Ovary-Achievers: How Hormones Shape Women’s Health

Welcome to Truth Be Told, the weekly food and fitness newsletter published by The Whole Truth Foods.

Editor’s note: There’s an often overlooked aspect of health discussions: we rarely talk about how women’s reproductive systems impact far more than just reproduction. The conversation often reduces to fertility and baby-making, when in fact, these hormones influence much more. This understanding is exactly what today’s piece offers. Dhanya Ramadurai explores how women’s bodies change with age and dives into the science of female hormones.

Dhanya is a science enthusiast and health researcher at Cranberry, a femtech company developing scientifically proven products for women’s symptoms. Please read, share, and contribute your own experiences. And if you have questions, do ask.

— Samarth Bansal (samarth@thewholetruthfoods.com)

Picture this: A 13-year-old experiencing her first period, a 25-year-old battling debilitating cramps at work, a 35-year-old navigating fertility treatments, and a 55-year-old dealing with hot flashes during an important presentation.

These snapshots represent just a fraction of the complex tapestry that is women’s health. For too long, we’ve viewed women’s health through a narrow lens, focusing mainly on reproduction. That must change.

Because women’s reproductive systems impact far more than just reproduction: female hormones are multitaskers extraordinaire, influencing mental health, sexual wellbeing, and even bone strength.

Understanding this biology is crucial for better health outcomes. A limited view leads to real problems: women being misdiagnosed, their pain dismissed, and their concerns overlooked. The impact ripples beyond individual health, affecting families, workplaces, and the economy.

Let’s explore how these hormonal influences shape women’s health across different life stages.

A note from the writer: Every woman’s body is unique. You may see stats and numbers in this article that are the ‘average’ or ‘typical’ for women broadly but may not represent your own experience. This is not to discredit the experiences of many women whose cycles and hormones don’t fall into these neat boxes—which are equally valid. This article intends to get into the basics of understanding women’s health.

The First Period

A woman’s reproductive health journey begins with menarche – the first menstrual period. This milestone holds both medical and social significance across cultures.

Medically speaking, a period is the shedding of the lining of the uterus (the organ where a baby develops during pregnancy). This process occurs roughly every month when pregnancy doesn’t take place. The blood and tissue exit the body through the vagina over several days.

This marks the beginning of a complex relationship with reproductive health that will last for decades. It signals the activation of estrogen and progesterone—two crucial reproductive hormones. Produced mainly by the ovaries (the organs that store and release eggs), these hormones play vital roles not just in reproduction, but in many aspects of a woman’s overall health.

As the body adjusts to these new hormonal influences, periods can be irregular for the first year or two. This unpredictability is normal—part of the body’s learning process.

The experience of menarche varies greatly depending on cultural context and personal circumstances. Many girls feel unable to discuss their periods openly, leading to anxiety or confusion. There is still some stigma, even disgust, around the topic of periods.

This leads to people brushing the topic away or not even wanting to say the word ‘period’, let alone understand the science of periods. Naturally, those who’ve just started menstruating will also be uninformed of what’s happening in their bodies, if nobody wants to talk about it.

A young girl might only know that menstruation involves monthly bleeding, that it’s a painful part of being a woman, and that pads are needed to manage the flow. This limited understanding can make the experience more challenging than necessary.

Which is why by cultivating open conversations and providing comprehensive education about menstruation, we can help young women navigate this new phase of life with confidence and understanding.

The Teenage Years

By their mid-teens, many young women have formed a love-hate relationship with their period. Relief that their cycles are becoming more predictable, but dread for the discomfort that often accompanies them.

There’s a common hope that periods will start on weekends to avoid sitting through school days with intense cramps. The first two days of the period are typically the worst. Many teens wish they could skip school and curl up in bed with a hot water bag. When that’s not possible, they might spend the day struggling to sit up straight, feeling nauseous and dizzy. For most, the pain finally wears down and stops by day 4.

These cramps occur because the uterus contracts to shed its lining. Hormones called prostaglandins, which are released during menstruation, cause these contractions and are responsible for much of the pain and inflammation associated with periods.

