Female hormones 101 as you age will help you understand how hormones change and affect many systems in your body.
They are also responsible for many other functions, which will help you understand how the decline in their levels contributes to a host of symptoms you will experience as you age. These hormones can begin changing drastically for some of you in your mid-30s to early-40s (see graph below with peri-menopause fluctuations).
I was in full menopause, no period for one year, at age 44. Looking back, I know a lot of unexplained changes, physically and mentally, were attributable to changing hormones beginning in my late 30s (peri-menopause).
It can be very confusing to know what to do to feel better especially as you enter peri-menopause, where the hormonal changes really feel like a rollercoaster ride. Let’s break it down.
Puberty arrives around the age of 10-12. It’s not uncommon for some of you to have been a bit younger or older. Hormones from the brain trigger the start of puberty. Essentially, these hormones tell your ovaries to make estrogen. This triggers the growth and release of eggs. Noticeable changes will arrive — breast development, menstruation, pubic hair, and a change in moods. And you can now become pregnant.
Progesterone levels change throughout your menstrual cycle. This hormone maintains your uterine lining during pregnancy; you need an adequate level until you’re ready to deliver your baby. Small quantities of the hormone testosterone (about 1/10th of what men have) are also produced in the ovaries and peak mid-cycle. This hormone essentially converts to estrogen and supports a woman’s growth, reproduction, sex drive, mood, and vaginal health.
Periods will continue (if you have no health issues) for 20 to 40 years and will be affected by the birth control you may be using. As shown in the graph below, premenopause is the years you have your period consistently. Hormone levels will ebb and flow with your cycle, but things feel pretty predictable.
As you age, it’s time to look ahead and face hormone changes that are coming or are already here for many of you. Puberty is in the rearview mirror. You need to make lifestyle changes to help manage symptoms of declining hormones in your 30s and 40s and prevent inevitable health risks.
If I Could Go Back
I wish someone told me that peri-menopause was showing up in my 30s. I fought so hard to keep doing what I was doing when I was younger. Consuming alcohol the way I always did (even though I was metabolizing it differently), eating and exercising the same but seeing a lot of changes in my body. Accepting the anxiety and stress I was feeling, which I now know was mostly attributable to changing hormones.
I wish I was kinder and less harsh with my changing body and mind. I needed to make changes sooner surrounding my nutrition, stress management, sleep, and movement. I also wish I had started hormone therapy (HT) (also referred to as HRT) earlier in my peri-menopause journey.
Courtesy of declining estrogen (which is anti-inflammatory), you’re now at risk for heart disease, diabetes, osteoporosis, dementia, and bone loss. Many of these health risks are happening silently within the body until they become more advanced. They will then demand lifestyle changes and/or medication.
Peri-Menopause and Menopause are Inevitable
There will be no big announcement to tell you that peri-menopause is starting. It’s essentially a gradual transition. Unless you have surgery to remove your ovaries, which means you will be thrust past peri-menopause into full menopause. It’s highly recommended that HT be taken under the direction of a physician at this time to prevent health risks and alleviate symptoms of the overnight drop in hormones.
It’s more obvious when menopause arrives — you will have no period for 12 full months. The average age is about 51. What’s less clear are the 7 to 10 years before menopause when peri-menopause starts. Symptoms can be subtle at first and sadly, many women feel there isn’t much they can do about how they look and feel.
Don’t ignore how you are feeling like I and many of the women I work with did! Reach out to me or talk to your physician, friends, or family members to get support. Other women may have advice to help you with your journey.
Peri-menopause is usually diagnosed with age, family history, and symptoms:
- irregular periods
- hot flashes / night sweats
- moodiness / anger / rage
- difficulty concentrating
- poor sleep
- change in libido
- decreasing fertility
- vaginal and bladder problems
- bone loss
- change in cholesterol levels
How Do You Know You are in Peri-Menopause?
With the rise and fall of estrogen during this transitional time, it’s difficult to test your hormones and get a definitive answer that you are in peri-menopause. Additionally, low levels of estrogen can be caused by: excessive exercise, eating disorders, a low-functioning pituitary gland, toxins, chemotherapy, substance use disorder, and kidney disease.
