If you’re tossing and turning at night and groggy the next day, don’t sleep on getting your hormones checked. A hormone imbalance could be the issue keeping you up at night.
Hormone imbalances in women can affect both the quality and quantity of your sleep. It’s a vicious cycle — when you get less sleep or your sleep is interrupted, it can throw your hormones out of balance.
Even worse, our hormones don’t just affect our sleep. A hormonal imbalance can cause mood swings, fatigue, hair loss, and a laundry list of other frustrating symptoms. But get ready to rest easy. There are simple, science-backed solutions. Sara Gottfried, MD, bestselling author of The Hormone Cure, shares a few easy yet surprising lifestyle changes that can bring your hormones back into balance. You can use the tips below to sleep better, but also to boost your overall health and vitality.
Q: Why is your book so wildly popular?
Your book, The Hormone Cure, has almost 1,700 ratings on Amazon, and the vast majority are 5-star, which is rare. It’s a New York Times bestseller, and it gets rave reviews for both the quality of the information and the enjoyable reading experience. That high praise comes from Booklist, Publisher’s Weekly, and over a dozen bestselling authors, MDs, and health experts. Why do you think you’ve been able to inspire such enthusiasm?
Dr. Gottfried: The Hormone Cure broke new ground, sparking conversations about hormone imbalances in women and shedding new light on the reality of the emotional, physical, and spiritual rollercoaster of perimenopause that was overlooked and poorly understood by the medical community.
Doctors offered very little help, as they themselves had minimal training in this area. The Hormone Cure was published at a time when we had millions of women struggling with unexplained weight gain, feeling crazed, and riding this rollercoaster of emotions. Sadly, they were offered no solutions other than being told, “Deal with it; it’s part of aging.”
Alternatively, they were offered the birth control pill and an antidepressant as the only solution. Women saw themselves reflected in the pages of The Hormone Cure with a resounding “OMG this is ME!” moment. The book made sense of their struggles, but it didn’t stop there. It not only validated a woman’s experience by explaining the WHY; it gave them tangible solutions on HOW to fix their hormone imbalances.
I think this is one of the main reasons why the book continues to inspire enthusiasm. The solutions shared in the book are inexpensive and accessible to all, yet safe and effective. My protocols are simple too, showing you the step-by-step processes to make lasting changes to your health.
One standout aspect, which remains true for every book I write, is the research behind every recommendation. I ensure that every piece of advice is extensively researched and supported by the highest quality evidence. Whether it’s breathing techniques to relieve hot flashes or phosphatidylserine for high stress, nothing makes it into my books unless it is evidence-based. Over the years, the feedback I have received, in particular on social media, is that people regard me as a trustworthy source of medical truths and rigorous solutions.
The fact that The Hormone Cure continues to remain on the bestseller lists on Amazon is a testament to the pressing need for understanding and managing hormone imbalances. But we can’t stop here. It shouldn’t be a health hazard to be female. We need to keep upgrading the conversation and demanding not only better understanding, but better solutions for the problems we face.
READ MORE: Everything You Need to Know About Hormone Optimization for Women
Q: Where does the women’s hormonal imbalance epidemic come from?
You say there’s an epidemic of hormone imbalance for women, and that most women have it but don’t know it. How can this be true? Why is it so prevalent, and what’s driving it?
Dr. Gottfried: Hormone imbalances have become increasingly prevalent in today's world. Various factors contribute to this epidemic, including trauma, high perceived toxic stress, inadequate sleep, poor dietary choices, misogyny, and exposure to environmental toxins.
Modern lifestyles, filled with endless responsibilities and pressures, disrupt our body's natural rhythm, affecting our hormones. Moreover, synthetic chemicals in everyday products and processed foods can disrupt our hormonal pathways, leading to imbalances.
Additionally, age-related hormonal changes and the challenges of perimenopause and menopause can contribute to the problem. The insidious nature of these imbalances is that their symptoms can often be overlooked or attributed to other causes, leaving many women unaware of their hormonal disruptions.
Q: How do imbalanced hormones affect sleep?
In your book, you point out that disrupted sleep is one of the biggest clues of a hormone imbalance. How do hormones affect our sleep?
Dr. Gottfried: We all know that good sleep is crucial to health. When ignored, poor sleep will make you fall down a hormonal flight of stairs. That is true whether you are 30, 50, or 70. Sleep is one of the smartest ways to regulate cortisol, thyroid, estrogen, and growth hormones, as well as hunger hormones (including insulin, which we’ll talk about more below). Nearly every hormone is released in response to your circadian rhythm, your sleep-wake cycle.
Menopause can reduce sleep quality. One of the common early signs of menopause is insomnia. Changes in estrogen levels lead to hot flashes that can disturb sleep. In addition, the level of progesterone drops in menopause. Higher levels of progesterone tend to promote a sense of calm, boosting relaxation and facilitating sleep. When your levels drop, sleep is affected.
Here are some of the main hormones that are affected by sleep:
Cortisol
Sleep tells your body when to regulate the level of cortisol. When you relax and sleep well and wake up feeling restored, your cortisol reaches a peak within 30 minutes of waking up. That peak sets off all your other hormones, including your thyroid and estrogen.
When you don't sleep well, cortisol is high when you wake up in the morning. That can disrupt the tango between estrogen and progesterone. It can cause your thyroid to slow down, which can affect your metabolism by slowing it down. Sleeping 7 to 8.5 hours every night keeps cortisol in check.
