienced your particular health challenge. You can however, see subtle changes even within the first month, especially if you include diet and lifestyle adjustments, along with TCM herbal medicine.

Lifestyle Tips to Help Support Hormone Imbalances

Lifestyle plays an integral role in our wellness journey. There are many easy things you can do today to help support a healthy hormone balance. From a TCM point of view the following tips can help us maintain the harmonious rhythmic flow between Yin and Yang energies that we need to have a smooth menstrual cycle and balanced hormones.

1. Connection: Tune-in to the signals your body is giving you by keeping a cycle symptom journal. The more information you have about your symptoms the better you can note any patterns or changes in symptoms and correlations with any activities.   
2. Recovery: Sleep is a crucial time for hormone regulation, so make sleep a priority, try to be asleep by 11p, and if that’s a challenge, have consistent sleep and wake times. 
3. Stress Response: Chronic stress can impact the natural rhythm of hormones, so find ways that help you metabolize stress. Even a 1 minute breath break can help reset our bodies - breathe in through the nose for a count of 5 and exhale through the mouth for a count of 6.
4. Movement: Get moving everyday to help keep the Qi flowing smoothly. Move in a way that is fun for you. 
5. Nourishment: Focus on a colorful whole foods diet with plenty of dark leafy greens, cruciferous vegetables, protein, and healthy fats, while reducing sugar, alcohol, caffeine, and industrial seed oil intake. Also try to limit the amount of iced beverages, as these can contribute to Qi Stagnation.     
6. Environment: Be mindful of the endocrine disrupting chemicals present in daily life that can impact hormone balance. One way is to reduce the amount of plastic used by replacing single use water bottles with reusable stainless steel or glass water bottles.

Chinese Herbs for Natural Hormone Balance

Chinese herbs can be your allies in supporting some of your most stubborn menstrual and hormonal problems (including period pain relief), and there are a variety of clinically effective, and time-proven herbs, which have a profound connection in balancing the flow of your body’s Qi, Yin, and Yang. There are many TCM herbs used for hormone and menstrual issues, two favorites include Cyperus Rotundus (Xiang Fu) and Motherwort (Yi Mu Cao).

Cyperus (Xiang Fu) is commonly known to be a wonderful hormone balancer, regulating menstruation while also being good for digestive complaints, and it directly affects that TCM Liver Qi Stagnation pattern diagnosis. Motherwort (Yi Mu Cao) is translated in Chinese literally as the “herb of the mother” and is an excellent herb for aiding menstrual cramps, premenstrual water retention, and PMS irritability for certain pattern diagnoses. 

TCM’s herbal medicine has over 3000 years of experience in supporting the menstrual cycle, infertility, perimenopause and other symptoms of hormonal imbalance. But herbal medicine is not a ‘fast food fix.’ Just as it took time to develop the hormonal imbalance that you are experiencing, it takes time to unravel and resolve the symptom picture.

Understanding the dynamic and fluctuating nature of Yin and Yang as the foundations of balance in your body, and how they affect Qi, creates the energy which we need to power lasting positive change. Traditional Chinese herbal remedies, like Cycle Balance, have the ability to support you at each stage of your journey towards wellness. Whatever you are currently experiencing physically and emotionally, take this opportunity to discover how TCM herbs can support and transform your individual path to a balanced life of hormonal wellness.

Begin your menstrual wellness journey now by taking Elix’s free Online Health Assessment to see what herbs can best support your unique menstrual cycle.

Reviewed by:

This article was reviewed by Dr. Jessica Ritch.

Dr. Jessica Ritch is a board-certified and fellowship-trained minimally invasive gynecologist who specializes in the management of benign gynecologic conditions such as abnormal bleeding, pelvic pain, fibroids, endometriosis, and polycystic ovarian syndrome. She completed residency training in obstetrics and gynecology at Columbia University, where she was selected as chief resident and received the prestigious AAGL Outstanding Resident in Minimally Invasive Gynecology award.

This article was reviewed by Dr. Elizabeth Fine.

Dr. Elizabeth Fine is currently the Dean of Clinical Education at Emperor’s College, the #2 ranked colleges for TCM. She has been practicing Acupuncture and Herbal Medicine for over 20 years, with a specialization in women’s reproductive health.

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