Have your physician test your follicle-stimulating hormone (FSH). This is a hormone produced by your pituitary gland (located in the brain) that stimulates your ovaries to release an egg during ovulation. Symptoms and a consistently high level can indicate you are nearing menopause.
Your doctor can also do a blood test to check progesterone levels, which is most commonly used to determine ovulation. Too little progesterone and too much estrogen can also lead to estrogen dominance. Read more in my blog about this condition: Estrogen Dominance Symptoms and Solutions.
When you notice your body and mind changing, print out my symptom tracker and track your symptoms. It’s important to schedule an appointment with your primary care physician or gynecologist for further testing and discussion. Your physician may need to rule out other health issues as well, including thyroid health. Be sure you’re working with a doctor who is willing to discuss HT as an option.
Although changing and declining hormones can start in your 30s, your doctor will need to rule out premature versus early menopause. It’s important to recognize what stage you’re in, especially if you plan to have children. You need adequate hormones, eggs and to continue ovulating for this to happen.
It’s important to remember that you can still become pregnant during peri-menopause. You will enter menopause when your supply of eggs runs out and your ovaries stop making estrogen. This can’t be reversed, and you can no longer get pregnant. You should talk to your doctor about other options.
Is Hormone Therapy Safe?
Hormone therapy is a safe option for most women beginning early in their journey through peri-menopause and the beginning of menopause. Since you are unique, your doctor should follow an individualized plan to help combat your peri-menopausal symptoms and health risks.
Progesterone and estrogen work in tandem in the body and may need to be replaced based on your symptoms and healthy history.
Two basic types of Hormone Therapy:
- ET means estrogen-only therapy for women without a uterus due to a hysterectomy.
- EPT means combined estrogen plus progestogen therapy if you still have a uterus.
Two general ways to receive Hormone Therapy:
- Systemic products move throughout the bloodstream to all areas of the body. These are available as an oral tablet, patch, gel, emulsion, spray, or injection and can be used for vaginal symptoms, hot flashes, night sweats, and osteoporosis.
- Local, non-systemic, products affect only the area they are applied to. These are available as a cream, ring, or tablet and can be used for vaginal symptoms.
Your doctor should prescribe the lowest dose of hormone(s) for the shortest amount of time. The benefit-risk ratio is favorable for women who start HT when they are in peri-menopause or at the start of menopause.
There is evidence that health risks such as stroke, breast cancer, and blood clots can occur especially with systemic products if used for longer than five years. Some women will choose to continue taking HT their entire lives and should regularly weigh the benefits and risks by having ongoing conversations with their physicians.
How to Stay Healthy with Changing Hormones
Peri-menopause, menopause, and post-menopause are natural processes in a woman’s reproductive cycle. Post-menopause is all the days after menopause when your body learns to function with low levels of sex hormones.
The hormonal changes you experience are mainly due to declining estrogen. Although, progesterone and testosterone will need to be checked as well. Many systems in your body will feel changes, but with improved lifestyle choices and possibly hormone therapy, you shouldn’t accept suffering as the new norm.
Improving your lifestyle is the best place to start to feel your best:
- Consume a nutrient-dense diet rich in protein, healthy oils, complex carbohydrates, fiber, fruits and vegetables.
- Maintain gut health to continue to help balance hormones, keep your immune system strong, and optimize the absorption of nutrients.
- Get outdoors and move in some way every day. Incorporate weights into your exercise routine to help with muscle loss.
- Get 7 – 9 hours of good sleep each night. Check out my blog ‘Seven Ways to Get Better Sleep in Midlife‘.
- Manage your stress with paced-breathing exercises or other relaxation techniques.
- Connect with others to get the support you need and deserve.
Reach out to me if you would like to have a discussion to further understand how to feel better in midlife. At this stage in your life, you deserve to truly thrive and not just survive!
I’m a registered nurse for over 24 years with a Masters Degree in Nursing (Education). I am also a Certified Women’s Health Coach specializing in helping women navigate changing hormones in their 30s and beyond after my own difficult experience through menopause. I believe women should truly thrive in midlife and not just survive!