Types of Hormone Imbalance in Women
By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham
Hormone imbalance is one of the most frequent presenting complaints in my clinic. It underpins a wide range of conditions — from irregular periods and PCOS to anxiety, fatigue, poor sleep, and difficulty conceiving. Understanding which hormones are out of balance, and why, is the first step towards effective treatment. Traditional Chinese medicine offers a detailed diagnostic framework that complements modern hormone testing and allows treatment to be precisely targeted.
On this page
- Signs and symptoms of hormone imbalance
- Causes of hormonal imbalance
- The main types of hormone imbalance
- How TCM treats hormone imbalance
- Frequently asked questions
Signs and symptoms of hormone imbalance
The symptoms of hormone imbalance vary depending on which hormones are affected, but many women present with a cluster of overlapping symptoms that point to the same underlying pattern. Common signs of hormonal imbalance in women include:
- Menstrual changes — irregular, heavy, painful, scanty, or absent periods
- Premenstrual syndrome — mood swings, breast tenderness, bloating, cravings and irritability in the two weeks before the period
- Fertility difficulties — trouble conceiving, recurrent miscarriage, or a short luteal phase
- Skin and hair changes — persistent acne (especially along the jawline), hirsutism, hair loss or thinning
- Weight changes — unexplained weight gain (particularly around the middle), difficulty losing weight, or rapid weight loss
- Mood and cognitive symptoms — anxiety, low mood, brain fog, poor concentration, irritability
- Sleep disturbance — difficulty falling asleep, waking in the early hours, night sweats
- Energy and temperature — chronic fatigue, cold hands and feet, hot flushes, heat intolerance
- Digestive symptoms — bloating, constipation, IBS-type symptoms that worsen cyclically
- Libido and vaginal changes — low libido, vaginal dryness, painful intercourse
Because hormones act as a regulatory network rather than in isolation, it is common to experience several of these symptoms together. The pattern in which they cluster is what helps identify which specific type of hormone imbalance is most likely.
Causes of hormonal imbalance
Hormonal imbalance rarely has a single cause. In my clinic I find it is almost always a combination of factors acting over time, including:
- Chronic stress — sustained cortisol elevation disrupts the hypothalamic-pituitary-ovarian axis and suppresses reproductive hormones
- Poor sleep — disrupted circadian rhythms interfere with melatonin, cortisol, and reproductive hormone release
- Diet and blood sugar dysregulation — insulin resistance drives androgen excess, and nutrient deficiencies impair hormone synthesis
- Perimenopause and menopause — the natural decline of ovarian function is the most common cause of hormonal symptoms after 40
- Post-pill rebound — stopping the contraceptive pill can temporarily unmask or exacerbate an underlying pattern (see my article on post-pill amenorrhoea)
- Environmental oestrogens — xenoestrogens from plastics, pesticides, and cosmetics mimic oestrogen and contribute to oestrogen dominance
- Thyroid and adrenal dysfunction — these glands influence reproductive hormones directly and are often implicated in fertility problems
- Underlying conditions — PCOS, endometriosis, fibroids, thyroid disorders, and hyperprolactinaemia all cause characteristic hormonal patterns
- Life-stage transitions — puberty, pregnancy, postpartum and perimenopause are all periods when hormonal imbalance commonly emerges
In TCM, these causes are understood through the lens of Liver qi stagnation, Kidney deficiency, Spleen weakness, and Blood stasis — patterns that often reflect the cumulative effect of modern lifestyle stressors on the body's regulatory systems.
The main types of hormone imbalance
Oestrogen dominance
Oestrogen dominance occurs when oestrogen is disproportionately high relative to progesterone, either because oestrogen is genuinely elevated or because progesterone is too low to balance it. It is the most common hormone imbalance I see in women of reproductive age. Symptoms include heavy or prolonged periods, premenstrual breast tenderness, bloating, mood swings, weight gain around the hips and thighs, and fibroids or endometriosis. In TCM, oestrogen dominance typically maps to a pattern of Liver qi stagnation with Blood stasis — the Liver is failing to metabolise and clear oestrogen efficiently. See my article on how to flush out excess oestrogen for more detail on supporting oestrogen clearance.
