Demystifying Hormones
Discover the truth about hormones, testing, HRT and natural support so you can make informed, confident choices about your health.
Your hormones are powerful. They influence metabolism and the way you handle stress. When they’re in balance, life feels easier. Your mind is clearer, your body runs smoothly and you have the resilience to handle what comes your way. In today’s digital world, misinformation about women’s health spreads fast and can leave you unsure about what your body actually needs. Between social media, online forums and even well-meaning advice from friends, it’s easy to feel lost in a sea of information and trends. This confusion can lead to misdiagnoses, ineffective treatments and years of unnecessary suffering. With the right knowledge, you can stop second-guessing your body and start working with it in a way that feels natural and sustainable.
Hormone replacement therapy
Is hormone replacement therapy (HRT) right for you? HRT can be life-changing for some women, but it’s not a one-size-fits-all fix. It involves supplementing the body with the hormones oestrogen, progesterone and, in some cases, testosterone or DHEA. It is regularly prescribed to women to support fertility, perimenopause, menopause and with specific health conditions.
While HRT (particularly bioidentical oestrogen and testosterone) is often seen as universally safe for all women, individual factors such as health history and the stage of perimenopause you’re in can make a big difference to your treatment outcome. This is because hormones don’t descend in a straight line, especially during perimenopause. One big misconception is that oestrogen always declines during perimenopause. In reality, it typically rises before it falls. This is because the communication between your ovaries and brain becomes disrupted.
As ovulation becomes less frequent and of poorer quality (often in your late 30s and early 40s), the brain increases the follicle-stimulating hormone (FSH) to push the ovaries into action. This can cause intermittent surges in oestrogen. And with fewer ovulations, less progesterone is produced, leaving oestrogen unopposed. This hormonal imbalance, commonly seen in perimenopause, can lead to symptoms such as heavy bleeding, bloating and weight gain. (As menopause approaches, the ovaries become less responsive and oestrogen levels gradually fall. This decline can lead to symptoms such as hot flushes, night sweats, vaginal dryness and anxiety.)
Starting oestrogen therapy too early can backfire, especially if you have impaired oestrogen metabolism, such as those with endometriosis, adenomyosis, fibroids or a family history of oestrogen-sensitive cancers. If this is you, adding in oestrogen or testosterone may add to the hormonal load and make symptoms worse.
Genetic variations in pathways like COMT, CYP1B1 and MTHFR can also affect how you break down hormones, sometimes leading to inflammation or tissue growth. This can contribute to conditions such as endometriosis, fibroids or increase the risk of hormone-related cancers.
Micronised progesterone isn’t suitable for everyone, either. For some women with PMDD (premenstrual dysphoric disorder), it can worsen symptoms due to altered sensitivity in the brain’s GABA receptors. This can often be overcome with tailored dosages, making personalised treatment key.
Because every woman is in a different stage in their hormonal health journey, HRT must be tailored to individual needs, health history and genetics.
Synthetic vs natural progesterone
Although often grouped together, synthetic progestins and natural (micronised) progesterone are very different. Progestins found in common hormonal medications like the oral contraceptive pill and intrauterine device don’t mimic natural progesterone. Progestins more closely resemble testosterone, which explains why, when on these medications, you might experience increased abdominal fat, acne, mood changes and unwanted facial hair. Progestins also come with increased risks and are associated with higher rates of breast cancer, blood clots and high blood pressure.
Micronised progesterone, on the other hand, is bioidentical. This means it fi ts perfectly into your body’s progesterone receptors. It promotes better sleep, reduces anxiety, supports cardiovascular health, reduces period pain and heavy bleeding, and may protect against ovarian and endometrial cancers. It’s also helpful for fertility, where it can support implantation, lower miscarriage risk and regulate cycles. And, unlike progestins, micronised progesterone hasn’t been shown to increase breast cancer risk.
Understanding the difference between these two is key to making informed choices, particularly if you’re using hormone therapy for long-term health.
Timing your tests
Hormones fluctuate throughout the menstrual cycle, and the timing of your blood test matters. Test on the wrong day and you risk misinterpretation, misdiagnosis and inappropriate treatment.
For example, oestradiol (E2), FSH and luteinising hormone (LH) should be tested on days two or three of your cycle to assess pituitary feedback and hormonal balance in the early follicular phase. While these markers can offer insight into ovarian function, Anti-Müllerian hormone (AMH) is the most reliable marker for assessing ovarian reserve and is used to assess your egg quantity. It is relatively stable across the cycle and is often tested early in the cycle, too. Other markers such as prolactin, DHEA-S, SHBG and testosterone are also best tested early in the cycle. Progesterone should be measured around day 21 of a 28-day cycle (about five to seven days post-ovulation).
