Hormonal imbalance in women is a multifactorial but common health disorder with impact on nearly all aspects of physiological health, ranging from reproductive function and metabolism to mood and cognitive function. It results from imbalances in the production, secretion, or sensitivity of hormone-secreting organs, most commonly estrogen, progesterone, testosterone, thyroid hormones, insulin and cortisol. Polycystic ovary syndrome, thyroid disease, menopause and adrenal disorders are few of the etiologies of the extensive spectrum of symptoms ranging from irregular menses to infertility, changes in weight, osteoporosis, cardiovascular diseases and mental illness. Increasing incidence of the imbalances is largely influenced by genetic predispositions, chronic stress, lifestyle and environmental toxins. Precise and timely diagnosis with the help of advanced hormonal assays, imaging modalities and clinical assessment is imperative for optimal treatment. Lifestyle modifications, pharmacotherapy, hormone replacement therapy and in severe cases, surgery are management measures. Future research on precision medicine and integrative endocrinology is shaping the development of customized treatment regimens with an emphasis on restoration of hormonal homeostasis and improved long-term outcomes. The review summarizes the etiology, mechanisms, clinical presentation, diagnostic technologies, treatment modalities and preventive strategies for hormonal imbalance in women and current innovations and evolving trends are outlined.