Perimenopause followed by menopause are among the steepest hormonal shifts women undergo in adulthood, second only to pregnancy and postpartum. The body drastically shifts gears, affecting nearly everything from sleep to body composition, weight distribution, appetite, mood, libido, heart health, skin and hair, and more.
Unfortunately, even though menopause is universal for women, it remains largely under-discussed. Being informed about hormonal changes during this time can help women better prepare for what’s ahead and seek the proper resources to support their physical, mental, and emotional health.
What happens to your hormones during menopause?
There are five hormones primarily involved in perimenopause and menopause: estrogen (namely estradiol), progesterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone. And let’s just say the levels get a bit wonky.
The most prominent changes are the decline in progesterone and estrogen, specifically estradiol, a type of estrogen. The reason? Women’s ovaries are filled with follicles, or sacs of fluid containing immature eggs. Follicles produce estradiol, which signals the start of ovulation. When the number of follicles dips very low, estradiol lowers significantly, which stops ovulation and ends the menstrual cycle.
Progesterone is another hormone produced that sharply reduces after ovulation stops. Simultaneously, testosterone, a hormone produced by the ovaries and adrenal glands, continues reducing with age.
Amazingly, the brain recognizes the drop in these hormones and increases two other hormones to help the ovaries continue producing follicles: follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Once the brain realizes the ovaries are finished, the body enters post-menopause.
What symptoms are caused by hormonal changes in menopause?
Many symptoms can be associated with hormonal changes in perimenopause and menopause. Symptoms vary in scope and intensity, as they are influenced by factors like genetics, body composition, and lifestyle.
Registered dietitian Morgan Beemiller of Health Loft told Parenthood Together, “Hot flashes and night sweats, skin and hair changes, sleep changes, changes in bone density, and body composition changes (more fat around the waist area and easier weight gain).”
Heather Ritter, MS, RD, LD, also shared with us that clients often show symptoms of low energy, vaginal dryness, joint aches, thinning hair, changes in cholesterol, and blood pressure.
“Not everyone experiences all of these, and severity varies enormously. If something feels disruptive to your quality of life, that’s reason enough to bring it to your doctor; you don’t need to meet a certain ‘severity threshold’ to deserve support,” Ritter told Parenthood Together.
How do hormone changes affect the body during menopause?
Menopause truly changes the women’s body and how it functions in its entirety. However, some regions of the body are affected more than others.
“Some of the most important health concerns to pay attention to as women enter menopause include cardiovascular health, muscle and metabolic health, bone health, sleep, and cognitive and mental health,” Ava Ajlouny, RD, told Parenthood Together.
Brain health
Reduced estrogen can cause changes in mood, emotional regulation, memory, and sleep. Estrogen receptors are located throughout the brain, and sharp declines can trigger anxiety, irritability, poor stress response, brain fog, emotional sensitivity and reactivity, and sleep disruptions.
The 6th Annual State of Menopause Survey, a national study of more than 2,000 U.S. women ages 40 to 64 conducted by women’s health care company Bonafide Health, LLC, found that mental and emotional symptoms are more uncomfortable than physical symptoms for women in menopause. Results indicated that anxiety, panic attacks, and depression were the most impactful symptoms.
Bone health
Bone loss accelerates as estrogen declines, increasing the risk of osteoporosis.
Cardiovascular health
The cardiovascular system is significantly affected by the drop in estrogen, as the hormone helps regulate cholesterol, vascular function, body fat distribution, blood pressure, and how glucose is metabolized. Collectively, these issues raise risks related to heart and cardiovascular health after menopause.
Body composition
Estrogen encourages body fat to collect in the hips and thighs. With less estrogen, weight becomes more distributed as visceral fat in the abdomen, even without significant weight gain. Muscle mass also declines, which can lower one’s daily recommended caloric intake.
Urinary and vaginal health
Reduced estrogen affects the entire female reproductive and bladder system. Vaginal and bladder tissue becomes thinner and loses elasticity. Vaginal pH levels rise, causing dryness, which may then cause pain during sex, and irritation during exercise and movement. Many women have more frequent urination, leakage, burning or discomfort, and an urgent need to urinate, as well as recurrent urinary tract infections.
Why does libido change during menopause, and how can you support a healthy libido?
Libido is largely affected by the physiological changes that occur in a woman’s body during menopause. “Declining estrogen contributes to vaginal dryness and thinning tissue, which can make sex physically uncomfortable, and pain is one of the fastest ways to dampen desire,” Heather Ritter told Parenthood Together. Declining testosterone (women produce it too, just in smaller amounts) can independently lower desire and arousal.
