Your hormones during menopause: what exactly happens in your body?

As a woman, you are born with a finite number of eggs. During each menstrual cycle, you lose a portion of this supply until it gradually runs out. This typically occurs around the age of 45, signalling the onset of menopause.

Two hormones play a key role in your cycle: oestrogen and progesterone. In the first half of the cycle, your body primarily produces oestrogen (oestradiol). In the second half, following ovulation, progesterone is also produced.

Entering menopause does not mean you suddenly become infertile overnight. On the contrary, your body works hard to mature the few remaining eggs. This process is regulated by the brain, which produces extra FSH (follicle-stimulating hormone) and LH (luteinising hormone) to stimulate egg maturation and ovulation. However, as menopause approaches, it becomes increasingly difficult to stimulate the remaining eggs.

Additionally, cycles without ovulation (known as anovulatory cycles) become more common during menopause, eventually leading to the complete cessation of the menstrual cycle (menopause). Without ovulation, your body produces little to no progesterone. This can result in symptoms such as heavy bleeding, prolonged periods, thickening of the uterine lining, and uterine polyps.

How do hormones behave during menopause? In the first phase, known as perimenopause, progesterone levels are low or absent, while oestrogen levels are high and fluctuate. This is often referred to as oestrogen dominance.

Over time, your periods become less frequent. Eventually, oestrogen production follows the same pattern as progesterone, gradually decreasing until the ovaries stop producing both hormones. If your period has been absent for a year, you can retrospectively determine that you reached menopause a year earlier.

Your body then enters the postmenopause phase. At this stage, oestrogen levels are low, and the ovaries no longer produce progesterone.

Although menopause varies for every woman, you may notice the following general changes in your menstrual cycle:

• Phase 1: In the first phase, your menstrual pattern remains unchanged. However, you may begin to notice initial symptoms such as tender breasts, irritability, poor sleep, and/or bloating.
• Phase 2: Your cycle becomes irregular or shorter, often accompanied by heavier bleeding.
• Phase 3: During this phase, cycles become longer, or you may skip periods more frequently. Menstrual flow also tends to become lighter.
• Phase 4: The final phase is the last year of menstruation. The pattern from the previous phase continues, but periods become increasingly infrequent. A year after your last period, you can confirm that you are in postmenopause (and that menopause occurred a year earlier). In the years following menopause, your body seeks a new balance.

During menopause, oestrogen and progesterone levels decrease in all women—this is inevitable. However, each body responds differently. It needs to adjust to the reduced levels of sex hormones, which doesn’t always happen smoothly. Some women experience numerous symptoms, while others notice little to no changes.

The cessation of oestrogen and progesterone production by the ovaries does not mean you no longer need these hormones after menopause. On the contrary, your body can function with much lower levels of sex hormones. Two systems in your body take over the ovaries’ role.

First, the ovaries continue to produce the male hormone testosterone, which your body converts into oestrogen. Second, the adrenal glands take over hormone production. Using the pro-hormone DHEA, they produce various oestrogens and ensure sufficient progesterone.

To ensure these bodily processes run smoothly—and to prevent or alleviate symptoms—you can support your body. These tips apply to all women going through menopause:

• Reduce stress and schedule relaxation: Otherwise, your adrenal glands may prioritise producing the stress hormone cortisol over the necessary sex hormones.
• Stabilise your blood sugar levels: Excessive fluctuations are a stress factor for the body and can affect the production of sex hormones.
• Maintain good digestion and a healthy microbiome: Both play a crucial role in regulating the stress system.
• Eat 300-500 grams of vegetables daily: This nourishes beneficial gut bacteria and provides the vitamins and minerals needed for hormone conversion.
• Exercise daily: A combination of strength training and activities like yoga is ideal. Increased muscle mass improves insulin sensitivity, which is essential for hormonal balance. Yoga also promotes relaxation, benefiting your adrenal glands.