Asking about your family history is an important aspect of holistic medicine consultations, especially when working with hormones and fertility. Sometimes this is the golden piece of information sitting beneath a woman’s hormone picture.

Your menstrual cycle will not always mirror your mother’s and the fact your grandmother had a hysterectomy does not mean you are heading down that same path, but their cycle trends help us to understand the hormonal, metabolic, immunological and inflammatory “terrain” a woman may have inherited, and then we look at how those patterns may be expressing in her body now.

Family history is especially relevant in female hormone cases because so many of the conditions we see clinically are not caused by one single factor. For example, PMOS/PCOS may be stress driven, or in a family with diabetes and obesity it may be more about a person’s inherited metabolic health. Similarly in complex hormonal presentations such as endometriosis, we can see a range of different drivers, from stress and trauma to poor liver and gut health, to immune dysfunction. Each driver is markedly different to the next, which means treatment options can also look vastly different. Once we find out the drivers of such a condition, we learn so much more about how best to help a person. 

PMOS, endometriosis, fibroids, adenomyosis, heavy or painful menstrual bleeding, early menopause, fertility challenges and perimenopausal symptoms are usually influenced by a mixture of genetics (what you are born with), epigenetics (how the way you live influences the genes you are born with), insulin signalling, inflammation, oestrogen metabolism, ovarian function, immune activity, gut health, stress and environmental exposure.

When I ask about your family history, I’m looking for patterns that can guide me to what might be influencing your own hormonal symptoms. If you are able, having these conversations with mothers, grandmothers, sisters and even aunties is invaluable. Some questions you may ask the women in your life (if relevant or appropriate to do so):

• What age were you when you got your period?
• What was your menstrual cycle like as a teenager?
• Were your cycles regular?
• Were your cycles painful?
• Did you get acne?
• How did you feel during pregnancy?
• Did you have trouble conceiving?
• Did you have any miscarriages?
• Did you ever have migraines?
• Why did you have a hysterectomy? What age?
• Did you ever use the pill / Mirena / IUD / depovera injection? Why or why not?
• How did your body respond on that form of birth control?
• Were you ever diagnosed with PCOS? Adenomyosis? Endometriosis? Fibroids (breast or uterine)? Polyps? Thyroid disease? 
• What was perimenopause like for you?
• When did you notice your hormones changed?
• What was menopause like for you?
• What helped you through your menopausal transition?
• What age were you at menopause?

There are so many questions you could ask, and so many more based on the answers to the above questions, however I implore you to ask them. These details can be incredibly clinically relevant. If you can, write them down for a future time when it might be relevant to you.

I can think of many examples when women present to me in clinic and its not until I hear about family history that we know exactly how to approach their individual situation. For example I have one patient who can no longer ask her mum about family history, but has older sisters who have had heavy bleeding, and hysterectomies. This was really important to know as we could see that her symptoms were likely signs of an inherited oestrogen dominance rather than a brief transient state. 

Another example is when we see very early hypothyroid signs in women who are not yet presenting with clinical hypothyroidism but do have strong family histories. In such cases we work to prevent the epigenetic factors surrounding their inherent genetic predispositions from escalating to a clinically diagnosed case of hypothyroidism. 

A couple of weeks ago in clinic, I saw a very young woman who was presenting with signs of PCOS/PMOS. She had just come off the pill, and this paired with her early ovarian maturity meant that I couldn’t be sure if this was traditional PCOS/PMOS with its traditional drivers, or if I should be viewing it as a temporary disruption in ovulation due to post-pill cessation and her current stress levels. After I asked her about her mother’s hormonal history and she told me that her mother had been diagnosed with PCOS it changed the way I thought about the case, and how I addressed the potential root cause.

PMOS and family history

PMOS is one of the clearest examples of how family history matters in approaching hormonal conditions. It is a complex endocrine and metabolic condition, meaning there is no single “PMOS gene” that explains every case. Instead, research suggests that PMOS is influenced by multiple genetic variants interacting with lifestyle, metabolic health, environmental exposure and possibly epigenetic programming.

Twin and family studies support the strong genetic component to PMOS. The development of PMOS is largely influenced by genetic factors, supporting the idea that PMOS susceptibility can be inherited, even though the way it expresses may differ between individuals. Multiple studies show that PMOS clusters in families. First-degree relatives of women with PMOS, including mothers, fathers, sisters and brothers, appear to have higher rates of metabolic syndrome, hypertension and high cholesterol.

In PMOS, family history is important and reminds us that the drivers can also affect the males in the family. In such cases I will also ask about whether there is a family pattern of insulin resistance, type 2 diabetes, gestational diabetes, central weight gain, high cholesterol, high blood pressure, cardiovascular disease or male-pattern hair thinning.

Oestrogen-dominant patterns and family history

Family history is also highly relevant when we are thinking about what many people refer to as “oestrogen dominance”. Symptoms such as heavy periods, menstrual clots, breast tenderness, premenstrual migraines, fluid retention, PMS, fibroids, adenomyosis, endometriosis, mid-cycle pain, ovulation pain, short luteal phases, spotting before the period, or worsening symptoms in perimenopause are all patterns that we see repeated among female family members. Often genetics are involved in how a woman’s liver metabolises oestrogen and therefore how her daughters and mother may also metabolise oestrogen. Some studies have linked these variations to oestrogen metabolism with inherited liver function. So if a grandmother had a hysterectomy for “heavy bleeding” or “women’s issues”, I want to know that. It may not give us a diagnosis, but it gives us a reason to ask better questions. If we are dealing with fibroids, endometriosis or andenomyosis, we especially want to ask these questions around oestrogen dominance in the family. 

Fertility, ovarian ageing and menopause timing

Family history can also help us understand our fertility and rate of ovarian ageing. Studies of menopause and how genetics impact the age at which menopause occurs show a very strong link between mother-daughter and even stronger between sister-sister. 

Knowing your family history here really matters in terms of being proactive with fertility planning, especially for women aging into their 30s who are starting to notice their cycles are changing. 

Women with a mother or sister who has experienced primary ovarian insufficiency (POI) or early menopause before the age of 40, are much more likely to experience it themselves.

Maternal side versus paternal side

The maternal side often gives us more direct information about menstrual and reproductive patterns: age at menarche, cycle regularity, heavy bleeding, fibroids, hysterectomy, endometriosis, fertility, miscarriage, perimenopause and menopause timing.

The paternal side can still be highly relevant, particularly for metabolic and androgen-related patterns. In PCOS cases, the father’s side may show insulin resistance, type 2 diabetes, high cholesterol, hypertension, cardiovascular disease, central adiposity or early male-pattern baldness. These clues can matter when we are thinking about androgen excess, ovulatory dysfunction and metabolic risk.

For endometriosis, fibroids and other oestrogen-sensitive conditions, both sides may still contribute genetic risk, but the information may be less obvious if the condition was not diagnosed, not discussed, or expressed differently across relatives. Family history is helpful, but it is not perfect. A woman can absolutely have PCOS, endometriosis, fibroids or POI without knowing of any family history, particularly if previous generations were undiagnosed or if symptoms were normalised.

Go and have the conversation!

So if you are able, have a chat with your female female members about their hormonal experiences around menstruation, pregnancy, fertility and menopause. It may just be the piece to your own hormonal puzzle you have been searching for!