Hormonal Imbalance in Women: the connected system behind PMS, your cycle, skin and mood
Female hormones are not a single value and not a single organ. They are a connected system. Once you understand that, you stop seeing one hormone behind PMS, skin problems and mood lows, and start seeing an interplay. This article is your guide through every topic.
When women with cycle complaints come to me, they often already have a sentence in their head: "Don't make such a fuss, that's normal." I see it differently. It is common, but not healthy to fall out of your own body for days every month. And it is rarely a single hormone that has slipped out of rhythm. Hormones work in a network with stress, blood sugar, gut, liver and thyroid. This article shows you the whole picture and guides you to each individual topic.
Maybe you know this. For two weeks you feel like yourself. Then something tips. Your mood becomes thin-skinned, your skin acts up, your sleep turns shallow, and you wonder who is living in your body right now. With the next cycle, the same game. You may already have seen a doctor. The values were fine. And yet something is not fine.
This pillar article is the map for the whole cluster. We look at what female hormones actually are and how they work together. We understand the estrogen-progesterone ratio, the role of stress, blood sugar, liver, gut and thyroid. And I show you the four lenses through which clinical psychoneuroimmunology looks at your hormone system. At the end you will find the guide to all 20 individual topics, from estrogen dominance through PCOS and perimenopause to hormone-free contraception and chasteberry.
Hormones are not a value, but a conversation
Picture your hormone system not as a switch, but as an orchestra. No instrument plays alone. Estrogen gives the upbeat, progesterone calms, cortisol sets accents under pressure, insulin holds the beat in metabolism, the thyroid sets the tempo. If one instrument plays too loud or too soft, the whole piece sounds different. That is exactly why a single lab value says so little.
Estrogen and progesterone are the two lead voices of the female cycle. They are counterparts in the best sense. Estrogen builds up, stimulates, sharpens drive and lets the uterine lining grow. Progesterone rises after ovulation, stabilises, calms and prepares everything for a possible pregnancy. Through its breakdown product allopregnanolone, progesterone even acts directly at the calming GABA system in the brain. Put simply: estrogen is the accelerator, progesterone more the steady hand on the wheel.
What matters, then, is not whether a hormone is high or low, but how the ratio looks in the respective cycle phase. If progesterone cannot hold its own against estrogen in the second half of the cycle, that very thing can promote symptoms. And now you know why "your values are normal" and "I feel terrible" need not be a contradiction.
A hormonal imbalance is usually not the defect of a single hormone. It is a disturbed relationship between several messengers, often triggered by factors outside the ovaries: stress, blood sugar, sleep, inflammation, environmental substances. That is not bad news. It means there are more points to work with than just turning one hormone dial.
The estrogen-progesterone ratio and the matter of estrogen dominance
You may already have heard the term estrogen dominance. It sounds like too much estrogen. Often, though, that misses the heart of it. More frequently there is a relative imbalance: progesterone is too low in the second half of the cycle, so that estrogen comes through proportionally too strongly. This happens, for example, in cycles without ovulation, because without ovulation no corpus luteum forms, and without a corpus luteum the progesterone is missing.
Why progesterone carries particular weight is shown very strikingly by the research on the second half of the cycle. The progesterone breakdown product allopregnanolone influences the calming GABA system in the brain. In sensitive women, this otherwise calming substance can do the opposite in the luteal phase.
Why progesterone breakdown tips the mood in some women
Review Torbjörn Bäckström and colleagues summarised decades of research on allopregnanolone and mood in Progress in Neurobiology in 2013. Their central observation: in women with premenstrual complaints, the strength of negative mood relates to the allopregnanolone level in an inverted U-curve. Exactly at the body's own values of the second cycle half the burden is greatest, while very low and very high values produce fewer symptoms. This explains the apparent paradox that a calming substance can trigger tension.
