Ask the doctor: Female hormonal imbalance explained

The term hormone imbalance is quite common in gynaecology circles. Many women of reproductive age will be familiar with what the term denotes.

Hormonal imbalance is simply a broad term that refers to disturbances in the hormonal control of the female reproductive system. The term is so broad that it can sometimes be erroneously used as a diagnosis in its own right, with the danger that a specific diagnosis can easily be missed out. 

For most women, the monthly bleeding (simply referred to as periods), is a regular and predictable event. Many will know well ahead of time when the next period is due.

A regular bleeding pattern often implies optimal functionality of the reproductive system.

It means all the hormones are well synchronised, there’s regular ovulation, and the uterus (womb) responds appropriately.

It therefore goes without saying that an irregular bleeding pattern may be an indicator of some form of malfunction within the reproductive system. 

Is abnormal bleeding always a sign of hormonal imbalance?

The reproductive system doesn’t function in isolation. There is an interplay with many other organ systems and hormones, and even other chronic conditions. So it is never a given that women who experience abnormal bleeding patterns will necessarily have reproductive hormone imbalances.

There are also other specific reproductive system diseases that can present with unusual bleeding, regardless of hormonal parameters. 

So if you have an unusual bleeding pattern, do not immediately think of hormone imbalance. The best strategy is to get a gynaecological evaluation. A review of your bleeding pattern, coupled with a gynaecological exam, usually gives clues on what might actually be the matter.

How do I know for sure that I have hormonal imbalance?

Hormone tests may be recommended, in addition to imaging of the reproductive organs. Additional tests will depend on what the diagnosis appears to be. 

Treatment options tend to depend on the specific diagnosis. If no physical disease is apparent within the reproductive system, and other conditions have been excluded, hormonal control of the bleeding pattern may be recommended.

The good old family planning pill is often used to control abnormal bleeding patterns. But hormonal treatment can be delivered in other ways like injections or via skin patches. It is important to remember the contraceptive effect of hormone treatments. Hence those trying to conceive at the same time should consider other treatment options. 

There is an ever present concern about hormonal treatments and future reproduction. Such concerns are mostly misplaced. The effect of hormone treatment is transient, and reversible.

Some methods of hormone treatments, like injectables or implants, may sometimes delay the return of regular cycles and ovulation. But this too is a transient phenomenon that does not negatively impact on future

reproduction. 

Dr Alfred Murage is a Consultant Gynaecologist and Fertility Specialist. [email protected]