9 Signs of Hormone Balance with PCOS and Endometriosis

_{This blog post about hormone balance for PCOS and endometriosis uses PMOS terminology, which stands for polyendocrine metabolic ovarian syndrome (formerly known as polycystic ovary syndrome – PCOS).}

This post covers 9 signs of hormone balance to look with PCOS (now PMOS) and endometriosis and how to recognise them.

If you have PCOS/PMOS, endometriosis, or both, you may be wondering: what does feeling hormonally balanced actually feel like? There was a time when I thought “hormone balance with PCOS/PMOS and endometriosis” meant my hormones were either balanced or they weren’t. Simple, right?

Somewhere out there, apparently, was a magical hormonal sweet spot. Find it, and suddenly I’d wake up full of energy, my skin would clear, my period would become effortlessly predictable, and I’d stop thinking about food at 4 p.m. Naturally, the internet had plenty of solutions. Take this supplement. Stop eating that. Drink this tea. Balance your cortisol. “Detox” your estrogen. Do a certain workout. Don’t do a certain workout.

At some point, you’ve probably started wondering whether balancing your hormones was actually a full-time job. But if you have PCOS/PMOS or endometriosis, there is a more useful question you can ask: What does hormone balance actually feel like? And perhaps even more importantly: How do I know when I feel better?

So, if you’re wondering what balanced hormones might feel like with PCOS/PMOS or endometriosis, here are nine things you need to pay attention to.

What is hormone balance with PCOS and endometriosis?

When we talk about hormone balance, we’re not talking about every hormone being at one perfect level. Hormones naturally rise and fall throughout the menstrual cycle and change throughout life. In everyday language, “hormonal imbalance” usually means that something about your hormonal function or symptoms doesn’t seem to be working as it normally does. But it’s not a diagnosis on its own. Fatigue, acne, irregular periods, mood changes, appetite changes, and sleep problems can have many different causes.

With PCOS/PMOS, hormonal changes can include higher androgen levels and irregular ovulation, while metabolic factors such as insulin resistance can also play a role. With endometriosis, the condition is hormone-responsive, but it isn’t simply a case of having “too much estrogen.” These are different conditions, and neither can be reduced to one “bad” hormone.

9 signs of hormone balance with PCOS and endometriosis

1. You wake up with more energy

Let’s start with the dream. You wake up and actually feel awake. Not “I have technically opened my eyes” awake. I mean, you don’t immediately start calculating how much longer you could stay in bed.

Truth is, when you’re feeling better, you may notice that you have more energy throughout the day and that everyday things don’t feel quite so exhausting. But here’s where I would resist blaming everything on hormones. Fatigue can be connected to poor sleep, pain, stress, mental health, and other health conditions. Research also shows that if you have PCOS/PMOS, sleep deserves particular attention because sleep disorders, including obstructive sleep apnea, are more common in people with PCOS/PMOS. Current PCOS guidance recommends considering sleep symptoms as part of care.

Sleep is also important if you have endometriosis. Pain and other endometriosis symptoms can interfere with sleep, while poor sleep may make pain, fatigue and overall quality of life harder to manage. And let’s be honest: getting better sleep is easier said than done. I experience sleep disturbances too, and I’m still figuring out what works for me and how to manage them.

So, what can you actually do? Before you go and buy every known “energy” supplement, ask yourself: Am I actually sleeping well? Am I waking during the night? Do I wake feeling refreshed? Am I exhausted despite getting what seems like enough sleep? If the answer is consistently no, that’s something worth investigating rather than simply accepting that you’re “hormonal.”

2. More predictable digestion

There is something deeply satisfying about digestion becoming boring. This becomes particularly interesting with endometriosis. Gastrointestinal symptoms can occur with endometriosis, and some people (myself included, unfortunately) notice that bowel symptoms become worse around their period.

I already write about gut health and endometriosis, and probably will in the future, because if I’m being completely honest, I didn’t think (or care) about gut health’s influence on endometriosis. Jokes on me, because as it turns out, there is probably an even bigger link than research thought. But let’s get back to today’s post.

