Women's Hormones: From PCOS to Menopause

The Hormones Nobody Explained Properly

According to research published in the Journal of Clinical Endocrinology, 1 in 5 Indian women of reproductive age has PCOS. Yet most receive a diagnosis without understanding what their hormone levels actually mean.

You've probably had multiple tests — FSH, LH, prolactin, TSH, AMH — and received results marked "normal" or "abnormal." But no one explained the why behind the numbers.

Understanding your hormonal landscape shouldn't require a medical degree. Whether you're trying to conceive, managing PCOS, or approaching menopause, you deserve to understand what your numbers mean — not just receive labels without context. This guide demystifies women's hormones from fertility through menopause.

Your Hormonal Symphony

Women's hormones aren't just about reproduction. They affect your mood, energy, sleep, weight, skin, bones, heart, and brain. They orchestrate a complex symphony throughout life — from puberty through reproductive years to menopause and beyond.

Let's understand the key players:

The Brain Hormones (FSH and LH)

Your pituitary gland — a pea-sized gland at the base of your brain — produces FSH and LH. These are the conductors of your hormonal orchestra.

Hormone	Full Name	What It Does
FSH	Follicle Stimulating Hormone	Stimulates your ovaries to develop eggs
LH	Luteinizing Hormone	Triggers ovulation (egg release)

These two hormones work in a delicate dance with your ovaries. When your ovaries are healthy and responsive, FSH and LH stay in a normal range. When your ovaries are struggling (fewer eggs, less responsive), FSH rises — the brain shouting louder because the ovaries aren't listening.

The Ovarian Hormones (Estrogen and Progesterone)

These are the hormones your ovaries produce in response to FSH and LH:

Hormone	When It's High	What It Does
Estrogen (Estradiol/E2)	First half of cycle, peaks before ovulation	Develops female characteristics, maintains bones, heart, brain, skin
Progesterone	Second half of cycle (after ovulation)	Prepares uterus for pregnancy, stabilizes mood

The Other Players

Hormone	What It Does	Why It Matters
Prolactin	Stimulates breast milk production	High levels can stop ovulation
Testosterone	Drives libido, energy, muscle	Excess causes acne, hair growth, PCOS symptoms
AMH	Reflects number of remaining eggs	Key fertility marker
TSH	Controls thyroid (which affects everything)	Thyroid problems mimic hormone imbalances

The Menstrual Cycle — What Should Happen

Before we discuss what goes wrong, let's understand what a normal cycle looks like:

Day 1-5: Menstruation

Your period. Estrogen and progesterone are at their lowest. FSH rises to start recruiting the next batch of eggs.

Day 1-14: Follicular Phase

FSH stimulates follicle development in your ovaries. One follicle becomes dominant. It produces increasing amounts of estrogen. Your uterine lining thickens.

Day 14 (approximately): Ovulation

Estrogen peaks. This triggers a surge of LH. The dominant follicle releases its egg. This is your fertile window.

Day 15-28: Luteal Phase

The empty follicle becomes the "corpus luteum" and produces progesterone. If pregnancy doesn't occur, progesterone falls, triggering your next period.

PCOS: The Most Common Hormonal Disorder

Consider Neha's story.

Neha was 24, a graphic designer, with irregular periods since puberty. Sometimes she'd get a period after 35 days, sometimes after 60. She'd been to multiple doctors who told her it would "regulate with time" or "regulate after marriage."

It didn't.

By 27, she had gained 15 kg over 3 years, had stubborn acne on her jawline, and noticed dark hair on her upper lip. Her ultrasound showed "polycystic ovaries." Her LH was 14 mIU/mL, FSH was 5 mIU/mL (LH:FSH ratio of nearly 3:1). Her testosterone was elevated. Her fasting insulin was 22 uIU/mL.

Neha had PCOS — Polycystic Ovary Syndrome. And like many women with PCOS, nobody had properly explained what it was or why it mattered.

What Is PCOS?

PCOS is a hormonal disorder affecting 10-15% of Indian women. Despite the name, it's not primarily about ovarian cysts — it's about hormonal imbalance and insulin resistance.

