DxD Session held on 20 Aug 2018.
Dr Lee graduated with Bachelor of Medicine and Bachelor of Surgery from St Bartholomew’s and the Royal London school of Medicine (UK) in 2003, and was accredited as a Specialist in Endocrinology by the Ministry of Health in 2011. She previously set up the reproductive endocrine service at Khoo Teck Puat Hospital. She has great interest in managing diabetes, thyroid, osteoporosis and reproductive endocrine disorders. She also manages all other aspects of endocrinology including pituitary disorders, adrenal disorders, lipid disorders and calcium disorders.
Dr Marilyn answered questions from readers on:
- Common endocrine diseases and disorders
- What causes hormonal imbalance
- Common symptoms of hormonal imbalance
- How to tell if you have a hormone deficiency
- How to treat hormonal imbalance
Hormone imbalance implies that the levels of certain hormones are too high or too low. This can involve any of the different hormones (e.g. thyroid hormone, female/male hormones, steroid hormones, growth hormones, and insulin).
I'll discuss the conditions that are more frequently encountered below. In women, a good sign of normal hormonal balance is regular menstrual periods.
Hyperthyroidism occurs when the body produces too much thyroid hormones. The symptoms are akin to everything “speeding up”.
Your metabolism speeds up and you lose weight, feel hot and perspire a lot, you heart rate speeds up, your bowels move more frequently, you tend to be fidgety and some people have difficulty sleeping because your mind is constantly active.
The commonest cause is Grave’s disease (caused by antibodies, tends to run in the family).
This will depend on what symptom you’re suffering from and generally, blood (and possibly urine) tests will be done to look at the levels of the appropriate hormones.
Menstrual periods are a very good indicator of general health. If your periods are regular, it is unlikely that you have an underlying hormonal problem. Irregular periods and sudden weight loss may be due to hyperthyroidism, where your body produces too much thyroid hormones.
Other symptoms include increased heart rate (you may be aware of your heart beating quickly), increased bowel frequency, increased sweating and feeling hot all the time, and difficulty sleeping.
Another potential explanation is the weight loss being the underlying cause of your irregular periods. We need a certain amount of body fat to have regular periods and if you’ve lost a significant amount of weight, your body will “switch off” the periods.
With regards to male hormones, symptoms of male hormone deficiency can be non-specific, so you feel tired all the time, lack the energy to do things and perhaps feel more moody.
They can be more specific like shaving less (for example, you previously used to shave daily and now only need to shave weekly because of less growth), reduced sex drive and erectile dysfunction, reduced morning erections and reduced fertility.
No, it isn’t. Treatment of PCOS depends on what your current concerns are. As you have been given the pill, I assume you’re not planning to get pregnant anytime soon. The next thing to determine is what type of symptoms you’re experiencing.
If you have symptoms of excess male hormones (acne, facial hair, scalp hair loss), medications can be given to treat these symptoms.
This can include medications to block the effect of testosterone (eg spironolactone), medications to improve insulin sensitivity (metformin) and the oral contraceptive pill.
The birth control pills do not actually make your hormones go back to normal. They will suppress your hormones (eg reduce male hormones from the ovary) and hence improve symptoms of acne and facial hair.
I find that acne tends to improve within a few weeks. With regards to facial hair, because of the length of the growth cycle of hair, I would expect improvements to be seen at around 6 months.
Once you’re on the birth control pill, your periods will come every month. This is a withdrawal bleed, where the period will come during the pill-free week. You can improve your hormone levels by reducing weight if you’re overweight.
Increased stress can cause increase in cortisol (stress hormone) levels. But this is usually still within the normal range and does not tend to increase to pathological levels.
You should not experience symptoms of high cortisol (weight gain, thin skin, easy bruising, etc.) from just work stress.
Severe stress may affect your menstrual periods by suppressing your female hormones at the level of the hypothalamus/pituitary gland. Most of the time, treatment is not needed in this situation as your hormones will normalize when the stress is over.
If this is persistent and prolonged, you may require some female hormones.
This depends on what type of hormonal imbalance is present. Generally, if there is a hormone deficiency, replacement of the hormone is usually required. If there is hormone excess, detection of the source of excess and management according to what the problem is.
In women who experience menopausal symptoms, there are certain supplements that contain phytoestrogens that may help to relieve these symptoms.
Similar to adults, children have symptoms depending on the type of hormonal imbalance that is present. Weight and height are usually measured at each clinic visit and are important parameters to take note of.
Short stature, especially if the height is under the 3rd percentile or if its crossing centiles on the growth chart (for example, previously 50th percentile and now 10th percentile) would be a significant symptom.
Obesity can sometimes be due to hormonal causes so this would warrant evaluation. Early puberty before the age of 8 in girls (breast development, pubic hair development) and before the age of 9 in boys (increase in the size of their testes) would warrant further evaluation.
These are just a few suggestive symptoms. If you have any concerns about your daughter having a hormonal imbalance, I would suggest seeing a paediatrician for an evaluation.
Certain psychiatric medications can increase the prolactin levels, and this can affect the female hormones. This is a picture of the hypothalamic-pituitary-gonadal axis in women (left) and men (right).
Essentially, the hypothalamus secretes gonadotropin releasing hormone (GnRH) which stimulates the anterior pituitary to secrete luteinising hormone (LH) and follicle stimulating hormone (FSH) and these in turn will stimulate the ovaries in women and the testes in men to produce oestrogen and testosterone respectively.
High prolactin levels that have come about as a result of the anti-depressants can affect production of the hormones at anywhere along this axis.
This again depends on what type of hormonal imbalance you are referring to. For example, in the case of hyperthyroidism (excess thyroid hormone), the most common cause is Grave’s disease and medical therapy for about 18 months is a common treatment modality.
If it is hypothyroidism (thyroid hormone deficiency, where the commonest cause is Hashimoto’s thyroiditis), then lifelong thyroxine replacement is required.
In the case of PCOS, the hormonal imbalance tends to improve with weight loss because insulin resistance (usually comes on with increased weight) is an important factor in this condition.
Weight loss is associated with improvements in insulin resistance and many women notice that their periods becoming more regular and that their symptoms of male hormone excess improve.
Certain conditions can be prevented, whilst others can’t. For example, if you have thyroid autoimmunity (antibody against the thyroid gland), you cannot prevent yourself from developing abnormal thyroid function.
If you have PCOS, a healthy lifestyle and maintaining a healthy body weight can reduce your chance of developing symptoms of PCOS.
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