Hormonal Decline in Your Forties: It’s Not in Your Head
Every day, women come to me with complaints - fatigue, weight gain, anxiety and frustration being at the top of their lists. If you’ve ever had a baby, and felt the very real ups and downs of emotions that come with the immediate postpartum period - you already understand how acutely our hormones can dictate our thoughts and feelings. Too often, women’s concerns are dismissed, and not worked up by medical providers. This comes not from lack of caring, but lack of knowledge. Now, more than ever, we must educate ourselves on what is happening in our bodies as we age.
It’s a word that carries so much weight. It marks the official end of our fertility. We no longer have a menstrual cycle and we can no longer bear children.
There is grief in entering this phase - and that’s normal.
Let’s first take a look at the definition of menopause, and the preceding perimenopausal period.
Menopause is when a woman has gone 12 months without having her period. This means she will no longer have menstrual cycles. Women tend to enter menopause between their mid-forties to mid-fifties. The average age is 51.
Perimenopause is the transitional period between regular menstrual cycling and menopause. This is the time when our ovarian hormones start to naturally decline. You will likely start to notice changes in your menstrual cycle – as well as other symptoms – around this time. For some women, it starts after age 35. For others, it begins in their forties.
Here are the key hormones on the decline at this time:
Estrogen
Estrogen (especially the estradiol form) is the single most important driver of our overall health and well-being during midlife, as well as what knocks us down the most when on the decline. It is responsible for not only our reproductive health but also benefits our heart and brain. It also plays a major role in our bone health, with estrogen deficiency being the leading cause of osteoporosis (a dangerously under-discussed health crisis for women right now). Dropping estrogen contributes to mood changes, low energy, and sleep issues.
Testosterone
While this is the primary sex hormone for men, this hormone is vital for maintaining a woman’s health too. It plays a huge role in our bone health, muscle mass, and sex drive. Low levels can leave us feeling exhausted, poorly motivated, and weak.
Progesterone
Progesterone is produced each month following ovulation. Low progesterone is one of the earliest signs of hormone decline and can occur due to irregular ovulation, poor communication between the brain and ovaries, and declining ovarian health. Dropping progesterone contributes to classic menopause symptoms like hot flashes, as well as sleep disturbances and anxiety.
Classic Menopause Symptoms
Mood Changes. During this time, you experience a dramatic shift in your hormone levels. These changes can disrupt how your body produces serotonin, which plays a pivotal role in our mood regulation. As our estrogen levels drop, feelings of irritability, sadness and moodiness increase. Dropping levels of the feel-good hormone, progesterone, can also lead to increasing anxiety levels.
Weight Gain. Declining estrogen can lead to a slower metabolism and increased fat storage, especially in our belly area. Cortisol imbalance can also cause weight gain and a slowed metabolism. Increased stress levels and lower quality sleep can also impact our exercise and eating habits.
Hot Flashes and Night Sweats. Estrogen helps to regulate our body temperature. As it diminishes, so does our body’s ability to modulate our core temperature. Keeping cool, especially at night, can become increasingly difficult.
Sleep Disturbances. Sleep changes are often caused by the accumulation of symptoms women experience. For example, it is a lot more difficult to have a restful night if you are kept awake by night sweats or intrusive thoughts. Progesterone levels are also at play here, as they simultaneously increase our anxiety and reduce our sleep quality when too low.
Lesser Known Symptoms
Gut Issues and Bloating. Our body’s ability to metabolize cortisol properly often declines as we age, which not only impacts our stress levels but also our digestive system. Our system often slows down drastically during this time, leading to gut issues (especially constipation) and bloating. Increasing stress levels can also lead to inflammation and declining gut health.
Decrease in Stress Tolerance. “I can’t do it all anymore.” This is one of the most common things I hear from women in my practice. Women who used to be expert multi-taskers and who felt like they could handle anything that life threw at them, suddenly feel completely burned out. You are not unraveling, your hormones are just imbalanced. You are no longer getting a calming dose of progesterone from ovulation each month and your cortisol levels are likely out of whack.
Brain Fog. Have you ever walked into a room for something and completely forgot what you were looking for? Maybe you have driven to the same store for years and suddenly can’t remember how to get there? Loss of focus and memory issues are very common complaints from women in their 40s. Estrogen plays a central role in our neurological functioning and when it declines so does our cognition.
An important note: We like to say test don’t guess. I recommend that you find a hormone literate practitioner who can assess and treat your hormone deficiencies and imbalances. You can locate a competent practitioner in your area here.
And if you live in Ohio, you can join The Right Way to Weight Loss, where we do a comprehensive workup on every woman and provide a complex hormone treatment plan.
The Perimenopausal Experience
I like to think of the forties as a period of hormonal decline that kicks off between 35-40 and culminates for most women around age 51 (the average age that women will go a full year without a period). This hormonal decline brings myriad symptoms with it.
The first sign of early hormone decline is dropping progesterone levels. This often presents as poor sleep, increased anxiety and shortened cycles and periods. The next sign – later hormone decline – is typically lengthier cycles or more irregular periods (some cycles being 23 days, and some being 40+ days). As menopause progresses, cycles happen just a few times per year, hot flashes may be ever present, and weight gain and other subtle symptoms accelerate.
Symptom Burnout
When your hormones are out of balance, you’re left feeling physically and mentally burned out. Burnout and overwhelm are the perfect ingredients for inaction and indecision. You feel like you are lost, stuck, and hopeless.
The desire to unfeel the uncomfortableness of it all is real. Many women turn to numbing their symptoms with excessive snacking and drinking. In fact, binge drinking in older women is climbing. In a recent study, binge drinking increased by 3.7 percent per year for women, but not for men. Other women go to their doctors and report “I just don’t feel like myself.” The problem is, many of these women are told mood changes and depression are par for the course for midlife and are simply prescribed SSRIs (according to current guidelines, the first-line treatment for women in this age group is an antidepressant).
Maybe you feel helpless because you have a strong desire to optimize your health but you feel like it's now unattainable for you. So many women experience debilitating symptoms in their forties (and late thirties), and chalk them up to “a reality of getting older.” I’m not okay with that (and you shouldn’t be either).
Symptoms are simply our body’s way of telling us what it needs.
“I’m exhausted” = the need for more sleep, better nutrition, more cortisol, or more estrogen (it could be any or all of these). Just because it’s confusing doesn’t mean it’s impossible.
Lifestyle upgrades are more important now than ever. Start with eating adequate protein (1g per lb of target body weight) and a low-inflammatory diet, and engaging in daily movement and stress-reducing practices (as a start). But if you’re doing all of those things and still suffering - look to hormones.
I want you to know that your hormones are responsible for how you’re feeling and that you can actually do something about it. This is not a time for women to simply bow down and feel miserable. We should instead be asking ourselves: are my hormones optimal? What can I do to fix them? And, is my health optimal? What can I do to live a long and healthy life?
Sources:
https://pubmed.ncbi.nlm.nih.gov/28340502
https://www.bmj.com/content/382/bmj-2022-072612