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Women’s Reproductive Health:

Understanding Hormones, Perimenopause & Menopause

For girls, going through puberty can be a rollercoaster of emotions as their bodies are changing and their minds are adjusting to fluctuations in hormone levels. This ‘ride’ continues through childbearing years with menstruation, when estrogen levels increase and decrease during each monthly cycle. Women adapt to experiencing these fluctuations throughout their reproductive years and through any childbirths they may have. Then, in their 30s or 40s, as their bodies begin preparing for the end of menstrual periods, hormones are once again triggered to change—this time by reducing their levels.

To help women–and men–better understand what’s going on with the female body during these periods of transition, we asked Barbara K. Estes, MD, MBA, FACOG, chair of Obstetrics and Gynecology at CalvertHealth Medical Center, to provide information on what to expect during perimenopause, menopause and post-menopause, and why it’s important to talk to a healthcare professional about symptoms affecting quality of life.

Changing Hormone Levels

Hormones are the chemical messengers regulating growth, metabolism and fertility for both men and women. They stimulate specific cells or tissues into action and are somewhat responsible for how we behave.

Young women’s bodies begin preparing for childbearing years by increasing levels of sex hormones. Increased levels of these hormones result in not only the physical and outward changes to girls’ bodies, but also to emotional changes.

Women who use contraceptive pills minimize the effects of changing hormone levels because the synthetic form of progesterone and estrogen in these medications prevent monthly ovulation by maintaining more consistent hormone levels.

Menopause is Only One Day in a Woman’s Life

By definition, menopause is only one day in a woman’s life, which is exactly when she has not had a period for 12 months.

Most women arrive at menopause naturally at about age 51. Early menopause, between the ages of 40 and 45 affects about 5 percent of women and premature menopause, before age 40, affects about 1 percent of women, according to a study from the Mayo Clinic.


The transition period leading up to the time when menstrual periods stop permanently is known as perimenopause.

“Often, coinciding with the time symptoms from perimenopause begin, women are also dealing with stresses of raising children, hitting their stride in their career, marriage or relationship issues, caring for aging parents and possibly serious health issues,” said Estes. “It may be difficult to distinguish between what is happening in your life and what may be happening within your body, so seeing a healthcare provider—and having an honest discussion on what you are experiencing—is a good first step in helping to sort out what help you may need.”

“When I talk to my patients, I like to divide [perimenopause] into early, mid and late as far as the timing of cycles. Early perimenopause is when there are breaks in periods of up to three months; mid is three to six months; and late is more than six months. With patients who have had a hysterectomy and no longer have periods, it can be hard to know when they are transitioning—so we have to go on other symptoms,” said Estes.

What to Expect When Hormone Levels Decrease

Most women know that irregular periods are a sign they are beginning the transition to menopause, but other symptoms may present years before changes in menstrual cycles.

Perimenopausal symptoms can include hot flashes, more frequent urinary tract infections, bladder control difficulties, vaginal dryness, hair loss and night sweats. Gradual weight gain is generally linked to changes in metabolism. Women may also have difficulty falling asleep and staying asleep.

“Getting enough sleep is one of the most important things women can do during this period in their lives,” said Estes, who added that fatigue is the top complaint from her patients.

Falling estrogen levels can lead to vaginal dryness as the vaginal tissue thins out. A common complaint among patients, vaginal dryness can cause itching, irritation and discomfort. “If a female patient is experiencing any type of discomfort due to vaginal dryness, she should speak with her healthcare provider about treatment. There are many topical creams, lubricants and hormone therapies available that can help women feel more comfortable during menopause as well as the years that follow.”

“Every woman is different and symptoms that friends and female family members experience may not be the same or present in the same sequence as the ones you experience,” said Estes. “Women have been accustomed to coping with hormone level changes since middle school years, for the most part, and by the time they reach their late thirties, they know their mental, physical and emotional selves very well. Educating women on perimenopausal symptoms is important, so that when those symptoms surface, they realize it is part of a normal process.”

Depression Could be a Concern

Most women navigate perimenopause without serious mental health issues. However, according to the National Institutes of Mental Health, women who have a previous diagnosis of major depression or anxiety disorder are going to be at a greater risk during perimenopause.

Symptoms of anxiety, depression and prolonged fatigue can be treated through medication and therapy.

“Women who, frankly, are used to dealing with emotional ups and downs successfully throughout their lives may feel that menopause is yet another thing they need to soldier through,” said Estes. “Don’t try to tough this out alone. Depression is real and it can be treated.”


Barbara K. Estes, MD,MBA, FACOG is board certified in obstetrics and gynecology and has been practicing in Calvert County for more than 30 years, most recently with CalvertHealth OB/GYN. Dr. Estes has refocused her specialty to care primarily for GYN patients, a transition that allows her to focus on the overall wellness and lifestyle needs of her patients. For more information on Dr. Estes or any of the OB/GYNs affiliated with CalvertHealth, go to: CalvertHealthMedicine.org.
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