Hormonal imbalance in people over 40: Understanding Perimenopause and how to take care of your health

Many women, when they reach their 40s, often begin to feel changes in their bodies that are not the same as before. Even though they have not yet reached menopause, they still experience hot flashes, insomnia, mood swings, or irregular menstruation, which are all signs of "hormonal imbalance" that are common in this age group. Book Hormone Repair Manual Dr. Lara Briden, ND, calls this “Second Puberty” because it marks the time when the body enters a perimenopause state, where hormones change dramatically, similar to entering adolescence all over again. Understanding this change is crucial to maintaining a healthy and confident hormonal balance in your 40s.

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What is perimenopause?

Perimenopause or Premenopause It is the time when the body begins to change hormones until it enters menopause, which means that menstruation stops for at least 12 months.

Perimenopause usually begins in women of 40+ And it can take years. During this time, the body will encounter “Hormonal swings"Especially estrogen that fluctuates erratically and progesterone that decreases, causing Hormonal imbalance Affects mood, sleep and weight

Difference between Perimenopause and Menopause

Different stories	Perimenopause	Menopause
period	It starts to come irregularly, sometimes missing, or coming heavier and more frequently than usual.	Absent for ≥12 months
hormone	Estrogen fluctuates erratically, progesterone is low and imbalanced.	Persistent low estrogen and progesterone
symptom	Hot flashes, mood swings, poor sleep	Hot flashes, night sweats, vaginal dryness, osteoporosis
health risks	Risk of hormonal fluctuations, migraines, insomnia, depression	Risk of long-term hormone deficiency such as heart disease, osteoporosis, and dementia.
period	Several years before menopause	It starts when menopause ends and lasts forever.

Common symptoms in women over 40

If you have at least 3 of these 9 symptoms, it could be a sign that you are entering perimenopause.

Menstrual periods are heavier or longer than usual.
Shortened menstrual cycle (< 25 days)
Menstrual cramps
Breast pain, swelling, or lumps
Poor sleep, waking up in the middle of the night
Night sweats, especially before menstruation
Migraine headaches during menstruation
Mood swings, irritability
Weight gain without changing eating or exercise habits

“About 20% of women have prominent symptoms during the perimenopause period.”

Why are hormones imbalanced?

During this age, the ovaries begin to function irregularly, causing Low progesterone But estrogen still fluctuates so much that it causes symptoms similar to riding a “roller coaster” or Estrogen Roller Coaster

Many symptoms are not caused by “low estrogen” as most people believe, but by Hormonal imbalance Between decreased progesterone and high estrogen swings

Hormone balance check

Hormonal mechanisms during premenopause

During Perimenopause Hormonal changes do not occur gradually. Estrogen, which many people think will gradually decrease, actually does. Uncertain ups and downs It's like riding a roller coaster, at the same time. Progesterone returns to a low level Because the ovaries start to work irregularly

This condition is called Progesterone Deficiency Or a lack of progesterone hormone causes the balance between estrogen and progesterone to be lost, resulting in various symptoms that women over 40 often experience, such as hot flashes, trouble sleeping, mood swings, or headaches.

So, many of the symptoms in the pre-menopausal period It is not caused by low estrogen. But it is caused by an imbalance of both hormones together.

Progesterone is produced by the corpus luteum, also known as eggshell It occurs after an egg is released from the ovaries. This hormone plays a key role in maintaining the body's balance, regulating the menstrual cycle, and preparing the uterus for pregnancy.

Progesterone is produced in the egg corpus luteum after ovulation.

How do you know if you're in perimenopause?