You eat. You digest. You have a comfortable bowel movement. The end. Sounds great, doesn’t it? For some people, that means going every morning. But maybe your normal pattern is different. The goal isn’t to achieve some magical number of bowel movements to prove that your hormones are balanced. I would say, if you have regular bowel movements with zero discomfort and bloating, then you’re good to go.

If you have, as I like to call it, bowel disturbances, one possible piece of the puzzle may be your hormonal health. Hormones can influence gut movement, fluid balance and how quickly food moves through the digestive system, which is one reason digestion can change throughout the menstrual cycle. Estrogen and progesterone, for example, can affect bowel habits and contribute to changes such as constipation, looser stools or bloating.

What can you actually do if you have PCOS/PMOS and/or endometriosis and difficult bowel movements? Instead of immediately deciding that your digestion means your estrogen is “too high,” look for patterns. Does bloating happen at a particular time in your cycle? Does bowel pain appear around your period? Is constipation or diarrhoea new? Is it getting worse? That information can be much more useful than trying to diagnose your hormones from your bathroom habits. And if you notice any difference, don’t hesitate to contact your doctor, who can evaluate further.

3. Your skin looks clearer (or at least calmer)

If you’ve ever had hormonal acne or other skin condition, like my rosacea, you know that skin can become a daily reminder that something feels different. One minute you’re probably happily buying skincare. The next, you’re conducting a small dermatological investigation in your bathroom. I had acne till I was 23 years old, and everything I did didn’t help. Later, I was also diagnosed with rosacea, chronic inflammatory skin condition, which flared almost every month before my period. What helped my skin was the diet change (a lot less refined sugar) and better skincare (more natural products, without parfumes).

Because with PCOS/PMOS, higher androgen levels or androgen activity can be associated with acne, increased facial or body hair, and scalp hair thinning. So if your skin becomes clearer or calmer, you may feel like something has improved. But clearer skin doesn’t prove that my hormones are balanced. Skin can be influenced by hormones, genetics, stress, medications, and skincare, among other things.

Endometriosis can affect skin as well, but that’s a whole other conversation. It suggests that because of the inflammation, which goes hand in hand with endo, your skin can have breakouts.

So, is there anything you actually do? Change your diet (aka find your trigger food), improve your skincare, buy more natural makeup, and use sunscreen. But also look at the bigger picture. If your acne has appeared alongside irregular periods, new facial hair, or scalp hair thinning, that’s a pattern worth mentioning to a healthcare professional.

4. You’re sleeping better

Sometimes I think sleep is the least glamorous and most important part of this entire conversation. Because I bet when you sleep well, suddenly everything else feels a little easier. Your mood is steadier. Your concentration improves. Your appetite feels more predictable. You have more energy. Or you become significantly less dramatic about answering emails. And if you have PCOS/PMOS, good sleep is particularly worth paying attention to because sleep problems are more common in PCOS/PMOS.

What can you actually do? Instead of asking only, “How do I balance my hormones?”, I’d also ask: “How can I improve my sleep?” A consistent sleep routine, enough time for sleep, and addressing persistent sleep problems may be much more useful than chasing another hormone-balancing trend. Try cutting down on blue light before you go to bed, keep your bedroom not too warm, don’t drink coffee, heavy meals, or alcohol right before bedtime, and reduce usage of electronic devices.

5. Your mind feels clearer and more focused with more hormone balance with PCOS and endometriosis

You know that feeling when your brain has seventeen tabs open, and none of them are loading? That. When I’m feeling better, I may notice that my concentration is easier. How to know if you’re losing that really annoying brain fog? You can focus on a task. You remember why you walked into the kitchen. You don’t need quite so much effort to get through ordinary things. But again, you can’t automatically label brain fog as a hormone imbalance. Poor sleep, stress, pain, anxiety, depression, medications, and other health issues can all affect concentration.

What can you actually do? Track the pattern. Does brain fog happen after a bad night’s sleep? During your period? When your pain is worse? During particularly stressful weeks? The goal isn’t to prove that hormones are responsible. The goal is to understand what is happening. I also started doing crosswords, sudoku, reading more (if that’s even possible), and I play board games for logic and thinking to improve my cognitive function.

