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I cannot tell you how many women sit in front of me as patients struggling with anxiety, insomnia, and fatigue. One of the first things I evaluate when I hear this is hormones. Hormones are chemical messengers. As messengers, they are in communication with nearly every system of your body, holding the potential to tremendously impact how you feel overall. When we balance hormones, we can re-calibrate communication between body systems, leading to whole body balance. So let's learn more about how your hormones hold the key to your well being:

Hormones & Energy

Many of the same hormonal imbalances that create weight gain also create fatigue. Here are some of the most common fatigue promoting hormone imbalances that I see:

Imbalances in estrogen and progesterone: There are many mechanisms by which estrogen and progesterone imbalances may create fatigue but it is important to remember that both of these hormones interact with other hormones and the metabolism. For example, low progesterone can contribute to low thyroid function while low estrogen can contribute to low cortisol levels. High estrogen can contribute to insulin resistance and weight gain, both of which are associated with fatigue.

Low Testosterone and Low Thyroid: Because both of these hormones directly support energy production, functionally low levels can contribute to fatigue.

High or Low Cortisol: Because cortisol plays a role in wakefulness, stress response, and maintaining blood sugar levels, functionally low cortisol often manifests as extreme fatigue. However, elevated cortisol can also contribute to fatigue. In situations of stress, the adrenal glands release cortisol. Along with cortisol, they also release norepinephrine and epinephrine, more commonly known as adrenaline and noradrenaline. Have you ever felt exhausted after an adrenaline rush? This is similar to what you may feel with prolonged functional elevations in cortisol, a feeling that has commonly been described as feeling “wired but tired.”

While the hormone imbalances listed above can directly create imbalances, hormones also interact with many other body processes and can contribute to fatigue through secondary mechanisms like lower muscle tone, sleep disruptions, poor digestion, and electrolyte imbalances.


If you have ever experienced menstrual related mood changes, you know that hormone changes can have an impact on mood. Deficiencies of cortisol, testosterone, and progesterone can all contribute to anxiety. Progesterone is well known for its calming effect on the brain, where it stimulates GABA receptors to reduce nerve firing. Imbalances in thyroid hormone, both high and low, have also been associated with symptoms of anxiety and depression.

Hormones & Sleep

Because of its calming effect on the brain, progesterone also aids in sleep and maintaining sleep throughout the night. Thyroid hormones and cortisol are also important players in promoting or disrupting healthy sleep.

A commonly observed symptom of hypothyroidism is insomnia or sleep disruption. Conversely, elevations in thyroid hormone can also shift the body into an arousal state that interferes with sleep.

There are 3 ways in which cortisol can disrupt sleep: functional elevation, functional deficiency, and changes in cortisol pattern. Functional elevations in cortisol can disrupt sleep by keeping the body in a state of fight or flight or arousal. You may experience racing thoughts or difficulty winding down. Functional deficiencies in cortisol can lead to fragmented sleep or waking during the night. Cortisol levels naturally drop overnight but when they get too low, your body secretes adrenaline which can wake you from sleep. Cortisol also follows a specific pattern throughout the day, called a diurnal pattern. It reaches its highest levels when you wake in the morning, to help you get out of bed and feel ready for the day. It then gradually drops throughout the day to prepare you for bed. In chronic illness, a reverse cortisol pattern is commonly seen in which the body struggles to secrete cortisol throughout the day and is finally able to produce some at night. This results in low daytime cortisol levels and high nighttime cortisol levels, experienced as daytime fatigue and nighttime wakefulness.

When we optimize hormones, we improve daytime energy, nighttime sleepiness, and month long moods. And, we change your life!! Ready to check your hormones?

DUTCH Test: A comprehensive hormone panel evaluating estrogen, progesterone, cortisol as well as hormone metabolism

Thyroid Panel: A complete thyroid panel (instead of the TSH your PCP runs) that helps you determine whether your thyroid is performing optimally.

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