However, even well-timed blood tests only show the total amount of hormone produced — not how much is available to cells or how well your body responds to it. For example, you might record healthy progesterone levels on a correctly timed test, yet still experience symptoms of deficiency such as anxiety, insomnia or heavy bleeding. This could reflect low bioavailability or progesterone resistance (common in endometriosis), where the body’s cells fail to respond effectively to the hormone despite its presence. Functional testing or clinical interpretation by a practitioner experienced in hormonal health can help uncover these hidden imbalances.
Pain isn’t normal
Mild cramping can be a normal part of menstruation, but moderate to severe pain that interferes with your daily life is not. These symptoms get dismissed by some doctors but it’s not something you should just put up with.
A healthy period should occur every 25–35 days, last between three and seven days and have a light to moderate flow. Moderate flow typically means needing to change a regular pad or tampon every three to four hours, with total blood loss around 30–50mL.
Painful periods also often go hand in hand with other signs that your cycle isn’t functioning optimally. If you experience pain, passing large clots, soaking through products hourly, bowel symptoms, fatigue or nausea, it’s time to investigate things further, as symptoms could be pointing to underlying issues.
Common causes of pelvic pain and heavy bleeding include endometriosis, adenomyosis, fibroids and even cervical or uterine polyps. These may get missed in standard medical care, especially if ultrasound results appear normal, which happens frequently due to the incorrect type of ultrasound being ordered.
Power of natural medicine
There’s a persistent myth that natural medicines are unregulated or lack scientific backing. In Australia, however, the Therapeutic Goods Administration (TGA) enforces strict manufacturing standards and requires all listed natural medicine supplements to be backed by scientific evidence. Any health claims must be supported by research.
Many natural compounds are potent. For example, Chaste tree (Vitex agnus-castus) can be used to support ovulation and the menstrual cycle. Berberine can reduce insulin resistance, inflammation and weight gain. For oestrogen overload, compounds like calcium D-glucarate help the liver and bowel clear oestrogen, relieving symptoms such as breast tenderness, irritability and heavy periods. Broccoli sprouts and rosemary also aid oestrogen detoxification.
For mood, PMS and nervous system support, magnesium, activated B vitamins, and zinc can promote your hormonal resilience and support your hormones. Liquorice and peony combined help balance male hormones and oestrogens, especially in polycystic ovary syndrome (PCOS). Withania and other adaptogenic herbs also enhance your hormonal resilience by supporting the stress response, especially helpful in burnout and chronic fatigue.
Natural medicines can exert powerful effects when used appropriately. Practitioner-only products prescribed by practitioners often contain more potent, bioavailable ingredients than those found in generic, over-the-counter formulas. These treatments are also most effective when tailored to the individual based on tests such as hormone panels, gut microbiome analysis or nutrient status. And because some herbs and nutrients can interact with medications, working with a qualified naturopath or nutritionist ensures both safety and efficacy.
The contraceptive illusion
Hormonal contraception is often said to “balance” hormones, but in fact, it works by overriding your body’s natural hormonal rhythm with synthetic versions. Prescription contraceptives that prevent ovulation entirely stop the natural rise and fall of oestrogen and progesterone. While these methods can reduce symptoms like pain or heavy bleeding, they act more like a mute button than a real solution to balancing hormones.
Regular ovulation, which is about much more than just fertility, is vital for hormone balance. Post-ovulation progesterone supports brain function, sleep and mood. Regular menstruation also plays a physiological role, with some research suggesting that monthly iron loss may reduce oxidative stress and inflammation, potentially helping women live longer. Long-term cycle suppression may also mask underlying conditions like PCOS or endometriosis, delaying diagnosis and treatment.
While many women choose contraceptives to prevent pregnancy, it’s not a fix for hormones. Balancing your hormones comes from addressing what’s happening beneath the surface, not just switching off your cycle.
Normal ranges
When testing your hormones, the ranges used by standard pathology labs are based on population averages, not what’s optimal for you. Just because your results fall within these ranges doesn’t necessarily mean everything is functioning well.
Take thyroid hormones, for example. Many labs consider TSH levels up to 4.5 mIU/L normal, but evidence suggests that levels above 2.5 may contribute to fatigue, depression, constipation and a sluggish metabolism. Assessing thyroid health also requires testing free T3, free T4 and thyroid antibodies. In standard care, these are often missed, as Medicare typically only covers them if TSH is abnormal or if a GP specifically requests and justifies them.
Fasting insulin is another example. A level under 25 mU/L may be considered normal but in functional medicine, the ideal is to aim for under 8 mU/L. Higher levels (even within the reference range) can indicate insulin resistance, which is a key driver of PCOS, weight gain and hormonal imbalance.
Symptoms matter
Hormonal health is nuanced and highly individual. Your hormonal story is shaped by your personal genetics, stress, diet, environment and life stage. By questioning myths and seeking personalised, evidence-informed care, you can better understand your body and take empowered steps toward lasting vitality.
