As a woman, you’re on a hormonal roller coaster ride most of your life. My books The Hormone Cure, The Hormone Reset Diet, and Younger were born of my passion to help women, one hormone at a time. I want to help you do that so you can stay looking and feeling great at every age.
Hormones are chemical messages, like text messages sent from an endocrine gland through your blood to target cells. Hormones influence your behavior, emotions, brain chemicals, immunity, and metabolism. When your hormones are in balance, you look and feel your best. But when they are imbalanced, they can make your life miserable. You can feel lethargic, irritable, weepy, grumpy, unappreciated, anxious, and depressed. The message from most conventional doctors is that it is normal to feel like this as you age and that you should just accept it. As a functional medicine doctor specializing in women’s hormones, I can assure you it’s not normal. You can balance your hormones and get back to feeling vivacious and genuinely content.
Each life stage has its hormonal benefits and challenges for women. I’ve broken them down for you and provided tips for staying balanced at any age.
Ages 10−20: Adolescence
In adolescence, the control system in the brain (hypothalamus and pituitary) is just getting started in the conversation with the key endocrine glands outside of the brain: adrenals, thyroid, and gonads (ovaries in girls, testes in boys). There’s a lot of excitement as the adolescent female brain goes through puberty and responds to estrogen for the first time, making girls care more about their appearance and their status among friends.
Ages 20−35+: Reproductive Years
The childbearing years are when you’re most likely to be a perfect hormonal specimen, especially in your twenties. You have a predictable level of estrogen and progesterone each day of the menstruation cycle. Progesterone is key to women’s ability to roll with the punches and be accommodating. Progesterone makes allopregnanolone in the brain, which interacts with GABA and serotonin for a foursome that truly soothes the female brain. Even thousands of years ago, in Chinese Medicine, women were considered to be at their peak hormonally around twenty-one to twenty-eight years old. Science suggests age twenty-four, but I’d argue that optimal age for reproduction is based on an empowered woman’s choice.
After I gave birth to my first child, I was shocked to experience symptoms of menopause during my postpartum stage: hot flashes, night sweats, brain fog, vaginal dryness, and CRS (Can’t Remember Stuff). That’s because when a woman delivers a placenta, estrogen and progesterone shift from sky high to nothing in a matter of minutes. It’s a preview of coming attractions in perimenopause.
Women in their twenties benefit from understanding that the best way to mind your hormones begins early in life. Master your sleep (97 percent of us need eight hours each night), eat nutrient-dense food (and not too much), stop sitting so much, and detox your liver periodically (get off the alcohol). When you don’t indulge stress or let it overpower you, you’re actually creating hormonal grace. The reason is simple: Cortisol, the main stress hormone, controls the levels of the other key hormones in your body, including thyroid, estrogen, progesterone, and testosterone.
Women in their thirties may feel increasingly tense and overwhelmed, in need of better strategies on how to chillax. Your goal should be to prevent the high blood pressure, pre-diabetes, and accelerated aging that come with chronically high-perceived stress.
Let’s Talk PMS Solutions
As your hormone levels fluctuate throughout your reproductive years, PMS can abate or worsen, depending on your age (or more precisely, the age of the eggs in your ovaries and how you’re navigating stress.
PMS is closely tied to progesterone levels, which decline as you age, especially around thirty-five to forty-five. If you want to geek out, PMS is actually a sign of imbalanced hormones beyond just progesterone. The best science shows that PMS is the result of the poorly synchronized dance between four entities: progesterone, allopregnanolone (a derivative of progesterone), and the GABA and serotonin pathways in the brain, which make you calm and happy. It’s a complicated situation, but the solutions are often surprisingly simple.
Symptoms of PMS include mood swings, food cravings, irritability, belly bloating and tender breasts. Here are a few ways to alleviate symptoms of PMS:
- Chasteberry and St. John’s Wort are herbal therapies that have been proven to relieve symptoms of PMS.
