Prolonged Stress Can Lead to Hormone Imbalance, by Dr. Bal Pawa

Stress is pervasive and has reached unprecedented levels during the past year. Pandemic stress has particularly impacted women at higher rates than men. That’s because women are more often caregivers for children and the elderly. They also tend to take on greater responsibility for home schooling while they work from home.

Add to this, overstimulation by technology, deadlines, increased household chores, financial uncertainty, fear of COVID-19, and strained relationships—and you get a perfect storm for menstrual and mood impairments. While our bodies are perfectly capable of dealing with acute stress, they are not designed to be exposed to prolonged levels of stress hormones called cortisol and adrenalin. We have a delicate symphony of hormones in the body that are designed to function in specific ways that allow for normal biological functions.

These hormones continuously communicate and influence each other and when the symphony is disrupted by an imbalance of stress hormones, it leaves women even more vulnerable for several reasons:

1. Female reproductive hormones serve as neuromodulators for mood, cognition, and memory.

2. Women experience significant fluctuations in hormones (monthly cycles, pregnancy, perimenopause, menopause).

3. When a woman’s demand for cortisol is high, her ovarian function is compromised.

Hormones Work in a Symphony
Since hormones regulate so many aspects of our physiology and function, women often suspect a hormone imbalance when they notice symptoms that seem to overlap their life stressors and their menstrual cycle. It is often described as, “I just don’t feel like myself anymore.”

Sometimes women experience physical symptoms such as fatigue, sleep disruptions, fluid retention or difficulty losing weight. Emotional changes can include irritability, feeling overwhelmed or not in control. Sometimes, symptoms can escalate to severe anxiety or depression especially before a woman’s period, during perimenopause, or at menopause when female hormones are also fluctuating.

Imbalanced hormones may be an excess or a deficiency of any of the sex steroid hormones, in relation to one another—and in relation to your usual healthy levels. These hormones may include estrogens, progesterone, DHEA, and testosterone, as well as their precursors and by products. Changes in thyroid hormones and adrenal hormones may also contribute to hormone imbalances, as when insulin is influenced by serum estrogen levels seen in gestational diabetes.

These are all examples of how hormones can influence each other. But by far the biggest bully on the block is cortisol. It acts as the biggest disruptor to normal hormonal function in women.

Hormone levels change throughout a woman’s menstrual cycle. Some women may notice the hormone changes in their cycle showing up as symptoms of PMS—those unwanted mood changes, fatigue, irritability, and/or breast tenderness—in the 1 to 2 weeks leading up to her period.

PMS is common and can often be managed with supplements such as Evening Primrose oil, B Vitamins, magnesium glycinate, and sometimes, low dose progesterone.

A more serious condition is Premenstrual Dysphoric Disorder (PMDD), which can result in severe mood swings that sometimes require medical intervention. Symptoms can become so extreme that others, such as family, friends and colleagues notice objective changes in mood and behaviour. These symptoms may interfere with everyday tasks or enjoyment of life. Severe cases of PMDD require medical intervention in the form of prescription drugs.

Perimenopause and Menopause
In their mid 30s and 40s, women’s ovaries begin to produce less progesterone, often leaving them with a hormonal imbalance in favour of estrogen, which can aggravate symptoms of PMS.

Perimenopausal symptoms might include more irritability, mood swings, bloating, breast tenderness, headaches, and heavy periods or cramping. During menopause, the ovaries also produce less estrogen, sometimes creating the symptoms typically associated with menopause, such as hot flashes or night sweats, low libido, difficulty sleeping and vaginal dryness.

Some women are also particularly prone to depression and anxiety around this time of transition. If a woman has a history of postpartum depression this may predispose her to severe mood disorders at perimenopause and menopause. Symptoms of hormone imbalance are so widespread that women have come to believe that the symptoms are normal. These symptoms are your body’s way of telling you that something is out of balance and that it needs your attention.

Women tend to put others before themselves, so it is important to highlight self care and boundary setting. Perimenopause and menopause are windows of opportunity where we often learn to finally put ourselves first, and to focus on our own needs. Since women support so many people around them, nothing is more important than a woman’s own health.

Stress Management Means Healthier Adrenal Function
The adrenal glands produce our sex steroid hormones once production in the ovaries declines. If the adrenal glands are functioning optimally, they can smooth out the hormonal fluctuations that occur during perimenopause and menopause, and these women may not experience remarkable symptoms.

However, if our adrenals are taxed (often due to excessive prolonged stress), they are simply not able to smooth out those hormonal changes and women will experience greater symptoms.

Adrenal stress or fatigue causes decreased DHEA levels, and thus low hormone reserves. DHEA converts into testosterone and estrogen after menopause. So here is a remarkably close relationship between our stress hormones and our female hormones.

What are Treatment Options for Women?
We are not passive spectators—we can regulate our stress. Lifestyle plays a huge role in our hormone health, particularly with respect to stress. The best way to help mitigate symptoms of hormone imbalance at any stage in life, is to manage our stress and to consume a healthy diet.

The importance of regular movement, adequate sleep, and a daily mindfulness practice for balanced hormones cannot be overstated. In my medical practice, we encourage women to incorporate dietary changes, exercise, and mindfulness techniques into their everyday routine in a way that works for them.

Specific dietary changes will also support hormone health. For instance, every woman can benefit from including healthy fats (such as avocado, olive oil and coconut), and sufficient fibre in her diet. These provide the building blocks for hormone production and help to eliminate excess hormones from the body.

Eating a clean diet that avoids pesticides and herbicides, as well as hormones and antibiotics found in conventional meat and dairy, is also important. Avoiding inflammatory foods that tax our adrenals, such as caffeine, alcohol, sugar, dairy, and wheat is also a good plan. Other specific dietary changes tailored to your requirements will also help to regulate blood sugar levels, support healthy thyroid function, manage weight, and support colon function; all helping to balance adrenal function and hormones.

Thus, women who have healthy adrenals are more resilient to hormonal fluctuations in their reproductive hormones. Depending on each woman’s unique requirements, specific natural supplements may also be part of a hormone health management plan.

Individualized nutrient supplementation can reverse nutrient deficiency, and nutraceuticals and herbs can support thyroid and adrenal function and help to maintain healthy cortisol levels. Additionally, many women are deficient in Omega-3 Essential Fatty Acids, Magnesium and Vitamin D, and can often benefit from regular supplementation of nutrients.


By Dr. Bal Pawa
Westcoast Women’s Clinic