Moody, Can’t Lose Weight, And Have Brain Fog? Here’s What Most Doctors Won’t Tell You.


About once a month, I have a fitful sleep during which I spend a couple of hours in a twilight state at best. In the days that follow, I have trouble finding my words. Instead of eloquently coaching my clients in session, I scan the corners of my brain for elementary vocabulary. But it’s not until I break down at something mildly frustrating (this month, getting accidentally disconnected from the Capital One customer service line after being on hold for 34 mins) that I realize: Oh right. It’s that time of month.

On average, a woman will have 450 periods from menarche to menopause. Eighty-four percent will have a child in her lifetime (although those numbers are declining) and will experience the pregnancy and postpartum hormonal effects. Every woman—if she makes it to a later chapter in life—will go through menopause. And we haven’t even scratched the surface of the number of women knowingly and unknowingly living with hormonal imbalances: PCOS, estrogen dominance, Graves and Hashimoto’s Diseases, to name a few.

For years, women have been gaslit around the effects of our hormones. We were even told at one point that PMS is a cultural construct (by a man, of course). Many physicians don’t conduct a thorough hormone panel with their women patients. If they do, routine blood tests don’t differentiate between “normal” and “optimal” ranges—which can mean the difference between making sense of debilitating symptoms or being told we’re “fine” when we’re clearly not. And I know firsthand as a mental health professional that clinical counseling assessments don’t involve asking women about cycle regularity or symptoms of hormonal imbalance: I can’t tell you how many times I’ve encountered a woman client who was prescribed antidepressants or anti-anxiety medication to mask the symptoms of what is ultimately a nutritional deficiency or hormonal imbalance. Or who, shortly after switching to a non-hormonal method of contraception, experienced a significant improvement in her mental health.

Women everywhere are experiencing depression, anxiety, insomnia, weight gain, brain fog, hair loss, low libido, and a slew of other symptoms without realizing their hormones are to blame. In some cases, these symptoms can be drastically improved with lifestyle change and hormone replacement therapy (HRT). In others (for example, when it comes to my monthly weeping session), they may be unavoidable; however, better understanding the connection between natural hormonal shifts and the unpleasant symptoms that accompany them can help us feel less destabilized and more empowered. I know for me, that Oh right, it’s that time of the month moment comes with a wave of relief. Like phew, I’m not crazy. I don’t need to break up with my boyfriend or fire that employee. But I do need to prioritize sleep, exercise, blood-sugar balancing foods, mindfulness, and self-compassion rather than believing whatever story my mind tells me.

I sat down with Dr. Vinita Tandon, Medical Director at Lifeforce to peel back the curtain on what every woman should know to advocate for herself in the doctor’s office:

Bruneau: If a woman were experiencing a hormonal imbalance, what symptoms would she notice?

Dr. Tandon: Hormones are very influential and affect almost every cell, organ, and system in our bodies. When women go through huge hormonal shifts like pregnancy or menopause, there can be intense changes in mood, cognition, energy, and overall well-being. Women will often say they just don’t feel like themselves anymore. Specific symptoms of hormonal imbalance include fatigue, moodiness, apathy, anxiety, sadness, poor sleep, change in fat distribution with more in the midsection, hair loss, irregular periods, brain fog, difficulty focusing, dry skin, decline in libido, and difficulty maintaining muscle tone.

Bruneau: Yikes, that’s a lot. Beyond life events like pregnancy and menopause, what lifestyle factors influence hormones?

Dr. Tandon: Hormones are fascinating because there’s so much interplay and cross-talk between various hormones, environmental factors, diet, gut health etc. Also, there’s so much bi-directional influences between hormones and our day to day habits. For example, if we don’t prioritize sleep, our stress hormones go up and that can further impair sleep! So, you end up in a vicious cycle. At Lifeforce, we do such an in-depth analysis into habits, lifestyle, as well as lab interpretations that we’re able to get a very holistic picture of a person’s health and what lifestyle interventions will be the most effective in breaking these cycles.

Bruneau: Sounds complex. What else has traditionally gotten in the way of women alleviating hormone-related symptoms?