Bäckström T, Bixo M, Johansson M, et al. Prog Neurobiol. 2013;113:88-94. doi:10.1016/j.pneurobio.2013.07.005 · PMID: 23978486
Two further layers belong to the picture of estrogen dominance, layers that at first have nothing to do with the ovaries. First the liver, which breaks estrogen down and clears it out. If this breakdown runs slowly, more estrogen stays in circulation. Second, estrogen-like environmental substances that intervene in the system from outside. We go deeper into both topics in their own articles. And now you know why estrogen dominance describes a ratio, not a single hormone.
"My estrogen is too high, that's why I have PMS." A single estrogen value does not prove that. First, estrogen fluctuates enormously across the cycle, a value without a cycle phase is barely interpretable. Second, it is about the ratio to progesterone, not an absolute number. Estrogen dominance is a helpful way of thinking, but not a diagnosis that a single lab result can deliver.
The four PNI lenses on your hormone system
In clinical psychoneuroimmunology, PNI for short, we do not look only at the ovaries. We look at four interwoven levels that together explain why hormones fall out of balance. Each lens explains a part at the cellular level. Together they form the picture.
Nervous system and stress
The stress system and the ovaries share the higher-level control in the brain. Persistent stress keeps cortisol high and can, via the hypothalamus, dampen the signals that trigger ovulation. If ovulation fails or weakens, the progesterone of the second cycle half drops. This is how chronic tension can help set a hormonal imbalance in motion, entirely without a defect of the ovaries themselves.
Immune system and inflammation
Silent inflammation is an underestimated player. In conditions such as endometriosis and PCOS, inflammatory processes play a role, and inflammatory messengers can disturb hormone signals at the cellular level. The gut belongs here too: a permeable gut barrier and an altered gut flora can irritate the immune system permanently and so act indirectly on the hormone balance.
Metabolism and blood sugar
Insulin is itself a hormone. If blood sugar swings strongly or insulin resistance develops, this reaches deep into the sex hormone balance. In PCOS, raised insulin is regarded as a central driver: it can prompt the ovaries to form androgens and lower the binding globulin in the liver, so that more free androgens circulate. Stable blood sugar therefore relieves the whole hormone system.
Hormone system and liver
This is where the threads come together. The thyroid sets the metabolic tempo and is closely linked to estrogen via binding proteins. The liver breaks estrogen down and has a say in how much stays in the body. And ovulation itself determines whether enough progesterone is formed. Anyone who wants to understand hormones must think of these organs as a connected whole, not as separate departments.
These four lenses are not a theoretical model. They are the reason why sleep, nutrition, stress regulation and gut health often achieve more in hormone complaints than expected. And now you know why a good hormone consultation asks about more than just your cycle.
Stress, cortisol and the cycle: why demanding phases shift hormones
Do you know the feeling that your cycle goes haywire in stressful months? The period comes later, the PMS is worse, or the bleeding stops altogether. That is not imagination. The stress system and the hormone system are biochemically closely interwoven.
Under persistent strain, the HPA axis runs at full tilt, that is the axis of hypothalamus, pituitary and adrenal gland that releases cortisol. This permanent activation can dampen the higher-level control of the ovaries. Ovulation shifts or fails, and with it the progesterone production changes. What is striking is that, conversely, the stress system also changes across the cycle.
The cortisol awakening response fluctuates across the cycle
Comparative study, n=29 Maren Wolfram and colleagues measured the cortisol awakening response in 29 healthy, naturally cycling women across four cycle phases in Psychoneuroendocrinology in 2011: during bleeding, in the first half of the cycle, around ovulation and in the second half. Result: the morning cortisol rise was most pronounced around ovulation. The authors attribute this to the raised sex hormones in this phase. This shows that the stress system and the cycle are not separate systems, but set each other's beat.
Wolfram M, Bellingrath S, Kudielka BM. Psychoneuroendocrinology. 2011;36(6):905-912. doi:10.1016/j.psyneuen.2010.12.006 · PMID: 21237574
This does not mean stress explains every hormone disturbance. But it is a real player. That is why regulating the nervous system is not a wellness extra, but a genuine lever. And now you know why hormone complaints often sharpen during demanding phases of life.
