“My Hormones Must Be Out of Balance…”
It’s one of the most common things I hear in clinic.
Women come to see me because they are experiencing:
- Weight gain
- Fatigue
- Brain fog
- Poor sleep
- Anxiety
- Low mood
- Sugar cravings
- Reduced motivation
- Difficulty losing weight
Often, they have already concluded that their hormones must be the problem.
And sometimes they are right.
Conditions such as perimenopause, menopause, thyroid disease and Polyendocrine Metabolic Ovarian Syndrome (PMOS) can certainly contribute to these symptoms.
However, what many women don’t realise is that insulin resistance, chronic stress and poor metabolic health can produce many of the same symptoms.
In some cases, these factors may be having an even greater impact than reproductive hormones themselves.
The Problem With Blaming Everything on Hormones
Hormones rarely work in isolation.
The body is a highly interconnected system where reproductive hormones, stress hormones, metabolic hormones and inflammatory pathways constantly influence one another.
This means that low energy, poor sleep or weight gain may not be solely due to changing oestrogen levels.
Instead, symptoms often arise from a combination of:
- Hormonal changes
- Insulin resistance
- Chronic stress
- Poor sleep
- Reduced muscle mass
- Inflammation
- Nutritional factors
Understanding the bigger picture is often the key to feeling better.
Meet Insulin: The Hormone Nobody Talks About
When people think about hormones, they tend to think about thyroxine, oestrogen, progesterone and testosterone.
Yet insulin is arguably one of the most powerful hormones in the body.
Its primary role is to help move glucose from the bloodstream into cells where it can be used for energy.
When the body’s cells become less responsive to insulin, the pancreas compensates by producing more. This is known as insulin resistance. More insulin = more sugar turned to fat and so the results can be:
- Increased fat storage
- Sugar cravings
- Fatigue
- Energy crashes
- Brain fog
- Difficulty losing weight
Importantly, blood sugar levels can remain completely normal for years while insulin resistance develops silently in the background.
Why Women Often Notice This During Perimenopause
Many women tell me:
“I’ve changed nothing, but suddenly I’m putting on weight around my middle.”
This is incredibly common.
As oestrogen levels begin to fluctuate during perimenopause, several metabolic changes occur:
- Muscle mass gradually declines
- Insulin sensitivity decreases
- Fat storage patterns change
- Sleep often deteriorates
- Stress resilience may reduce
The result is that the same diet and activity levels that worked in your thirties may no longer be enough in your forties and fifties.
This isn’t a lack of willpower.
It’s physiology. My post The Estrobolome in Menopause: Why Gut Health Matters goes into this in more detail.
Cortisol: The Stress Hormone
Cortisol is often portrayed as the villain of the hormone world.
The reality is more nuanced.
Cortisol is essential for:
- Energy regulation
- Immune function
- Blood pressure control
- Responding to stress
The problem occurs when stress becomes chronic.
Modern life frequently exposes us to:
- Work pressures
- Financial concerns
- Caring responsibilities
- Relationship difficulties
- Sleep deprivation
When stress becomes prolonged, cortisol patterns may become disrupted.
Many women notice:
- Poor sleep
- Early morning waking
- Increased appetite
- Cravings for sugary foods
- Reduced exercise motivation
- Increased abdominal fat
Stress and insulin resistance often reinforce one another, creating a cycle that can be difficult to break.
Lifestyle medicine focusses on re-balancing life stressors and encouraging a more healthy work-life balance. My blogs The Five Pllars of Lifestyle Medicine and Integrating Lifestyle Medicine into GP Care give more information on this.
Why HRT Isn’t Always the Complete Answer
As a menopause specialist, I see many women who benefit enormously from hormone replacement therapy (HRT).
HRT can be transformative for symptoms such as:
- Hot flushes
- Night sweats
- Joint aches
- Vaginal dryness
- Mood changes
- Sleep disruption
- Congitive slowing
However, HRT cannot fully compensate for poor metabolic health.
