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Our decade-by-decade guide to how these natural chemicals affect your body and mind, plus keeping unpleasant symptoms in check.
Here’s the thing about hormones: You can’t live without them, but it can be hard to live with them. Our body’s chemical messengers, these powerful regulatory substances take the blame for a ton of super-unpleasant symptoms, from mood swings to cravings
to bloating to exhaustion. (We’ve all had those days when we’re too tired to do much more than binge-watch The Handmaid’s Tale.)
Our sex hormones play a major role in menstruation, pregnancy and menopause, and they have a hand in
sexual function, metabolism and sleep habits. As we age, our progesterone and estrogen levels fluctuate, affecting fertility, weight gain, heart attack risk, cognitive function and more. The good news? These dips and spikes are normal, and there’s a lot you can do to manage the more objectionable symptoms. To find out what to expect down the road, we asked the experts what happens to our hormones as we age. Here’s what we learned.
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In Your 30s
It may be time to reevaluate your method of contraception. “As we become older, we usually gain a bit of weight and our risk for blood clots increases,” says Dr. Jerilynn C. Prior, founder and scientific director of The Centre for Menstrual Cycle and Ovulation Research in Vancouver. “The usual dose of a combined hormonal contraceptive—the pill, patch or vaginal ring—doubles our clot risk in our 20s and may triple it in our 30s.Weight gain, especially to a body mass index of 30 or higher, also increases the risk of blood clots related to the use of combined hormonal contraceptives.”
Feel-good Fix: There are other contraceptive options, including using a barrier method (diaphragm or condom), combined with a vaginal spermicide, or a copper or progestin-releasing intrauterine device, which is easily removed with no delay in fertility returning (as there is when stopping the pill) if you decide to have a child.
Drop in Fertility
Your menstrual cycle, between 21 and 35 days, and your normal ovulation are likely the most regular they have ever been. “While this decade is the start of perimenopause [the transition into menopause, usually associated with changes in your cycle and ovarian hormone levels] for a small percentage of women, the majority will carry on as premenopausal women with an increasing desire for—and, sometimes, difficulty with—getting pregnant,” says Dr. Prior, adding that women may have regular cycles and yet not release an egg and make progesterone. Even a cycle with ovulation but too few days of progesterone is one in which a woman won’t be able to become pregnant. “A couple shouldn’t begin to think they’re having difficulty getting pregnant until they’ve tried without contraceptives for one year,” says Dr. Prior.
Feel-good Fix: Keeping a record of your period (and, yes, there are apps for that) is still the gold standard when you’re unsure about what’s going on with your cycle. The Centre for Menstrual Cycle and Ovulation Research offers free tools for monitoring your cycle and ovulation (cemcor.ca). Show the record to your doctor, who may be able to spot inconsistencies and offer solutions. If you’re having trouble getting pregnant, see a reproductive endocrinologist to check for hormone-related fertility problems.
In Your 40s
Transmenopause (a technical term for the one year before the last menstrual period up to two years after the last period) is associated with significant bone-density loss. “Women may lose about seven percent of the bone density at their spine and almost six percent
of the bone density at their hip,” says Dr. Aliya Khan, a clinical professor of medicine and director of the Calcium Disorders Clinic at McMaster University in Hamilton. You’re at a higher risk if you have a low body weight, smoke, consume more alcohol than outlined
in Canada’s Low-Risk Alcohol Drinking Guidelines or have a family history
Feel-good Fix: Weight-bearing and strength-training exercises are key, as is getting enough calcium and vitamin D. “Maintaining a normal body mass index is also important for bone health during the menopause transition,” says Dr. Khan. “A low body weight is associated with greater rates of bone-density loss postmenopause.” It’s a good idea to chat with your health-care provider about arranging a bone-density test and blood work.
Moodiness and Decline in Cognitive Funciton
You can thank dips and fluctuations in estrogen and progesterone for contributing to the decline in cognitive functioning (including forgetfulness and difficulty concentrating) and the increase in moodiness and depressive symptoms, from mild mood swings to (in susceptible individuals) major depressive episodes. A New England Research Institutes follow-up to data collected by the Massachusetts Women’s Health Study found that women who experienced a perimenopause of more than 27 months were twice as likely to have “elevated depressive symptoms.” But don’t let that worry you too much; some estimates peg the number of women who experience mood symptoms at this stage at 10 to 20 percent, and much of it depends on how vulnerable we are to hormone-related changes.
Feel-good Fix: Mood fluctuations and feelings of depression don’t last—phew! “They commonly return to normal after menopause, once the hormonal swings stop,” says Dr. Christine Derzko, obstetrician-gynecologist and an associate professor in the reproductive endocrinology and infertility division at the University of Toronto. “The severity of symptoms may be greatest in those with a history of depression,” she adds. Speak to your physician or psychiatrist; treatment options include antidepressants, psychotherapy or hormone replacement therapy (or a combination). Be kind to yourself, get enough sleep, pay attention to triggers and don’t skip medications or therapy sessions.
Prepare for fatigue. “When you hit perimenopause, your ovaries produce varying amounts of estrogen and progesterone, until the levels of these are consistently low. This can result in symptoms such as sleep disturbance, hot flashes and night sweats,” says Dr. Khan. A study published in the journal Nature and Science of Sleep in 2018 found that 26 percent of women experience severe symptoms during the menopausal transition, including insomnia.
Feel-good Fix: Going to bed at the same time each night, avoiding caffeine and turning off electronic devices (bye-bye, smartphone) before bedtime helps. “If menopausal symptoms are very significant and impact quality of life, low-dose hormone replacement therapy with estrogen and progesterone can be used for short periods in women who have a low risk of breast cancer, cardiovascular disease or cerebrovascular disease,” says Dr. Khan.
In Your 50s (and beyond)
Dr. Tricia Peters, an endocrinologist at McGill University in Montreal, says this one’s controversial. “Many studies have shown an increase in cardiovascular risk for women after age 50, which corresponds to the time of the typical menopausal transition, so this may be age-related versus hormonally related,” says Dr. Peters. Researchers have looked at women in early menopause—before age 45—and have noticed an increased risk of heart disease. That said, women with existing cardiovascular issues—those who smoke or have high blood pressure or high cholesterol—tend to go through menopause earlier, so it’s a bit of a chicken-and-egg situation.
Feel-good Fix: Reduce your risk and control what you can. So, stop smoking, stay active, maintain a healthy body weight and get screened for high blood pressure, high cholesterol and diabetes, says Dr. Peters.
These brutal headaches are triggered by a drop in estrogen, says Dr. Derzko. “Drops, especially sudden drops, in circulating estrogen levels—at the onset of a period, for example, and also sometimes at ovulation—are major triggers to headaches.” If you experienced migraines with your period, you’re likely to find that they’re less frequent and less severe during menopause or may entirely disappear after menopause; but if they started at perimenopause or menopause, they are likely to worsen. Like mood swings and problems concentrating, hormonal migraines tend to stop after menopause, once the hormonal fluctuations stop.
Feel-good Fix: If fluctuating hormones are the cause of your migraines, your physician may recommend hormone-stabilizing medication. You can discuss these and other medications (both over the counter and prescription) for migraines with your health-care provider.
Falling estrogen levels cause the vaginal tissue to get drier and thinner, which inevitably causes burning, irritation and pain during sex—which really doesn’t put you in the mood.
Feel-good fix: Your vagina and your libido don’t have to suffer. Topical vaginal treatments such as lubricants and moisturizers often work, and there are lots to choose from over the counter. There are also topical forms of estrogen therapy (tablets, cream and vaginal rings) that require a prescription.