Can't concentrate? Pants feel snug? Burning with rage? "It's hormones," you say. And your mom says. Actually, everyone says. Often, everyone is correct. Think of hormones as the little metal balls that wreak havoc in the board game Mouse Trap. "As they circulate through the body, hormones stimulate cells that have a special receptor for them," says endocrinologist JoAnn Manson, MD, chief of preventive medicine at the Harvard-affiliated Brigham and Women's Hospital in Boston. "With estrogen, for example, there are receptors in virtually every tissue, including the heart, the G.I. system, and the brain." That's a lot of havoc waiting to happen. And it's more pronounced in women than men: Even though both have the sex hormones estrogen, progesterone, and testosterone, their effect is most noticeable when levels fluctuate, as they do throughout the menstrual cycle. During perimenopause, the on-ramp to menopause that can last up to a decade, these fluctuations can be drastic.

But even for women in their turbulent 40s and 50s, hormones aren't always to blame. And while you've been talking smack about them, you may have been letting other stealth causes get the better of you. Consider:

"I hate you!" / "What would I do without you?" mood swings

Maybe it's hormones: Stable estrogen levels are associated with even-keeled moods, says Adelaide Nardone, MD, an ob-gyn in New York City who's been treating perimenopausal and menopausal women for more than two decades. So when levels start to fall the week before your period, your mood can nose-dive, too. And during perimenopause, you may feel like a cartoon villain, veering dramatically from anger to sadness to absent-mindedness to exhaustion.

What else it could be: If you're feeling down or are stuck on an emotional roller coaster all day, every day, for more than two weeks, it may be related to mental health issues rather than hormonal ones. Indeed, about 20 percent of perimenopausal women experience symptoms of depression. "Ask your doctor about treatment," says Nieca Goldberg, MD, medical director of NYU Langone's Joan H. Tisch Center for Women's Health. Moods tend to brighten after menopause, but in the meantime, antidepressants and talk therapy may help.

The "Not tonight—or any other night" blues

Maybe it's hormones: Women's libido tends to spike around ovulation, when estrogen levels are highest, then dip once an egg is released. The bigger dipper: Estrogen levels drop during perimenopause and menopause, coinciding with the decline in libido-sparking testosterone that happens with age. Perhaps not coincidentally, more than half of menopausal women in one 2008 study reported having low sexual desire.

What else it could be: Where to begin? Stressful life transitions (moving, switching jobs) are notorious libido killers. And resentment, alienation, or relationship insecurity can quash a woman's drive at any age. Physiologically speaking, it's tough to even think about sex if you're exhausted; for the women who participated in a 2015 study, each hour of additional sleep corresponded to a 14 percent increase in the chance that they would have sex the next day. Then there's the fire-extinguishing effect of meds like antihistamines, antidepressants, and hypertension drugs (not to mention the pill), which is something to discuss with your doc. Exercise may help you warm up to the idea of sex because of its ability to reduce stress and improve sleep (and body image)—even after just one workout. A small 2012 study found that women taking antidepressants who jogged on a treadmill for 20 minutes before watching a bit of porn became more physically aroused than those who relaxed before showtime.

Hurts-so-bad sex

Maybe it's hormones: Estrogen keeps the vaginal tissues lubricated, so when hormone levels dip during the last week of your menstrual cycle— or during perimenopause and menopause—sex can be excruciating.

What else it could be: Obsessive exercising and extreme dieting can cause a sharp drop in sex-positive estrogen for two reasons. First, body fat produces estrogen, so the leaner you get, the less you have. Second, these habits can interfere with the production of estrogen and other hormones. Talk to your ob-gyn. If your pain is simply dryness related, vaginal estrogen and plain-old over-the-counter lubricants can help. If it's not, yeast infections or STDs can also make sex painful, as can endometriosis and fibroids.

Sleeplessness in Seattle, and Des Moines and Tampa...

Maybe it's hormones: Menopause is an infamous sleep wrecker; up to 60 percent of women experience difficulty sleeping during this time, research has found. Lower estrogen levels can affect sleep cycles, leading to wakefulness. Plus, night sweats, hot flashes and related heart palpitations can turn nighttime into the pit of hell. (Hormone therapy is the primary treatment, but some antidepressants can also help control symptoms.)

What else it could be: Sleep troubles could also be due to issues like anxiety, depression or stress, says Nardone. Another culprit: After-dinner cocktails help you unwind enough to nod off, but also affect the restorative REM phase of sleep, potentially disrupting slumber. Whatever your sleep issues, decades of research shows that workouts help people—even insomniacs—sleep better within four to 24 weeks.

"Wait, what?" weight gain

Maybe it's hormones: Well, some of it certainly is. Women tend to put on an average of five pounds during the menopausal transition, according to the North American Menopause Society. This fat tends to be stored around the waist, Manson says, though researchers aren't sure why.

What else it could be: An underactive thyroid can lead to a five- to ten-pound weight gain and cause menopause-like symptoms such as mood swings and irregular periods. A more common cause for women in their 30s and 40s is loss of lean muscle and a resulting decrease in metabolism. Sedentary people can lose 3 to 5 percent of their muscle mass, which has the ability to burn more calories, every decade starting at age 30. "But this can be countered," Manson emphasizes, "mostly with strength training and being physically active in general." Aim for 30 minutes of moderate activity most days, including at least two weekly sessions of strength training, and feel better about your body, hormones and all.

It is hormones. Now what?

Talk to your doctor about treatments like birth control pills or hormone therapy (HT), the use of pills, patches or gel containing female hormones. Large long-term studies have shown that HT can help women with severe menopausal symptoms—but there are health risks, including blood clots and stroke. It's safest and most effective when started either before age 60 or within ten years of the onset of menopause.

Track It!
Keep tabs on your symptoms with a calendar or an app like Clue. If you notice they always occur during certain weeks of your cycle, it's likely they're related to hormonal fluctuations, says Nieca Goldberg, MD.  (Past the period stage? The app MenoPro can help you get a handle on symptoms.)


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