Perimenopause and menopause happen because the ovaries gradually make less estrogen and progesterone, and as that happens, follicle-stimulating hormone (FSH) from the brain rises. Testosterone falls slowly with age, while cortisol and thyroid hormones are not menopause hormones as such, but stress, sleep and thyroid problems can feel very similar to menopause symptoms. These changes can affect much more than your periods, including sleep, mood, concentration, body composition and bone health. Every woman's experience is different, and if your symptoms are affecting your daily life, it is worth talking to your doctor.
Image source: www.pexels.comThis article is the big-picture guide: which hormones change from perimenopause through the years after your final period, and how each one fits into the wider picture. If you mainly want to understand why the perimenopause years feel so up and down, our simpler guide on what happens to your hormones during perimenopause focuses on exactly that.
Many women describe the years before menopause in the same way: "I don't feel like myself anymore." Your sleep changes, your body seems to react differently to food, your patience runs shorter, and your concentration isn't what it used to be.
Some days you feel perfectly normal, while on others you wonder whether everything in your body has shifted overnight. It's easy to think that one hormone must be responsible. In reality, menopause is not the story of a single hormone disappearing. Several hormones change, and they influence one another.
Understanding these relationships won't stop menopause from happening, but it can help explain why symptoms vary so much from one woman to another, why your experience may change from month to month, and why your health needs more attention than any single hormone.
What Happens to Your Hormones During Perimenopause?
During perimenopause, hormone levels don't simply fall in a straight line. They can rise and fall unpredictably for years before settling at a lower level after menopause.
The NHS explains that menopause is caused by a fall in hormone levels and usually happens between the ages of 45 and 55, although it can happen earlier. Perimenopause is the stage when your periods become irregular; menopause is defined as not having had a period for 12 months when you're not using hormonal contraception.
The road there is rarely smooth. Cleveland Clinic describes it as common for hormone levels to go up and down "like a rollercoaster" during perimenopause. A 2016 review adds that, in a given cycle, a woman may ovulate, or not ovulate with relatively high estrogen levels, or not ovulate with low estrogen levels.
This unpredictability helps explain why symptoms often seem inconsistent. You might sleep well for two weeks, then notice night sweats, mood changes or a change in your bleeding, before feeling relatively normal again.
Why Does Estrogen Affect So Much More Than Reproduction?
Estrogen influences many body systems beyond reproduction, including bone density, brain function, cholesterol levels, blood sugar, circulation, skin and muscle.
Although estrogen is often associated with fertility, Cleveland Clinic lists a much wider range of processes it affects: blood sugar levels, bone density, brain function (including your ability to focus), cholesterol levels, circulation and blood flow, collagen production and moisture in your skin, and muscle mass and strength. It also keeps the vaginal walls elastic and lubricated, and its decline may lead to symptoms such as vaginal dryness and hot flashes.
As estrogen levels become less predictable and eventually fall after menopause, these systems may respond in different ways. This is one reason why menopause can affect sleep, joints, skin, concentration and bone health, not just your periods. If you'd like to know what tends to change once your periods have stopped, read our guide on menopause symptoms and what changes next.
What Happens to Progesterone?
Progesterone is made mainly after ovulation, so as ovulation becomes less regular in perimenopause, less of it is produced. After menopause, the ovaries no longer make it.
According to Cleveland Clinic, progesterone is produced by the corpus luteum, a temporary gland that forms in the ovary after you ovulate. It thickens the lining of the womb each cycle, and its levels decline in the years leading up to menopause, when ovulation stops.
Research on the late reproductive years has observed lower progesterone after ovulation alongside higher FSH, and a 2016 review notes that around the final period and in the year after it, progesterone is no longer produced. Because the changes in progesterone overlap with the ups and downs of estrogen, it is often difficult to pin any one symptom on a single hormone. Our article on why the balance between estrogen and progesterone matters looks at how the two interact.
Does Testosterone Matter for Women?
Yes. Women produce testosterone too, and levels fall gradually with age. Many women notice no symptoms from this, and the evidence for testosterone treatment is limited to low sexual desire.
Women's Health Concern, the patient arm of the British Menopause Society, explains that testosterone is one of the sex hormones women produce, alongside estrogen and progesterone, and that its levels gradually reduce as you get older. Many women don't notice any symptoms from this, while others are more sensitive to the change. It also notes that there is currently not enough evidence to recommend testosterone for low energy, low mood, fatigue or brain fog.
