We've all heard about hormones — the culprits behind everything from PMS to acne. But during perimenopause and menopause, our sex hormones impact our lives in a new way. If you haven't learned anything about hormones since your high school health class, now is a great time to catch up
What Exactly Are Hormones?
Hormones are chemical messengers in the bloodstream, which carry specific signals to different cells, organs, muscles, and tissues. “It’s a complex and extraordinary chemical communication system that works via hormone receptors throughout the body,” says Kristy Prouse, MD, FRCSC, an OB-GYN and chief medical officer for the Institute for Hormonal Health in Canada. Each particular hormone attaches to a receptor on a specific cell, which is how messages are relayed. There are many types of hormones, including thyroid hormones, stress hormones like cortisol, and the sex hormones estrogen, progesterone, and testosterone — those last three are the ones that impact perimenopause most, so let’s take a closer look at them.
What’s Going on with Your Sex Hormones During Perimenopause?
When estrogen, progesterone, and testosterone go up and down (in puberty, PMS, or perimenopause), unexpected things happen to your body. This hormonal upheaval is to blame for symptoms such as mood swings, night sweats, and brain fog. Think about that amazing chemical communication system going haywire, just as it does during adolescence. Only this time, instead of a surge in sex hormones, you’re going through a decline.
“Hormone fluctuations during the transition to menopause can trigger everything from hot flashes to breast pain,” Prouse says. “The leveling out of hormones is why, a few years after your periods have stopped and you are in postmenopause, many symptoms start to resolve.” The reason that some issues, such as dry skin and, yes, vaginal dryness, don’t go away is because of low hormone levels. Basically, your sex hormones have gone into retirement (the medical term is “senescence”). The communication has slowed to a crawl, so many of their functions aren’t working like they used to on their own.
What Does Estrogen Do?
Estrogen is responsible for the reproductive system and sexual development, and is produced primarily by the ovaries. (The adrenal glands and fat tissue also secrete a small amount of estrogen.) There are three forms of estrogen: Estradiol (E2) is the main type in the body during your reproductive years. “This is the most potent form of estrogen, and the one associated with menopause changes when it drops,” Prouse says. “Estrone (E1) is the form of estrogen that increases after menopause, and usually gets converted into fat tissue.” Estriol (E3) rises during pregnancy and is responsible for keeping the uterus and embryo healthy.
Estrogen (in particular, estradiol) is such an important hormone from puberty on, and not just for sexual and reproductive health. Because there are estrogen receptors all over the body, this hormone impacts a multitude of things. “It affects the urinary tract, and has protective and regulatory effects on the heart, bones, and brain,” says Somi Javaid, MD, a Cincinnati-based OB-GYN and co-founder and chief medical officer of HerMD. Did you know that estrogen stimulates the production of collagen, hyaluronic acid, and lipids in the skin? It’s no wonder the drop-off in estrogen is a culprit in dryness and skin aging. It’s also a supreme multitasker. So, when it dwindles, you’re going to feel it in myriad ways.
What Does Progesterone Do?
The main function of progesterone is to prepare the lining of the uterus for pregnancy. “Progesterone’s other important role is to balance estrogen and regulate certain processes like menstruation,” Prouse says. “These hormones are interconnected and don’t work in isolation. Hormones are all about balance.” Perimenopause, on the other hand, is all about imbalance. Estrogen and progesterone work as teammates, and during the years preceding menopause, these two get out of whack. Estrogen can spike while progesterone levels fall, and these ups and downs trigger perimenopause symptoms like irregular periods.
What Does Testosterone Do?
Since the androgen hormone testosterone is known as the “male hormone,” you may be thinking, “What’s testosterone got to do with women and sex hormones?” Javaid’s answer: “When it comes to libido and sex, it’s got so much to do with it. Testosterone is the forgotten hormone for women, and data has shown its beneficial effects supporting sexual function, arousal, desire, pleasure, and orgasmic function.
Declining testosterone in menopause is the primary cause of sexual dysfunction. If you’re experiencing this symptom, it’s important to seek out a healthcare provider that’s familiar with sexual health and menopause.” (To find a menopause practitioner in your vicinity, check the database of The North American Menopause Society.) While hormone replacement in the form of a transdermal testosterone patch that’s FDA-approved for women is not yet available, there are other options — including mind-body strategies to increase desire, arousal, and pleasure.
How to Balance Your Hormones in Menopause
Keeping your body (and mind) on a relatively even keel through perimenopause is a challenge, but there are simple ways to manage the highs and lows. “Encouraging your body to balance itself can go a long way toward making you feel better, and you can do that with lifestyle adjustments, whether it’s a good sleep hygiene routine, or diet modifications, or supplements,” Prouse says. For instance, that could mean minimizing your intake of alcohol and caffeine to improve sleep, anxiety, hot flahses, and brain fog. Note: It may take some experimentation to find what works best for you.
Hormone Replacement Therapy
While all of these wellness strategies can help to manage perimenopause issues, they aren’t going to actually change your hormone levels. That’s where hormone replacement therapy (HRT) comes in. “If your menopause symptoms are interfering with your life and becoming really bothersome, consult your OB-GYN and discuss hormone therapy as an option. It can be very beneficial in managing things like brain fog or hot flashes,” Javaid says.
Hormone therapy is an FDA-approved treatment of low-dose estrogen and progesterone that can be prescribed to treat menopause symptoms. “I think of going through menopause as estrogen withdrawal,” Javaid explains. “It’s similar to your body being used to having six cups of coffee a day for most of your adult life. All of a sudden, if you go cold turkey, you’re going to have headaches and mood swings and feel horrible. The goal of hormone therapy is getting your body used to two cups a day. You may find you feel so much better at that happy medium, compared to zero.”
While your sex hormones and HRT aren’t quite as simple as your Starbucks order, it’s definitely important to discuss all of it with your healthcare provider. Whether it’s hormone therapy or behavioral modifications, there are excellent options to get the balance right.
Gina Way is a writer and editor specializing in beauty, health, and lifestyle content. Her work has been featured in Marie Claire, Harper’s Bazaar, Martha Stewart Living, Real Simple, Cosmopolitan, and Shape. She also writes digital content for Allure, The Cut, Refinery29, Vogue, Oprah Daily, Violet Grey, Well+Good, and more.