What are the symptoms of high and low levels of estrogen, progesterone, Follicle-Stimulating Hormone (FSH), and Luteinizing Hormone (LH) during the menstrual cycle?

From the Guidelines

Hormone fluctuations during the menstrual cycle produce distinct symptoms when levels are high or low, with high estrogen causing breast tenderness, water retention, headaches, and improved mood and energy, while low estrogen leads to hot flashes, night sweats, vaginal dryness, and mood changes 1.

Symptoms of Hormonal Imbalances

The symptoms of high and low levels of estrogen, progesterone, FSH, and LH during the menstrual cycle are as follows:

• High estrogen: breast tenderness, water retention, headaches, improved mood and energy 1
• Low estrogen: hot flashes, night sweats, vaginal dryness, mood changes 1
• High progesterone: breast tenderness, bloating, fatigue, mood changes
• Low progesterone: irregular or heavy periods, spotting, anxiety, insomnia
• Elevated FSH: indicates ovarian function decline, not typically symptomatic
• Low FSH: disrupts follicle development and ovulation
• High LH: triggers ovulation, possible mild pelvic pain
• Low LH: may prevent ovulation altogether

Hormonal Balance and Menstrual Cycle

These hormones work together in a delicate balance throughout the cycle, with estrogen dominating the follicular phase, peaking before ovulation when LH surges, followed by progesterone dominance in the luteal phase 1. Understanding these patterns helps explain common symptoms like PMS before menstruation when progesterone drops, and why hormonal imbalances can cause irregular cycles, fertility issues, and various physical and emotional symptoms.

Key Findings

A study published in 2021 found that hormonal therapy is effective for menopausal symptoms and prevention of bone loss and fractures, and that estrogen has benefits on metabolic health, including inhibition of hepatic stellate cell activity and fibrogenesis 1. Another study published in 2002 found that PCOS is a common cause of irregular periods in women, and that abnormalities of the reproductive axis are manifested as hypersecretion of luteinising hormone, ovarian theca stromal cell hyperactivity, and hypofunction of the follicle stimulating hormone (FSH)–granulosa cell axis resulting in hyperandrogenism, hirsutism, follicular arrest, and ovarian acyclicity 1.

From the Research

Hormone Levels and Symptoms

The symptoms of high and low levels of estrogen, progesterone, Follicle-Stimulating Hormone (FSH), and Luteinizing Hormone (LH) during the menstrual cycle are as follows:

• High estrogen levels:
  • Symptoms include breast tenderness, mood swings, and heavy or irregular menstrual bleeding 2
  • Occur during the follicular phase of the menstrual cycle, with peak levels just before ovulation
• Low estrogen levels:
  • Symptoms include hot flashes, night sweats, and vaginal dryness 3
  • Occur during the luteal phase of the menstrual cycle, with low levels after menopause
• High progesterone levels:
  • Symptoms include drowsiness, breast tenderness, and bloating 4
  • Occur during the luteal phase of the menstrual cycle, with peak levels after ovulation
• Low progesterone levels:
  • Symptoms include irregular menstrual bleeding, infertility, and recurrent miscarriage 4
  • Occur during the follicular phase of the menstrual cycle, with low levels in women with corpus luteum insufficiency
• High FSH levels:
  • Symptoms include hot flashes, night sweats, and vaginal dryness 2, 3
  • Occur during the perimenopausal period, with high levels indicating declining ovarian function
• Low FSH levels:
  • Symptoms include irregular menstrual bleeding, infertility, and polycystic ovary syndrome (PCOS) 5
  • Occur during the reproductive years, with low levels indicating normal ovarian function
• High LH levels:
  • Symptoms include infertility, PCOS, and irregular menstrual bleeding 2, 3
  • Occur during the perimenopausal period, with high levels indicating declining ovarian function
• Low LH levels:
  • Symptoms include infertility, irregular menstrual bleeding, and hypogonadism 5
  • Occur during the reproductive years, with low levels indicating normal ovarian function

Menstrual Cycle Phases

The menstrual cycle is divided into two main phases: the follicular phase and the luteal phase.

• Follicular phase:
  • Characterized by increasing estrogen levels and follicular growth 6
  • Lasts from Day 1 of menstruation to ovulation (around Day 14)
• Luteal phase:
  • Characterized by increasing progesterone levels and corpus luteum formation 4
  • Lasts from ovulation to the start of menstruation (around Day 28)

Hormonal Changes Throughout Reproductive Life

Hormonal changes occur throughout a woman's reproductive life, with significant changes occurring during the perimenopausal period.

• Perimenopausal period:
  • Characterized by declining ovarian function, increasing FSH and LH levels, and decreasing estrogen and progesterone levels 2, 3
  • Lasts for several years before menopause, with significant hormonal fluctuations
• Menopausal period:
  • Characterized by low estrogen and progesterone levels, and high FSH and LH levels 2, 3
  • Marks the end of a woman's reproductive life, with significant hormonal changes occurring after menopause