- Calcium, magnesium, and vitamin B6 help combat hormone imbalance, bloating, and anxiety. Magnesium is a girl’s best friend when it comes to preventing the ungodly fluid retention that occurs a few days before menstruation.
- Women with PMS eat 275 percent more refined carbs than women without PMS. Not surprising, this makes mood swings and fluid retention even worse. To avoid this symptom, ditch all processed foods.
- Moderate exercise, acupuncture, and a sugar-free diet all go a long way in alleviating PMS.
Ages 35−50+: Perimenopause
Perimenopause refers to the ten years of hormonal upheaval that precede a woman’s final menstrual period. Most women start to notice signs of perimenopause around age forty: you can’t roll with the punches as well as you used to; you’re tired and/or moody; you can’t sleep as well; and maybe metabolism becomes less forgiving. Perhaps you want to wake up feeling more restored, without obsessive thoughts or brain fog.
Your ovaries begin to falter in their once-reliable production of the sex hormones progesterone and estrogen, and ovulation becomes intermittent. As a result, your periods may be irregular and heavy or light, or alternately both. Other hormones also start to fade or deregulate; your ovaries, thyroid, and adrenals start to work against you, not for you. To confuse matters even further, the brain becomes less responsive to the hormones that your body does still produce. Further symptoms of perimenopause include hot flashes, sleep problems, unpredictable mood swings, weight gain, and loss of energy. I like to say perimenopause is puberty in reverse! You forget to brush your hair and start to wear yoga pants everywhere as the brain becomes resistant to estrogen.
Generally, most women who are in perimenopause sit into one of two phases.
Stage 1 of Perimenopause
You’re running out of ripe eggs in your ovaries, progesterone has started to drop, and estrogen is fluctuating wildly. That can lead to more PMS, depression, and issues with sleep. Progesterone is like nature’s valium, so low levels make many women between forty and fifty feel like they’re going nuts, they’re overwhelmed, they’re premenstrual, they can’t sleep, they want a divorce, or they’re having a personal global warming crisis (hot flashes or night sweats)—or all of the above. Lower progesterone can also make one’s period come more often – for instance if you used to be once-every-twenty-eight-days, you may notice menstruation happens once every twenty-three or twenty-five days. (Note: If bleeding occurs more often than once every twenty-one days or is heavy, please see your health provider for a full evaluation as it may be a serious issue.)
Most women at this stage become estrogen dominant because of the drop in progesterone (Pg). Estrogens are a family of hormones, including estradiol, which is the main estrogen (also known as E2) of your reproductive years, estriol (or E3), which is the main estrogen of pregnancy, and estrone (E1), which is the main estrogen of menopause. You want the ratio of Pg/E2 to be about 300 optimally, or at least in the range of 100−500. A functional or integrative medicine practitioner can help you find the right range.
Estrogen-dominance symptoms can also occur from being overweight or obese, not getting enough fiber, eating too much red meat, or exposure to xenoestrogens or fake estrogens that mimic estrogen in your body and bind to the estrogen receptor.
Stage 2 of Perimenopause
Your estrogen levels start to drop, which usually happens between forty-five and fifty. This is often when women notice low sex drive, vaginal dryness, brain fog, slower thinking, and perhaps depression. About 20 to 30 percent of women are sensitive to estrogen and need it to bolster their mood and prevent depression, which is possibly related to serotonin pathways in the brain that are connected to mood, sleep, and appetite. Lower estrogen greatly impacts serotonin, which is what some women notice and experience postpartum. When it comes to women and depression, my bias is always to address the hormonal root cause first before reaching for a prescription.
In this stage, you can have three simultaneous sets of symptoms: low progesterone, high estrogen, and low estrogen. The low estrogen symptoms are related to the estrogen levels you had in phase 1 of perimenopause, maybe five or ten years ago, and are low for you. The estrogen dominance is about your estradiol levels now versus progesterone levels, so the ratio of Pg/E2 is less than 100. Low progesterone is a result of ovarian aging, which is a normal and natural but can cause more problems in some women than others, including PMS, difficulty sleeping, and anxiety.
