10 Common Signs of Hormonal Imbalance in PCOS

Lisa Smith Nutritionist
Jun 21
5 min read

Updated: 6 days ago

If you’re dealing with stubborn weight gain, painful periods, fatigue, or sugar cravings that never seem to go away, it could be more than just stress or bad luck with your cycle. These are often signs of a hormonal imbalance, especially in women with PCOS (Polycystic Ovary Syndrome).

Whether you’ve been diagnosed or are still searching for answers, this post will help you understand the real symptoms of hormone imbalance in PCOS, and why they’re so often dismissed or misunderstood.

What Are The Signs of Hormonal Imbalance in PCOS

Hormonal imbalance is at the core of PCOS, but what that looks like varies from woman to woman. Some experience irregular periods or acne, others struggle with fatigue, mood swings, or fertility issues. Often, women are told everything is “normal” on blood tests, even when they feel far from it.

The key hormones that tend to be out of balance in PCOS include:

Insulin (linked to cravings and weight)
Androgens (like testosterone, linked to acne and hair growth)
Oestrogen and progesterone (linked to cycle issues and PMS)
Cortisol (stress hormone)
Thyroid hormones (often overlooked)

This NHS Gynaecology leaflet encourages the natural management of symptoms, through lifestyle changes. Now let’s break down the symptoms that might point to a deeper hormonal issue.

1. Irregular or Missing Periods

If your cycle is longer than 35 days, unpredictable, or completely absent, this is a key red flag. In PCOS, irregular ovulation is common, even if you’re still having bleeds. Many women are told this is “normal” or just need to go on the Pill, but cycle irregularity is a sign your hormones need attention.

2. Persistent Fatigue

Waking up tired, crashing in the afternoon, or needing caffeine to function may be signs of:

Poor blood sugar regulation (insulin resistance)
Low thyroid function
Cortisol imbalance
Low B12, iron or magnesium (common in PCOS)

Fatigue is not “just part of being a woman,” it’s a sign your body is under strain.

3. Sugar Cravings and Energy Dips After Meals

Intense cravings, feeling “hangry,” or needing to snack often can all signal insulin resistance. In PCOS, insulin is often too high, which drives weight gain, inflammation and excess androgens. Blood sugar balance is a critical first step in supporting hormone health.

4. Bloating and Digestive Discomfort

If you feel bloated every day or struggle with constipation, wind or reflux, your gut may be involved. Gut health affects oestrogen clearance, inflammation and nutrient absorption, all crucial for hormone balance. Women with PCOS often have gut issues that are missed or labelled as IBS.

5. Acne, Oily Skin, or Hair Growth (Hirsutism)

Chin or jawline skin breakouts, oily skin, or unwanted hair on the face, chest or abdomen are classic signs of high androgens. This is one of the most visible (and frustrating) hormone imbalances in PCOS. It’s not just cosmetic, it’s a clue your hormones are out of sync.

6. Hair Thinning or Hair Loss

Thinning hair, particularly around the crown or temples, can be due to excess androgens or low thyroid function. It’s also common when iron or zinc levels are low. If your hair is shedding more than usual, it’s worth investigating.

7. Trouble Losing Weight (or Gaining Without Change)

Weight gain around the middle, or difficulty losing weight despite eating well and exercising, is one of the most frustrating PCOS symptoms. It’s often driven by insulin resistance, high cortisol or underlying inflammation. Dieting harder won’t fix it, understanding your metabolism will.

8. Low Mood, Anxiety or Brain Fog

Hormones affect brain chemistry. If you feel overwhelmed, anxious, or mentally drained, it may be connected to imbalances in cortisol, oestrogen, progesterone or thyroid hormones, all common in PCOS. Blood sugar imbalances also play a role in mood swings and irritability.

9. PMS or Breast Tenderness

Painful, swollen breasts, mood swings, or spotting before your period are often linked to oestrogen dominance, a common imbalance in PCOS, especially when ovulation is irregular. Your body can’t make enough calming progesterone without ovulation, so oestrogen goes unchecked.

10. Fertility Struggles or Lack of Ovulation

If you’re trying to conceive and not ovulating regularly (or at all), it’s essential to look beyond basic fertility advice. PCOS often causes silent anovulation, meaning you might bleed but not actually release an egg. Ovulation is the foundation of hormone balance, not just for fertility but long-term health too.

When to Seek Support

You don’t need to tick every box to know something isn’t right. Many of my clients feel “off” for years before they’re given any answers. If you’re noticing several of the signs above, it’s time to stop second-guessing yourself, your symptoms are valid, and they deserve a proper investigation.

A Root Cause Approach to Hormone Imbalance in PCOS

Instead of just treating symptoms, we want to ask: Why are your hormones out of balance?

Common drivers I look for in clinic include:

Insulin resistance and blood sugar instability
Nutrient deficiencies (especially B vitamins, magnesium, iron, zinc)
Inflammation from gut issues or stress
Thyroid dysfunction
Oestrogen clearance and liver detox issues

Supporting these foundations helps your body rebalance naturally, no extreme diets or hormone replacement needed.

Wondering if your symptoms could be hormonal?

Download your free Hormone Health Snapshot to uncover the signs of imbalance and where to start.

Final Thought

Hormonal imbalances with PCOS can show up in so many ways, not just through your cycle. Whether you’re newly diagnosed or still looking for answers, know this, your symptoms are real, and there is a better way forward.

Real-Life Example: How Sarah Rebalanced Her Hormones and Got Her Energy Back

Sarah, 42, came to me feeling exhausted, foggy-headed and frustrated. She was juggling a demanding job in finance, school runs, and trying to stay on top of her health. Despite eating well and going to the gym three times a week, she’d gained weight around her middle, struggled with PMS, and hadn’t slept through the night in over a year. Her GP had run basic tests and told her everything looked "normal."

In our initial consultation, we mapped out her symptoms using my Hormone & Thyroid Symptom Checklist. It was clear that there were signs of low progesterone, blood sugar dysregulation, and likely oestrogen dominance. We discussed how her high stress load, frequent coffee intake, and irregular meal timing were impacting her cortisol curve and hormone metabolism.

Sarah decided to join my 12-week Be Balanced Programme, where we focused on realistic steps she could implement around her schedule. She started eating balanced meals every 4–5 hours with a focus on protein and fibre, reduced her caffeine intake, and swapped her HIIT workouts for strength training and regular walks. We also supported her liver and gut with targeted foods and a few key nutrients.

By week 6, Sarah reported fewer energy crashes, improved sleep, and her bloating had significantly reduced. By the end of the programme, her cycle was less erratic, she’d lost several centimetres from her waist, and most importantly she felt more like herself again.

This wasn’t about perfection. It was about making hormone-smart choices that worked with her body, not against it.