Hormonal Imbalance Symptoms Female Athletes Don't Want To Ignore

It's important for active women, especially endurance athletes, to know that training without adequate recovery and nutrition can cause your hormone levels to go awry. Imbalanced hormones occur when levels of one or more hormones become proportionately lower or higher than usual, typically due to stress, often causing adverse effects that should not be ignored (1).

What are hormones?

Hormones are chemical messengers affecting metabolic and reproductive health. They trigger feelings like hunger, thirst, sleep, libido, mood, and more. Key hormones for female endurance athletes include but are not limited to cortisol, insulin, estrogen, testosterone, progesterone, thyroid hormone, growth hormones, and hepcidin.

Why is hormone status important?

Firstly, if you ever want to conceive a child or at least have satisfaction in the bedroom, healthy hormone levels are a must. Furthermore, having imbalanced hormones can lead to the unforgiving symptoms listed below, as well as conditions such as osteoporosis, Alzheimer's, dementia, neurological disorders, cancers, and cardiovascular diseases (1, 3).

Awareness of your baseline

Familiarize yourself with your bloodwork and menstrual cycle symptomology to understand your "normal" or baseline. Obtain bloodwork at least once a year; if suboptimal results are found, consider every 3-4 months. Track your menstrual cycle in an app or journal and monitor your menstrual cycle length (this varies individually, but on average is around 28 days), duration and amount of menses (shedding the lining of the uterus), timing of ovulation, temperature, types of discharge, acne, sleep patterns, and more. Over time, you will notice trends in your symptoms and become more knowledgeable about what your body needs and when (e.g., food types, exercise, or restful activities).

Consider all your life's stresses

Work, relationships, school, family dynamics, calorie restriction, fasting, poor sleep, driving in traffic, exercise, and more are all sources of stress. Exercise is often thought of as a stress reliever; in actuality, it puts your body in a state of stress to stimulate a response to become stronger. Stress in all its forms causes increases in cortisol; without rest, levels cannot return to baseline.

RELATED: Understanding Relative Energy Deficiency in Sport (RED-s)

Positivity and rest

The perception of stress itself can carry an additional burden. Are you a person who gets worked up over a rude email? Or can you let it go and move on? Additionally, are you setting aside a rest day to allow for recovery? Learning to overcome stressful situations with positivity, replacing screens with relaxation techniques, and proper recovery from exercise significantly reduce your overall stress and prevent chronically high stress levels.

Potential hormone imbalance symptoms (1,2):

• Insomnia, or feeling groggy in the morning but wide awake at night.

• An elevated or decreased heart rate.

• Pain in muscles or joints or edema (swelling).

• Irritable bowel syndrome, food intolerances, or leaky gut syndrome.

• Temperature dysregulation, night sweats, and hot flashes (non-pre-menopausal).

• Mood swings, irritability, apathy, depression.

• Chronic fatigue or low energy.

• Sudden weight loss or weight gain.

• Intense sugar cravings.

• Acne and skin breakouts, dry skin, rashes.

• Poor immune system functioning or frequent illnesses.

• Frequent injuries, long healing times, or bone stress injuries.

• Absent or irregular menstrual cycles.

• Lack of libido, painful sex, or urinary tract infections.

• Thinning hair or dark hair around the mouth and chest.

• Darkening of skin.

RELATED: The Rise in REDs and Why Athletes Should Be Aware of It

If you notice some of these symptoms, talk to your coach and seek a medical professional trained in sports science, naturopathy, or sports dietetics to help navigate these perplexing issues. There may be an underlying health condition, such as thyroid issues, polycystic ovary syndrome, or relative energy deficiency in sport (RED-S). RED-S occurs with chronically low energy availability (more calories burned than ingested), where the body begins to shut down the reproductive system, often with altered hormone levels. Certain conditions concerning imbalanced hormones can overlap with others. Hormone imbalances are complex; seek guidance and don't navigate them alone.

How are hormone imbalances detected?

A medical professional may advise you to obtain blood work, metabolite and hormone panels, stool testing, ultrasounds, pelvic exams, bone density scans, etc. Depending on the type of test, insurance providers may cover some, while others are costly. Many tests can be helpful; however, sometimes they only offer a snapshot in time. Minor differences can affect your results, such as what time of day it was if you were fasting or non-fasting, where you were in your menstrual cycle, and more.

RELATED: Eat Healthy! Five Delicious Evening Meal Ideas for Athletes

How are hormone imbalances treated?

Treatments to regain an optimal hormone state may include altering nutrition; modifying exercise frequency, duration, and intensity; relaxation and breathing techniques; counseling and therapy; supplementation; hormone therapy; and more. Seek guidance from a medical professional (or a few) trained in hormone health to understand treatment options. Be aware that certain medications can lead to hormone imbalances, and hormonal contraception often hides symptoms. Tackling imbalanced hormones through a holistic lens, such as optimizing sleep and nutrition, reducing stress levels, and modifying exercise habits, may be the ideal place to start.

References

1. Nnodim John Kennedy., et al. (2022) “The Perspective of Hormonal Imbalance in Humans: A Review." Acta Scientific Clinical Case Reports 3.11: 03-06.

2. Stellingwerff, T., et al. (2021). Overtraining Syndrome (OTS) and Relative Energy Deficiency in Sport (RED-S): Shared Pathways, Symptoms and Complexities. Sports Medicine. doi:10.1007/s40279-021-01491-0

3. Satpathi S, Gaurkar S S, Potdukhe A, et al. (2023) Unveiling the Role of Hormonal Imbalance in Breast Cancer Development: A Comprehensive Review. Cureus 15(7): e41737. DOI 10.7759/cureus.41737