Let’s Talk Perimenopause Relief
To combat symptoms of perimenopause,
- Eat foods rich in vitamin C (e.g., papaya, bell peppers, citrus, dark leafy greens) to increase progesterone levels naturally, or take a supplement of 750mg daily.
- Reduce caffeine consumption, and try yoga to balance cortisol and relieve mood swings, difficulty sleeping, and lack of energy.
- Check your thyroid. You may notice that tricks to lose weight no longer work—and that may be because your thyroid is slowing down or your testosterone fell off a cliff. Be sure to get your levels checked with your healthcare professional, and follow the recommendations I provide for optimal ranges rather than conventional numbers.
- Cut out sugar to counteract weight gain and keep your insulin in check.
- Make sleep a priority, which will put your growth hormone (it does repair work in your body while you sleep) production back on track.
Age 51+: Menopause and beyond
Menopause is the permanent end to a woman’s menstruation and fertility and begins twelve months after a woman’s last period. Symptoms include mood swings, hot flashes, night sweats, and insomnia. In menopause, estrogen is low and progesterone is super low. Those levels cause the female brain to feel distracted (even ADD-like) and difficult to soothe. The ratio of estrogen to progesterone makes women more likely to be depressed and to gain weight, particularly fat at the waist (muffin top anyone?)
Let’s Talk Menopause Help
To make the transition into menopause easier,
- Take vitamin E to alleviate hot flashes, vaginal dryness and mood swings. Doses between 50−400 IU have been proven to be effective.
- Magnesium can help reduce hot flashes, fatigue, and distress.
- Maca helps with insomnia, depression, memory, concentration, energy, hot flashes, and vaginal dryness. Maca also improves body mass index and bone density. I love adding Maca to my morning shake. Don’t take it too close to bedtime as it may be too stimulating.
- Pueraria lobata is a traditional Chinese herbal remedy for menopausal symptoms and is prepared as a brew like tea.
- Red ginseng can help reduce hot flashes and improve symptoms of fatigue, insomnia, and depression in menopausal women.
Let’s Talk Bioidentical Hormones
The truth is that bioidentical hormones are a godsend for some women and inappropriate for others. So one-size-fits-all is obsolete medicine. There’s no harm in trying a small amount of bioidentical hormone replacement to see if it’s right for you. Your body will either say yes or no quickly.
Hormone testing is controversial because it only measures a point in time (like looking at the speedometer in your car only once during a road trip) and hormones fluctuate widely throughout the day. (This applies to blood, saliva or urine tests.) Results also depend upon what you eat, your activity level, the time of day, and your nutritional status. Still, a baseline blood test is a good starting point for monitoring therapy. The vast majority of experts agree that blood hormone values are the most reliable compared to saliva. These should be tested by a lab that has a lot of experience in hormone testing such as Genova Diagnostics.
Natural Hormone Balancing
Many safe, proven supplements can help you balance hormones naturally in conjunction with lifestyle changes. I recommend a “food first” philosophy: Get what you need from food, and only if you can’t, rely on supplements. You need the foundation of nutrient-dense whole foods (no processed foods, and especially no refined carbohydrates, which worsen adrenal problems) and restorative sleep. Then certain foods and supplements can help fill nutritional gaps and effectively balance hormones for all ages:
Brazil nuts. Brazil nuts provide 100 percent of the recommended daily allowance of selenium, which you need to keep your thyroid happy. Don’t overdo it: five to six Brazil nuts per day is just right.
Oysters. This is my favorite order at happy hour: a half dozen fresh oysters. They provide the copper you need to boost your thyroid and testosterone levels. If oysters are not your thing, try cashews for the dose of zinc and iron.