Blood sugar, insulin and PCOS: metabolism has a say
Polycystic ovary syndrome, PCOS for short, is the most common hormone- and metabolism-related disorder in women of reproductive age. It shows strikingly that hormones and metabolism cannot be separated. Many women with PCOS have irregular cycles, signs of raised male hormones such as acne or increased hair growth, and very often insulin resistance.
Insulin as a central driver in PCOS
Review In a comprehensive review, Di Lorenzo and colleagues described in Current Nutrition Reports in 2023 how insulin stands at the centre of PCOS development. Raised insulin can prompt the ovaries to form more androgens and at the same time lower sex hormone-binding globulin in the liver, so that more free androgens act. The authors stress that a healthy nutritional approach could improve insulin resistance as well as metabolic and reproductive functions, and so can be a sensible strategy.
Di Lorenzo M, Cacciapuoti N, Lonardo MS, et al. Curr Nutr Rep. 2023;12(3):527-544. doi:10.1007/s13668-023-00479-8 · PMID: 37213054
A medical review by Ricardo Azziz from 2018 in Obstetrics and Gynecology classifies PCOS as a highly inheritable, multilayered disorder with different forms and names abnormalities of insulin action as one of the core points (doi:10.1097/AOG.0000000000002698, PMID: 29995717). This explains why, in PCOS, one should not turn the hormone dial alone, but keep blood sugar at the centre. And now you know why nutrition and exercise often change more here than a single medication.
Thyroid, liver and environmental substances: the quiet players
Three factors are often overlooked in hormone complaints, even though they steer a great deal. The thyroid, the liver, and exposure to hormonally active environmental substances.
How estrogen changes the thyroid balance
Review Federica Torre and colleagues described in the Journal of Endocrinological Investigation in 2020 how the estrogen component of hormonal contraception increases the formation of binding proteins in the liver, including thyroxine-binding globulin and sex hormone-binding globulin. More binding protein means that more hormone is bound and therefore less is freely available. This can change the need for thyroid hormone, especially in women with an already borderline thyroid function. Thyroid and sex hormones are therefore not separate topics.
Torre F, Calogero AE, Condorelli RA, et al. J Endocrinol Invest. 2020;43(9):1181-1188. doi:10.1007/s40618-020-01230-8 · PMID: 32219692
The system can also be disturbed from outside. So-called endocrine disruptors are environmental substances that can mimic or block hormone actions. These include, among others, bisphenol A from some plastics, phthalates from softeners and parabens. The evidence here is still in flux, but the topic deserves attention.
Endocrine disruptors and the female hormone system
Review Saqib Hassan and colleagues summarised the state of research on endocrine disruptors and the reproductive health of women in Environmental Research in 2023. They describe a connection between exposure to substances such as bisphenol A, phthalates and parabens and a growing number of disorders, including endometriosis, PCOS, cycle irregularities and fertility problems. The authors stress that the mechanisms need to be understood better, and that reducing exposure could be sensible. A complementary review on endocrine disruptors in endometriosis (Dutta 2022, Reproductive Toxicology) supports this direction.
Hassan S, Thacharodi A, Priya A, et al. Environ Res. 2023;241:117385. doi:10.1016/j.envres.2023.117385 · PMID: 37838203 · Dutta S et al. Reprod Toxicol. 2022;115:56-73. doi:10.1016/j.reprotox.2022.11.007 · PMID: 36436816
What matters is honest classification. Much of this is mechanistically plausible and supported by observational data, but not proven on every point by large controlled human studies. That does not mean it is irrelevant. It means we act with a sense of proportion. And now you know why the liver, the thyroid and your everyday surroundings should not be missing from any complete view of hormones.