Many people may wonder if their symptoms, such as hot flashes, insomnia, or mood swings, are caused by stress or if they are entering a new stage of life. Perimenopause For sure, the way to confirm this is: Hormone level testing in conjunction with symptom assessment by a physician

Commonly used tests include:

Estrogen (Estradiol)
Progesterone
FSH and LH (Ovarian stimulating hormone)

The most common test results are: Estrogen is still high and fluctuating, Progesterone decreases, or Elevated FSH levels This indicates that the body is entering pre-menopausal conditions. The test also helps to rule out other diseases that have similar symptoms, such as: Thyroid dysfunction or Anemia You can also

How to cope with hormonal fluctuations during premenopause

Proper care of your body can help reduce symptoms of hormonal imbalance. Key approaches include:

Increase progesterone levels naturallySuch as using bioidentical progesterone Under the care of a specialist doctor
Support ovulationBy adjusting lifestyle behavior and nutrition to be balanced
Helps expel excess estrogenPromote liver function by eating green leafy vegetables, broccoli, sulfur-rich vegetables (such as garlic, acacia, stink beans) and increasing fiber by at least 25 grams per day.
Control weight and reduce abdominal fatTo balance hormones and reduce the risk of chronic diseases
Reduce chronic inflammationAvoid sugar, white flour, and alcohol, and supplement with foods that have anti-inflammatory properties, such as turmeric, fish oil, and colorful fruits and vegetables.

Lifestyle adjustments to restore hormone balance

Maintaining a healthy daily routine can help reduce hormonal fluctuations and promote a more balanced body rhythm. Some ways to do this include:

Get enough restGetting 7–8 hours of sleep a night allows melatonin, cortisol, and sex hormones to function according to their natural cycles.
Manage stressUse yoga, massage, or meditation to relax, increase endorphins, and help you sleep more deeply.
Reduce alcoholAvoiding or reducing the amount of alcohol you drink allows your liver to function optimally and reduces inflammation in the body.
Choose foods that are good for your hormones.Focus on anti-inflammatory foods such as vegetables, fruits, whole grains, fish, and healthy oils, while minimizing processed foods and sugar.
Exercise regularlyAerobics, weight training, and stretching can help balance insulin, strengthen muscles and bones, reduce cortisol levels, and improve sleep.
Give yourself timeDo activities you enjoy, such as reading, listening to music, or spending time with loved ones, to recharge and reduce daily stress.

Nutrients and supplements to balance hormones for those over 40

In addition to rest, exercise, and good nutrition, certain nutrients and herbs can help relieve symptoms and support hormone balance, including:

Magnesium Glycinate → Helps reduce stress, relax the body and help you sleep better.
Taurine → Promotes brain function, reduces anxiety, and nourishes the heart.
Vitamin B6 (P5P) → Reduces premenstrual symptoms (PMS) and helps balance estrogen levels.
Ashwagandha → Adaptogen herbs that help reduce stress and promote quality sleep.
Fish Oil (Omega-3) → Reduces inflammation, balances blood fats, and nourishes both the heart and brain.
Vitamin D3 + K2 → Strengthens bones, boosts immunity, and reduces the risk of atherosclerosis.
Probiotics → Balances the intestines, reduces inflammation and helps strengthen the immune system.
Micronized Progesterone → A well-absorbed form of progesterone helps reduce hot flashes and balances overall hormones.

Doctor's advice

“Being in your 40s doesn't mean your body is starting to deteriorate. It's a time of hormonal changes that require personalized care. Early hormone screening and lifestyle changes can help you maintain energy, sleep well, and live confidently.”

Dr. Chalermpol Innachit (Dr. Nong), W9 Wellness Center

Perimenopause is a transitional period that many women over 40 face without warning. Estrogen levels remain high while progesterone levels drop, causing a variety of physical and emotional symptoms. Understanding these mechanisms and taking proper care of yourself, whether it's adjusting your lifestyle, choosing good nutrition, supplementing with essential nutrients, or consulting a medical professional when necessary, will help women confidently navigate this period and build a strong and balanced foundation for their 40s.

Make an appointment for a hormone test with Dr. Nong.

Phramongkutklao Hospital (3rd floor, Building A)