Hormonal Imbalance Signs And Symptoms

Hot flashes

The most common menopause related discomfort is the hot flash (sometimes called a hot flush). Although their exact cause is still a matter of speculation, hot flashes are thought to be the result of changes in the hypothalamus, the part of the brain that regulates the body’s temperature. If the hypothalamus mistakenly senses that the body is too warm, it starts a chain of events to cool the body down. Blood vessels near the surface of the skin begin to dilate (enlarge), increasing blood flow to the surface in an attempt to dissipate body heat. This produces a red, flushed look to the face and neck in light-skinned women. It may also make a woman perspire to cool the body down. An increased pulse rate and a sensation of rapid heart beating may also occur. Hot flashes are often followed by a cold chill. A few women experience only the chill. Hot flashes typically stop on their own over time; however, the duration is individual and may vary from a few months to a few years.

Sleep Disturbance

Some women experience sleep disturbances (insomnia) around menopause, especially if hormone changes provoke hot flashes during the night. Sleep is adequate when one can function in an alert state during desired waking hours. Most adults require 6 to 9 hours of sleep each night. Sleeplessness may be associated with other medical conditions, and are not always reviewed with hormone replacement. Most patients seem know the difference.


Studies suggest that hormones may play a role in headaches. Women at increased risk for hormonal headaches during perimenopause are those who have already had headaches influenced by hormones, such as those with a history of headaches around menstrual periods or when taking oral contraceptives. Decreased estrogen levels appear to be the common theme in these types of headaches. Hormonal headaches typically stop when menopause is reached. Replacement strategies have value short term and even long term in some patients.


There is no firm evidence that memory or other cognitive skills actually decline because of natural menopause. However, difficulty remembering and concentrating are common complaints during perimenopause and the years right after menopause. More research is needed to determine the cause of these complaints. Although studies are lacking to prove the association, sleep disturbances and hot flashes may contribute to these symptoms, as well as dealing with various midlife stressors. Remaining physically, socially, and mentally active may help prevent memory loss. Women who are concerned about declining cognitive performance are advised to consult with their healthcare provider.

Moodiness and Depression

Few scientific studies support the belief that menopause contributes to true clinical depression, severe anxiety, or erratic behavior. However, some perimenopausal women report symptoms of tearfulness, mood swings, and feeling blue or discouraged. It is unclear whether these mood symptoms are related to the gradual decline in ovarian hormone levels, but sleep deprivation associated with night sweats often results in fatigue, irritability, and moodiness. Abrupt hormonal fluctuations during perimenopause may have an impact on these symptoms as well. During their reproductive years, most women become accustomed to their own hormonal rhythm and most are familiar with the syndrome known as PMS (premenstrual syndrome) or PMDD (premenstrual dysphoric disorder). It is thought that these symptoms are triggered by the hormone fluctuations and mediated through the hypothalamus via neurotransmitters (especially serotonin). During perimenopause, this rhythm changes, and the erratic hormonal ups and downs, although normal, can create a sense of loss of control that can be upsetting. So most physicians can validate the strong influence of hormones on emotion and support the use of the hormone treatments for stabilization during these challenging seasons.

Genital dryness

During their life, at least one-third of all women will experience some troubling symptoms in the vulvovaginal area (external female genitals and vagina). These symptoms range in severity from mildly annoying to debilitating and include vaginal discharge, irritation, burning, dryness, itchiness, and pain, both with and outside of sexual activity. There are many possible causes of vulvovaginal symptoms. Although estrogen deficiency is the most common cause of these symptoms, women, around the time of menopause, should not assume that vulvovaginal problems are due to declining hormone levels. Symptoms should be investigated by a physician to identify the cause and possible treatment. A thorough, regular evaluation of vulvovaginal health is recommended to all women at menopause and beyond, regardless of whether or not they have symptoms or are sexually active. Replacement of estrogen, and even testosterone, can markedly improve the symptoms of vulvovaginal atrophy.

Decreased libido

In general, sexual desire (sex drive) decreases with age in both sexes, but each individual is different. Although some experience a significant decline in desire, a few have increased interest, and others notice no change at all. Research shows, however, that sexual problems are common for both women and men of all ages, with women being two to three times more likely than men to be affected by low desire. Low sexual desire is especially common in relationships of long duration. Decreases in estrogen and especially testosterone (also produced by the ovary) have been clearly associated with decreased libido. Adding a little sleep deprivation, depression, and vaginal dryness and in would be no surprise that libido can be significantly affected in the menopausal patient.

Urinary leakage

Urinary symptoms, including incontinence (persistent, involuntary leaking of urine) become more common with aging. Women are much more prone to the occasional episode of urine leakage than men. These symptoms may be affected by menopause. As menopause approaches and during the years that follow, lack of estrogen can cause thinning of the lining of the urethra, the outlet for the bladder. With aging, the surrounding pelvic muscles and support tissue may also weaken because of the loss of estrogen. As a result, women are at increased risk for urinary incontinence.

Weight gain

Women and men get bigger as they get older. The average weight gain is about a pound a year between the age of 30 and 50. This is primarily caused by a decrease in energy expenditure due to less activity and a slowing metabolism while maintaining a food intake that does not change to accommodate the decrease in requirements. There are many other hormone modifiers that also contribute to weight gain. Estrogen, progesterone, testosterone, and adrenal hormones have an important affect on metabolism and the tendency for fat storage. Loss of muscle mass from loss of testosterone can have a significant effect on metabolism. Studies also show that the distribution of fat (especially in the abdomen) is affected by that same hormone environment. Whether weight gain is linked to menopause itself and/or age, the important thing is that studies show that weight gain around the menopausal years can be minimized by lifestyle changes i.e. proper diet modification and exercise. Female hormone replacement therapy can have a beneficial effect if added to healthy living habits.

Skin sagging

Aging skin undergoes normal loss of collagen and elasticity, which creates slight sags and wrinkles. It also becomes more dry and flaky. Hormones play an important role in skin health. Diminished levels of estrogen at menopause contribute to a decline in skin collagen and thickness, which is more rapid in the years right after menopause than in later ones. Estrogen therapy may have beneficial effects on skin, but it cannot reverse genetic aging or sun damage, nor can it change any risk of skin cancer.

Hair thinning

Aging increases the likelihood that hair will become gray and more brittle. In addition, excessive hair growth (hirsutism) may occur in areas of the body where hair follicles are especially androgen-sensitive (testosterone), such as the chin, upper lip, and cheeks. This menopause related shift in the balance between androgen (testosterone) and estrogen can also result in the opposite effect—hair loss. Eating a healthy diet, adding a daily multivitamin, and avoiding harsh chemicals and sunlight that dry the hair certainly help in maintaining healthy hair. Replacement of estrogen can restore the balance, counteracting some of the androgen (male pattern or testosterone) dominant features that occur with menopause.