Omega 3s. I advise my tribe to eat two to three servings of wild-caught fish every week. In between your “fish” days, take a high-quality supplement. Men and women who took 4,000 mg (4 grams) of fish oil a day for six weeks lowered morning cortisol levels to healthier levels and got leaner. I recommend choosing a form of fish oil that has been tested by a third party and free of mercury and other endocrine disruptors.
Maca. The magical herb maca (Lepidum meyenii) has consistently been shown to increase estradiol in menopausal. See details above under “Let’s Talk Menopause Help.”
Vitamin B5. Stress-crazed? Also known as pantothenic acid, B5 reduces the hypersecretion of cortisol in people under high stress, and it is a low-risk treatment. If you’re chronically stressed, I recommend taking 500 mg/day.
Lifestyle Effects on Hormones
Drink less. Alcohol raises cortisol, robs you of deep sleep, and lowers metabolism by more than 70 percent. I suggest getting off alcohol completely for a minimum of two weeks, twice per year, to give your liver a break.
Dance differently with stress. Develop a more playful attitude. Laugh more, roll with the punches, hang out with friends, take a hot detox bath with Epsom salt.
Master your sleep. Only 6 percent of the population does well on less than 7 hours of sleep, so chances are you’re not one of them. Sleeping seven to eight and a half hours every night keeps cortisol in check, which prevents the muffin top and accelerated aging.
Burst train. It’s better than cardio. Interval training raises your growth hormone and melts the muffin top.
Activate the positive. Write a nightly gratitude list of three big wins. Practice forgiveness and intentionally connecting with those you love. Focusing on the positive has been shown to lower cortisol by 23 percent and raise DHEA, the precursor to testosterone.
Remove estrogen disruptors. More than 700 synthetic chemicals mimic estrogen in a toxic way, and their prevalence in our environment is on the rise. These toxins, found in an array of items from receipts to canned foods and from plastics to pesticides, have now been linked with early puberty, female infertility, ovulation, miscarriage, endometriosis, male infertility, obesity, diabetes, and an increase in certain cancers.
Don’t suffer needlessly by letting your hormones run wild. I don’t want you to be misinformed by prevailing myths, underserved by your doctors, or miseducated by the media. You can find more on these topics in my book, The Hormone Cure. By keeping your hormones balanced, all your years can be fun and sexy!
L. Gorbach et al., “Diet and the Excretion and Enterohepatic Cycling of Estrogens,” Preventative Medicine 16, no. 4 (1987): 525–31.
Gottfried, Sara, MD. The Hormone Cure. New York, NY: SCRIBNER, 2013.
Spiegel et al., “Effects of Poor and Short Sleep on Glucose Metabolism and Obesity Risk,” Nature Reviews Endocrinology 5, no. 5 (2009): 253–61, doi:10.1038/nrendo.2009.23; and L. Morselli et al., “Role of Sleep Duration in the Regulation of Glucose Metabolism and Appetite,” Best Practice and Research: Clinical Endocrinology and Metabolism 24, no. 5 (2010): 687–702, doi:10.1016/j.beem.2010.07.005.
Flint et al., “Food-Addiction Scale Measurement in 2 Cohorts of Middle-Aged and Older Women,” American Journal of Clinical Nutrition 99, no. 3 (2014): 578–86, doi:10.3945/ajcn.113.068965.
P. Markovic et al., ”The Determinances of Glycemic Response to Diet Restrictions and Weight Loss in Obesity and NIDDM,” Diabetes Care 21, no. 5 (1998): 687.
Ismail et al., “A Systematic Review and Meta-Analysis of the Effect of Aerobic vs. Resistance Exercise Training on Visceral Fat,” Obesity Reviews 13, no. 1 (2012): 68–91, doi:10.1111/j.1467-789X.2011.00931.x.
“EndocrineDisruptors,” National Institute of Environmental Health Sciences, National Institutes of Health, May 2010, accessed January 28, 2014, www.niehs.nih.gov/health/ materials/endocrine_disruptors_508.pdf.