Hormones in Your 40s – What to Expect

Written by: Ryah Nabielski, MS, RDN

Many women in my practice have children in their late 30s or early 40s when natural hormone changes are beginning. I had my daughter at 35, and I can attest that it’s hard to know where postpartum ends and perimenopause begins. The postpartum hormones can feel like they slide right into perimenopause.

As women get into their 40s, things can get a little wonky until you hit menopause, the 1-year mark without a period. It’s the years leading up to menopause – called perimenopause – that can be the most challenging for many women as they experience irregular cycles and a wide range of symptoms.

Your hormones aren’t the same as they were in your 20s or even 30s, at your fertile prime. It’s likely the lifestyle tools you used to maintain your weight and health, like diet and exercise, no longer work. You might not have changed anything in your routine, but you are noticing weight gain, insomnia, anxiety, night sweats, crazy PMS, and unpredictable cycles.

There isn’t a lot of public conversation, or conversation between women and their doctors, about perimenopause and hormonal changes in your 40s. In fact, doctors brush off women’s concerns routinely by saying their symptoms are just part of getting older and being a woman. Many resign to suffering in silence.

Women must be educated and empowered during this decade. Perimenopause is a critical opportunity to build health, resilience, and longevity. So, let’s cover the basics, including:

·      Perimenopause definition and phases

·      Hormonal symptoms in your 40s

·      Reasons to love estrogen and progesterone, and want them around as long as possible

·      Foundational tools for hormone balance in your 40s

Let’s jump in!

What is Perimenopause? Female Hormone Changes in 40s

In the premenopausal or reproductive years, you experience regular menstrual cycles. In the first half of the cycle, estrogen is dominant, supporting cervical mucus, building the uterine lining, and preparing for ovulation. Ovulation is the main event as a mature egg is released. Then, progesterone rises to maintain the uterine lining, balance estrogen, and support a pregnancy should that egg get fertilized. If it doesn’t, progesterone drops, you have your period, and the cycle repeats.

Perimenopause is the term that describes the time – often in our 40s – that leads up to menopause. Menopause is a single point in time, one year after the last menstrual period; then, you are post-menopausal. The average age of menopause in the U.S. is 51, although the range of 45-55 is normal.

Perimenopause, also called “second puberty” or the menopausal transition, is characterized by large hormone fluctuations and an eventual decline of ovarian hormone production. It’s during perimenopause that women experience many of the “menopausal” symptoms.

In early perimenopause, you may notice irregular or anovulatory cycles (cycles where you don’t ovulate) and an associated decline in progesterone levels. Progesterone balances estrogen; without it, you’ll experience symptoms of estrogen dominance, like PMS, heavy bleeding, breast tenderness, migraines, and more.  

In later perimenopause, you may experience longer cycles, and eventually, your last period, which is the sign perimenopause is ending. During the later stages of perimenopause, estrogen levels will decline, and you may experience symptoms related to the body adapting to lower estrogen levels (primarily lower estradiol or E2), like hot flashes, vaginal dryness, and brain fog.

Hormonal Symptoms in Perimenopause

In reality, hormones in your 40s can be all over the place, and you may experience different symptoms from cycle to cycle. You may also experience times when you feel pretty good and others where symptoms feel more extreme.

Symptoms you may experience during perimenopause include:

·      Irregular cycles

·      Heavy menstrual bleeding

·      Light menstrual bleeding

·      PMS

·      Anxiety

·      Depression

·      Irritability

·      Mood swings

·      Breast tenderness

·      Headaches and new or worsening migraines

·      Insomnia

·      Fatigue

·      Brain fog

·      Memory loss

·      Weight gain

·      Hot flashes

·      Night sweats

·      Low libido

·      Vaginal dryness

·      Increased urinary frequency or urgency

·      Urinary tract infections

·      Pelvic floor weakness

·      Signs of skin aging

Some women will experience mild symptoms for a few years, while others may experience more extreme symptoms for many years, impacting their quality of life. The average length of perimenopause is seven years but may last as little as four and as many as 13 years.

I realize all this sounds horrible and not very fun to look forward to as you mark off birthdays through your 40s, but the good news is that many of these symptoms are temporary. Most women experience relief from many by a year or two following menopause. In addition, there are many tools to support hormonal symptoms and make your 40s the best years yet.

It's helpful to think of perimenopause as a time of recalibration. Estrogen has bathed your cells since puberty. As estrogen levels decline, the body needs to recalibrate and adapt to the new hormonal landscape, and this adjustment can feel uncomfortable. Often women report feeling much better on the other side.

