How Do I Know If My Hormones Are Out of Balance?
By Michelle Clay, APRN, FNP-C | Balanced Health
“How do I know if my hormones are out of balance?”
Usually by the time a woman asks me this, she already suspects something isn't right.
Maybe she's suddenly gaining weight even though she hasn't changed how she eats.
Maybe she's waking up in the middle of the night and can't get back to sleep.
Maybe she's exhausted, irritable, anxious, having hot flashes, craving sugar, losing hair, or simply looking in the mirror thinking, “I just don't feel like myself anymore.”
And very often, she's already been to her doctor.
She's had labs.
She's been told everything is “normal.”
But she still doesn't feel well.
So how do you actually know if hormones are part of the problem?
The answer isn't one symptom or one lab value.
You have to look at the whole picture.
Your Symptoms Are Clues
One of the first things I tell patients is that symptoms matter.
Lab work is incredibly helpful, but I don't treat lab numbers in isolation. I want to know what has changed, when it started, and what else is going on.
Some of the symptoms I commonly see when hormones aren't working optimally include:
Weight gain or difficulty losing weight
Fatigue or a noticeable drop in energy
Poor sleep or waking frequently during the night
Hot flashes or night sweats
Increased anxiety or irritability
Mood changes
Brain fog or difficulty concentrating
Changes in menstrual cycles
Low libido
Hair thinning
Sugar or carbohydrate cravings
Changes in where you carry your weight
But here's the important part:
Having one of these symptoms doesn't automatically mean you have a hormone imbalance.
Fatigue could be related to thyroid function, but it could also be iron deficiency, poor sleep, insulin resistance, stress, low vitamin levels, or something completely unrelated to hormones.
Weight gain doesn't automatically mean your estrogen is low.
Anxiety doesn't automatically mean you need progesterone.
This is where I see women get into trouble trying to diagnose themselves based on symptoms alone.
Hormones Don't Work Independently
I often explain hormones like an orchestra.
Hormones don't work in isolation. They're playing together.
If one section of an orchestra gets out of tune, it can affect the entire performance. Hormones can work the same way.
Thyroid hormones affect energy and metabolism.
Insulin affects blood sugar regulation, hunger, cravings and fat storage.
Estrogen and progesterone influence much more than your menstrual cycle. They can affect sleep, mood, body composition and how you feel overall.
Testosterone can influence libido, energy, muscle mass and strength.
Cortisol is involved in your stress response and can affect sleep, appetite and metabolic health.
That's why I'm usually less interested in finding “the bad hormone” and more interested in understanding how everything fits together.
A Recent Patient Is a Great Example
A recent patient came to me because she simply didn't feel like herself. She knew something was “off.”
She had already taken her concerns to her doctor, who checked her labs and told her everything was normal. She told me she left feeling dismissed and defeated.
When I reviewed those same labs, I agreed that her individual hormone levels fell within the laboratory reference ranges.
But that wasn't the whole story.
When I looked at the relationship between her estrogen and progesterone along with her symptoms, the picture was consistent with relative estrogen dominance.
That doesn't necessarily mean she had too much estrogen. In her case, she had more estrogen relative to the amount of progesterone available to balance it.
I often describe estrogen and progesterone as yin and yang. We don't just care about each hormone individually; we also care about how they're working together.
For this patient, we started progesterone therapy to help restore that balance.
Over time, her insomnia, anxiety, irritability and struggles with weight all improved.
And the best thing she told me?
“I finally feel like myself again.”
That's why I don't believe we should look at symptoms alone or lab values alone.
The symptoms, the labs and the individual patient all matter.
Wondering If Your Hormones Could Be Out of Balance?
Sometimes women really do know that something has changed in their bodies—even when they can't quite put their finger on what it is.
If you've been thinking, “I just don't feel like myself,” my FREE Hormone Imbalance Assessment can help you identify patterns in your symptoms and decide whether it's worth looking a little deeper.
👉 Take the FREE Hormone Imbalance Assessment and get your results immediately.
Author’s Note:
Michelle Clay is a Family Nurse Practitioner and founder of Balanced Health, a Kentucky-based telehealth practice specializing in women's hormone health, thyroid optimization, insulin resistance, and weight loss resistance.
Michelle takes a whole-person approach to helping women understand why they don't feel like themselves—even when they've been told their labs are “normal.”
Through Balanced Health and The Balanced Health Library, she provides practical, evidence-informed education to help women better understand their hormones, metabolism, and health.