The diagnosis requires 2 of these 3 criteria (Rotterdam criteria):

1. Irregular or absent periods (fewer than 8 cycles per year)
2. Signs of excess androgens (acne, excess hair, elevated testosterone)
3. Polycystic ovaries on ultrasound (12+ follicles per ovary or enlarged ovaries)

The PCOS Hormone Pattern

Marker	Normal	PCOS Pattern
LH:FSH ratio	Around 1:1	Often 2:1 or higher
Testosterone (Total)	15-70 ng/dL	Often elevated
DHEAS	35-430 µg/dL	Often elevated
Fasting Insulin	Below 10 uIU/mL	Often 15-30+ uIU/mL
AMH	1.0-4.0 ng/mL	Often elevated (4-10+ ng/mL)

Why PCOS Is About More Than Periods

PCOS isn't just a fertility problem. It's a metabolic disorder that increases your risk of:

• Type 2 diabetes: 50% of women with PCOS develop diabetes by age 40
• Cardiovascular disease: Higher rates of heart disease
• Endometrial cancer: Unopposed estrogen (no progesterone) thickens the uterine lining
• Fatty liver: Due to insulin resistance
• Depression and anxiety: Both hormonal and psychological

Fertility: The Numbers That Matter

Understanding your fertility markers empowers you to make informed decisions about timing and planning. Here are the key numbers every woman should know:

AMH — Your Ovarian Reserve

AMH (Anti-Müllerian Hormone) is produced by the follicles in your ovaries. It reflects how many eggs you have remaining.

AMH Level	Interpretation	What It Means for Fertility
Above 3.0 ng/mL	High reserve	Plenty of eggs; may indicate PCOS if very high
1.0-3.0 ng/mL	Normal reserve	Good fertility potential
0.5-1.0 ng/mL	Low reserve	Reduced egg quantity; consider not delaying
Below 0.5 ng/mL	Very low reserve	Significant fertility challenge

But here's what most women aren't told: AMH measures quantity, not quality. A 25-year-old with low AMH still has better egg quality than a 40-year-old with normal AMH. Age remains the most important factor.

FSH — The Effort Hormone

FSH on Day 2-5 tells you how hard your brain is working to stimulate your ovaries:

FSH Level (Day 2-5)	Interpretation
Below 7 mIU/mL	Excellent — ovaries responding easily
7-10 mIU/mL	Normal — good ovarian response
10-15 mIU/mL	Elevated — reduced response
Above 15 mIU/mL	High — significantly diminished reserve

Day 21 Progesterone — Did You Ovulate?

Progesterone rises only after ovulation. Testing 7 days after you ovulate (Day 21 in a 28-day cycle) confirms whether you ovulated:

Progesterone Level	Interpretation
Below 1 ng/mL	No ovulation occurred
1-3 ng/mL	Probably no ovulation
3-10 ng/mL	Ovulation occurred
Above 10 ng/mL	Strong ovulation — good luteal function

The Thyroid Connection

Thyroid testing is essential in any hormonal workup. Here's why:

Thyroid problems are incredibly common in Indian women — hypothyroidism affects nearly 1 in 10 women. And thyroid dysfunction wreaks havoc on reproductive hormones:

• Hypothyroidism: Irregular periods, heavy bleeding, difficulty conceiving, miscarriage risk
• Hyperthyroidism: Light or absent periods, fertility problems

Prolactin — The Hidden Troublemaker

Consider Sunita's experience.

Sunita, 32, hadn't had a period in 4 months. She wasn't pregnant. Her FSH and LH were low-normal. Her estrogen was low. But her prolactin was 58 ng/mL (normal is below 25 ng/mL).

Prolactin is the hormone that stimulates breast milk production. When it's high outside of pregnancy and breastfeeding, it suppresses FSH and LH, preventing ovulation.

Causes of High Prolactin

• Pituitary adenoma: A small, usually benign tumor (prolactinoma)
• Medications: Antipsychotics, some antidepressants, metoclopramide
• Hypothyroidism: Low thyroid can raise prolactin
• Stress: Physical or emotional stress elevates prolactin
• Chest wall irritation: Herpes zoster, tight bras (!), nipple stimulation

Sunita's MRI showed a small pituitary microadenoma. With medication (cabergoline), her prolactin normalized, her periods returned, and she conceived within 6 months.

Perimenopause and Menopause

At 47, Kamala started experiencing symptoms she couldn't explain: terrible sleep, drenching night sweats, periods that went from regular to chaotic, mood swings that made her feel like a different person.

"Am I going crazy?" she wondered. "Or is this menopause?"