As the reproductive system starts to mature, the ovaries and the brain learn to work together to control the release of estrogen and progesterone. The brain and ovaries form an alliance called the hypothalamic-pituitary-ovarian axis, or HPO axis, which produces new hormones responsible for the functioning of the reproductive system, like estrogen and progesterone.

It’s worth noting that period pain affects over 90% of young adults. The severity of this pain can vary widely from person to person, but it’s particularly common in teens and young adults as their bodies are still adjusting to the complex hormonal changes of the menstrual cycle.

This stage of life isn’t just about physical changes. The hormonal fluctuations can also affect mood and emotions. Many teenagers experience mood swings, increased anxiety, or feelings of depression around their periods. These experiences are normal but can be challenging to navigate, especially when combined with the other pressures of teenage life.

The Twenties: PMS and Beyond

As women enter their twenties, many begin to notice a pattern of physical and emotional changes that occur in the days leading up to their period. This phenomenon, known as Premenstrual Syndrome (PMS), affects three out of four women to varying degrees.

PMS can manifest in a variety of ways. Many women struggle with anxious, racing thoughts, tend to isolate themselves and find it hard to get out of bed despite getting enough sleep. They might beat themselves up about being unproductive, which only exacerbates negative feelings. Often, as soon as the period starts, the emotional crisis lifts, and they feel like their usual happy, energetic selves – until the next cycle begins.

The root cause of PMS lies in the hormonal fluctuations that occur before menstruation. In the days leading up to a period, both estrogen and progesterone levels drop sharply. These hormones are linked to serotonin and dopamine—brain chemicals that regulate mood and motivation. The hormonal changes can therefore have a significant impact on emotional well-being.

Despite its prevalence, many women don’t seek help for PMS, even when it significantly affects their lives. This reluctance often stems from a societal normalisation of women’s pain and discomfort or a lack of awareness about available treatments. It’s crucial to recognise that severe PMS symptoms are not something women should just “put up with”.

The Thirties: Beyond the “Biological Clock”

As women approach their late twenties and early thirties, they often encounter increased social pressure regarding fertility and childbearing. Terms like “biological clock,” “fertility,” and inquiries about future children become more frequent, sometimes overshadowing other aspects of their health.

The phrase “biological clock” about women’s fertility first appeared in a 1978 Washington Post article titled “The Clock is Ticking for the Career Woman.” The author, Richard Cohen, suggested that regardless of career success, women fundamentally desire to have children due to biological imperatives.

Interestingly, the term “biological clock” in scientific contexts doesn’t actually refer to fertility. Instead, it describes the body’s innate ability to regulate daily rhythms and functions such as sleep-wake patterns, hormone release, temperature control, and appetite regulation. These functions are regulated by the brain, which sends signals to internal timers in the body’s cells (ironically called CLOCK proteins). This is the actual biological clock.

While it’s true that fertility generally decreases with age, the “biological clock” metaphor oversimplifies a complex issue. The decline in fertility is gradual and varies among individuals. Assisted fertility treatments are increasingly common and accessible. However, a 2018 study revealed that many Indian women have a limited understanding of age-related fertility changes.

The key thing is to be aware of other changes going on that can impact a woman’s health, beyond just fertility.

Perimenopause: The Transition Years

As women enter their forties and fifties, they experience perimenopause—a transitional period lasting months to years as the body shifts towards menopause.

During this time, the connection between the brain and ovaries weakens, causing fluctuations in estrogen and progesterone levels. These hormonal changes lead to various symptoms, including unpredictable menstrual cycles lasting anywhere from 25 to 50 days, and changes in menstrual flow.

The hormonal shifts of perimenopause can bring about a range of physical and mental challenges. Many women report feeling more achy, tired, and sluggish. Sleep disturbances, hot flashes, night sweats, and headaches are common. Mood swings and increased irritability are also frequent complaints, and some women notice changes in their cognitive function, such as increased forgetfulness.