Low progesterone
Progesterone is produced primarily after ovulation and is essential for maintaining the uterine lining in early pregnancy. Low progesterone leads to a shortened luteal phase, spotting before the period, recurrent early miscarriage, PMS, and difficulty sustaining a pregnancy after IVF. In TCM terms, low progesterone is most often associated with Kidney yang deficiency — insufficient warming energy to support the second half of the cycle. Treatment focuses on tonifying Kidney yang from ovulation through to menstruation.
Elevated androgens (including testosterone)
Excess androgens in women most commonly occur in the context of PCOS, though they can also arise from adrenal dysfunction or insulin resistance. Symptoms include acne, excess facial or body hair (hirsutism), irregular or absent periods, male-pattern hair thinning, and difficulty ovulating. In TCM, this pattern is usually one of Kidney yang deficiency with Phlegm-Dampness obstructing the ovaries — the same underlying pattern that produces the cystic ovarian morphology seen on ultrasound.
High FSH and low AMH
Follicle-stimulating hormone (FSH) rises as the ovarian reserve declines, and anti-Müllerian hormone (AMH) falls in parallel. Together these markers reflect diminished ovarian reserve — a common concern for women over 35 or those who have experienced premature ovarian insufficiency. In TCM, low AMH and high FSH are a clear expression of Kidney jing and yin deficiency — the fundamental reproductive essence that governs egg quality and quantity. Treatment with acupuncture and Kidney-tonifying herbs can help to regulate FSH levels and optimise the quality of the remaining follicles.
Thyroid hormone imbalance
Thyroid hormones regulate metabolism, temperature, and energy — and have a direct effect on the menstrual cycle and fertility. Hypothyroidism (low thyroid function) is associated with heavy periods, fatigue, weight gain, cold intolerance, and difficulty conceiving. Even subclinical hypothyroidism — where TSH is only mildly elevated — can impair implantation. Hyperthyroidism causes the opposite picture: scanty periods, weight loss, palpitations, and heat intolerance. In TCM, hypothyroidism frequently reflects a pattern of Kidney and Spleen yang deficiency, while hyperthyroidism is typically Liver fire with Yin deficiency. Acupuncture and herbal medicine can support thyroid function alongside any conventional treatment your doctor prescribes.
Elevated cortisol (stress hormones)
Chronic stress raises cortisol levels, which in turn suppresses the hypothalamic-pituitary-ovarian axis — effectively putting the reproductive system on hold. The result can be delayed ovulation, cycle irregularity, reduced libido, and disrupted sleep. Over time, persistently elevated cortisol can progress to adrenal fatigue, where cortisol output becomes blunted and the woman feels exhausted. In TCM, this pattern is understood as Liver qi stagnation affecting the Thoroughfare and Conception vessels, often progressing to Kidney deficiency. See my article on cortisol and stress for a detailed discussion. Acupuncture is particularly effective at regulating the stress response and restoring hypothalamic-pituitary function.
Elevated prolactin
High prolactin (hyperprolactinaemia) can suppress ovulation and cause irregular or absent periods. It is worth checking if you have irregular cycles, galactorrhoea (spontaneous milk production outside of breastfeeding), or persistent difficulty conceiving. In TCM, excess prolactin is typically associated with Liver qi stagnation — the same pattern that underlies oestrogen dominance and PMS — and responds well to Liver-regulating acupuncture and herbal treatment. See my dedicated article on prolactin and fertility.
Insulin resistance
Insulin resistance is not always thought of as a hormonal imbalance, but insulin is a hormone and elevated insulin drives much of the androgen excess seen in PCOS. Signs include abdominal weight gain, sugar cravings, post-meal fatigue, skin tags, and darkened patches of skin (acanthosis nigricans). In TCM, insulin resistance is understood as Spleen Qi deficiency with Phlegm-Dampness accumulation. Treatment addresses the Spleen and Liver together, alongside dietary changes to stabilise blood sugar.
