The Hormone Education Nobody Gave You (or Your Mom)
Picture a woman in her twenties sitting across from me and saying she’s exhausted, anxious before her period, and that her doctor told her everything looks normal. Then a few weeks later I’ll see a woman in her late forties, sometimes it’s literally the first patient’s mother, describing the exact same thing plus night sweats, and she was also told everything looks normal.
Two different women, two different decades, one shared problem: nobody ever taught either of them how their own hormones actually work.
I’ve spent my career in preventative medicine and women’s health, and I can tell you that the single most useful thing I do all day isn’t prescribing anything. It’s explaining. Because once you understand the system, your body stops feeling like a betrayal and starts feeling like something you can actually work with.
So this is the primer I wish someone had handed both of you, the 24 year old and the 52 year old. Save it. Forward it to your daughter. Forward it to your mom. This is the foundation for everything else I’ll ever write here.
First, a reframe
Your hormones are messengers. Chemical signals your body sends to coordinate energy, mood, sleep, metabolism, and reproduction. When something feels off, it’s rarely because your body is broken. It’s usually because a message isn’t getting through, or two messengers are out of sync with each other.
There are many hormones, but in this case, five you need to know:
Estrogen
Estrogen builds. In the first half of your cycle it builds your uterine lining, but it does so much more than that. It supports your bones, your skin, your heart, and your brain. When estrogen rises, most women feel it: better mood, more energy, more patience for other humans. That’s real. Estrogen directly supports serotonin, one of your brain’s feel-good chemicals.
For the moms reading this: perimenopause is largely the story of estrogen becoming erratic before it declines. Not a smooth fade. A rollercoaster. High one week, low the next. That’s why your forties can feel like PMS with no pattern, and why “you’re too young for menopause” is one of the least helpful sentences in medicine.
Progesterone
If estrogen is the gas, progesterone is the brake. It shows up after ovulation and its job is to steady things. It calms the nervous system and it’s a big part of why some weeks you sleep like a rock and others you’re staring at the ceiling at 3am.
Here’s what I find most women were never told, and I mean women with graduate degrees, sometimes even women who work in healthcare: you only make meaningful progesterone if you ovulate. No ovulation that month, no real progesterone. Stress, undereating, overtraining, and PCOS can all quietly interfere with ovulation. And progesterone is also the first hormone to decline as women move into their late thirties and forties, often years before periods change. When patients tell me their anxiety appeared out of nowhere at 42, this is frequently where I start looking.
Testosterone
Yes, you have it. Yes, it matters. Women make testosterone too, and it drives libido, motivation, muscle, and that sense of drive that’s hard to name but very easy to notice when it’s gone. Low testosterone in women doesn’t usually look dramatic. It looks like flatness. Workouts that stop working. A libido that quietly left.
It peaks around ovulation, but not in the same way as estrogen. Your body has an agenda and it is not subtle-have sex around the time of ovulation to get pregnant.
Cortisol
Cortisol is your stress hormone and you actually do need it. It wakes you up in the morning and gets you through real demands.
The problem is that your body can’t tell the difference between an actual threat and a full inbox. When stress is constant, cortisol stays elevated, and your body makes an ancient calculation: this is not a safe time to reproduce. So it deprioritizes your sex hormones. Ovulation gets delayed or skipped. Progesterone drops. PMS gets louder.
I have seen this myself when I travel (even vacation can be a stress to the body!) and during long grueling hours in school. My cycle told the story of my stress before I was willing to admit it out loud. Your body keeps honest records even when you don’t.
Insulin
Most people hear insulin and think diabetes, then tune out. Please don’t. Insulin manages your blood sugar, and it’s tangled up with everything above. When blood sugar spikes and crashes all day (very easy to do on a diet of coffee, something beige at lunch, and grazing until dinner), insulin runs high. Chronically high insulin nudges the ovaries to make excess testosterone, which is a core driver of PCOS. And every blood sugar crash triggers, you guessed it, cortisol.
If you get shaky and irritable between meals, that’s a blood sugar pattern, and it’s something we can work on.
How a cycle actually feels
Textbooks show you a tidy 28 day chart. Real life feels more like this:
Your period, days one through five or so, is the low point for everything. Energy is naturally quieter. Honoring that isn’t weakness, it’s working with your physiology.
Then estrogen climbs for about a week and a half and you feel increasingly like yourself. Sharper, lighter, more social. Around ovulation, estrogen and testosterone peak together. Many women feel their best here, then notice a strange one or two day dip right after, when estrogen drops fast. That dip is real too.
The second half belongs to progesterone. Early on it can feel calm, almost cozy. But in the last several days before your period, both hormones fall, and that withdrawal is what drives PMS. The irritability, the tears over nothing, the conviction that everyone around you is being deliberately annoying.
One important thing, and I say this as a clinician, not to scare you: if those last days feel less like moodiness and more like a different person hijacks your brain, with rage, despair, or thoughts that frighten you, that often has a name. PMDD. It is real, and it is treatable. Please bring it to someone who will take it seriously. And do not try to self-diagnose or self-manage.
What “balanced hormones” actually means
“Hormonal imbalance” is a pretty controversial term that I hear and respect both sides of. My traditional medicine brain says this is not a diagnosis, not found in the ICD10 and not something we see concrete evidence on. Most data in fact supports that PMS/PMDD has more to do with the neurosensitvity to hormonal changes versus absolute levels of the hormones themselves. That said, in clinical practice I see a major correlation between women whose mid-luteal progesterone to estradiol ratio is lower than a certain threshold and symptoms including pre-menstrual mood swings, cyclical migraines, and heavier periods. Data is very unclear and nuanced on this and I make that very clear to my patients, but anecdotally, it is hard for me to ignore when addressing women’s health needs.
Balanced hormones means the relationships are working. Enough progesterone to steady your estrogen. Cortisol that rises in the morning and falls at night instead of humming high all day. Insulin that isn’t bullying your ovaries.
This is also why “your labs are normal” can be true and unhelpful at the same time. Normal compared to what? Drawn on which day of your cycle? Interpreted by someone who asked about your sleep, your stress, your ovulation? Context is everything, and context is exactly what a seven minute appointment doesn’t allow for.
Why I wanted mothers and daughters reading this together
Because your hormonal stories rhyme. The daughter dismissed for period pain at 19 often becomes the mother dismissed for perimenopause symptoms at 47. Same system, same gaps in her education, same “everything looks normal.”
It doesn’t have to repeat. Understanding this blueprint is where it stops.
More soon. We have a lot to talk about.
If something in here made you think “wait, that’s me,” trust that instinct. And if it made you think of your mom or your daughter, send it to her. That conversation is worth having..