Perimenopause: when the fluctuation is the burden, not the low value
Somewhere between the mid-forties and the early fifties, a new phase begins for many women. Perimenopause. Many expect the hormones to simply decline slowly. In reality it is more chaotic. Estrogen fluctuates wildly, sometimes very high, sometimes very low, often within a few days.
How sensitively a woman reacts to estrogen fluctuations predicts the risk
Cohort, prospective Jennifer Gordon and colleagues followed 101 women in perimenopause in Psychological Medicine in 2020. Over twelve weeks they measured an estrogen breakdown product in urine weekly, alongside mood. They then observed depressive symptoms over nine months. Result: how strongly mood and estrogen were linked in a woman predicted the later occurrence of clinically meaningful depressive symptoms, especially in women without prior depression and early in the transition. Not the level, but the individual sensitivity to the fluctuation was decisive.
Gordon JL, Sander B, Eisenlohr-Moul TA, Sykes Tottenham L. Psychol Med. 2020;51(10):1733-1741. doi:10.1017/S0033291720000483 · PMID: 32156321
In a companion review, Gordon and Sander describe in Psychoneuroendocrinology in 2021 four possible sensitivity profiles: some women react sensitively to a rise in estrogen, others to the withdrawal, some to fluctuations in both directions, and some barely at all (doi:10.1016/j.psyneuen.2021.105418, PMID: 34607269). This explains why the transition years run so individually. And now you know why "you're just in menopause" falls short as an explanation.
In perimenopause, what burdens most is often not the low hormone level, but the strong fluctuation and the withdrawal. Your brain has to keep readjusting. That is exhausting and can throw mood, sleep and heat regulation off balance. It is not a sign of weakness, but a real neurobiological phase of adaptation.
Three levers that can support the whole system
Before turning individual hormone dials, it is worth looking at the foundations. They do not work spectacularly, but they support the whole connected system. These three levers are a start, not a treatment plan. You find your individual path with medical guidance.
Stabilise your blood sugar across the day
Regular meals rich in protein and fibre keep blood sugar calm and relieve insulin. This could make a difference especially in PCOS and hormonal acne, because less insulin can mean less androgen drive. You do not have to eat perfectly. Even stable rather than roller-coaster meals support the whole system.
Protect sleep and the nervous system
A fixed sleep rhythm and genuine recovery windows lower the permanent activation of the stress system. Because cortisol and ovarian control are coupled, this can also benefit the cycle. Breathing, walks and screen breaks are not niceties, but act directly on the axis that helps steer your hormones.
Have the whole system assessed, not just one hormone
If complaints persist, assessment belongs with them, looking at the cycle phase, the thyroid, iron and blood sugar, not just a single hormone value. This way treatable causes can be found, rather than attributing symptoms prematurely to one hormone. Good assessment takes your complaints seriously.
Among herbal remedies, chasteberry has the best evidence for PMS. A systematic review and meta-analysis by Saskia Verkaik and colleagues in the American Journal of Obstetrics and Gynecology in 2017 found a large advantage over placebo, but urged caution because of high heterogeneity and risk of bias (doi:10.1016/j.ajog.2017.02.028, PMID: 28237870). A stricter meta-analysis by Dezső Csupor and colleagues in Complementary Therapies in Medicine in 2019, which included only well-documented double-blind studies, also found an advantage (doi:10.1016/j.ctim.2019.08.024, PMID: 31780016). Chasteberry could ease PMS, but it does not replace assessment. Before use, this should be discussed with a doctor.
It is not about one hormone, it is about your balance
Your hormones are not a switch you flip. They are a conversation between nerve, immune, metabolism and hormone. When you support the whole system, you give your body the chance to find its rhythm. Your wellbeing is not a luxury. It is the precondition for being able to be yourself again.
Frequently asked questions about hormonal imbalance in women
What does hormonal imbalance in women mean?
