Women’s Health Beyond Hormones: The Missing Model
Listen to the companion podcast episode on The Trip Lab: #28 – Women’s Health Beyond Hormones: The Missing Model
Women’s health is often approached only through a hormonal lens. But hormones are only one part of the story. A more complete model of women’s health includes the brain, the immune system, inflammation, metabolism, the gut, stress physiology, whole-body care and lived experience. The conditions women deal with most commonly do not stay neatly in one category. They cross systems. They blur the lines between endocrine, neurologic, immune, and mind-body medicine.
For a long time, women were excluded or underrepresented in research, which created major blind spots in how women’s physiology was understood and treated. In more recent years, there has been welcome renewed attention to women’s hormones, including more nuanced conversations around menopausal hormone therapy. That is a good thing. But this is also an invitation to expand the model further.
A brief overview of women’s health hormones
Estrogen
Estrogen is not just a reproductive hormone. It influences the menstrual cycle and ovulation… but also bone health, cardiovascular health, skin, and brain function. It also affects neurotransmitter systems involved in mood, resilience, cognition, and motivation. Estrogen tends to rise in the first half of the menstrual cycle, peaks around ovulation, then changes again in the luteal phase. And notably, estrogen specifically affects serotonin receptors, which we will get more into in the next section.
Progesterone
Progesterone rises after ovulation in the luteal phase and helps prepare the body for a possible pregnancy. But it also affects the brain. Progesterone is metabolized into neuroactive compounds such as allopregnanolone, which interact with calming GABA pathways. This is one reason progesterone can feel soothing for some women and why oral micronized progesterone is often taken at night in menopause care. At the same time, some women are unusually sensitive to normal progesterone-related shifts, which is part of the PMDD story.
Testosterone
Women make testosterone too, just in lower amounts than men. It plays a role in libido, motivation, energy, strength, and vitality. When androgen signaling is excessive, it can contribute to acne, hair growth, or PCOS-type patterns. When it is low, some women notice lower drive, lower libido, or less sense of vitality.
DHEA
DHEA is an adrenal and ovarian precursor hormone that can convert downstream into estrogens and androgens. It sits at the crossroads of the adrenal system, sex hormones, and aging. It is one more reminder that women’s hormones are part of a larger endocrine web, not a single isolated pathway.
Thyroid hormones
Thyroid hormones regulate energy, metabolism, temperature, bowel function, hair, skin, and menstrual health. When thyroid function is off, women may experience fatigue, constipation, hair loss, mood changes, cycle irregularity, or fertility issues. Testing for overt hypo- or hyperthyroidism is essential, but women can also experience ‘functional’ imbalances that require more testing than just TSH alone.
Cortisol
Cortisol is not “bad.” It is essential for blood sugar regulation, inflammation, circadian rhythm, and survival. But when the stress system becomes dysregulated, it can affect sleep, ovulation, insulin sensitivity, inflammation, and mood. Stress physiology is often part of the women’s health picture, even when it is not the whole picture.
Insulin
Insulin belongs in much more than just the diabetes conversation. When insulin resistance develops (far before someone develops pre-diabetes or diabetes), it can affect ovarian function, androgen production, ovulation, and inflammatory tone.
Key neurotransmitters in women’s health
Serotonin
Serotonin is often called the “happy chemical,” but that is far too simplistic. One of its important roles is helping the brain regulate emotional intensity and keep stress in proportion. Estrogen supports serotonin activity, which is one reason many women feel more emotionally steady and resilient as estrogen rises after the period. As estrogen shifts or falls, that support can change too. This helps to explain some of the mood sensitivity seen in the luteal phase and in perimenopause.
Dopamine
Dopamine helps regulate drive, motivation, reward, interest, and mental energy. Hormonal shifts can influence how energized, focused, or engaged a woman feels, which is part of why some phases of the cycle feel more activated and others feel flatter.
GABA
GABA is the brain’s primary calming neurotransmitter. Progesterone-derived neurosteroids interact with GABA pathways, which is part of why progesterone can support sleep and calm in some women. But in women with PMDD, the issue may be less about “not enough progesterone” and more about an abnormal brain response to normal hormonal fluctuation.
Women’s health conditions beyond hormones
PMDD
PMDD or premenstrual dysphoric disorder is not just “bad PMS.” It is a severe premenstrual mood disorder characterized by severe depression and/or severe anxiety in the weeks leading up to the period. Some women may have ovulatory or hormonal patterns that contribute (low progesterone is usually what we look for), but many women with PMDD do not have dramatically abnormal hormone levels. In many women, we see that the issue is that the brain is unusually sensitive to otherwise normal hormone shifts, especially in the luteal phase. So if low progesterone is the root cause, then supporting progesterone (which in turn supports GABA signaling) is key… but often digging deeper and supporting the nervous system makes a much bigger impact.