If insulin resistance, chronic stress, inadequate protein intake, poor sleep or loss of muscle mass are contributing to symptoms, these factors also need to be addressed.
This is one reason some women start HRT and feel significantly better, while others continue to struggle with fatigue, weight gain or brain fog despite optimisation of their hormone therapy.
The Missing Piece: Muscle
One of the most overlooked aspects of women’s health is muscle mass.
Muscle is not just important for strength.
It plays a critical role in:
- Blood sugar regulation
- Insulin sensitivity
- Metabolic health
- Bone health
- Healthy ageing
From around our thirties onwards, we naturally begin to lose muscle unless we actively work to maintain it.
This is one reason resistance training is one of the most powerful interventions available for long-term health.
Could Insulin Resistance Be Affecting You?
Common signs include:
- Weight gain around the abdomen
- Sugar cravings
- Fatigue after meals
- Difficulty losing weight
- Increased waist circumference
- Brain fog
- PMOS
- Elevated cholesterol
- Prediabetes
Not everyone will experience all of these symptoms.
Some women develop significant Insulin Resistance despite appearing otherwise healthy.
Looking Beyond Individual Hormones
Rather than asking:
“Which hormone is causing my symptoms?”
A more helpful question is often:
“What is happening across my entire hormonal and metabolic system?”
This broader perspective frequently reveals opportunities for improvement that extend far beyond replacing a single hormone.
What Can You Do?
Improving metabolic health does not require perfection.
Small, sustainable changes can have a significant impact.
These include:
Prioritising Protein
Protein supports muscle maintenance, appetite regulation and blood sugar control.
Building Strength
Resistance training improves insulin sensitivity and helps preserve muscle mass. It also maintains bone strength which is important as we age.
Protecting Sleep
Sleep deprivation worsens both insulin resistance and stress hormone regulation. You should aim for 7-8 hours sleep a night.
Managing Stress
Simple practices such as mindfulness, walking, social connection and time outdoors can all help support healthy cortisol patterns. Screen time is shown to affect mental stress and exposure to blue light radiation from devices contributes to skin aging.
Seeking Medical Support
If you are struggling with symptoms, it may be worth assessing:
- Hormone levels
- Thyroid function
- Metabolic health
- Insulin resistance
- Cardiovascular risk factors
A personalised approach is often far more effective than focusing on a single hormone in isolation.
The Bottom Line
Hormones matter.
But they are rarely the whole story.
If you are experiencing fatigue, weight gain, brain fog, poor sleep or low mood, it may be tempting to assume that changing oestrogen levels are entirely to blame.
In reality, insulin resistance, stress, sleep quality, muscle mass and overall metabolic health often play equally important roles.
By looking at the bigger picture, we can often identify the root causes of symptoms and create a more effective plan for long-term health and wellbeing.
Explore More Women’s Health Insights
- What is Polyendocrine Metabolic Ovarian Syndrome (PMOS)?
- PMDD Symptoms: Understanding Premenstrual Dysphoric Disorder
- The Estrobolome in Menopause: Why Gut Health Matters
- Insulin Resistance and Hormone Health: The Hidden Connection
Can insulin resistance cause symptoms similar to menopause?
Yes. Fatigue, brain fog, weight gain and poor sleep can occur in both conditions, which is why a holistic assessment is important.
Can you have insulin resistance if your blood sugar is normal?
Yes. Insulin resistance often develops years before blood glucose levels become abnormal.
Will HRT improve insulin resistance?
Oestrogen may have beneficial effects on insulin sensitivity in some women, but HRT is not primarily a treatment for insulin resistance.
Is cortisol testing necessary?
Not usually. Most people with stress-related symptoms do not require cortisol testing. Assessment should be guided by symptoms and clinical findings.
What is the best exercise for improving metabolic health?
A combination of resistance training, regular movement and cardiovascular exercise provides the greatest benefit.