Hormonal Imbalance In People Assigned Female At Birth

Overview

Hormonal disorders are common in people assigned female at birth (AFAB) and can have considerable impact on an individual’s health. Endocrine (hormone) diseases have the potential to cause long-term disability, a decline in quality of life, infertility and can lead to cancer.¹ Hormones play a key part in people AFAB’s health and general wellbeing and are responsible for the regulation of many different bodily processes such as sleep cycle, metabolism, menstrual cycle and mood. It is hence crucial that  hormones are being secreted in the right amounts at the right times during an individual’s life. During our lives, hormone levels naturally fluctuate at various stages such as puberty, pregnancy and menopause. A hormone imbalance occurs when there is abnormal hormone production: too little or too much of a hormone is being produced, which can have negative effects.¹

Irregular levels of oestrogen and progesterone, two of the most important female sex hormones, are commonly responsible for hormone imbalances.² When these two hormones are out of balance, a variety of negative side effects can take place, including irregular menstruation, pelvic pain, and uterine fibroids. According to statistics, a staggering 80% of people AFAB have a hormonal imbalance, and often do not realise it since there are a wide range of unspecific symptoms.

Causes of hormonal imbalance in people AFAB

The cause of hormonal imbalances in people AFAB can vary and is not always known, however such imbalances can be caused by factors like stress, improper diet, obesity, genetics and endocrine-disrupting chemicals (EDCs).

 In everyday life, we are subject to many stressful situations, but experiencing high levels of stress on a daily basis can lead to major health issues, one of which is an imbalance in hormones.³ Stress can affect the levels of hormones such as glucocorticoids, prolactin, and growth hormone which can contribute to conditions such as obesity and endocrine disorders. Stress-related endocrine disorders include gonadal dysfunctions and Graves’ disease.³ Gonadal dysfunction is an umbrella term for conditions associated with the reproductive organs (gonads); such conditions can cause problems such as menstrual dysfunction, poor ovary function and even infertility.

Graves’ disease (hyperthyroidism) takes place when the thyroid gland becomes overactive and produces too many hormones. Symptoms include mood swings, fatigue, sensitivity to temperature, swelling in the neck (enlarged thyroid gland) and weight loss. When studied, 33% of women with stress showed menstrual irregularity.³

Obesity can also cause imbalances of hormones such as oestrogen and hypothalamic-pituitary hormones these are produced in the brain and regulate the production of various other downstream hormones.⁴ In healthy premenopausal people AFAB, oestrogens are synthesised in the ovaries under the control of gonadotropin-secreting hormones from the pituitary gland in the brain. Obesity is associated with an increased level of oestrogen in the body and activation of androgens in fat cells, increasing the risk of developing a hormone imbalance.⁴ An increase in adiposity (body fat) can also increase the risk of developing breast cancer. 

Endocrine-disrupting chemicals (EDCs) are substances which alter the body’s normal hormone production.⁵ Such chemicals can be found in solvents, plastic, food and even medication, the most commonly-known being the contraceptive pill. Long-term exposure to these chemicals can have significant effects on the body; in people AFAB these include PCOS, vaginal cancer, breast cancer and ovulation disorders.⁵ Various of these chemicals have been outlawed in the past few years, and it is important to note that not everyone who is exposed to EDCs will develop hormone imbalances; various other risk factors are at play including genetics and age of exposure.⁵

Signs and symptoms of hormonal imbalance

Fluctuations in a woman’s hormones (particularly oestrogen and progesterone) can influence mood, sexual desire, fertility and ovulation. The main symptoms to look out for are:

• Mood swings
• Hot flashes
• Weight gain
• Urinary tract infections or urinary incontinence
• Brain fog and/or memory loss
• Vaginal dryness
• Night sweats
• Anxiety
• Decreased sex drive
• Excessive hair growth
• Menstrual changes/irregularity and/ord heavy periods

PCOS is one of the main disorders associated with hormonal imbalance, and is often caused by defects in the hypothalamic-pituitary hormone axis and the secretion of insulin, which then affects ovarian function.⁶ PCOS has 3 main features: irregular periods, excess androgen hormone levels (causing excess body hair) and polycystic ovaries (the ovaries contain fluid-filled sacs). Individuals with PCOS may have at least 2 of these features.