The UK's NICE guideline says testosterone can be considered for low sexual desire associated with menopause if HRT alone is not effective. Women's Health Concern adds that the causes of low sexual desire at menopause are complex and rarely due simply to low testosterone. If this is something you're experiencing, talk to your doctor about your own situation.
Why Does FSH Increase During Menopause?
FSH (follicle-stimulating hormone) is made by the pituitary gland in the brain to stimulate the ovaries. As the ovaries respond less, FSH levels tend to rise.
Cleveland Clinic explains that FSH stimulates the ovaries to release an egg, and that a consistently high FSH level can indicate you're getting near menopause. However, FSH tests can be misleading during perimenopause, because hormones rise and fall erratically, and certain medications and health conditions can also affect the results.
This is why a single blood test usually can't tell you where you are in the transition. The NICE guideline says that in otherwise healthy people aged 45 or over with menopause-associated symptoms, perimenopause and menopause should be identified without laboratory tests. It suggests considering an FSH test to confirm menopause only in people aged 40 to 45 with menopause-associated symptoms, including a change in their cycle, and in people under 40 in whom menopause is suspected.
How Do Hormonal Changes Affect Metabolism?
Around the menopause transition, research shows that the body tends to gain fat faster and lose lean mass, even when overall weight doesn't change much faster than before.
Many women notice changes in their body composition after 40. The NHS says weight gain during perimenopause and menopause is common and often happens around the stomach and upper body.
In one large US study that followed women through the transition, the rate of fat gain doubled at the start of the transition and lean mass began to decline; these changes continued until about two years after the final period and then levelled off. The researchers found no clear change in the rate of overall weight gain, which may be why the scales don't always reflect what you notice in the mirror. Estrogen also plays a part in blood sugar levels and muscle mass, which is one reason why staying active, including strength exercises, is so often recommended at this stage.
Can Hormones Affect Your Mood and Brain?
Yes. Mood swings, low mood, anxiety, and problems with memory and concentration are all recognised symptoms of perimenopause and menopause.
The NHS lists mood swings, low mood or depression, and problems with memory or concentration among the symptoms of menopause and perimenopause, and notes that they may feel worse if you also have sleep problems and feel very tired. Stress and life circumstances can add to this, too. If worry has become a bigger part of your days, our article on whether perimenopause can cause anxiety goes into more detail.
The NHS also notes that cognitive behavioural therapy (CBT), a type of talking therapy, can help with low mood and anxiety. If changes in your mood or thinking are persistent, getting worse or affecting your daily life, talk to your doctor.
What About Cortisol, the Stress Hormone?
Cortisol helps manage your body's response to stress and your sleep-wake cycle. Ongoing stress and poor sleep can affect how you feel during menopause, but genuinely high or low cortisol is something only a doctor can assess.
According to Cleveland Clinic, cortisol is made by the adrenal glands, plays a key role in your stress response and helps control your sleep-wake cycle, with levels usually lowest in the evening and highest in the morning. It notes that chronic sleep problems such as insomnia can cause higher cortisol levels, and that if you have symptoms of high or low cortisol, it's important to see your healthcare provider.
Many women go through menopause while managing demanding work, caring for others and other big life changes. The NHS suggests rest, regular exercise and relaxing activities such as yoga, tai chi or meditation, and lists finding ways to reduce your stress among the things that may help with hot flushes.
Do Thyroid Hormones Play a Role?
Thyroid problems are not caused by menopause, but an underactive thyroid can cause symptoms that look very similar, such as tiredness, weight gain, low mood and changes to your periods.
The NHS lists feeling extremely tired, feeling cold more than usual, putting on weight, low mood or depression, and irregular or heavy periods among the common symptoms of an underactive thyroid. It also notes that Hashimoto's disease, a common cause, is most common in women and usually starts between the ages of 30 and 50.
Because the symptoms overlap, persistent or severe changes shouldn't automatically be put down to menopause. The NHS says that although some of these symptoms are common and can have other causes, it's important to get them checked by a GP.
Why Every Woman's Hormonal Journey Is Different
Menopause is different for everyone. Some women have symptoms that affect daily life, work and relationships, while others hardly notice any.
The NHS says perimenopause and menopause are different for everyone, and that ethnic background can sometimes affect how severe symptoms are and how long they last. It adds that symptoms usually last for 7 to 9 years, sometimes longer, and can change over that time.
There is no single "normal" menopause experience. Comparing yourself to friends or family members can create unnecessary frustration.
What Can You Do to Support Your Health Through These Changes?
Lifestyle changes can't stop menopause, but eating well, exercising, resting and looking after your mental wellbeing can help with symptoms and support your long-term health.