Hormonal imbalance does not describe a single lab value, but a disturbed interplay of several messengers. In women it is mainly about the ratio of estrogen and progesterone across the cycle, embedded in stress hormones such as cortisol, in blood sugar and insulin metabolism, in the thyroid and in the liver, which breaks hormones down. From the perspective of clinical psychoneuroimmunology, four lenses work together here: the nervous system, the immune system, metabolism and the hormone system. A single deviating value therefore says little. What matters more is whether the whole system keeps its rhythm. Complaints such as PMS, cycle disturbances, skin problems or mood swings are often the visible end of such a connected regulation problem.
What is the estrogen-progesterone ratio and why does it matter?
Estrogen and progesterone are the two lead characters of the female cycle, and they act as counterparts. Estrogen builds up, stimulates and often raises drive. Progesterone calms, stabilises the uterine lining and acts via its breakdown product allopregnanolone on the calming GABA system in the brain. What matters is not the absolute value of a single hormone, but their ratio to one another in the respective cycle phase. If progesterone is too low relative to estrogen in the second half of the cycle, for example in cycles without ovulation or under chronic stress, this can promote symptoms. Exactly this relative imbalance often sits behind what is colloquially called estrogen dominance.
Which symptoms point to a hormonal imbalance?
Typical signs are cycle-dependent mood swings, pronounced premenstrual syndrome, breast tenderness, water retention, irregular or absent cycles, spotting, hormonal acne especially on the chin and jaw, hair loss, sleep problems in the second half of the cycle, loss of libido and growing irritability. In midlife, hot flushes, sleep problems and the mood lows of perimenopause are added. Important: such complaints are unspecific and can have many causes, from the thyroid to iron deficiency to psychological strain. Persistent or new complaints belong in medical assessment, rather than being attributed prematurely to a single hormone.
How are stress and female hormones connected?
The stress system and the sex hormone system share biochemical building blocks and influence one another. Persistent stress activates the HPA axis and keeps cortisol high. This can dampen the higher-level control of the ovaries and so impair ovulation and the progesterone production of the second cycle half. Studies also show that the cortisol awakening response changes across the cycle and is strongest around ovulation. This does not mean stress explains every hormone problem. But it is a real player, which explains why hormone complaints often increase during demanding phases of life. That is why regulating the nervous system is an important lever.
Does blood sugar play a role in hormone disturbances?
Yes, and often an underestimated one. Insulin is itself a hormone, and insulin resistance reaches deep into the sex hormone balance. In polycystic ovary syndrome (PCOS), insulin is regarded as a central driver: raised insulin can prompt the ovaries to produce more androgens and lower sex hormone-binding globulin in the liver, so that more free androgens circulate. This promotes acne, increased hair growth and cycle disturbances. Stable blood sugar across the day therefore relieves not only metabolism but also the hormone system. That is one of the reasons why nutrition and exercise achieve more in many hormone complaints than is often expected.
What does the thyroid have to do with female hormones?
The thyroid and the sex hormones are closely linked. Estrogen increases the formation of binding proteins in the liver, such as thyroxine-binding globulin and sex hormone-binding globulin. More bound hormone means less free, biologically active hormone. That is why thyroid requirements and the hormone balance can change, for example on the pill, in pregnancy or in menopause. Conversely, an underactive thyroid can disturb the cycle and amplify complaints that look like a pure hormone problem. Anyone with cycle and mood complaints should keep the thyroid in view, rather than considering it in isolation.
Why do hormones change so strongly in perimenopause?
In perimenopause, the years before the final menstrual period, hormones do not simply decline steadily. Instead they fluctuate strongly and unpredictably. Estrogen can be very high at times and then very low again. Research suggests that not the low level alone, but the strong fluctuation and the withdrawal are responsible for many complaints, from hot flushes to sleep problems to depressive moods. Studies also show that women differ greatly in how sensitively they react to these fluctuations. This explains why one woman barely notices the transition years and another suffers considerably.
What is meant by estrogen dominance?
