By Dr. Shawna Darou, ND
The 40’s for women tend to be a decade with the most significant hormone changes. Menstrual cycles, fertility and even the impact of stress can cause shifts in your hormones. It is extremely helpful to understand the mechanisms of what is happening, and also to test for hormone levels so we can treat the body accordingly. There are so many routes available to support hormone changes in the 40’s, beginning with the basics of nutrition, exercise and stress reduction, leading to herbs and supplements, and possibly the use of bio-identical hormones. The 40’s are the start of perimenopause, so hormone shifts are expected during this decade.
Here are some of the ways hormones change in your 40’s:
1) Your periods come closer together:
Through your forties, periods will start to come closer together. Below is a typical pattern many women experience with their cycles over time.
- 20’s: approximately 31 days apart
- 30’s: approximately 28 days apart
- 40’s: 24-27 days apart
2) Fertility drops rapidly:
Fertility in the 40’s is very hard to predict, because even with optimal hormone balance, your eggs are aging. Almost entirely due to egg quality, miscarriage rates are as high as 60% by age 44. (1) There are no hard and fast rules however, some women’s fertility does continue up to about 45 years old, but you really can’t count on it. Read more on miscarriage here.
3) Stress hits harder in the 40’s:
According to a 2015 study, during the 5 years before menopause, women are three times more likely to have anxiety, depression, and insomnia. The apparent cause is the drop in progesterone, which is the hormone that stabilizes your stress response. (2,3)
4) PMS may become more intense:
For similar reasons, meaning the drop in progesterone and irregularities in the menstrual cycle, many women experience more intense premenstrual symptoms: mood swings, irritability, bloating, breast tenderness, sleeplessness and food cravings.
5) Hormones shift in one of three patterns:
Through the 40’s I notice that hormones can shift in a few different patterns
- Periods get lighter and lighter through the 40’s and eventually taper off. This scenario is more typical in women who have always had fairly light periods, and especially women with lower body fat and low estrogen.
- Periods can get extremely heavy and irregular. Many women experience more of a wild swing in their hormones where periods get extremely heavy in the 3-5 years before menopause. In some cases the body is actually producing more estrogen, causing a thicker endometrial lining and heavier flow. This may also be caused by the presence of uterine fibroids or adenomyosis.
- Some women will experience no change in their flow, but find their cycles get initially closer together and then more irregular. These are the women who seem to breeze through menopause with less symptoms.
6) Fibroids, cysts, polyps and adenomyosis can become more problematic:
Since we are looking at a either a relative or absolute estrogen dominance, many of these hormone-sensitive conditions can progress more quickly in the 40’s. Fibroids are likely to grow faster, as are cysts, polyps, and endometriosis. If you are experiencing a dramatic change in bleeding, or increased pelvic pain, an ultrasound is highly recommended.
7) Takes more effort to maintain weight and muscle tone:
Shifts in hormone with a drop in testosterone and DHEA can make it harder to maintain muscle mass, meaning your body doesn’t stay as toned unless you are regularly working out. Weight can go up more easily if there are any issues with blood sugar metabolism, especially insulin resistance. I don’t, however, believe that weight gain in the 40’s is inevitable. With good nutrition, regular exercise, and prioritizing sleep, your weight can stay in a healthy zone. You just may not be able to get away with as much as you did in your 20’s or 30’s!
8) The mid-late 40’s is the start of perimenopause:
This is the 3-5 year period of time leading up to menopause. It is characterized by a drop in progesterone and shorter cycles first and then more irregular cycles until they finally stop all together with menopause. I’ve written about perimenopause before. Click here to read the previous article, Are your hormones changing but you’re too young for menopause?
The 40’s are a time where a proactive health plan works extremely well. A healthy lifestyle with good nutrition, regular exercise, sufficient sleep and stress management all go a long, long way. Before hormone support is considered we look to directly balance hormones. Your healthy self-care habits will really pay off in this decade!
Personally, I believe that in spite of hormone changes, the 40’s are a time when women really embrace their complete selves with a level of confidence that didn’t exist as strongly before. This shows up in work life and career, personal life and relationships. Surely you’ve noticed that women in their 40’s in the media have a different kind of beauty with confidence.
If I had to pick the most important thing to help create hormone balance and ease in the 40’s it is to develop a very strong and consistent stress management practice. Stress will amplify any type of hormone imbalance, and can certainly make the normal shifts in hormones through this decade more challenging.
If you are in your 40’s and experiencing a shift in your hormones, this is a time where you can be proactive with your health, optimize hormone balance, and set your body up to thrive through this decade and into menopause later on. We start with hormone testing, and a good focus on nutrition, sleep, stress management and regular movement. This is an area where naturopathic and functional medicine can make a big impact in your health and wellbeing.
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- Nybo Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M. Maternal age and fetal loss: population based register linkage study. BMJ. 2000 Jun 24; 320: 1708-1712.
- Gordon JL, Girdler SS, Meltzer-Brody SE, Stika CS, et al. Ovarian Hormone Fluctuations, neurosteroids and HPA axis dysregulation in perimenopausal depression: a novel heuristic model. Am J Psychiatry. 2015; 172(3): 227-236.
- Briden L. Why stress hits harder in the 40’s. Published online March 6, 2017. (http://www.larabriden.com/real-reason-stress-hits-hard-in-your-40s-adrenal/)