6. Your mood feels more stable

Okay, this was one of the first things I noticed when I stopped taking my birth control pills and stared to woking on my hormonal balance. I wasn’t such a bi*** anymore. And I’m not looking for permanent happiness. That sounds exhausting. I started to feel more like myself. Maybe being less irritable. Maybe feeling less emotionally overwhelmed.

Maybe your mood doesn’t seem to change dramatically for days at a time. Mental well-being is particularly important in PCOS/PMOS. Anxiety and depression are more common among people with PCOS/PMOS (and also endometriosis, for that matter), and current guidelines recommend screening for both.

So if your mood has changed significantly, you don’t want to dismiss it with: “It’s just my hormones.” Maybe hormones are part of the picture. Maybe something else is. Either way, you deserve support.

What can you actually do? Notice whether mood changes follow my cycle, poor sleep, pain, or periods of stress. And if low mood or anxiety is persistent or affecting everyday life, you need to talk to a healthcare professional. “It’s hormonal” shouldn’t mean “You have to put up with it.”

7. Your appetite feels more balanced

This was the second thing I noticed – I had a lot less sugar craving. But a balanced appetite doesn’t mean I never feel hungry. Please. I’m not interested in creating another reason for women to be afraid of food. For me, a more balanced appetite means that hunger and fullness feel easier to understand. I’m eating regularly, I’m enjoying food, and I’m not spending my entire day wondering whether the last thing I ate has somehow “ruined my hormones.”

Metabolic health is an important part of PCOS/PMOS, but there isn’t one special diet that is universally best for everyone with PCOS/PMOS. Current international guidance recommends sustainable healthy eating that can be adapted to individual preferences and needs. The same goes for endometriosis. I know there’s a lot of different dietary advice on how to manage your endo symptoms, but in reality, what can be useful for some can be harmful (or not necessary) for others.

What can you actually do? You can make food simpler, not more complicated. Regular, nourishing meals. Foods you enjoy. Enough variety. A way of eating you can actually maintain. You don’t need a perfect “PCOS/PMOS or endo diet.” You need something that supports your health without taking over your life.

8. Your libido feels like yours again

Let’s talk about the subject everyone seems to forget. Libido. If your sex drive has disappeared, it’s tempting to assume that your hormones are broken. But desire is influenced by so many things: sleep, stress, relationships, mental health, medications, hormones, and physical comfort. And if you have endometriosis, pain during sex can understandably affect intimacy and desire. Endometriosis can cause pelvic pain, painful periods, and painful intercourse, among other symptoms.

What can you actually do? Track your patterns (I know, you hoped for a magical solution, but there isn’t one). Are you exhausted? Are you stressed? Are you in pain? Do you feel comfortable in your body? Have your medications changed? Sometimes improving libido isn’t about adding something. Sometimes it’s about finding and addressing what’s making intimacy difficult.

9. Your periods feel easier

And then there’s the monthly report card. Your period. “Easier” doesn’t necessarily mean perfectly regular, completely painless, or identical every month. Maybe your cycle is more predictable. Maybe your bleeding is less disruptive (oh, I wish). Maybe your pain is more manageable. Maybe you don’t have to reorganise your entire life around the first two days of your period.

With PCOS/PMOS, irregular or absent periods can occur because ovulation isn’t happening regularly. With endometriosis, painful periods are a common symptom, and symptoms can be severe enough to interfere with daily life. So if your periods are unusually painful, increasingly painful, or interfering with your life, you don’t want to simply call it a “hormone imbalance.” You want to understand why.

And if your periods are very irregular or absent, you want to understand that too. But remember, your cycle is information. It’s not a diagnosis.

What if you don’t have hormone balance with PCOS and endometriosis yet?

This is probably the part you would have wanted to read first. Because maybe you’re reading this list and thinking: Well… none of this sounds like me. I’m exhausted. My skin is unpredictable. My sleep is terrible. My period is either missing or completely ruining my week. My digestion is all over the place.

So what now? First: You don’t need to fix everything at once. I’d choose the symptom that is affecting your life the most. If it’s fatigue, start there. If it’s painful periods, start there. If it’s irregular cycles, start there. If it’s sleep, start there. Then you can start looking for patterns. For a couple of cycles, you might track your period, pain, sleep, energy, digestion, skin, mood, and appetite.