How TCM treats hormone imbalance
One of the strengths of TCM is that it does not treat individual hormone levels in isolation. Instead, I assess the whole person — your menstrual cycle patterns, temperature regulation, energy levels, emotional state, tongue and pulse — and identify the underlying pattern of imbalance. This allows me to address the root cause rather than manage symptoms in isolation. Treatment typically combines weekly acupuncture with a bespoke Chinese herbal formula, adjusted at each follow-up as your pattern shifts. I prescribe pharmaceutical-grade granules from Sun Ten in Taiwan.
For most women, I work across the menstrual cycle in four phases — menstrual, follicular, ovulatory, and luteal — with treatment adjusted to support the dominant hormone at each stage. This cycle-phase prescribing is one of the most distinctive features of Chinese medicine for hormone regulation, and it is particularly effective for fertility. See my article on the menstrual cycle in Chinese medicine for more on this approach.
Most women notice meaningful improvement within two to three menstrual cycles. Hormone testing before and after a course of treatment can provide useful objective confirmation of progress.
Frequently asked questions
What are the signs of hormone imbalance in women?
The most common signs of hormone imbalance in women are irregular, heavy or painful periods, premenstrual syndrome, unexplained weight changes, persistent acne, hair loss or hirsutism, low libido, anxiety or low mood, fatigue, insomnia, and difficulty conceiving. Because hormones work as a network, most women experience a cluster of these symptoms together rather than in isolation.
How is hormone imbalance diagnosed?
Hormone imbalance is usually diagnosed through a combination of symptom assessment and blood tests. Key tests include FSH, LH, oestradiol, progesterone (timed to day 21 of the cycle), testosterone, AMH, prolactin, and a full thyroid panel (TSH, free T4, free T3, and thyroid antibodies). In my clinic I use both Western hormone testing and TCM pattern diagnosis — tongue, pulse, and symptom pattern — to build a complete picture of what is happening.
Can hormone imbalance be treated naturally?
Yes. In many cases, hormone imbalance responds very well to natural treatment — particularly when the underlying cause is stress, diet, or lifestyle-related rather than structural. Acupuncture, Chinese herbal medicine, nutritional changes, stress management, and good sleep hygiene can all contribute to restoring hormonal balance. Severe or structural causes (such as thyroid disease, pituitary tumours, or premature ovarian insufficiency) may require conventional medical treatment alongside natural approaches.
How long does it take to balance hormones naturally?
Most women notice meaningful improvement within two to three menstrual cycles of starting acupuncture and Chinese herbs. Deeper patterns — such as diminished ovarian reserve or long-standing PCOS — typically need three to six months of consistent treatment. Because the menstrual cycle itself takes 28 days to complete, at least three full cycles are usually needed to reliably assess whether a given approach is working.
Does acupuncture help with hormone imbalance?
Yes. Acupuncture has been shown to regulate the hypothalamic-pituitary-ovarian axis, reduce cortisol, improve blood flow to the ovaries, and normalise menstrual cycle hormones including FSH, LH, and progesterone. It is particularly effective for stress-related hormonal disruption, PCOS, and fertility-related hormone imbalance. Treatment is typically weekly, with adjustments made across the menstrual cycle.
What is the best Chinese herbal formula for hormone imbalance?
There is no single best formula — the right prescription depends entirely on your TCM pattern. For Liver qi stagnation with oestrogen dominance, Xiao Yao San or Jia Wei Xiao Yao San is often the foundation. For Kidney yang deficiency with low progesterone, formulas like You Gui Wan are used. For Kidney yin deficiency with high FSH, Zuo Gui Wan. In practice, formulas are always tailored and modified to the individual, and they change across the menstrual cycle as the pattern shifts.
Can diet affect hormone imbalance?
Diet has a significant effect on hormones. Blood sugar regulation, adequate protein, healthy fats (for steroid hormone production), cruciferous vegetables (for oestrogen clearance), and minimising alcohol and ultra-processed foods all support hormonal balance. Reducing exposure to xenoestrogens in plastics, cosmetics, and pesticides also makes a measurable difference, particularly for women with oestrogen dominance.
To discuss your hormone health, contact me or book a consultation at my Wokingham clinic.
