Dr. Aviva Romm on Why Your “Exposome” Is the Key to Your Hormonal Health

Aviva Romm

Dr. Aviva Romm is many things: a midwife; an herbalist; a Yale-trained, board-certified physician with specialties in integrative gynecology, obstetrics, and pediatrics; a bestselling author; and the mother of four and grandmother of two. So given all of those titles, it’s probably not a huge shock that she’s the first WellBe expert we’ve invited back to talk about a different topic! Last year, we spoke with Dr. Romm about thyroid health, and now she’s returned to talk about a related but different (and much bigger!) topic: your hormones. On the heels of publishing her newest book, Hormone Intelligence, Dr. Romm sat down to talk about everything hormones, including signs of hormonal imbalance in women, how something called your exposome could lead to hormonal irregularities, how to balance your hormones, and much more.

*This is a short clip from our interview with Dr. Aviva Romm. Click here to watch the whole thing!*

You can also listen to Adrienne’s interview with Dr. Aviva Romm on The WellBe Podcast.

Signs of Hormonal Imbalance in Women

One of the main messages of Dr. Romm’s latest book is that there is a line between normal and not normal when it comes to female hormone-related symptoms. Many women spend their lives dealing with debilitating menstrual cycles or something else hormone-related, and just chalk it up to part of being a woman. According to Dr. Romm, this resignation is an unfortunate result of conventional medicine’s attitude toward many female issues, and it’s something we need to push back against.

“Being a woman is not a diagnosis,” says Romm. “We as a culture, from medical doctors to our mothers to ourselves, we’re taught to think ‘Oh well that must be normal.’ But it’s not normal.” To combat this, Dr. Romm lays out in her book exactly what is normal and healthy, as well as the signs of hormonal imbalance in women, providing a frame of reference for readers. She wants women to be able to find where they are in the spectrum of what’s normal, and then, if they fall outside of normal symptoms, begin to get to the root of their problems. “You shouldn’t have to live with abnormal symptoms,” says Dr. Romm. “There are reasons and there are solutions.”

Hormones play countless different roles in the functioning of our body, so identifying hormonal imbalance can be tricky. However, there is a set of well-established signs of hormonal imbalance in women that can be very helpful in identifying hormonal irregularities. 

Signs of Hormonal Imbalance in Women:

  • Abnormally heavy periods
  • Cramps so severe that you’re doubled over in pain
  • Fertility challenges/infertility (including not ovulating) 
  • Breast pain around menstruation
  • Menstrual migraines
  • Irregular or missing menstrual cycles
  • Hair on your chin
  • Hair loss
  • Binge eating 

While many people immediately turn to lab tests when they suspect something might be off in their body, Dr. Romm says that you can generally get all the information you need just through observation. “By actually paying attention to the wisdom that our body offers, and then comparing it to information that you can find in my book, or on the internet, or any number of places,” she says. “We often say, ‘If it walks like a duck, and it quacks like a duck, it’s probably a duck.’” 

Because many signs of hormonal imbalance in women can be clearly identified and mapped to a certain hormonal irregularity, Dr. Romm often advocates for common sense over lab tests. However, she notes that there are some hormonal conditions that are more difficult to detect, in which case a lab test could help provide a diagnosis sooner. As an example, she cites the shocking statistic that it takes the average woman 9.3 years of visiting doctors to finally get an endometriosis diagnosis. With the symptom checklist in her book, she hopes to equip women with the information they need to demand specific tests that can deliver a diagnosis as soon as possible.  

Many of the signs of hormonal balance outlined above have to do with specific hormonal irregularities — like, say, too much estrogen or too little progesterone or something like that — while others are the result of specific conditions, like PCOS, fibroids, or endometriosis, which also have hormonal irregularities behind them. No matter the diagnosis (or lack thereof), Dr. Romm’s goal for every woman is to get to the root cause behind their symptoms and map a course of treatment from there. While she believes that things like the pill can provide some helpful temporary relief for certain conditions, she knows that simply putting a Band-Aid on the issue won’t address the actual hormonal irregularities, and this can lead to more issues down the road.

Exposome Medicine: The Key to Hormonal Health?

In Dr. Romm’s 37 years of working with women and passionately searching for the real underlying factors behind hormonal irregularities, she was led to something called exposome medicine. While it may sound foreign to most of us, it’s actually an incredibly simple concept. 

Dr. Romm explains that your exposome is simply all of the things you’re exposed to — similar to how your microbiome is simply all of your microbes. The idea rose out of environmental medicine

Exposome medicine arose out of environmental medicine and toxicology, and today it is firmly established as a non-fringe discipline, with centers for exposome studies at many respected institutions, including Mt. Sinai and Columbia University. However, that wasn’t always the case. Conventional medicine dismissed the idea of endocrine disruptors and other toxins for decades, something that Dr. Romm experienced firsthand. 

