How the body’s most powerful communication system became one of the least understood in women’s health
If there is one word medicine has managed to both overuse and under-explain in relation to women, it is hormones.
They are invoked to explain tears, hunger, rage, acne, exhaustion, low libido, bad sleep, brain fog, and the quiet feeling that your body is no longer entirely cooperative. And yet, for all this casual invocation, hormones remain one of the least democratically understood systems in women’s health.
They are treated as obvious and mysterious at the same time, and that contradiction has a history.
We have been misreading women’s bodies for a very long time
Women’s symptoms have rarely been taken at face value.
In ancient medical pedagogy, the uterus was imagined as a nearly sentient organ capable of wandering throughout the body, causing ailments, usually as a consequence of lack of sexual activity or childbearing. That idea, in various forms, fed centuries of thinking around “hysteria” as a uniquely female condition. Even as medicine modernised, the habit persisted: women’s suffering was often interpreted as exaggeration, emotional instability, moral weakness, or some mysterious excess of femininity, before it was treated as biology deserving precision.
Modern medicine did not fully correct this - it refined it.
For decades, women were excluded from clinical trials because hormonal cycles were considered “too variable,” and reproductive potential “too risky.” Male bodies became the default model. Female biology became the exception that had to be managed around. Even when women were eventually included, outcomes were often not analyzed by sex. It is a remarkable point to consider when one realises how many diseases, drugs, devices, and other therapies were then generalised back onto women anyway.
So when women say hormones explain everything and nothing, they are not confused.
They are inheriting a system that never fully explained them.
“Female biology was treated as too complex for clean science. Then expected to fit neatly into it.”
What hormones actually are (and why this matters)
Hormones are one of the body’s primary communication networks.
They are chemical messengers that regulate:
- energy
- mood
- sleep
- metabolism
- appetite
- immune response
- stress adaptation
- reproductive function
The hypothalamus alone helps regulate body temperature, appetite and weight, mood, sex drive, sleep, and thirst. Stress hormones interact with reproduction, metabolism, growth, and immunity. Sleep itself is not merely rest; it is one of the times the body produces hormones that help regulate growth, tissue repair, energy use, and immune function. In other words, the endocrine system does not sit in one corner of the body. It coordinates the whole thing.
And yet, most women are taught about hormones in one context: reproduction. Periods. Pregnancy. Menopause. Everything else is treated as incidental.
“Hormones are not just about reproduction. They are about how your body functions daily, quietly, constantly.”
What still surprises women about hormones
One of the most persistent blind spots is how often hormonal symptoms are narrated as personality rather than being recognised as physiology.
A fact about hormones that still surprises people, including many women, is that hormones can affect how hungry you feel, how well you sleep, how your body stores fat, how alert you are, how steady your mood is, how your immune system responds, and in some cases how much your joints, brain, or heart seem to cooperate with the rest of you. That should be obvious. It still isn’t.
Take postpartum depression.
We now understand that it is not simply “sadness,” nor is it purely hormonal. It is a biopsychosocial condition. But reproductive hormone withdrawal after childbirth is biologically significant for some women, interacting with sleep disruption, stress, and environmental factors.
And contrary to popular opinion, this is not rare, nor a preserve of Western culture or stratified by socioeconomic status. Here at home in Kenya, a 2022 meta-analysis estimated postpartum depression among lactating women at 24%, with studies in Nairobi informal settlements reporting 27.1% prevalence.
Taken together, these data raise a more serious question: how much suffering still gets flattened into “stress,” “you are just overwhelmed,” or “this is motherhood, you'll adjust” when your body is, in fact, undergoing one of the most dramatic endocrine transitions of your life?
“A woman can be sleep-deprived, unsupported, and undergoing a major endocrine shift yet only one of these gets named.”
Before endocrinology, our cultures already understood this
The language may have been different, but the understanding was not.
Across several African countries, traditional postpartum healing practice has long treated childbirth as a full-body transition requiring recovery, restoration, and communal support. The colloquial saying "it takes a village" reflects this perspective. Systematic reviews show widespread use of traditional medicine in pregnancy and postpartum care, not only for access reasons, but because these stages were understood as physiologically significant states requiring intervention.
Traditional Chinese medicine, Ayurveda, and indigenous medicine in Latin America and the South Pacific echo this systems approach, framing reproductive transitions as states that affect multiple organ systems rather than single conditions.
These systems may not have described hormones by etiology, but they reflect an integrated understanding of what we now describe through hormones.
“Long before endocrinology, many cultures understood that women’s bodies do not change in parts.”
What is obvious now, and what still isn’t
What remains unknown, or at least insufficiently incorporated into care, is not merely that hormones affect many systems. It is how seriously that fact should reorganize medicine. It is now well established that hormonal shifts affect:
- cardiovascular health
- immune function
- metabolic regulation
- mental health
- sleep
- cognition
And yet, incorporation into care remains uneven.
Cardiology is one example. Cardiovascular disease in women remains understudied, underrecognized, underdiagnosed, and undertreated, even though women often present differently and despite clear evidence that hormonal transitions (particularly menopause) alter risk profiles. If the endocrine system helps shape vascular function, metabolism, inflammation, and long-term risk, then women’s cardiovascular care cannot remain hormonally illiterate without consequence.
Autoimmune disease is another. Many autoimmune conditions disproportionately affect women, with estimates suggesting ~80% of patients are female. Endocrine transitions such as puberty, pregnancy, and menopause alter immune behaviour, yet these systems are still often treated separately in practice. The body does not.
Even in pain medicine, the consequences of hormonal illiteracy and gendered assumptions linger, with women’s pain often interpreted through social norms about emotionality and coping, rather than assessed on its own terms. When you place that beside a medical tradition that historically treated the female body as volatile and reproductive first, it becomes easier to understand why some hormonal symptoms are still minimized, psychologised, or simply endured.
While the science is advancing, the integration lags.
The gap is no longer knowledge. It is translation.
We know enough to say:
- Hormones are not a niche system
- Women’s health is not limited to reproduction
- Endocrine transitions affect multiple organ systems
- Variability is not noise; it is biology
And yet, women are still often told, “You’re hormonal.”
Which is a dismissal thinly veiled as an explanation.
“The problem is no longer that we don’t know. It’s that we haven’t translated what we know into care.”
Where this leaves us
If all of this sounds like a plea for women’s health to be taken more seriously, it is. But more precisely, it is a plea for the endocrine system to be treated as the infrastructure it is.
Hormones are not incidental to “real” medicine. They are one of the ways the body coordinates reality - timing ovulation, yes, but also modulating sleep, appetite, body temperature, immune response, mood, blood pressure, metabolism, and stress adaptation. They are part of why a woman may feel unlike herself before anyone can see why on a scan or a lab report. And they are part of why women’s health keeps overflowing the narrow categories medicine tries to place around it.
What would surprise many women, I think, is not that hormones matter. It is that they have probably been shaping far more of their lives than they were ever told.
What should surprise medicine is that we still behave as though this is niche knowledge.
It isn’t.