Estrogen. Progesterone. Testosterone. Cortisol. If it feels like hormones are suddenly everywhere — in your social feeds, your group chats, and maybe even your 1 a.m. Google searches — you’re not imagining it.
But for all the attention they’re getting, there’s still plenty of confusion about what hormones actually do, why they change as we age, and whether we should be trying to replace them when they decline.
On this episode of Next Question, Katie sits down with Stephanie McNally, MD, an OB-GYN, medical director and vice president for clinical initiatives and patient experience at Northwell’s Katz Institute for Women’s Health, system director for the Center for Menopause and Midlife Health, and a Menopause Society-certified menopause practitioner, to separate fact from fiction.
The first thing Dr. McNally wants women to understand? Hormones are about much more than just menopause. “A hormone is a little messenger that takes pieces of information from one part of your body to another, to send a signal to get things moving,” she explains. Those messengers are involved in many processes: metabolism, stress, sleep, mood, reproductive health, and more.
What happens to your hormones during perimenopause?
When it comes to women’s reproductive health, estrogen, progesterone, testosterone, FSH, and LH are what Dr. McNally calls the “big five.” Throughout much of your reproductive years, estrogen and progesterone rise and fall in a relatively predictable cycle. Then perimenopause arrives, and, as Dr. McNally puts it, “all bets are off.”
Hormone levels begin fluctuating more unpredictably as ovulation becomes less consistent. That transition can last four to eight years (and sometimes even longer), and its earliest signs may be surprisingly subtle. “You may notice mood changes. You may have more breast tenderness, more headaches. Your periods may be off by a day or two,” Dr. McNally says. Those unpredictable fluctuations are also why a single blood test generally can’t provide a definitive answer about whether you’re in perimenopause.
Instead, to answer that question, Dr. McNally pays close attention to how a patient talks about their health. The complaint she hears most often? “I don’t feel like myself.” Sleep problems, irritability, headaches, changing periods, breast tenderness, and mood shifts can all be part of the picture. But because symptoms vary considerably from woman to woman, treatment shouldn’t be one-size-fits-all either.
What does declining estrogen do to your body?
As a woman approaches menopause, the ovarian production of estrogen and progesterone drops significantly. And because estrogen receptors exist throughout the body, those changes can affect much more than your period. “Every part of a biologic female body has an estrogen receptor,” Dr. McNally explains.
That includes your brain, bones, skin, cardiovascular system, and vaginal tissue — which helps explain why menopause can bring seemingly unrelated symptoms, from hot flashes and sleep disruption to vaginal dryness and changes in sexual health.
Understanding those connections is important, but that doesn’t mean estrogen supplementation is the answer for combating every symptom. Treatment should depend on what an individual woman is experiencing and what’s appropriate for her health.
Is hormone therapy safe?
Some of the lingering fear around hormone therapy dates back to 2002, when the Women’s Health Initiative released findings that dramatically changed how women and doctors viewed menopausal hormone therapy. But Dr. McNally points out an important distinction: The average age of women in the study was 64, while the average age of menopause in the U.S. is around 51 or 52. “A 64-year-old woman is not the same as a 50-year-old woman,” she tells Katie.
Treatment has evolved since then, too, and Dr. McNally says the decision to use hormone therapy should take into account a woman’s age, symptoms, health history, risk factors, and where she is in the menopause transition.
What are the alternatives to hormone therapy for menopause symptoms?
Hormones aren’t the only tool available for managing menopause symptoms. That fact is especially relevant for women who can’t take hormone therapy, or simply don’t want to.
“If you think about it holistically, cognitive behavioral therapy [is] incredibly effective for vasomotor symptoms, mood, and insomnia,” Dr. McNally tells Katie. She also points to acupuncture as another potential adjunct treatment for women looking for non-hormonal options.
In fact, Dr. McNally says the Katz Institute has studied acupuncture in perimenopausal women, with researchers finding a statistically significant response in sexual health — an area she says warrants further research.
There are also non-hormonal medications that may help with symptoms including hot flashes, mood changes, anxiety, and sleep issues. The larger point, Dr. McNally says, is that women have more options than they may realize. “Definitely speak up,” she says. “There’s a lot out there not just based on hormonal therapy.”
Ultimately, there’s no universal hormone prescription, because there’s no universal menopause experience. Dr. McNally’s advice is to pay attention to changes in how you feel and bring up any problematic symptoms with your healthcare provider, rather than assuming they’re simply something you have to live with.
Catch Katie’s full conversation with Dr. McNally on Next Question to learn more about hormone therapy, brain and heart health, menopause weight changes, sexual health, and what women can do now to support their health for decades to come.
This interview has been condensed and edited for length and clarity.