“When I applied to do an OB/GYN residency at my medical school alma mater, I was interviewed by a gentleman who, when he saw my application said, ‘I see that you’re interested in studying endocrine disruptors. You don’t really believe that BPA crap do you?’” remembers Dr. Romm. “And I said, “Thank you, yes, I do. And I don’t think I’m gonna be choosing to go to school here for my residency!” Interestingly, just ten years later at that same university, Dr. Hugh Taylor blew open the real truth around BPAs and other endocrine disruptors, and is now the head of obstetrics at Yale. 

Indeed, endocrine disruptors are a huge contributor to hormonal irregularities, but there are many other elements of a person’s exposome. To illustrate the idea of an exposome, Dr. Romm explains that we all have an internal set of ecosystems: our gut, our mental health, our genetics, etc. The exposome is the totality of all of our external ecosystems, or anything that our bodies are exposed to: everything from the food you put inside your body to the air you breathe to the products you put on your skin to the stress your lifestyle creates to the medicine you take and so on. 

Dr. Romm’s work and her most recent book pull from the idea of exposome medicine to understand which exposures affect women’s hormonal health across the board. Exposome medicine makes it possible to pinpoint exactly which environmental factors play a role in hormonal irregularities, though she notes that the effect these environmental factors have may vary from woman to woman. “Depending on who you are, they show up differently,” she says. “For you they might show up as endometriosis. For me they might show up as PCOS. For the next person they might show up as a fertility problem.” 

How to Balance Your Hormones Naturally 

If you Google how to balance your hormones, you’ll find tons of tips and tricks on things you can do or not do to reduce hormonal irregularities. While some of these things might be effective, Dr. Romm’s expert opinion is that it’s actually simpler than that. It all boils down to the idea of the exposome, and to this concept of being “overburdened and undernourished.” Certainly, there are very specific things people can do when they’re dealing with very specific hormone-related conditions, but for most women dealing with hormonal irregularities, the advice Dr. Romm gives is similar. 

“The way I think about women’s health, or health in general, boils down to these two questions: what am I getting too much of that’s putting a burden on my body? In this case, environmental toxin exposures,” explains Dr. Romm. “Then, what am I not getting enough of that my body really needs to optimize whatever the pathway is.” To restore hormonal balance for most women, she says, all it takes is this two-pronged approach of reducing your burden and nourishing your body properly. Let’s look at each of these a bit more closely. 

Overburdened: reducing the toxins coming in. Dr. Romm explains that there are over 80,000 environmental toxins currently used in the United States, most of which have not been approved by the FDA or EPA. The vast majority of them were grandfathered in, and have never been tested on pregnant women, or women’s reproductive or hormonal health. “They’re really out there,” says Dr. Romm. “We’re really getting exposed to them, in our air, our water, our soil, our food, and our homes.” This sounds scary, but the good news is that if you take steps to cut out your exposure to these toxins, it makes a big difference. 

She points to phthalates as just one example. Phthalates, which are known to disrupt the hormonal system, are frequently used in conventional products, often to provide fragrance in things like car air fresheners. Dr. Romm points to one study that showed that just by cutting out products with phthalates — including sunscreen and other personal care products — for three days, a group of teenagers showed a dramatic drop in their blood levels of phthalates. 

In terms of taking practical steps to reduce your burden, Dr. Romm recommends starting with the things that will have the biggest impact. “If you have to pick and choose, do the things that you put all over your body: your soap, your shampoo, which gets all over your body when you’re washing your hair,” she says. “Your body lotion, your foundation, your lipstick. Also, think about household cleaners: anything that you can really kind of uplevel in terms of being ecologically friendly can make a huge, huge difference in your life.” For a comprehensive list of over 1,500 curated and fully vetted non-toxic products that won’t disrupt your hormones, check out the WellBe Non-Toxic Product Database

She also specifically points to stress as an important factor in your exposome. “We’ve all had some kind of stress happen in our life, and we skip a period, or we have an irregular period, something happens,” she says, drawing a direct line between stress and hormonal irregularities. She explains that this happens because there are so many connections between the stress hormone, cortisol, and other hormones in our body, that stress can’t help but have an impact. Practicing mindfulness or meditation, getting enough sleep, and managing stressful things in your life can all be helpful. 

Undernourished: supporting your body’s natural processes through diet. In order for your body to maintain its optimal hormonal balance, it needs to be able to get rid of excess hormones and other compounds through your detoxification pathways. Our bodies naturally know how to process and eliminate the things it doesn’t need through the process of metabolic detoxification, but for many people living in the modern world, those pathways need some support. This is not only because of the excessive amount of toxins our bodies now need to process, but also because many of us aren’t eating enough of the nutrients our detoxification pathways need to function at their best. “Most people aren’t getting enough of those nutrients in their diet to keep up with adequate detoxification that they need on a daily basis, let alone in this excess,” says Dr. Romm. 

