Oestrogen dominance, low progesterone, low testosterone — understand the most common hormonal imbalances in women, their symptoms and your options.
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Hormonal imbalances are among the most widespread yet most frequently missed health issues affecting South African women today. Because the symptoms are so varied — ranging from fatigue and weight gain to mood swings, hair loss, irregular periods and low libido — they are often attributed to stress, ageing or lifestyle factors rather than an underlying hormonal cause. HealthLab’s Hormonal Imbalances section provides in-depth, evidence-based information to help women recognise the signs of imbalance, understand the underlying mechanisms and access appropriate care.
Oestrogen dominance occurs when oestrogen levels are disproportionately high relative to progesterone — either because oestrogen is elevated, progesterone is low, or both. It is increasingly recognised as one of the most common hormonal patterns in women of reproductive age, particularly during perimenopause when progesterone declines more rapidly than oestrogen. Symptoms include heavy, painful or irregular periods, severe PMS, breast tenderness, water retention, bloating, mood swings, brain fog and weight gain particularly around the hips and thighs. Oestrogen dominance is also associated with an increased risk of fibroids, endometriosis and certain oestrogen-sensitive cancers when left unaddressed over many years.
Treatment of oestrogen dominance focuses on supporting oestrogen clearance through the liver (via nutrition, cruciferous vegetables and supplements such as DIM), restoring progesterone balance (through bioidentical progesterone cream or oral micronised progesterone), reducing xenoestrogen exposure from plastics and personal care products, and addressing underlying gut and liver health. Lifestyle factors including stress reduction and regular exercise also play a significant role.
Low progesterone is extraordinarily common in women over 35 and in those with irregular cycles or high stress levels, yet it is rarely the first thing tested when women present with mood problems, sleep issues or period irregularities. Progesterone is produced by the corpus luteum after ovulation, meaning it only rises adequately when ovulation actually occurs. Stress, under-eating, excessive exercise and certain thyroid conditions can all suppress ovulation and thus reduce progesterone production. Symptoms of low progesterone include anxiety, insomnia, night waking, PMS, spotting before periods, short luteal phases and recurrent early miscarriage. Natural progesterone supplementation, when prescribed by a knowledgeable practitioner, can be transformative for many women.
Testosterone is not just a male hormone. Women produce testosterone in their ovaries and adrenal glands, and it is essential for libido, energy, muscle mass and maintenance, bone density, mood and cognitive function. Levels naturally decline from the mid-20s onwards and drop significantly at menopause. Women who have had their ovaries removed experience an abrupt decline. Symptoms of low testosterone in women — including low libido, persistent fatigue, reduced motivation, poor muscle tone and mood changes — are frequently dismissed or attributed to depression or “normal ageing.” Targeted testosterone therapy for women, though used off-label, is increasingly being offered by specialist practitioners and has strong evidence for improving quality of life in postmenopausal women with low levels.
Many of the most common chronic conditions affecting South African women are fundamentally hormonal in nature. Polycystic Ovary Syndrome (PCOS), which affects approximately 1 in 10 women of reproductive age, is driven by elevated androgens, insulin resistance and disrupted ovulation. Thyroid disorders — particularly Hashimoto’s hypothyroidism — affect women disproportionately and can cause a spectrum of symptoms from fatigue and weight gain to depression, hair loss and fertility difficulties. Endometriosis and adenomyosis are oestrogen-driven conditions that cause significant pain and are notoriously difficult to diagnose, with an average diagnostic delay of seven to ten years in South Africa. Understanding the hormonal roots of these conditions is the foundation of effective, targeted treatment.
