Four Common Types of Hormonal Imbalance – Menopause

by | Oct 25, 2019

This is part 2 of a series of four common types  hormone imbalance BHRT providers find in their patients including the causes of the imbalance, typical lab findings, and treatment suggestions. These 4 include: 

  • Perimenopausal / PMS – these patients are typically progesterone deficient
  • Menopause – patients with estrogen changes along with progesterone deficiency
  • Androgen Deficient – associated with low testosterone and / or DHEA and may include additional hormone imbalances 
  • Androgen Excess – associated with elevated testosterone and may include additional hormone imbalances 

In  part 1  of this series, we discussed the first category: Perimenopausal / PMS, which is associated with progesterone deficiency. Following the decline of progesterone comes the decline of estrogen. This stage normally occurs in women between 40 to 50 years of age. 


Five to ten years prior to actual menopause (cessation of menstrual cycles for 12 months), the perimenopausal stage consists of wildly fluctuating estrogen levels that cause irregular cycles and symptoms varying from menopausal to PMS. Changes in estrogen production tends to occur during the 40s.

Women can experience symptoms of estrogen deficiency for three possible reasons: fluctuating levels of estrogen, estrogen levels that are lower than what their body has been used to or if estrogen drops to deficient levels.  

Symptoms commonly associated with changes in estrogen or a deficiency include: hot flashes and night sweats, heart palpitations, dry skin/eyes, hair loss, bone loss, foggy thinking and poor memory, vaginal dryness, frequent urination or UTIs. Due to the effect on the brain and CNS low estrogen is associated with depression or low mood and food cravings. Another common problem women face around menopause is weight gain.  This can occur because estrogen helps with carbohydrate metabolism and insulin sensitivity. The other 2 prevalent symptoms of low estrogen is insomnia or sleep disturbances and fatigue. 


Since estrogen triggers monthly build up of the endometrial lining, estrogen is expected to decline so that menstrual cycles cease. However, there are factors that can worsen this natural decline or trigger it inappropriately. 

  • Age related decline
  • Stress
  • Adrenal fatigue
  • Poor diet – extreme low calorie
  • Excessive exercise
  • Surgical
  • Statins


Playing over 400 different roles in the body estrogen is essential for a woman’s health and wellbeing in many ways. Probably best known for its reproductive role estrogen creates the endometrial lining and regulates menstrual cycles. 

Decades of research demonstrate the importance of estrogen to the cardiovascular system. For example, it helps maintain low blood pressure, lowers Fibrinogen, LDL, homocysteine and lipoprotein and also has antioxidant properties. 

In the Central Nervous System estrogen promotes memory capacity and prevents memory disorders and loss of cognition. It supports synthesis of the neurotransmitters serotonin, dopamine, epinephrine and norepinephrine which offset  low mood and depression. Estrogen increases reaction time, alertness, verbal ability and verbal recall. It also increases REM sleep and regulates inflammatory cytokines, reducing inflammation. 

Estradiol (physiologic levels) improves carbohydrate metabolism and helps with insulin sensitivity. To help protect the skin, estrogen increases the moisture content and collagen formation improving vascularization, elasticity and firmness. The health of the urogenital system requires estrogen for the prevention of vaginal dryness, urinary urgency and urinary tract infections. Normal levels of estrogen are essential to regulate osteoclasts production slowing down the rate of bone loss. 


Trying to identify estrogen deficiency with hormone testing, especially during the menopausal transition can be a bit misleading.  This is because estrogen levels can fluctuate month to month or even day to day prior to menopause. Generally speaking, if a woman is still having periods she still has adequate estrogen unless periods are very scant and she is very symptomatic. Once women are post menopausal, estrogen levels stabilize and estrogen deficiency indicated by lab testing and symptoms is much more clearly defined.  However, that does not mean that providers should wait until postmenopause to test or prescribe estrogen. 

Physiological dosing is the best starting point especially since excess estrogen causes symptoms such as breast tenderness or fluid retention. Topical estrogen is recommended over oral. Many BHRT experts prescribe a combination of estriol and estradiol called Biest.  Another option is estradiol patches.  

Women on estradiol or Biest can expect relief from depressed mood, insomnia and sleep disturbances, irritability and anxiety, joint pain, vaginal dryness and urinary incontinence.

Caution is advised in prescribing estrogen to women that are still having cycles even if lab results show low estrogen. 

To get a handy tool to assess hormone imbalance for your patients – download my Signs and Symptoms of Hormone Imbalance Checklist. It’s an excerpt from the training manual of the BHRT Providers Program online training program. I think you will find it helpful. 


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