Understanding Hormonal Imbalance: Symptoms, Tests, and What They Mean for Women

'Hormonal imbalance' has become something of a catch-all phrase used to explain a wide variety of symptoms in women — fatigue, weight gain, irregular periods, mood changes, acne, hair loss, and poor libido. The phrase is used widely and often imprecisely. But genuine hormonal disorders are very common in Ghanaian women, frequently undertested, and when properly identified and treated, respond well to management. Understanding which hormones matter, what they do, and what tests reveal them is empowering knowledge.

The Major Female Hormones and Their Functions

Oestrogen

The primary female sex hormone, produced mainly by the ovaries. Oestrogen drives the development of female secondary sexual characteristics, regulates the menstrual cycle, maintains bone density, supports cardiovascular health, influences mood and cognition, and maintains the health of vaginal and urinary tissues. Levels naturally decline at menopause, which is why menopause is associated with bone loss, cardiovascular risk increase, mood changes, and vaginal dryness.

Progesterone

Produced by the corpus luteum after ovulation. Progesterone prepares the uterine lining for implantation, maintains early pregnancy, and has calming, sleep-promoting effects. Low progesterone in the luteal phase causes symptoms including premenstrual syndrome (PMS), irregular cycles, spotting between periods, and difficulty conceiving.

FSH and LH — Gonadotropins

Follicle-stimulating hormone (FSH) and luteinising hormone (LH) are produced by the pituitary gland and drive the menstrual cycle — FSH stimulates follicle development, LH triggers ovulation. Their levels provide critical information about ovarian function. Elevated FSH in a woman of reproductive age suggests reduced ovarian reserve. The LH:FSH ratio is an important diagnostic tool in polycystic ovary syndrome (PCOS).

Prolactin

Produced by the pituitary, prolactin's primary role is stimulating milk production after childbirth. Elevated prolactin outside pregnancy (hyperprolactinaemia) — caused by a pituitary adenoma, certain medications, or hypothyroidism — causes menstrual irregularity, amenorrhoea (absent periods), galactorrhoea (spontaneous milk production), infertility, and reduced libido. It is a frequently missed diagnosis in women with irregular cycles.

Testosterone and DHEA-S

Women produce small amounts of androgens (male hormones) from the ovaries and adrenal glands. Excess androgens cause acne, hirsutism (excess facial and body hair), male-pattern hair loss (androgenic alopecia), and menstrual irregularity. The most common cause of androgen excess in women is PCOS.

Polycystic Ovary Syndrome (PCOS): The Most Common Hormonal Disorder in Women

PCOS affects approximately 1 in 10 women of reproductive age globally and is thought to be similarly prevalent in Ghana, though significantly underdiagnosed. Despite its name, not all women with PCOS have cysts on their ovaries — the diagnosis is made clinically and biochemically based on two of three criteria: irregular or absent ovulation (causing irregular periods), clinical or biochemical hyperandrogenism (acne, hirsutism, or elevated testosterone/DHEA-S), and polycystic ovarian morphology on ultrasound.

PCOS is not just a reproductive disorder. It is a metabolic condition strongly associated with insulin resistance, metabolic syndrome, type 2 diabetes, cardiovascular disease, endometrial cancer, and mental health issues. Women with PCOS should receive annual metabolic screening (glucose, HbA1c, lipids) regardless of age.

The Hormone Test Panel

When investigating possible hormonal imbalance in women, the following blood tests are typically relevant:

• Day 2–5 of cycle: FSH, LH, oestradiol (E2) — assess ovarian reserve and cycle regulation

• Day 21 (or 7 days after predicted ovulation): Serum progesterone — confirms ovulation has occurred (level above 30 nmol/L confirms ovulation)

• Any time: Prolactin, TSH (thyroid dysfunction commonly disrupts menstrual cycle), testosterone, DHEA-S, SHBG (sex hormone-binding globulin)

• If menopause suspected: FSH above 30 IU/L on two occasions 4–6 weeks apart, with oestradiol below 100 pmol/L

• AMH (anti-Müllerian hormone): Measures ovarian reserve — relevant for fertility planning, does not require cycle timing

Menopause and Perimenopause

Menopause — defined as 12 consecutive months without a menstrual period — is a natural biological event marking the end of reproductive capacity, typically occurring between ages 45 and 55. In Ghana, age at natural menopause is similar to global averages. Perimenopause — the transitional period preceding menopause — can last 4–10 years and involves irregular cycles, hot flushes, sleep disturbance, mood changes, vaginal dryness, and declining bone density.

Hormone replacement therapy (HRT) is effective for managing menopausal symptoms and preventing bone loss. Its use should be individualised based on symptom severity, age, and personal risk factors for breast cancer and cardiovascular disease — a conversation for every menopausal woman to have with her gynaecologist or physician.

�� Hormonal disorders in women are common, measurable, and treatable. If you have irregular periods, unexplained acne, hair loss, fertility challenges, or perimenopausal symptoms, a hormonal panel is your starting point.

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