Perimenopause
We are learning so much more about perimenopause even in the past few years. It can start many years before menopause and looks different for everyone. It is a phase characterized by hormonal unpredictability. Ovulation starts to become less consistent, progesterone can become less reliable, and estrogen does not simply decline in a straight line. Those shifts can affect mood, sleep, anxiety, cognition, and thermoregulation, which is why many women feel unlike themselves during this transition. HRT (hormone replacement therapy) is a great option for many women far before menopause starts. But we can also look deeper and work on supporting the other systems that hormones are influencing.
PCOS
PCOS, or polycystic ovarian syndrome, is actually a clinical diagnosis (meaning diagnosed by symptoms rather than specific labs) defined by a syndrome of at least 2 out of the 3 following states: 1) irregular cycles 2) signs of hyperandrogenism (acne, increased hair growth on chin, thinning hair on scalp, etc,) and 3) cysts on the ovaries (seen on imaging). Labs can help support this diagnosis, but are not necessary. The main thing I want to emphasize here is that PCOS is best thought of as a syndrome, not a rigid static diagnosis. The condition is heterogeneous and dynamic. Underneath it is often a hormonal, metabolic, and inflammatory pattern involving insulin resistance, androgen excess, disrupted ovulation, and chronic low-grade inflammation. That is why treating PCOS holistically often means addressing sleep, nutrition, movement, metabolic health, stress, and inflammatory burden, not just the menstrual cycle.
Endometriosis
Endometriosis is when there is endometrial-like tissue (endometriomas) outside the of the uterus. Commonly this tissue is in the pelvic region, but it can technically surface anywhere in the body (even in the lungs!). So how did that tissue end up in a place its not supposed to be? Estrogen stimulates the growth and survival of endometriosis lesions. The immune system does not clear that tissue as effectively as it should. Inflammatory cytokines build up in the pelvic environment. Immune cells like macrophages stay activated. Over time, that inflammatory environment can promote pain, scarring, fibrosis, and ongoing tissue irritation. Beyond that, chronic inflammation affects the whole body. Ongoing pain impacts the whole the nervous system. This broader lens helps explain why endometriosis often includes not just pelvic pain, but fatigue, bloating, bowel symptoms, infertility, and whole-body strain.
Autoimmune disease
Autoimmune disease is more common in women, and that is a clue that female physiology is immunologically distinct, not just hormonally distinct. Women tend to mount more robust immune responses, which can be protective in some contexts but may also increase vulnerability to immune dysregulation. Sex hormones, X chromosome biology, stress physiology, and environmental factors all contribute.
IBS
IBS, or irritable bowel syndrome (not to be confused with IBD, or irritable bowel disease which is a more severe autoimmune condition) is one of the best examples of medicine moving toward a more complete model. It is actually classified as a functional GI disorder, and now it is more precisely understood as a disorder of gut-brain interaction. The gut and the brain are in constant communication. Normall, the brain filters out most of the sensations that are happening in the gut (meaning those sensations stay in the background and do not reach conscious awareness). But in syndromes like IBS, that relationship between the brain and the gut is dysregulated. People become more sensitive to what is going on in there, gut motility changes, then pain gets amplified and the whole body comes into play. The reason I bring it up in the women’s health conversation is because it is far more common in women, which tells us that hormonal fluctuations and the woman body is much more dynamic than just thinking about hormones alone.
Closing thoughts
Beyond the diagnoses, lab values, and hormone charts, women’s health has always been a story of rhythm. Long before we had endocrine models, women understood their bodies as cyclical, changing, and deeply connected to nature. The menstrual cycle was never just a reproductive event. It was also an inner rhythm and embodied calendar. And there is something fascinating about the fact that the average cycle mirrors the moon more closely than the modern calendar does.
That older way of seeing women may have been symbolic, but it really tells us something important that we often forget in modern medicine. Women’s physiology really is rhythmic. Hormones rise and fall. Neurotransmitters shift in response. Mood, energy, sleep, sensitivity, and even pain can change across phases of the cycle and across the lifespan. And even in the psychedelic space, this opens interesting questions. Estrogen helps support and upregulate serotonin signaling, and serotonin receptors are part of the very system psychedelics act on. We are only beginning to understand what that might mean for the female experience of these medicines, and that conversation deserves much more attention.
And that is the invitation here: not just to treat women’s health as a set of isolated problems to solve, but to remember that the female body has always carried intelligence that is rhythmic, responsive, and deeply relational. Women are beautifully complex. And the future of women’s health may depend on building models of care spacious enough to honor not only hormones, but the full conversation between body, brain, spirit, and cycle.