The term estrogen dominance is not an official lab finding, but describes a relative imbalance: estrogen acts too strongly in relation to progesterone. Often this is not based on too much estrogen, but too little progesterone, for example in cycles without ovulation or under chronic stress. A slowed estrogen breakdown in the liver or exposure to estrogen-like environmental substances can also contribute to the picture. Symptoms can be breast tenderness, PMS, water retention and heavy bleeding. What matters is a sober reading: estrogen dominance is an explanatory model that helps to think about the ratio of hormones, not a label that proves a single cause.
Which hormones should a woman have tested, and when?
A meaningful hormone test depends on the question and the timing. Progesterone is only informative in the second half of the cycle, ideally around a week after presumed ovulation. Estrogen, FSH and LH are often measured in the early first half of the cycle. If PCOS is suspected, androgens, fasting insulin and blood sugar belong with them, and with exhaustion and cycle disturbances also thyroid values and ferritin. A single value without reference to the cycle phase and to the complaints is worth little. That is why hormone diagnostics belong in medical hands that interpret the finding in the context of your life situation, rather than treating a number in isolation.
Can herbal remedies like chasteberry help with hormone complaints?
For chasteberry (Vitex agnus-castus) there is the comparatively best herbal evidence for premenstrual syndrome. A systematic review and meta-analysis found a clear advantage over placebo, although with high heterogeneity and a high risk of bias in the studies. A stricter meta-analysis that included only well-documented double-blind studies also found an advantage. Chasteberry could therefore ease PMS symptoms, but it is no cure-all and does not replace assessment. Before use, the application should be discussed with a doctor, especially with hormone-dependent conditions, with a wish to conceive, in pregnancy and breastfeeding, or alongside hormonal contraception or other medication.
Is a hormonal imbalance dangerous, and when should I see a doctor?
Many cycle-related complaints are distressing, but not dangerous. Still, no online text replaces medical assessment. You should seek urgent medical assessment for: suddenly changed or very heavy bleeding, bleeding after menopause, an absent period without pregnancy over several months, pronounced increased hair growth with a deepening voice, and severe premenstrual mood lows with despair or hopelessness. Treatable causes can sit behind hormone complaints, such as thyroid conditions, PCOS or iron deficiency. Good diagnostics look at the whole system and take your complaints seriously, rather than dismissing them as normal. If you have thoughts of no longer wanting to live, please seek help immediately.
All 20 topics in the cluster "Hormone Guide"
This pillar is the hub. From here it goes into depth. Each topic illuminates a part of the connected system.
- Estrogen dominance: addressing symptoms naturally
- Xenoestrogens and hormone disruptors in daily life
- Coming off the pill: what happens in the body
- Progesterone deficiency: symptoms and testing
- PMS: symptoms and what can ease them
- PMDD: premenstrual dysphoric disorder
- Perimenopause: symptoms and from when
- Menopause: symptoms and what can help
- PCOS: causes and symptoms
- Hormonal acne addressed from within
- Endometriosis: causes seen integratively
- Hormone-free contraception compared
- Loss of libido in women: causes
- Testing hormones: which test, which cycle day
- Lowering estrogen naturally via the liver
- Cycle-based nutrition by phase
- The thyroid and female hormones
- Insulin resistance and hormones in women
- Cortisol, stress and female hormones
- Chasteberry and herbal hormone helpers
Connections to other topics
Why normal values are not always enough, and how a borderline thyroid can influence cycle, mood and energy.
An honest classification of the stress hormone cortisol and the HPA axis, which is closely interwoven with the control of your ovaries.
Iron deficiency amplifies many complaints that look like a pure hormone problem, from exhaustion to hair loss.
Via the immune system and estrogen metabolism, the gut helps determine how well your hormone balance stays in equilibrium.
An honest look at why some women develop complaints with the copper IUD and what can sit behind it.
Why women react differently to fasting and how the cycle and the hormone situation can play a role.