Dr. Tandon: Gosh, don’t get me started. Even though women make up half of the population and menopause is as inevitable as taxes, no one teaches us how to manage menopause or hormonal imbalances in medical school, throughout residency or beyond. For example, when the women’s health initiative came out over 20 years ago, the media made damning announcements about the risks of breast cancer by taking hormone therapy that were subsequently refuted by the study’s own investigators. Twenty years later, we are still feeling the effects of such misreporting. For clinicians to learn the true ins and outs of hormonal imbalance and menopause management, we often have to pay for additional optional courses and thus women don’t get the care they deserve (and it’s even worse amongst the lower socioeconomic populations).

Bruneau: Woah, I totally thought Hormone Replacement Therapy (HRT) was considered controversial! So you’re saying it’s safe now?

Dr. Tandon. Yes! The latest perspective is that for the majority of women, it is safe and the most effective way to eliminate menopausal symptoms as well as improve quality of life and mitigate many health problems associated with hormone deficiency. There’s also a “therapeutic window” meaning the sooner you start hormone therapy after the onset of menopause, the greater the benefit. Once you are more than 8-10 years out, the benefits of therapy are blunted and there could be more risk of cardiovascular issues starting that late.

That all said, I would women to truly vet hormone clinics and avoid “pill mills” that don’t do any follow up or lab testing. Find a provider that approaches hormonal health holistically and can address it from all sides.

Bruneau: That sounds like good news for women everywhere. Okay, let’s geek out for a minute. What hormones are important for us to be ensuring are in the “optimal” range, not just normal?

Dr. Tandon: The most important ones are estradiol, progesterone, testosterone, thyroid, and at Lifeforce we also check IGF-1.

A drop in estradiol is what contributes to hot flashes, night sweats, mid-section adiposity, vaginal dryness, foggy-headedness, decline in bone density, increased cardiovascular risk, and changes in hair and skin. Progesterone, on the other hand is primarily responsible for maintaining a positive mood and outlook as well as maintaining an intact sleep pattern.

Testosterone, although thought of as a male hormone, is actually very important for women, too. It contributes to energy, motivation, libido, ambition, strength and endurance. It’s also a significant hormone in maintaining lean muscle mass. It’s produced by the adrenal glands and ovaries but as a woman approaches her 40’s and 50’s, the ovarian production declines, leading to overall reduced levels.

Thyroid hormone and IGF-1 decline with age in both men and women, but women are more prone to autoimmune thyroid dysfunction which can show up in middle-age. Classic symptoms of low thyroid levels include fatigue, foggy-headedness, weight gain or difficulty losing weight, dry skin and hair, hair loss, constipation and cold intolerance.

IGF-1 is a measure of growth hormone that also declines with age, and contributes to body composition, energy, endurance and well-being. Signs of low IGF-1 also include fatigue, reduced stamina, difficulty maintaining lean muscle mass, and an overall reduced sense of well-being.

Bruneau: For those who may already be aware of an imbalance, what are some natural ways to balance hormones?

Dr. Tandon: In general, the foundations of good hormone health are getting good quality and quantity sleep, maintaining a healthy weight, staying active, effectively managing stress, eating a balanced nutritional diet that includes a variety of colorful veggies, high fiber and healthy fats. Getting enough water, avoiding sugar and processed foods and maintaining a healthy microbiome are all natural ways of keeping hormones in balance.

For supplementation, I recommend rhapontic rhubarb, vitamin D, DHEA, melatonin and magnesium which are not all specifically for “hormone balance” per se, but target other deficiencies that often occur in menopause and hormonal imbalance. Once a woman’s hormones decline, she may experience an increased risk for osteoporosis, insomnia, loss of libido, anxiety, and a decline in lean muscle mass. Vitamin D and DHEA improve bone density and DHEA also improves libido and lean muscle mass. It may have a modest effect on hot flashes, night sweats, and vaginal dryness as well. Both melatonin and magnesium improve sleep and stress mitigation.

Bruneau: Love the holistic approach. Any last thoughts to leave women feeling more empowered about their hormonal health?

Dr. Tandon: I want women to be judicious about who they see for their hormonal health, and if they’re hitting a wall obtaining answers they should find care elsewhere. We have to acknowledge that hormone imbalances can really wreak havoc on women, affecting their work performance, their relationships, their sense of self, and their overall health. If something feels off, it probably is. Women shouldn’t be dissuaded from doing a deep dive into hormone assessments and receiving the treatment they so deserve.

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