5 Clinical Signs of Hormonal Imbalance
Hormonal imbalances often hide in plain sight. You might be told everything looks “normal” in your lab results, but still feel completely off in your body. As a Naturopathic Doctor, I frequently work with women who intuitively know something isn’t quite right — even when conventional lab results say otherwise. The reality? Many hormonal imbalances are missed with standard screening. “Normal” does not always mean optimal.
Here are five clinical signs I often see in practice that suggest your hormones may need deeper investigation:
1. Persistent Morning Fatigue Despite Adequate Sleep
Waking up exhausted, regardless of how many hours you’ve slept, often points to a disrupted cortisol rhythm — the hormone responsible for helping you feel alert and energized throughout the day.
🩺 CLINICAL NOTE: Cortisol levels need to follow a healthy rhythm — rising in the morning to help you feel alert and gradually tapering off at night to support restful sleep and recovery. While we typically start with bloodwork to assess serum levels, sometimes we need to dig deeper. If symptoms persist despite improving serum markers, I may recommend salivary or urine testing to evaluate how cortisol fluctuates throughout the day — especially if you’re feeling fatigued in the morning and wired at night. This often reflects broader HPA (hypothalamic-pituitary-adrenal) axis dysfunction, which can impact thyroid, insulin, and sex hormone signaling as well.
2. Worsening PMS, Perimenopausal Symptoms, Or Irregular Cycles
Bloating, breast tenderness, low libido, weight fluctuations, heightened irritability, anxiety, or tearfulness — particularly around ovulation or in the luteal phase — may be signs of estrogen-progesterone imbalance. These symptoms often intensify during perimenopause but can occur at any reproductive stage. You may also notice irregular cycles, missed periods, heavier bleeding, hot flashes, vaginal dryness, or sleep disturbances as hormones begin to fluctuate. Hormones like estrogen and progesterone also influence brain chemicals like serotonin and GABA, which affect mood, emotional stability, and sleep. When these hormones shift, it can lead to increased anxiety, low mood, restlessness, or insomnia.
🔬 CLINICAL NOTE: I often find these patterns are connected to insufficient progesterone production after ovulation, or a higher relative level of estrogen compared to progesterone. This hormonal mismatch can affect everything from emotional regulation to sleep quality and menstrual flow.
3. Weight And Metabolic Changes
Sudden or stubborn weight gain — especially around the midsection — or increased difficulty maintaining your usual weight may be tied to deeper hormonal disruptions. While nutrition and movement are foundational to metabolic health, they’re only part of the picture. Hormones such as insulin, thyroid hormones, cortisol, and sex hormones like estrogen, progesterone, and androgens all influence how your body stores fat, builds muscle, and maintains energy balance. When these hormones are out of balance, you may find it harder to manage your weight, notice more sugar cravings, experience dips in energy, feel inflamed, or even develop signs like muscle weakness or decreased exercise tolerance — all despite maintaining a healthy routine.
⚖️ CLINICAL NOTE: I take a comprehensive approach by assessing labs such as fasting insulin, fasting glucose, HbA1c, lipid panel, liver enzymes, cortisol, thyroid panel, inflammatory markers, nutrient status, and sex hormones to better understand what may be driving metabolic resistance. Addressing these root causes helps restore balance in a way that supports long-term energy, strength, and body composition.
4. Cycle-Linked Digestive Changes
Bloating, irregular bowel movements, or digestive discomfort that worsens before or during your period may be hormonally mediated. Estrogen and progesterone don’t just influence your reproductive system — they affect your whole body, including your digestive system, playing a role in gut motility, microbiome balance, and inflammatory signaling within the GI tract. As a result, many women experience GI symptoms that fluctuate with their cycle, often misattributing them to other factors.
🔍 CLINICAL NOTE: In addition to addressing gut dysbiosis and food sensitivities, it’s important to consider hormone-related imbalances that may be affecting digestion — particularly how fluctuations in estrogen and progesterone influence gut function throughout the menstrual cycle. By identifying the root drivers, we can support hormone balance and gut health more effectively — rather than chasing temporary fixes.
5. Changes In Skin, Hair, Or Nails
Dry or thinning hair, brittle nails, increased breakouts, or dull skin are often overlooked signs of hormonal imbalance — but they can offer valuable insight into what’s happening internally. These tissues are highly responsive to shifts in thyroid hormones, stress hormones like cortisol, and sex hormones — including estrogen, progesterone, and androgens. For example, low thyroid function can lead to hair shedding, thinning of the outer eyebrows, and dry, flaky skin. While elevated androgens may contribute to hormonal acne, oiliness, or unwanted hair growth along the chin or jawline. Estrogen helps maintain skin elasticity, hydration, and collagen production, while progesterone plays a role in regulating oil production and calming inflammation. When any of these hormones are out of balance, it can contribute to changes in skin texture, breakouts, scalp dryness, or fragile nails — especially around the menstrual cycle or during hormonal transitions like post-birth control, perimenopause, or postmenopause.
🧴 CLINICAL NOTE: In addition to investigating nutrient status, it’s essential to analyze all hormonal systems — including thyroid function, cortisol, and sex hormone balance (estrogen, progesterone, and androgens). Supporting your hormones from the inside out can make a significant difference in restoring not just how you look, but how you feel in your body.
What Can You Do Next?
Hormonal health is complex, and it cannot always be captured in a single lab result. If you are experiencing any of these signs, it may be time to explore a more comprehensive approach — one that looks at patterns, symptoms, and root causes.
Looking to get to the root of your hormonal symptoms — even if your labs say everything’s fine? Whether you’re new to my practice or returning to continue your care, I’d love to connect.
Let’s work together in discovering the underlying causes of your hormonal concerns through an in-depth history-taking & assessment, and functional lab testing in order to create a comprehensive + customized naturopathic treatment plan, so you can look and feel your absolute best by rebalancing your hormones!
In health,
Dr. Marlee, ND
About Dr. Marlee, ND
Dr. Marlee, ND is a licensed Naturopathic Doctor based in Toronto with a clinical focus on hormonal imbalances, skin health, digestive concerns, adrenal dysfunction, and healthy aging. Known for her patient-centered and results-driven care, she helps individuals understand the root causes of their symptoms through comprehensive assessments and personalized treatment plans. Dr. Marlee, ND empowers her patients to take an active role in their health, blending education with evidence-based naturopathic medicine to support lasting change. She is a trusted voice in women’s health, with appearances on Rogers Media, Today’s Shopping Choice, and features in Chatelaine Magazine.
Dr. Marlee, ND offers virtual naturopathic medical care to patients across Ontario.
