Part 2: When hormones get disrupted: what it looks like and why it happens

By: Dalia Harush MS RD CDN

 

If you read part 1, you know that your body runs on a complex hormonal system involving dozens of hormones across multiple glands, all in constant communication. That system is remarkably resilient. It's also genuinely vulnerable to the conditions most women are living in right now.

Hormonal disruption isn't a single event. It's usually a gradual shift: a system that's been under pressure long enough that it starts showing signs.

What disruption actually looks like

The symptoms of hormonal imbalance are easy to dismiss, partly because they're so common and partly because they overlap with so many other things.

Fatigue that sleep doesn't fix. Mood changes that feel disproportionate. Cycles that become irregular, heavier, or more painful. Difficulty sleeping even when you're exhausted. Brain fog. Afternoon energy crashes. Weight changes that don't track with what you're eating. Skin and hair changes. Anxiety that seems to appear out of nowhere.

None of these symptoms point to one hormone. That's the part that makes this complicated, and the part that conventional medicine often handles poorly, by looking at one marker in isolation rather than at the system as a whole.

The most common hormonal drivers

Cortisol is frequently the starting point. Chronic stress keeps cortisol elevated, and elevated cortisol has effects on almost every other hormone in the system. It may suppress progesterone production, disrupt estrogen metabolism, impair thyroid function, and destabilize blood sugar.¹ Stress isn't just psychological; the body registers it as a physical event, and the hormonal consequences are real.

Estrogen and progesterone imbalance is one of the most common hormonal patterns in women of reproductive age. Estrogen dominance, a relative excess of estrogen compared to progesterone, may contribute to heavy periods, PMS, mood instability, and difficulty sleeping in the luteal phase, which is the second half of the menstrual cycle, roughly the two weeks between ovulation and the start of your next period.² Progesterone has a calming, sleep-supporting effect; when it's low relative to estrogen, the nervous system may feel it.

Insulin resistance is underdiagnosed and underconnected to hormonal conversations. When cells become less responsive to insulin, the pancreas produces more of it to compensate. Elevated insulin may increase androgen production, disrupt ovulation, and contribute to cycle irregularities. Research has found a strong association between insulin resistance and polycystic ovary syndrome (PCOS), now being reclassified as polyendocrine metabolic ovarian syndrome (PMOS) in updated clinical guidance, which affects an estimated 1 in 10 women of reproductive age.³˒⁸

Thyroid disruption affects energy, metabolism, mood, and cycle regularity. The thyroid is sensitive to nutritional deficiencies, chronic stress, and immune dysfunction. Hypothyroidism, meaning underactive thyroid, is significantly more common in women than men and is frequently missed because standard TSH (thyroid stimulating hormone) testing doesn't always capture the full picture.⁴

Melatonin and the sleep-hormone connection is less discussed but worth understanding. Melatonin isn't just a sleep hormone; it has antioxidant properties and may support reproductive hormone balance.⁵ Disrupted sleep affects melatonin production, which in turn can affect cortisol rhythm, and cortisol rhythm affects nearly everything else. Sleep disruption doesn't just follow hormonal imbalance; it can also drive it.

Why one symptom usually has more than one cause

A woman experiencing severe PMS, for example, might have low progesterone relative to estrogen, elevated cortisol from chronic stress, and low magnesium, all contributing to the same cluster of symptoms through different pathways. Treating any one of those in isolation may help partially. Understanding how they interact is how you get further.

This is the core of a functional approach to hormonal health: symptoms are information. They're the body's way of communicating that something in the system needs attention. The question isn't just what the symptom is; it's what's driving it, and whether there are multiple drivers working together.

What can disrupt the system

Some of the most common factors that put hormonal systems under pressure:

• Chronic psychological and physical stress

• Poor or insufficient sleep

• Blood sugar instability from diet or insulin resistance

• Nutritional deficiencies, including magnesium, zinc, vitamin D, and B vitamins

• Hormonal contraceptives, which alter the natural hormonal environment in ways that vary significantly between women⁶

• Environmental exposures to endocrine-disrupting compounds, which are chemicals that interfere with hormone production, signaling, or metabolism in the body, found in plastics, pesticides, and some personal care products⁷

• Perimenopause and menopause, during which estrogen and progesterone levels shift significantly and the entire system recalibrates

None of these are character flaws or signs that you haven't tried hard enough. They're conditions. And conditions can be addressed.

A different starting point

Understanding your hormonal system doesn't mean you need to test every hormone or overhaul everything at once. It means you have a framework for understanding what your body might be telling you, and a basis for making decisions that actually address the underlying picture rather than just managing symptoms.

References

1. Whirledge S, Cidlowski JA. Glucocorticoids, stress, and fertility. Minerva Endocrinol. 2010;35(2):109–125.

2. Prior JC. Progesterone for symptomatic perimenopause treatment. Climacteric. 2011;14(2):153–161.

3. Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited. Endocr Rev. 2012;33(6):981–1030.

4. Garber JR, et al. Clinical practice guidelines for hypothyroidism in adults. Endocr Pract. 2012;18(6):988–1028.

5. Reiter RJ, et al. Melatonin as an antioxidant: under promises but over delivers. J Pineal Res. 2016;61(3):253–278.

6. Zimmerman Y, et al. The effect of combined oral contraception on testosterone levels in healthy women. Syst Rev. 2014;3:84.

7. Gore AC, et al. EDC-2: The Endocrine Society's second scientific statement on endocrine-disrupting chemicals. Endocr Rev. 2015;36(6):E1–E150.

8. Teede H, Khomami M, Morman R, et al. Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process. The Lancet. 2026. Online ahead of print. doi:10.1016/S0140-6736(26)00717-8