 Insulin is one of the hormones regulating ovarian function. Excessive production of insulin can result in anovulation: a feature of PCOS where the ovaries do not release an egg during ovulation. Individuals with PCOS often display elevated levels of luteinizing hormone and gonadotropin-releasing hormone.⁶ Increased gonadotropin-releasing hormone results in higher production of androgens, male hormones which result in hormone imbalance and symptoms such as excessive hair growth.⁶ 

Management and treatment for hormonal imbalance in people AFAB

Management of hormonal imbalance can include the use of herbal and pharmaceutical medications, as well as lifestyle changes. Hormone replacement therapy (HRT) can be prescribed if the body is not producing adequate levels of a specific hormone, while other medications or surgical interventions can be prescribed for excessive hormone production.⁷ There are medicines available to treat the symptoms of PCOS, such as excessive hair growth, irregular and painful periods and fertility problems once an individual has been diagnosed.

Lifestyle changes have the potential to improve symptoms for those with hormone imbalances. By maintaining a healthy weight and eating a balanced diet, symptoms can be reduced, such as with PCOS. It has been shown that a 5% weight loss can mean significant improvements in PCOS and other reproductive hormone imbalances.⁸ Some patients can be referred to a dietician for specific dietary advice. For irregular periods, the contraceptive pill or progestogen tablets can be suggested, although consulting with a doctor is essential to make sure the pill will not increase side effects of hormonal imbalance.⁹ For people AFAB having difficulty getting pregnant, clomiphene and/or metformin are medicines used to stimulate ovulation, which can be prescribed by a doctor.¹⁰

If a person AFABexperiences large drops in hormone secretion during menopause and shows a hormone imbalance, hormone replacement therapy can be used.¹¹ HRT can mimic hormones produced by the ovaries if too little of them are being produced. Such synthetic hormones can be administered orally or transdermally through a cream, pellet, patch or vaginal insert.¹¹ When oestrogen is given orally, there is an increase in protein-C resistance, which can increase the risk of a blood clot, while transdermally-administered oestrogen does not cause protein-C resistance increase, hence eliminating blood clot risk.¹¹ The duration of treatment should not exceed a few years and patients will be monitored closely.

Diagnosis

When considering hormone imbalance, a GP will ask the patient about their symptoms to eliminate any other causes. An endocrine (hormone) blood test will be carried out to determine if and which hormones are in imbalance. For PCOS, an excess of “male hormones” showing up in the endocrine blood test can aid diagnosis. Talk to your healthcare provider if you believe you may have a hormone imbalance to organise a diagnosis. 

Complications

Hormone imbalances can increase a person’s risk of developing type 2 diabetes, depression, cancer, high blood pressure and sleep apnoea. People AFABwho have had absent periods for many years show an increased risk of developing cancer in the womb lining.¹² Complications usually occur if the condition is left untreated for years, so talk to a doctor if you have any concerns to avoid the risk of further issues developing.

FAQs

Can hormonal imbalance in women cause weight gain?

Obesity has been linked to several endocrine alterations occurring as a result of changes in the hypothalamic-pituitary hormones axes⁴. Obesity is also a common feature present in PCOS, with the key factor being hyperinsulinemia (excess insulin production). Around one to two thirds of women with PCOS are obese and 50-70% of these women were shown to have insulin resistance, resulting in further weight gain.¹³

How common is hormonal imbalance in people AFAB?

Statistics have shown that 80% of women suffer from hormonal imbalance, and 1 in 10 women in the UK are affected by PCOS.

Can I prevent hormonal imbalance?

There are various types of hormone imbalances with many different factors at play, including genetics which may predispose individuals to certain conditions. However, maintaining a healthy weight, exercising and eating a balanced diet may decrease your chances of a hormone imbalance.

When do symptoms usually develop?

Symptoms are likely to present themselves after puberty has completed, usually in late teens or early twenties. 

When should I see a doctor?

You should see a GP if you have any symptoms of hormone imbalance, or symptoms that are interfering with everyday life.

Summary

Hormonal disorders are prevalent in individuals assigned female at birth (AFAB), potentially leading to serious health concerns, including infertility and cancer. These imbalances often revolve around the female sex hormones, oestrogen and progesterone. Major causes for these imbalances include stress, diet, obesity, genetic factors, and exposure to endocrine-disrupting chemicals (EDCs). Key symptoms to be aware of include mood swings, weight gain, and menstrual irregularities.

Management and treatment options range from medication, including hormone replacement therapy, to lifestyle changes focused on diet and weight control. Conditions like PCOS are particularly linked to these imbalances, with symptoms like excessive body hair and ovarian cysts. Early diagnosis is crucial, with hormone blood tests serving as a primary diagnostic tool. If untreated, hormonal imbalances can lead to complications like type 2 diabetes and cancer. Given the commonality of these disorders, individuals should consult healthcare providers if they experience related symptoms.