The Hormone Shifts Happening in Your Mid-40s

I’m a hormone doctor who takes care of midlife women. Most of my patients are just like you: busy mothers who are balancing work, children, friendships, marriages or divorces, and eventually taking care of aging parents. Outside of that, you are also supposed to find time to maintain your home, sleep, exercise, eat healthy, and maybe enjoy a hobby or two. When perimenopause symptoms become more accentuated during your mid to late 40s, it can feel like your well-oiled machine suddenly comes to a screeching halt. Or “falls off a cliff”, as some of my patients have described it.

By your mid to late 40s, you are farther along in the perimenopause transition. Progesterone has been steadily declining for years now. Estrogen has been erratic but generally declining as well. The symptoms you might experience include hot flashes, insomnia, anxiety or depression, fatigue, joint pain, brain fog, heart palpitations, vaginal dryness, urinary tract infections, skin dryness or sensitivity, painful intercourse, sinus congestion, itchy skin. This is by no means an exhaustive list! None of these symptoms in isolation necessarily point to perimenopause, but it is often the constellation of symptoms that can point towards a hormonal root cause.

The average age of menopause is 51, and the normal range is 45 to 54 years of age. Menopause is a retroactive diagnosis, in that you need to go through a whole year without a period before you can look back at your final period, and identify that as your menopause date. If your period returns after a nine month hiatus, the clock resets. Your mother’s age at menopause can be a soft indicator but is by no means definitive indication of your expected menopause age.

The symptoms of perimenopause can be vague and the diagnosis itself can be hard to obtain. There is not a single blood test that can confirm perimenopause, until you are in the late perimenopause transition. The hormone level FSH (follicle-stimulating hormone) will rise during late perimenopause, extend into menopause, and eventually settle into a new higher level in the late menopause transition. While blood tests are often not contributory to diagnosing perimenopause, they are still important to rule out other conditions that can mimic perimenopausal symptoms. It is worthwhile to ask for a complete blood count, iron, thyroid, Vitamin D and B12, kidney and liver function tests. In my practice, I often see perimenopausal women who also have low iron and other nutrient deficiencies. Our treatment plans involve multiple systems, and we are addressing your hormone deficiencies while also supplementing and monitoring your nutritional deficiencies. The constellation of all these deficiencies lead to the bigger picture of fatigue, stress, gut dysfunction. Our body systems do not work in isolation, and the smooth functioning of one system (ie: our hormones) depend on the smooth functioning of another system (ie: our gut).

Hormone Replacement Therapy (HRT) is generally safe and there are very few reasons why a woman cannot go on HRT. In some women, the right dose of HRT can be life-changing. They can have their energy, mood, vitality, and sense of self restored within weeks. Beyond the symptom control benefits of going on HRT, there are also heart- and bone-protective benefits from estrogen therapy. We know that estrogen is critical to bone building and that older women who suffer from an osteoporotic hip fracture have a 30% chance of dying within the year of their fracture. Estrogen also has a stabilizing effect on heart plaque build-up, and heart disease remains the #1 killer of older women. Even if you think you can “tough through” your perimenopausal symptoms, you need to take a step back and look at the bigger - longevity focused - picture. With advances in health sciences, we are living longer than ever, but it is up to us to ensure that the last decade(s) of our lives are spent with energy and vitality.

At Westcoast Women’s Clinic, we are a team of physicians focused on women’s midlife health. We employ an integrative and holistic approach to your health, look at root causes of your symptoms, connect multiple systems together, focus heavily on your sleep and diet, and take a very active and longevity-focused approach to your health. You give so much to others; you must firstly take care of yourself.

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