The Hormone Shifts Happening in Your Mid-30s

I’m a hormone doctor who takes care of midlife women. I’m also a busy mother with three young children. Our family calendar is what I affectionately call “The Rainbow of Crazy”. Each person has their own colour code, family events have a colour, meal plans have a colour, and even our family dog has his own colour. Between work, chauffeuring, homework, and supporting the kids during their activities, life is busy. Sometimes I feel on top of the world and marvel at how well I’m keeping it all together. Other times, the balls come crashing down and I feel stressed, exhausted, and overwhelmed. These are all normal high’s and low’s. But when does it become abnormal, and could your exhaustion or stress be caused by hormone shifts?

Perimenopause can start as early as 35 years of age for some women. The normal range of menopause is 45 - 54 years of age, and perimenopause can start a whole 10 years before menopause. Perimenopause marks the transition period in your life where your ovarian function starts to decline.

Progesterone is typically the first hormone to decline. Progesterone is responsible for sleep and mood stability. Progesterone decline leads to unexplained insomnia, irritability, and anxiety. Estrogen changes as well. It behaves more erratically, and instead of undergoing neat and predictable cycles, it will go through extreme high’s and extreme low’s. Estrogen is responsible for bone strength, brain function, happiness, heart health, skin moisturization, joint lubrication, just to name a few of its functions. During periods of low estrogen, you might feel depressed, have hot flashes, experience joint pain, have heart palpitations, or experience skin reactivity. The list goes on.

As a hormone doctor, one of the most impactful phrases I can hear from a patient is: “I just don’t feel like myself anymore.” Women are resilient. We are strong, capable, and intuitive. When something has shifted in our body, we intuitively know that something feels wrong. So when you’re suddenly awake at 3 am, work causes you more anxiety than previous, or you find yourself very irritable with your family, your hormones might be partly to blame. Your provider might say that you are “just stressed”, ask you to slow down, or ask you to meditate or exercise. The duality can be true: you might be stressed and overwhelmed, and your hormones might be out of balance.

Perimenopause is not singularly defined by changing cycles or hot flashes. In some women, it can be something as subtle as a shift in their body. Maybe your PMS is worse than previous. Maybe you are not sleeping well and are fatigued. Perimenopause cannot be diagnosed by bloodwork, which makes its diagnosis challenging. If you suspect symptoms, you should seek out your primary care provider and ask for a panel of bloodwork to rule out other conditions (low thyroid, iron, or vitamin D or B12 deficiency). If your bloodwork comes back normal, you should have a frank discussion with your provider about doing a trial of bio-identical progesterone. Within 3-6 months, you will know whether you feel better. And if your provider seems reluctant or unsure about initiating hormones, please do not be upset with them. Most providers were simply not trained to prescribe them and many are working within the confines of a very strained healthcare system. Instead, you can seek out a Menopause Society Certified provider like myself and my colleagues at Westcoast Women’s Clinic. We spend our entire days taking care of women just like you.

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