Although hormones work synergistically in the body to keep our cells functioning optimally, there are classic signs and symptoms for each hormone if there is an excess or deficiency. This is a simple way to get an idea of which bioidentical hormones are causing your symptoms. Simply write down the number of symptoms from each cluster and look to the key beneath each cluster to learn about the possible hormonal imbalances you have. If you have two or more it is possible that is why you are symptomatic. This is not diagnostic but will give your bioidentical hormone doctor an idea of where to start when approaching treatment.
Severe fatigue, specifically around 2-3PM
Unstable blood sugars
Difficulty focusing or concentrating
Increase pigmentation in the skin
Low blood pressure
If you have two or more of these symptoms it suggests that your adrenal glands are being overly worked and your body is having difficulties regulating cortisol production. This is often referred to as adrenal fatigue or hypocortisolemia. The gold standard for testing your adrenal gland function is to do a 4 point saliva cortisol test where we check you cortisol levels in your saliva upon awakening, at 12PM, at 4PM and before bed. I encourage anyone who thinks they have issues with adrenal gland function to contact my office and I can send them the kit to have it done.
Difficulty Losing Weight
Cold Hands and Feet
Brain Fog or Poor Memory
Sadness or depression
If you have two or more of these symptoms it suggests that you have a sluggish or suboptimal thyroid gland. Thyroid hormone is the gas pedal for our metabolism. It regulates how efficiently we convert food into energy for every cell in the body. How every cell utilizes hormones is also dependent on optimal thyroid function. I encourage you to ask your doctor to check your TSH, free T3, free T4, reverse T3 and thyroid antibodies. You should also complete the 4 point saliva cortisol test as high levels of cortisol can suppress thyroid function. These symptoms can be easily treated using compound desiccated thyroid hormone.
If you have two or more of these symptoms it suggests that your body is not making enough estradiol. We typically don’t see these symptoms until women reach the menopausal period of their life. However, I have seen women as early as 30 have premature menopause as a result of primary ovarian failure. The simple test to ask for is a follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol level in the blood (not saliva). The only treatment for symptoms of low estradiol is to take bioidentical hormones (estradiol).
Menstrual migraines or headaches
History of miscarriage
Premenstrual Syndrome (PMS)
This cluster of symptoms is generally retaliated to insufficient levels of progesterone. Women make the most progesterone from the days 14 to 28 of their menstrual cycle. However, if they do not ovulate or have excessive levels of estradiol then it can cause any or all of these symptoms. Although we can check progesterone levels in the blood, because they fluctuate so wildly during the month it does not provide a lot of valuable information. In these patients we generally just treat them with bioidentical micronized progesterone and titrate the dose up or down until they feel great again. Some women will use it daily while others will use it only at certain times of their menstrual cycle.
Excessive vaginal bleeding
Acne or red flushing of the face
History of abnormal pap smears
If you suffer from two or more of these symptoms it is likely a result of too much estradiol (estrogen dominant) or a lack of progesterone or both. If you are still having menstrual cycles than having your estradiol or progesterone levels checked doesn’t provide us with valuable information as they fluctuate wildly throughout the month. However, we can easily treat this by balancing excess estradiol using progesterone. I do recommend that women who have these symptoms go and get a gyn exam to make sure that there is no pathology causing these symptoms (uterine fibroid or cancer, ovarian cyst or cancer etc).
Hisrsutism or excessive hair on face
History of high blood sugars
History of Ovarian cysts
History of Polycystic Ovarian Syndrome (PCOS)
Patients with these symptoms generally have excess androgens (testosterone) but also insulin resistances (blood sugar issues). Polycystic Ovarian syndrome is the most under diagnosed endocrinopathy in women of reproductive age. They generally have acen, facial hair, are obese (or overweight in most cases) and have high blood sugar and/or insulin levels. They do not necessarily have to have ovarian cysts ironically (many do not). But each of these women need treatment with metformin and progesterone as they are much more likely to develop breast and uterine cancer and have miscarriages.
Hormone imbalances can occur at any point during a womens reproductive period. Earlier in life we tend to see lack of progesterone, estradiol excess and PCOS. Later in life we see deficiencies of all bioidentical hormones. The first thing you need to do if you suspect a hormone imbalance is have your blood work checked. Only then, should you go to a hormone doctor that specialized in bioidentical hormone replacment.
Dr. Sean Breen is board certified in Anti-Aging, Functional and Regenerative medicine and is an expert in bioidentical hormone replacement therapy. He treats women with hormone imbalance daily in his office and gets amazing results.