Not obsessively. Just enough to answer: What changed? When does it happen? How long has it been happening? Is it getting better or worse? And if something is persistent, severe, or interfering with everyday life, you take that information to a healthcare professional and start looking for answers.

And if you have both PCOS and endometriosis?

First, congrats (I wrote this in a very sarcastic voice; I hope you read it in one too). This is where I especially want to avoid putting everything into one giant “hormonal imbalance” box.

PCOS/PMOS and endometriosis are different conditions, although they can occur in the same person and some symptoms overlap. Research has documented co-occurrence of the two conditions, although estimates vary depending on the population studied. PCOS/PMOS can involve irregular ovulation, androgen-related symptoms, and metabolic changes. Endometriosis can involve pelvic pain, painful periods, painful intercourse, and gastrointestinal or urinary symptoms. So if you have both, you may need to think about different symptoms in different ways.

Maybe irregular cycles are part of your PCOS/PMOS. Maybe severe pelvic pain is related to endometriosis. Maybe you’re dealing with both. That doesn’t mean your body is failing. It means you may need a more individual approach.

What you don’t need to do for hormone balance with PCOS and endometriosis

You don’t need to buy twelve supplements because a woman on social media told you your hormones are “crying for help.” You don’t need to follow a perfect hormone-balancing diet. You don’t need to eliminate every food you enjoy. You don’t need to punish yourself with exercise. And you don’t need to measure your health entirely by your weight.

For PCOS/PMOS, evidence-based guidance supports sustainable healthy eating and physical activity, but it does not identify one diet or exercise routine as universally superior. The focus is on sustainable health behaviours and individual needs. That, honestly, is quite freeing. You don’t need to become a completely different woman to support my health. You need to understand my body and find things you can actually live with. Same goes for endometriosis, but research is even more limited than for PCOS/PMOS.

FAQ about hormone balance with PCOS and endometriosis

What does hormone balance feel like with PCOS/PMOS and endometriosis? It can look like more stable energy and mood, better sleep, clearer skin, more predictable digestion and appetite, a healthy libido, and easier periods. These are signs you may be feeling better overall—not proof that your hormones are “balanced.”

What are the signs of hormone imbalance with PCOS/PMOS? Irregular periods, acne, increased facial or body hair, scalp hair thinning, and metabolic changes can occur with PCOS/PMOS. However, symptoms alone can’t diagnose a hormone imbalance.

Can hormones affect digestion? Yes. Hormones can influence gut movement, which is why digestion and bowel habits can change throughout the menstrual cycle.

How can I support hormone health with PCOS/PMOS? Focus on sustainable habits: nourishing food, regular movement, good sleep, and looking after your mental and metabolic health. There isn’t one “perfect” hormone-balancing diet or supplement.

When should I seek professional help? If symptoms are persistent, worsening, or interfering with your daily life, especially significant pelvic pain, very painful or irregular periods, or ongoing fatigue, it’s worth speaking with a healthcare professional.

Final thoughts before you go

Maybe “hormone balance with PCOS/PMOS and endometriosis” isn’t about perfect numbers. Maybe it’s not even something I can prove by ticking nine boxes. Because waking up with more energy doesn’t prove your hormones are balanced. Neither does clearer skin. Or a daily bowel movement. Or better sleep. Or a stable mood. Or a healthy libido. These are simply things you may notice when you’re feeling better overall. And that’s the part you don’t want to lose sight of.

If you have PCOS or endometriosis, you don’t need to spend your life chasing the perfect hormonal state. You need to understand your own patterns. You need to notice when something changes. You need to take persistent pain and other disruptive symptoms seriously. Because what you really want isn’t a perfect hormone chart. It’s waking up more energized, sleeping well, clearer skin, more regular digestion, a clear and focused mind, stable mood and appetite that feel more manageable. Just understanding your body well enough to notice when something isn’t right and knowing what to do next.

How do you track your hormonal balance with PCOS and endometriosis? Do you have any tricks? Let me know in the comments.