Sources and further reading
- Bäckström T, Bixo M, Johansson M, et al. Allopregnanolone and mood disorders. Prog Neurobiol. 2013;113:88-94. doi:10.1016/j.pneurobio.2013.07.005 · PMID: 23978486 [Review]
- Sikes-Keilp C, Rubinow DR. GABA-ergic Modulators: New Therapeutic Approaches to Premenstrual Dysphoric Disorder. CNS Drugs. 2023;37(8):679-693. doi:10.1007/s40263-023-01030-7 · PMID: 37542704 [Review]
- Timby E, Bäckström T, Nyberg S, et al. Women with premenstrual dysphoric disorder have altered sensitivity to allopregnanolone over the menstrual cycle compared to controls. Psychopharmacology (Berl). 2016;233(11):2109-2117. doi:10.1007/s00213-016-4258-1 · PMID: 26960697 [RCT, Crossover, n=20]
- Stiernman L, Dubol M, Comasco E, et al. Emotion-induced brain activation across the menstrual cycle in individuals with premenstrual dysphoric disorder. Transl Psychiatry. 2023;13(1):124. doi:10.1038/s41398-023-02424-3 · PMID: 37055419 [Cohort, fMRI]
- Wolfram M, Bellingrath S, Kudielka BM. The cortisol awakening response (CAR) across the female menstrual cycle. Psychoneuroendocrinology. 2011;36(6):905-912. doi:10.1016/j.psyneuen.2010.12.006 · PMID: 21237574 [Cohort, n=29]
- Di Lorenzo M, Cacciapuoti N, Lonardo MS, et al. Pathophysiology and Nutritional Approaches in Polycystic Ovary Syndrome (PCOS): A Comprehensive Review. Curr Nutr Rep. 2023;12(3):527-544. doi:10.1007/s13668-023-00479-8 · PMID: 37213054 [Review]
- Azziz R. Polycystic Ovary Syndrome. Obstet Gynecol. 2018;132(2):321-336. doi:10.1097/AOG.0000000000002698 · PMID: 29995717 [Review]
- Torre F, Calogero AE, Condorelli RA, et al. Effects of oral contraceptives on thyroid function and vice versa. J Endocrinol Invest. 2020;43(9):1181-1188. doi:10.1007/s40618-020-01230-8 · PMID: 32219692 [Review]
- Hassan S, Thacharodi A, Priya A, et al. Endocrine disruptors: Unravelling the link between chemical exposure and Women's reproductive health. Environ Res. 2023;241:117385. doi:10.1016/j.envres.2023.117385 · PMID: 37838203 [Review]
- Dutta S, Banu SK, Arosh JA. Endocrine disruptors and endometriosis. Reprod Toxicol. 2022;115:56-73. doi:10.1016/j.reprotox.2022.11.007 · PMID: 36436816 [Review]
- Gordon JL, Sander B, Eisenlohr-Moul TA, Sykes Tottenham L. Mood sensitivity to estradiol predicts depressive symptoms in the menopause transition. Psychol Med. 2020;51(10):1733-1741. doi:10.1017/S0033291720000483 · PMID: 32156321 [Cohort, n=101]
- Gordon JL, Sander B. The role of estradiol fluctuation in the pathophysiology of perimenopausal depression. Psychoneuroendocrinology. 2021;133:105418. doi:10.1016/j.psyneuen.2021.105418 · PMID: 34607269 [Review]
- Verkaik S, Kamperman AM, van Westrhenen R, Schulte PFJ. The treatment of premenstrual syndrome with preparations of Vitex agnus castus: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017;217(2):150-166. doi:10.1016/j.ajog.2017.02.028 · PMID: 28237870 [Meta-analysis]
- Csupor D, Lantos T, Hegyi P, et al. Vitex agnus-castus in premenstrual syndrome: A meta-analysis of double-blind randomised controlled trials. Complement Ther Med. 2019;47:102190. doi:10.1016/j.ctim.2019.08.024 · PMID: 31780016 [Meta-analysis]