The Hormone-Health Connection (Part 1): Understanding Hormonal Balance and Women’s Health Across the Lifespan

March 31, 2026 - Behnaz Atree, MD

Hormones are central to various aspects of a woman’s health.  They can affect energy level, mood, sleep, as well as cognitive function, bone health and cardiovascular health in later years. Hormonal changes are natural as a woman goes through reproductive years, perimenopause, menopause and beyond, but understanding how hormones work, how they change across the lifespan, and most importantly how everyday behaviors can influence them can be empowering.

What are hormones and which are the key players for women?

Hormones are chemical messengers in the body.  They are produced by specialized glands and travel through the blood stream to exert effects on target cells at a different site in the body.  They regulate numerous physiological processes like reproduction, metabolism, mood, and immune function.

The key hormones affecting women’s health are estrogen, progesterone, androgens (DHEA, testosterone), thyroid hormones, cortisol, and insulin.  Their influence goes far beyond reproduction.  They affect cardiovascular, brain, bone, and immune health.

Estrogen:  Is produced in the ovaries.  Its target organs are the brain, bone, cardiovascular system, skin, breast, and uterus.  It is responsible for supporting cognition, mood, bone density, cardiovascular health, lipid metabolism and skin elasticity.  If there is excess estrogen it can increase breast cancer risk, uterine hyperplasia, and thrombosis (blood clot) while a deficiency can cause osteoporosis, cognitive decline, increase cardiovascular risk and vasomotor symptoms like hot flashes.

Progesterone: Is produced in the ovaries, placenta, and adrenal glands.  It’s target organs are the brain, breast, and uterus.  It helps maintain pregnancy and regulates mood and sleep.  An excess can cause mood changes, breast tenderness and a deficiency can cause mood disorders, sleep disturbances, infertility, and irregular menstrual bleeding.

Androgens (testosterone, DHEA):  Often considered “male hormones”, they are essential to women’s health.  They are produced by the ovaries and adrenals.  Target organ of testosterone is brain, bone, muscle, skin, and ovaries.  DHEA does not have a specific target organ.  It functions as a precursor hormone which is converted to active androgens and estrogens in multiple peripheral tissues. They help maintain brain plasticity, bone density, muscle mass, energy, and immune function.  If there is an excess (most commonly from PCOS) it can cause hirsutism, acne, hair loss, insulin resistance, metabolic function and increase cardiovascular risk.  If there is a deficiency it can cause fatigue, decreased bone density and depression.

Thyroid hormones (T4/T3):  Are produced in the thyroid gland and target numerous organ systems in the body including the brain, heart, liver, muscle, bone, adipose tissue, ovaries, uterus, pituitary, kidney, skin, and GI tract.  They regulate metabolism, energy, body temperature, mood and are vital for female reproductive function.  An excess or deficiency can have far reaching effects.  An excess of thyroid hormone (hyperthyroidism) can cause weight loss, palpitations, anxiety, insomnia, diarrhea, muscle weakness, oligomenorrhea, decreased fertility and fatigue.  A deficiency (hypothyroidism) can cause weight gain, dyslipidemia, cognitive impairment, depression, constipation, bloating, joint pain, dry, coarse skin, hair loss and menstrual irregularities.

Cortisol: Is produced in the adrenal gland.  Cortisol targets almost every organ system in the body including the liver, adipose tissue, muscle, bone, cardiovascular system, kidney, immune system, brain, skin, pancreas, and reproductive system, making it one of the most broadly acting hormones.  It affects metabolism, immune function, cardiovascular regulation, and stress responses throughout all tissues in the body.  Cortisol plays a dual role in stress and inflammation.  It is essential for mounting an appropriate response to acute stress and is the body’s primary anti-inflammatory hormone, but chronic stress can lead to dysregulation of cortisol and promote chronic inflammation.  Clinical consequences of chronic stress-induced inflammation are obesity, metabolic syndrome, cardiovascular disease, depression, autoimmune disease exacerbation and increased susceptibility to infections.

Insulin: Is produced by the pancreas and targets numerous tissues with primary metabolic effects on the liver, skeletal muscle, and adipose tissue.   It also plays a critical role in reproductive health.  Insulin deficiency can cause high glucose, weight loss, amenorrhea, infertility, and early menopause.  Insulin resistance can cause weight gain, high cholesterol, increase in Type 2 diabetes risk.  Insulin resistance plays a central role in polycystic ovary syndrome (PCOS). 