This is also a time when some women may start to notice subtle changes in their bodies. Metabolism might slow down slightly, making weight management more challenging. Some women may notice changes in their skin or hair.

As perimenopause progresses, the ovaries gradually produce less estrogen and progesterone, eventually ceasing function altogether, leading to menopause—the complete cessation of menstrual cycles. This typically occurs in the late 40s, though the exact timing varies for each woman.

Contrary to what some might expect, the end of menstruation doesn’t necessarily mean the end of health challenges. The decrease in estrogen affects multiple aspects of health. One major impact is on bone health, as estrogen plays a crucial role in protecting against bone loss. The drop in estrogen increases the risk of osteoporosis, a condition that causes weak, brittle bones and increases the likelihood of fractures.

Sexual health is another area affected by these hormonal changes. During and after menopause, many women experience a shift in their sex drive and may suffer from uncomfortable vaginal dryness. This not only can make sexual intercourse painful but also increases the risk of urinary tract infections.

It’s worth noting that this life stage often coincides with other significant life events, such as the loss of parents or loved ones, career changes, and lifestyle disruptions. These external factors can compound the physical and mental health challenges associated with perimenopause and menopause.

Despite these challenges, it’s important to remember that perimenopause and menopause are natural processes. With proper understanding and care, women can navigate this transition while maintaining their health and well-being. Healthcare providers can offer the most appropriate treatments and strategies to manage symptoms and protect long-term health during this important life stage.

Embracing change and taking control

It’s clear that as we age, the systems that regulate our bodies undergo significant changes. While there isn’t a one-size-fits-all solution for these evolving health challenges, the first step is body awareness. Understanding why and how your body changes during menstrual cycles and with age is crucial for maintaining overall health and well-being.

The landscape of women’s health is rapidly transforming. Research is expanding, knowledge is deepening, and funding is increasing. We’ve made significant strides in the past decade, shedding light on aspects of women’s health that were previously in the shadows.

This progress marks a pivotal shift in perspective. As Dr Ana Langer from Harvard T. H. Chan School of Public Health notes:

“The past decade has witnessed a growing recognition that women’s health goes well beyond issues related with their reproductive functions and that such a reductionist perspective does not reflect women’s burden of disease […]” (p. 4).

Here’s the takeaway: It’s never too late to take charge of your health. Whether you’re grappling with irregular periods, riding the perimenopause rollercoaster, or adapting to post-menopausal life, remember that you’re not alone. Resources and healthcare professionals are at your disposal.

Your body is unique, and you are its best advocate. Stay informed. Listen to your body. Seek help when needed. By doing so, you’re not just managing your health – you’re empowering yourself to thrive at every stage of life.

I’ll leave you with some actionable tips:

1. Schedule regular lipid profile tests: Get tested every 5 years after age 35, especially if you have a family history of heart disease or risk factors like obesity. These tests identify changes in your blood cholesterol levels.

2. Monitor bone health with DEXA scans: If you’re over 65 or post-menopausal, get a DEXA scan every 2 to 5 years. These X-ray scans detect risks of fractures and bone loss from osteoporosis, allowing for early intervention.

3. Stay up-to-date with Pap tests: Schedule a Pap test every 3 years from age 21 to 65. While potentially uncomfortable, these tests are crucial for detecting cancerous cells in the cervix.

4. Increase protein intake for hormonal balance: Aim for 1-1.5 grams of protein per kilo of body weight daily. A high-protein diet may help lower testosterone levels, potentially addressing hormonal imbalances in women.

5. Focus on essential micronutrients: Pay attention to B vitamins, vitamin D, and calcium intake. Consider supplements if your diet doesn’t provide enough, especially as your requirements increase with age.

6. Incorporate strength training: Start a weight or resistance training routine to preserve bone and muscle health, especially as estrogen levels decrease with age. Begin slowly and gradually increase intensity over time.

7. Schedule preventative visits to your gynaecologist – While it is not common in India to visit a gynaecologist regularly, a visit every 2-3 years can equip you with the necessary information for every changing stage of life.