Neither. It was perimenopause — the transition phase that can begin 8-10 years before menopause.

The Perimenopausal Hormone Roller Coaster

Perimenopause isn't about low hormones — it's about erratic hormones. Estrogen can swing wildly from very high to very low, sometimes within the same week. This creates:

• Irregular cycles: Longer, shorter, heavier, lighter — unpredictable
• Hot flashes and night sweats: The vasomotor symptoms
• Sleep disturbance: Often related to night sweats or hormonal shifts
• Mood changes: Irritability, anxiety, sometimes depression
• Vaginal dryness: As estrogen declines
• Brain fog: Difficulty concentrating, memory issues

The Hormone Pattern of Menopause

Hormone	Reproductive Age	Perimenopause	Postmenopause
FSH	3-10 mIU/mL	Variable, often high	Above 30-40 mIU/mL
Estradiol	30-400 pg/mL (varies with cycle)	Erratic	Below 20 pg/mL
AMH	1.0-4.0 ng/mL	Very low	Undetectable

Premature Menopause and POI

Menopause before 40 is called Premature Ovarian Insufficiency (POI). It affects about 1% of women and has significant implications:

• Fertility: Natural conception becomes very unlikely
• Bone health: Early estrogen loss accelerates osteoporosis
• Heart health: Cardiovascular risk increases
• Cognitive health: Some studies suggest increased dementia risk

If you're under 40 with absent or very irregular periods and elevated FSH, please seek evaluation.

Hormone Replacement Therapy — The Facts

No discussion of women's hormones is complete without addressing HRT. Here's the evidence-based view:

For Whom Is HRT Beneficial?

• Women with moderate to severe menopausal symptoms (hot flashes, night sweats, sleep disruption)
• Women with premature menopause or POI (essentially replacing what should naturally be there)
• Women with genitourinary symptoms (vaginal dryness, painful intercourse, recurrent UTIs)

The Timing Hypothesis

Research now shows that HRT started within 10 years of menopause or before age 60 is safe for most women and may actually protect the heart. Started later, the calculus changes.

Who Should Be Cautious?

• History of breast cancer
• History of blood clots
• Active liver disease
• Unexplained vaginal bleeding
• History of stroke or heart attack

Special Situations

Hair Loss in Women

Female pattern hair loss (thinning at the crown and along the part) can be hormonal. Consider testing:

• Thyroid function (TSH, Free T4)
• Iron studies (ferritin especially — optimal is above 70 ng/mL for hair)
• Androgens (testosterone, DHEAS) — especially if other PCOS signs
• Prolactin

Adult Acne

Acne along the jawline and chin in adult women is often hormonal. The same androgen panel used for PCOS is relevant. Many women with hormonal acne have "normal" testosterone but elevated free androgens or androgen sensitivity.

Low Libido

While often multifactorial (stress, relationship, medications), hormonal causes to consider:

• Low testosterone (yes, women need it too)
• Low estrogen (especially postmenopause)
• High prolactin
• Low thyroid

The Tests You Should Get

Stories of Understanding and Action

Neha (PCOS) started metformin, modified her diet, and began strength training. Within 6 months, her periods became regular, she lost 8 kg, and her skin cleared. When she was ready to conceive two years later, she needed just one cycle of medication to ovulate and got pregnant.

Priya (fertility workup) understood that her mildly low AMH at 29 meant she shouldn't wait indefinitely, but also that it wasn't a crisis. She conceived naturally within a year of trying. Knowing her numbers helped her make informed decisions about timing.

Kamala (perimenopause) tried lifestyle modifications first — better sleep hygiene, exercise, stress management. When symptoms remained severe, she started low-dose HRT. "I got my life back," she reported at her 6-month follow-up.

Each woman's story is different. But what united them was finally understanding their bodies instead of being given labels without context.

Your Hormone Health Action Plan

Life Stage	Key Hormones to Know	What to Watch For
Teens/20s	If irregular periods: FSH, LH, prolactin, TSH, androgens	PCOS signs, thyroid issues
Trying to conceive	FSH, AMH, progesterone, TSH	Ovarian reserve, ovulation confirmation
30s-40s	AMH if curious about reserve; TSH annually	Early perimenopause, thyroid changes
Perimenopause	Often don't need tests — symptoms are enough	Thyroid if symptoms confusing
Postmenopause	Bone density, cardiovascular markers	Long-term estrogen-deficiency effects

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