Hormones & mitochondria: An overlooked partnership shaping women’s health | Lucknow News
Prof Ram Shankar UpadhayayaFor decades, women’s health has been explained almost entirely through hormones. From adolescence to pregnancy, from perimenopause to aging, fluctuations in estrogen and progesterone have been treated as the primary drivers of fatigue, metabolic changes, fertility challenges, and emotional well-being. Hormonal imbalance has become the default explanation – and often the default treatment.
Yet this hormone-centric narrative explains symptoms better than it explains causes. Emerging biological science points to a deeper, often overlooked system that determines how hormones work in the body: the health of our cellular energy machinery.The missing biology beneath hormonesHormones are chemical messengers. They carry signals that regulate reproduction, metabolism, mood, immunity, and aging. But hormones do not act in isolation. For their signals to translate into biological action, cells must have the energy and metabolic flexibility to respond.This is where mitochondria play a defining role. Commonly described as the “powerhouses” of the cell, mitochondria do far more than produce energy. They regulate cellular stress responses, inflammation, metabolism, and even gene expression. Crucially, they also influence how cells interpret and respond to hormonal signals. When mitochondrial function declines, hormonal signalling becomes inefficient, even when hormone levels appear normal.In other words, hormones send instructions; mitochondria decide whether those instructions can be carried out.How this interaction changes across a woman’s lifeThe relationship between hormones and mitochondria follows a distinct biological arc across the female lifespan.In the 20s, high estrogen levels actively support mitochondrial efficiency. This biological partnership enables high energy availability, reproductive fitness, and metabolic resilience. It is one reason younger women often tolerate physiological stress better.By the 40s, mitochondrial resilience often begins to decline before major hormonal changes are clinically evident. This mismatch helps explain why many women experience fatigue, sleep disturbances, weight changes, or mood fluctuations during perimenopause even when hormone levels remain within “normal” ranges.In the 60s, declining estrogen removes a layer of mitochondrial protection. This accelerates changes in metabolism, cardiovascular risk, bone health, and cognitive function. Hormonal replacement alone cannot fully restore cellular energy systems that have already deteriorated.By the 80s, mitochondrial integrity becomes one of the strongest biological predictors of mobility, cognition, and independence. At this stage, cellular energy, rather than hormonal levels, often determines quality of life.Why this matters for womenWomen’s health carries a biological dimension that extends beyond individual well-being. Mitochondrial DNA is inherited exclusively from the mother. This means a woman’s cellular health influences not only her own aging trajectory, but also the metabolic and developmental health of future generations.This maternal inheritance underscores why mitochondrial health is particularly critical during periods of high energy demand such as adolescence, pregnancy, and midlife transitions. It also reframes reproductive health as a cellular, not purely hormonal, phenomenon.Rethinking women’s health conditionsA growing body of research links mitochondrial dysfunction to conditions that disproportionately affect women, including polycystic ovary syndrome, endometriosis, infertility, thyroid disorders, and chronic fatigue syndromes. These conditions are often managed through hormonal modulation, yet their underlying biology frequently involves impaired cellular energy metabolism, oxidative stress, and inflammation.Addressing hormones without addressing mitochondrial health is akin to adjusting a thermostat in a building with failing electrical wiring. The signal may be correct, but the system cannot respond.A more complete model of careReframing women’s health through the lens of cellular energy does not diminish the importance of hormones. Instead, it completes the picture. Hormonal therapies remain valuable tools, but their effectiveness depends on the biological capacity of cells to respond.As medical science advances, integrating mitochondrial biology into women’s health offers an opportunity to move from symptom management toward prevention and long-term resilience. This shift has implications not only for clinical practice, but also for how society understands aging, fertility, and vitality in women.The future of women’s health lies not in choosing between hormones and mitochondria, but in finally understanding how deeply they depend on each other.(The writer is a US-based medical scientist)
