Hormonal imbalances constitute a significant burden in contemporary clinical medicine, underpinning a diverse array of metabolic, reproductive, and endocrine disorders including hypothyroidism, polycystic ovary syndrome, type 2 diabetes mellitus, and adrenal insufficiency. While conventional hormone replacement therapies and pharmacological interventions have demonstrated clinical utility, their long-term use is associated with substantial risks such as cardiovascular complications, hepatotoxicity, thromboembolism, and hormone-dependent malignancies, necessitating the exploration of safer therapeutic alternatives. Phytopharmaceuticals, comprising bioactive compounds derived from medicinal plants, have garnered increasing scientific and clinical interest due to their capacity to interact with hormonal axes, modulate endocrine gland function, and restore hormonal homeostasis with comparatively favourable safety profiles. This article presents a comprehensive and critically evaluated review of the current understanding of phytopharmaceuticals in hormonal imbalance management, with emphasis on major bioactive classes including phytoestrogens, flavonoids, alkaloids, and terpenoids. The mechanisms underlying their endocrine activity, encompassing receptor binding, enzyme modulation, and regulation of hormone biosynthesis and metabolism, are systematically examined. Preclinical models, clinical trial evidence, pharmacokinetic challenges, and advanced formulation strategies are analysed. The review further discusses regulatory and commercialisation challenges and identifies priority areas for future translational research, with the goal of advancing plant-based therapies into evidence-based clinical practice for hormonal disorders.