The NHS suggests trying to get plenty of rest and keeping to regular sleep routines, eating a healthy, balanced diet, including calcium-rich foods to keep your bones healthy, exercising regularly with a focus on weight-bearing exercise, trying relaxing activities, and talking to other people going through the same thing. It advises not smoking, as this can make symptoms worse, and trying not to drink more than the recommended alcohol limit.
You may see supplements promising to "balance your hormones." The NHS advises talking to a doctor before taking herbal supplements or complementary medicines, so if you're considering any supplement, talk to your doctor or pharmacist first.
The goal isn't to eliminate every symptom. It's to look after your body through a natural transition, and to get support when you need it.
When Should You Seek Medical Advice?
Contact your GP if you think you have menopause symptoms and want to know your options, if your bleeding becomes heavier than before, if you have palpitations, or if you have any bleeding after 12 months without a period.
The NHS advises contacting a GP if you think you have symptoms of menopause or perimenopause and want to know what your options are; if you have symptoms such as a fast heartbeat (palpitations); if you still have periods but are bleeding more than before; or if you haven't had a period for 12 months or more and have any vaginal bleeding. Postmenopausal bleeding is not usually serious, but it needs to be checked.
The NHS adds that early advice can help reduce the effects of menopause on your health, relationships and work. Your doctor can help work out whether your symptoms are related to menopause, another condition, or both.
Frequently Asked Questions
Are hormones the only cause of menopause symptoms?
No. Hormonal changes are central, but sleep, stress, physical activity, other health conditions and medicines can all affect how you feel. Some conditions, such as an underactive thyroid, can cause symptoms that look very similar, which is why persistent symptoms are worth checking with your doctor.
Which hormone changes first during perimenopause?
There is no single starting point that applies to everyone. Research on the years before menopause has observed lower progesterone after ovulation and higher FSH, while estrogen tends to fluctuate, sometimes running high, before it eventually falls after menopause.
Do I need a blood test to know if I'm in menopause?
Usually not if you're 45 or over. The NICE guideline says perimenopause and menopause should be identified from your symptoms and periods, without laboratory tests, in otherwise healthy people aged 45 or over. Blood tests may be considered in younger women, so talk to your doctor about what's right for you.
Is hormone therapy the only option for menopause symptoms?
No. The NICE guideline says HRT should be offered to people with hot flushes and night sweats, and also suggests considering menopause-specific CBT for these symptoms. Lifestyle changes can help too. Whether any treatment is right for you depends on your health history and is a decision to make with your doctor.
Read next:
Understanding Hormonal Patterns Over Time
Hormonal changes rarely happen in isolation. Sleep, stress, food, physical activity and symptoms often interact in ways that are hard to notice from memory alone. Keeping track of them over time can make your experience easier to understand and easier to describe to your doctor.
Menoup lets you log symptoms, sleep, food, activity and how you feel day to day in one place. Mona, the app's AI companion, can help you look at those patterns and share general, evidence-informed information—it isn't a substitute for advice from your doctor.
Last updated: October 10, 2026
Medical Note: This article is for general information only and doesn't replace advice, diagnosis or treatment from a healthcare professional. Hormone tests and treatments are decisions to make with your doctor, based on your own health history. If your symptoms worry you or affect your daily life, please talk to your doctor.
References
- NHS. What are menopause and perimenopause? 2026. nhs.uk
- NHS. Symptoms of menopause and perimenopause. 2026. nhs.uk
- NHS. Things you can do to help menopause and perimenopause symptoms. nhs.uk
- NHS. Underactive thyroid (hypothyroidism). nhs.uk
- National Institute for Health and Care Excellence (NICE). Menopause: identification and management (NG23). Recommendations. 2015, updated 2026. nice.org.uk
- Women's Health Concern (British Menopause Society). Testosterone for women. Fact sheet. 2026. womens-health-concern.org
- Cleveland Clinic. Perimenopause. my.clevelandclinic.org
- Cleveland Clinic. Estrogen. my.clevelandclinic.org
- Cleveland Clinic. Progesterone. my.clevelandclinic.org
- Cleveland Clinic. Cortisol. my.clevelandclinic.org
- Santoro N. Perimenopause: From Research to Practice. Journal of Women's Health. 2016. pmc.ncbi.nlm.nih.gov
- Greendale GA, Sternfeld B, Huang M, Han W, Karvonen-Gutierrez C, Ruppert K, Cauley JA, Finkelstein JS, Jiang SF, Karlamangla AS. Changes in body composition and weight during the menopause transition. JCI Insight. 2019. pmc.ncbi.nlm.nih.gov