Systems Affected by Hormonal Changes

As discussed above, hormonal changes do not just affect the reproductive system, their effect spans almost every system in the body. Below is a summary of the most important effects of hormonal changes.

Mental health, mood, and cognition – Estrogen receptors exist in the brain.  Declining levels contribute to mood changes, anxiety, and cognitive shifts.

Sleep quality – Progesterone has sleep-promoting properties.  As it declines, insomnia and disrupted sleep architecture become more common.

Cardiovascular health – Estrogen has protective effects on blood vessels.  Its decline in menopause is associated with increased cholesterol, increase in stiffness of the arteries, and increased cardiovascular risk.

Bone health – Estrogen maintains bone mineral density.  Bone loss occurs as estrogen levels decline, increasing osteoporosis and fracture risk.

Metabolic Health – As insulin sensitivity decreases with age, it affects fat distribution and metabolic rate which increases the risk of type 2 diabetes and metabolic syndrome.

Now that we have introduced the key players and the main body systems they affect, let’s see how they change over a woman’s lifespan and what could be the effect of the changes. 

Hormones Across the Lifespan

It is vital to understand that hormonal change is a natural part of every woman’s life – It is not a malfunction.  So, it helps to know which hormones are changing, when they are changing and what could happen during these changes.

Reproductive Years (approx. ages 16-40s) – Decades of Cycling estrogen and progesterone

During the reproductive years, estrogen and progesterone rise and fall in a monthly rhythm.  This cycle affects fertility as well as mood, cognition, energy, gut function, immune response, and cardiovascular risk.   Testosterone and DHEA peak in early reproductive years and then start declining.  Thyroid usually stays stable, and cortisol goes through its normal diurnal rhythm.  Insulin sensitivity is high in early reproductive years and starts declining in late reproductive years.   These are the years conditions like PCOS, thyroid disorders and endometriosis (which are all hormonally mediated) are most commonly diagnosed.  Lifestyle behaviors have a powerful influence on cycle regularity and symptoms during this stage.

Perimenopause (average age 40-52) – The Beginning of the Hormonal Transition

Around age 40 or even in mid to late 30s, the transitional stage leading to menopause can start.  At this time estrogen levels start getting erratic – it can be high, normal, or low – then, toward the end of perimenopause it declines along with a decline in progesterone.  These highly fluctuant and unpredictable levels of estrogen can lead to hot flashes, irregular cycles, sleep disruption, mood changes, brain fog and weight gain.  Insulin sensitivity starts decreasing, leading to changes in body fat distribution.  Androgens continue to decline, and thyroid hormones may start to decline.  Cortisol may start to show subtle changes.  Changes in body fat and insulin sensitivity, along with the constitutional symptoms of hormonal changes during this stage make lifestyle behaviors especially important.

Menopause and Post-Menopause (average age 51 and beyond) – Life Beyond the Cycle

Menopause is defined as 12 consecutive months without a menstrual period.  Ovarian estrogen production is low, and progesterone is negligible.  Clinical consequences can include decreased bone density, increased cardiovascular risk and decreased cognitive function.  Urogenital health and metabolic function are affected.  Androgens continue to decline steadily, and thyroid hormones decline slowly with age.  Mean daily levels of cortisol increase which is associated with cognitive decline, sarcopenia (muscle loss) and metabolic dysfunction.  Insulin sensitivity continues to decrease, causing truncal obesity and fat deposition in liver and muscle.  Almost 40% of a woman’s life is spent in the post-menopause stage.  Lifestyle behaviors initiated before and during this transition significantly affect long-term health outcomes.

Hormonal changes are a natural part of every stage of a woman’s life, so understanding these shifts can provide a powerful foundation for recognizing what your body needs during each stage.  In Part 2 of this blog (April 2026), we’ll explore how specific lifestyle behaviors like nutrition, movement, sleep, and stress management can directly influence hormonal balance in each stage and how optimizing them can help you feel your best at every phase of life.

Sources:

Climacteric : The Journal of the International Menopause Society. 2025. Anekwe CV, Cano A, Mulligan J, et al.

Behnaz Atree, MD

Dr. Behnaz Atree has been a practicing Primary Care physician in Raleigh, NC, for over 20 years. Dr. Atree has become certified in Lifestyle Medicine in 2022 as well as Health and Wellness Coaching in 2023. She is excited to integrate her experience in Internal Medicine with her training in Lifestyle Medicine and Health Coaching to provide evidence-based, therapeutic lifestyle interventions through Carolina Lifestyle Medicine.

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