The nutrients and micronutrients that our bodies need to detox optimally include zinc, vitamin C, magnesium, B complex, N-acetylcysteine, and glutathione. Our bodies also need various sulfur compounds that come from garlic and onions, as well as lots of fiber. Dr. Romm explains that our Paleolithic ancestors ate around 100 grams of fiber each day, and that the American Cancer Society recommends at least 30 grams a day — meanwhile, the average American eats just 10 to 15 grams each day. Fiber, says Dr. Romm, is “hugely important for hormone health, and feeding the microbiome, and keeping estrogen levels in balance.

While a lot of the nutrients your detoxification pathways need can be found through food, that’s not usually the case. “What our bodies need, up until about 70 or 80 years ago, we were getting it from our food and our lifestyles, and we’re just not now,” says Romm. For this reason, she’ll often recommend a multivitamin that can check all those micronutrient boxes without you having to worry about it too much (though you should of course still strive to eat a varied, whole-foods-based diet!). For people who have more severe hormonal irregularities going on and really need to rev up their detoxification pathways, she’ll also recommend additional herbal supplements — such as curcumin, dandelion, or milk thistle — that provide specific detoxification support. 

The WellBe Takeaway on Female Hormonal Health 

Our hormones are incredibly important for our well-being, but they’re part of such a huge and complex system that understanding your own hormonal health can feel overwhelming. Here are the concrete things you need to know about female hormonal health:

  • There is a spectrum of what’s normal and what’s not normal when it comes to female hormonal symptoms. While a certain amount of changes are expected throughout your cycle, there are symptoms that are abnormal and could signify a hormonal imbalance. Understanding what’s outside the spectrum of normal (such as cramps so severe you can’t stand up; fertility issues; menstrual migraines; and more) can empower women to identify and treat the root cause of their symptoms. 
  • Many hormonal imbalances don’t require a test. Dr. Romm recommends simply comparing your symptoms against the available research (either from a book like hers, or online) to pinpoint which hormones might be out of whack. For certain conditions, such as endometriosis or fibroids, a test is necessary for a diagnosis, but doing your own symptom-based research first can equip you with the knowledge you need to request the right test.
  • One of the biggest contributing factors to hormonal health is your exposome, or the totality of all the things you’re exposed to. Exposome medicine looks at how external exposures (such as environmental toxins, the products you use, the food you eat, etc) contribute to your health, and research suggests that a person’s exposome can have a significant impact on their hormonal health. This is mostly because our modern environment is filled with thousands of toxins that we encounter on a daily basis, many of which are endocrine disrupting. Be sure to check out the WellBe Non-toxic Product Database for over 1500 curated, fully vetted and rated products (with links) to make it fast and easy to find things that won’t disrupt your hormones in over 20 categories.
  • To reverse hormonal imbalances, Dr. Romm recommends a two-pronged approach: first, reduce your burden by making your exposome as clean as possible; and second, support your body’s natural detoxification pathways by eating a healthful diet and taking supplements to ensure that your body has all of the micronutrients it needs to properly eliminate toxins and excess hormones. 
  • In terms of reducing your burden, Dr. Romm suggests starting with the things that will make the biggest difference first, including things like soap, shampoo, makeup, and household cleaning products. In terms of nutrition, make sure to get plenty of vitamin C, zinc, magnesium, B-complex, and antioxidants like N-acetylcysteine and glutathione, as well as plenty of fiber. Try to get as much as you can through diet, though a multivitamin can ensure that you’re not missing any micronutrients. Those who need extra detox support may consider a herbal supplement, like dandelion, curcumin, or milk thistle.

Have you experienced hormonal irregularities? What were your symptoms, and how did you heal them? Share your experience in the comments below!

Watch the full interview with Dr. Aviva Romm to hear what she thinks are the biggest misconceptions about hormones, the impact that culture has on how women respond to hormone fluctuations, why women’s menstrual health is now considered the “sixth vital sign,” what she thinks the value and limitations of at-home hormone testing kits are, how quizzes on wellness sites could be harming women’s health, the problem of over pathologizing in functional medicine, her thoughts on soy, what causes man boobs, and more.

You can also listen to Adrienne’s interview with Dr. Aviva Romm on The WellBe Podcast.

The information contained in this article comes from our interview with Dr. Aviva Romm, MD. Her qualifications and training include graduating from the Yale School of Medicine, and a residency in Family Medicine with Obstetrics at the Tufts Family Medicine Residency. She is also a midwife and herbalist. You can learn more about her here.


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  2. Harley, K. et al. “Reducing Phthalate, Paraben, and Phenol Exposure from Personal Care Products in Adolescent Girls: Findings from the HERMOSA Intervention Study.” Children’s Health Vol. 124 No. 10. October 2016.
  3. Eaton SB. The ancestral human diet: what was it and should it be a paradigm for contemporary nutrition? Proc Nutr Soc. 2006 Feb;65(1):1-6. doi: 10.1079/pns2005471. PMID: 16441938.
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