“On top of the physiology, this is often a season of poor sleep, mood changes, relationship shifts, and plain exhaustion, all of which affect libido regardless of hormones,” Ritter added.
Ava Ajlouny and Ritter described several ways to support a healthy libido during menopause, with both noting the importance of addressing physical discomfort and pain during sex with a doctor. “If vaginal dryness or painful sex is affecting intimacy, it’s worth discussing those symptoms with a healthcare provider,” Ajlouny advised. “There are effective treatments available, and women don’t simply have to accept discomfort as a normal part of aging.”
Ajlouny added, “Beyond nutrition, regular physical activity, adequate sleep, and effective stress-management strategies can all support overall well-being, which can positively impact sexual health and desire.”
Is it necessary to check hormones?
Hormone testing is not necessary to diagnose menopause for most women, especially age 45 and older, according to Ava Ajlouny. “Hormone levels can fluctuate from day to day, so a single test may not reflect what is happening,” she shared with Parenthood Together.
She explained that hormone testing may be considered if menopause occurs earlier than anticipated, especially before age 40, or if there is an unclear diagnosis. “Your healthcare provider may also order thyroid testing if a thyroid disorder is suspected, since thyroid conditions can cause symptoms that overlap with menopause,” Ajlouny noted.
Menopause is a full-body hormonal transition in which women undergo a major shift. It’s a rite of passage for nearing the end of childbearing years, though it doesn’t make the process any easier.
Such intense biological and mental changes warrant meetings with physicians to discuss one’s experience and identify solutions. Uncomfortable symptoms don’t have to be endured alone: there are solutions available.
What health screenings should you prioritize during menopause?
During perimenopause, which typically happens in your 40s, hormonal fluctuations can affect your health. Heather Ritter told Parenthood Together that, along with a baseline lipid panel and blood pressure check, you should also talk to your doctor about bone density, especially if there is a family history of osteoporosis or previous fractures.
Ritter added, “Thyroid function testing is key. Thyroid disorders often emerge or worsen in this decade and can mimic or compound menopausal symptoms.” She urged women to keep on top of their mammograms and cervical cancer screenings, as well as mental health check-ins. “Depression and anxiety risk both rise during this transition, independent of prior history,” Ritter shared.
Once you’re in menopause, keep on top of your cardiovascular health. Both Morgan Bemiller and Ritter stressed that cholesterol, blood pressure, and glucose/A1c should be checked. Additionally, pelvic exams and cancer screenings should not be skipped. “Colorectal cancer average risk screening typically begins at 45 years old,” Bemiller stated.
How to stay on top of your health during menopause
Healthy eating is essential, especially during menopause, and your dietary needs may need a tweak during this era. “Focus on a balanced diet with adequate protein, healthy fats (such as avocado, nuts, seeds, olive oil, and fatty fish), and fiber (around 25 grams per day from a variety of sources), along with calcium-rich foods such as milk, fortified milk alternatives, yogurt, and cheese to support bone health,” Ava Ajlouny told Parenthood Together.
She continued, “Women over 50 generally need about 1,200 mg of calcium per day. Aim to meet this need through food when possible, and consider a calcium supplement if you’re not getting enough through your diet.”
Heather Ritter stressed, “Protein adequacy matters more, not less. Muscle mass naturally declines with age, and estrogen loss accelerates that process, so many women benefit from higher protein intake than they needed in their 30s to help preserve muscle and support metabolic health.”
Morgan Bemiller told us, “Don’t be afraid of carbohydrates!” Ritter advised, “Fiber-rich carbohydrates paired with protein or fat tend to support steadier energy and mood, since some women become more sensitive to blood sugar swings during this transition.”
Regular exercise is important as well, with Ajlouny noting, “Aim for at least 150 minutes of moderate-intensity exercise per week, including at least two days of strength training to support muscle and bone health.”
If you find working out a chore, Ajlouny urged, “Find activities you genuinely enjoy, or exercise with a friend or family member, to make staying active more sustainable. Prioritize good sleep hygiene and aim for 7–9 hours of sleep each night. Stress-management practices such as yoga, meditation, spending time in nature, or reading can support mental well-being.”
Menopause is a life transition every woman goes through, but it doesn’t have to be a struggle. The right care, a good support system, and reliable information can make all the difference, helping you feel more prepared and armed with knowledge as you navigate this new chapter.