The Importance of Estrogen and Progesterone

Estrogen and progesterone play essential roles in many body systems. There are so many benefits to experiencing your natural hormones for as long as possible. Ovarian hormones support:

·      Metabolic health and insulin sensitivity

·      Bone health

·      Heart health

·      Brain health

·      Muscle strength

·      Skin structure

·      And so much more!

After losing estrogen and progesterone, women become more at risk for dementia, heart disease, diabetes, osteoporosis, depression, and other chronic diseases.

So, while it might be easy to wish away your period or mask symptoms with synthetic hormones like birth control, having menstrual cycles for as long as possible is protective, allowing body tissues access to these critical hormones.

Balancing Hormones in Your 40s

In your 40s, it’s common for your hormones to take you on a roller-coaster ride. So, it’s perhaps not realistic to have the goal of “balancing” hormones, but there are many ways to support more balance and ease through this transition.

Perimenopause is a brilliant window of opportunity for you to create better health for yourself in the future. The nutrition and lifestyle work you do now will not only make perimenopause easier but post-menopause too.

Here are some foundational lifestyle strategies I work with my clients on:

·      Balance Blood Sugar – Estrogen helps with insulin sensitivity, meaning your cells respond better to insulin and easily pull sugar (glucose) from the blood into cells for energy. As estrogen declines, women become more prone to insulin resistance, where cells become less efficient at receiving insulin signals. Insulin resistance may translate to elevated blood sugar, metabolic dysfunction, and weight gain.

Using nutrition to balance blood sugar counters the pull toward insulin resistance and helps keep blood sugar levels stable. A few ways to do this are:

·      Choose whole, unprocessed food

·      Eat balanced meals (and snacks) that include fiber-rich plant foods, quality protein, and healthy fat

·      Eat regularly throughout the day but give your body a rest overnight for 12 hours

·      Reduce inflammation – Loss of estrogen can create an inflammatory state, and inflammation drives chronic disease and autoimmunity. Use nutrition to counteract inflammation by choosing anti-inflammatory foods, such as:

·      Cold water fish (high in omega-3s) – wild salmon, sardines, mackerel

·      Colorful vegetables – leafy greens, cabbage, carrots, beets, bell peppers

·      Polyphenol-rich fruits – berries, pomegranate, cherries, grapes

·      Herbs and spices – turmeric, ginger, garlic, rosemary, oregano

·      Seeds – flax, hemp, chia, sunflower, pumpkin, sesame

·      Organic cacao and chocolate (without the heavy metals)

·      Green and black tea

·      Extra virgin olive oil

·      Support liver and gut health – The liver transforms estrogen into its metabolites, which leave via the colon. If the liver or colon is sluggish, hormones reabsorb into circulation, making estrogen fluctuations more dramatic.

Use nutrition to support liver and gut health by including:

·      Fiber-rich foods to support regularity – beans/lentils, apples, berries, flax, avocado, artichoke, etc.

·      Cruciferous vegetables to drive estrogen down protective liver pathways: broccoli sprouts, collards, kale, broccoli, cauliflower, arugula, etc.

·      Gather and practice stress management tools – Adrenal health becomes even more important in perimenopause and menopause, so now is the time to promote good adrenal health by managing stress since stress will strain the adrenals and impact hormone levels. As ovarian hormone production declines, you’ll still get some hormone production from the adrenal glands. The adrenals produce DHEA-S, which converts into testosterone and estrogen.

Some great tools are spending time in nature, walking, meditation, and yoga. You can also consider adaptogen herbs, like maca, eleuthero, rhodiola, and ashwagandha, along with B vitamins and vitamin C for support.

·      Build muscle – Muscle is your metabolic insurance policy. It improves insulin function, protects bones, and counteracts the changes in body composition that can occur as your hormones change. If you don’t already strength train, your 40s is the perfect time to start so you can build more muscle before menopause. In addition, make sure you are eating enough protein, including animal protein, so you have the building blocks for muscle repair and growth.

·      Manage symptoms – Just because perimenopause is a natural transition doesn’t mean you have to live with uncomfortable or miserable symptoms. There are so many effective tools to support you through this time. Consider supplements, phytoestrogens (plant estrogens), and bioidentical hormone therapy when it’s a good fit.

Creating a solid foundation with whole food nutrition, blood sugar balance, and adrenal health will be grounding as your sex hormones fluctuate and change. If you’d like personalized support on this journey, please reach out. I’m going through it, too, and would love to work with you!