Hunger Hormones
Poor-quality sleep disrupts your levels of leptin, ghrelin, and insulin. These are your fullness, hunger, and sugar-regulator and fat-storage hormones. The interplay and signaling between these hormones are responsible for how the food you eat gets used for energy use and storage in your body. Poor sleep messes with this delicate interaction and can lead to insulin resistance and weight gain, in particular around your middle.
Even one night of bad sleep can disrupt your insulin levels, so it’s important to compensate the next day by watching your sugar intake. This is difficult to do, because if you wake up tired, you’re more likely to consume sugary foods to give you an energy boost. Hence, the vicious cycle of poor sleep and weight gain is perpetuated.
If you sleep five hours a night or less, you have more ghrelin, which tells you to eat, and less leptin, which tells you to stop. In short, you’re hungrier when you sleep less. The problem with ghrelin and leptin — combined with the disruption of other key healthspan hormones such as melatonin, cortisol, insulin, and growth hormone — may be why sleeping less is associated with weight gain.
Melatonin and Growth Hormone
Melatonin and growth hormone help you fall asleep and stay asleep, and are mainly secreted at night. Melatonin controls more than 500 genes in the body, including the genes involved in the immune system, so managing your melatonin with good sleep is key.
When you cut sleep, you reduce your levels of growth hormone, and you may be less able to repair injuries and more likely to accumulate belly fat.
Q: What are your top three tips that will help women sleep more restfully?
Dr. Gottfried:
Take Vitamin D. This vitamin is also a hormone, and it appears to have direct brain effects on your regulation of sleep, specifically in the diencephalon (the part of your brain that contains the hypothalamus and regulates hormones) and brain stem (the trunk of the brain). Some researchers hypothesize that sleep disorders have risen to epidemic levels because of widespread vitamin D deficiency, and I agree.
Kick ALAN out of your life. Artificial Light At Night (ALAN) is a major sleep disrupter. Make sure you shut off those screens at least an hour or more before bed. I recommend a curfew at 8 p.m.
Avoid alcohol and caffeine. If you are a slow-metabolizer when it comes to coffee, it will negatively impact your sleep quality. Alcohol raises cortisol, so even though you feel like you need that glass of wine to unwind after a stressful day, it will impair your sleep quality.
Mental health apps like Calm can help you sleep better with a mix of meditations, breathing programs, and soothing sounds. See our article: 8 Mental Health Apps for Stress, Sleep, and Self-Care.
Q: What are the other telltale signs of a hormone imbalance in women?
Dr. Gottfried: Hormonal imbalances can manifest in various ways, including irregular menstrual cycles, mood swings, fatigue, weight fluctuations, hair loss, and skin issues. Additionally, issues like hot flashes, low libido, and disrupted digestion can also be caused by imbalances to your hormones.
There are so many ways that hormonal imbalances show up. It’s for this reason that I created my comprehensive hormone questionnaire that you can find in Chapter 1 of The Hormone Cure. It lists hundreds of symptoms and categorizes them in a way to help women identify which hormone imbalances they need to work on.
What gets measured gets improved. See our article: 8 Biomarkers You Need to Know for Hormone Balance.
Q: How can women balance their hormones?
In your book you emphasize that women can naturally balance their hormones without prescription medications, though in some cases hormone replacement may be needed. Can you explain your three-step plan, along with some of your favorite supplements?
Dr. Gottfried: This three-step strategy is a sequential system that includes:
Lifestyle design: food, nutraceutical, and targeted exercise
Herbal therapies
Bioidentical hormones
Nearly all of the recommendations I make are available without a prescription. The interventions include nutrition, supplements, exercise, stress management, movement, and botanicals. If these don’t solve the problem, then hormone therapy may be the best option, but only after a very careful evaluation of the patient’s history, including genetic workup, and family history.
When it comes to supplements, I don’t have a one-size-fits-all list designed for all women. I like to take my supplements in pulses, in other words, take them for a limited amount of time. That could be a few weeks or several months, depending on what imbalance needs addressing.
However, so many hormonal problems in women are due to the downstream effect of cortisol. In The Hormone Cure, I describe cortisol as a bully and if it is high, it impacts all the hormones in our bodies. Addressing your cortisol response and finding ways to manage your stress is essential. So here are my top supplements for managing cortisol:
Make sure your multivitamin includes the B vitamins (B1, B5, B6, B12).
Add vitamin C and tyrosine, as they can help lower cortisol.
Try phosphatidylserine (PS). This has been shown to reduce cortisol levels when taken in pill form. Dose: 400 to 800 mg/day.
Take fish oil daily. Men and women who took 4,000 mg (4 grams) of fish oil a day for six weeks lowered morning cortisol to healthier levels.
Ashwagandha. I like it because it’s less sedating than other ginsengs, for women with anxiety and/or sleep issues. Dose: 300 mg twice per day.
You can also find 65 mg of Ashwagandha per serving in Lifeforce Peak Rest™.
To learn more about Sara Gottfried, MD, and her evidence-based integrative approach to medicine, visit SaraGottfriedMD.com You can also follow her on Instagram at @saragottfriedmd, and order her New York Times bestselling books The Hormone Cure and Women, Food, and Hormones. Dr. Gottfried’s Guide to Tracking Your Blood Sugar is available as a free download.
This article was medically reviewed by Mary Stratos, PA-C, Institute for Functional Medicine Certified Practitioner.