Your 40s really can feel like the new 30s—but with a few extra curveballs from your hormones. For women 40 and over, this decade often brings noticeable hormonal changes that can affect everything from menstrual cycles and sleep patterns to mood, energy, and metabolism.  

These shifts are a natural part of your body’s transition toward perimenopause and beyond. Now is the perfect time to prioritize your annual well-woman visit and talk openly with your gynecologist about any new symptoms or concerns.  

Regular checkups help you stay ahead of changes, manage them effectively, and protect your long-term health as your hormones and your life enter an exciting new phase. 

What Happens to Hormones During Perimenopause? 

“Oh, the places your hormones will go!” In your early 40s, your reproductive hormones, particularly estrogen and progesterone, begin to fluctuate dramatically. These fluctuating hormones during perimenopause are a natural part of the transition toward menopause, the stage when menstrual cycles eventually stop for good. 

During this time, you may notice irregular cycles, changes in flow, or new sensations like bloating, night sweats, or mood shifts. These are all signs that your body is entering perimenopause, the stage that bridges your fertile years and menopause. 

Perimenopause Stages and Hormone Levels 

Most women begin perimenopause in their late 30s or early 40s, and it can last anywhere from four to ten years. Your perimenopause hormone levels (primarily estrogen and progesterone) swing up and down, creating that “roller-coaster” effect many women describe. 

 The stages of perimenopause broadly cover the hormonal changes and their accompanying symptoms. However, everyone is different, so your experience may not look exactly like these: 

• Early perimenopause (around 38-42): Shorter cycles, mild mood or sleep changes. 
• Late perimenopause (mid to late 40s): Missed periods, more pronounced hot flashes or night sweats. 
• Menopause: Reached when you’ve gone 12 consecutive months without a period. 
• Postmenopause: Hormones stabilize at lower levels, but you may continue to experience mild symptoms. 
   

Remember: Even if your periods are irregular,  you can still get pregnant during perimenopause. Talk to your provider about safe contraception if needed. 

Common Perimenopause Symptoms to Watch For 

Every woman’s experience is different, but the most common perimenopause symptoms include: 

• Hot flashes or night sweats 
• Changes in menstrual flow or cycle length 
• Sleep disturbances and fatigue 
• Mood swings or anxiety 
• Vaginal dryness and discomfort during sex 
• Weight gain, bloating, or slower metabolism 
• Brain fog or forgetfulness 
   

These hormonal changes during perimenopause can be frustrating—but they’re manageable with the right care plan. 

How to Balance Hormones During Perimenopause Naturally 

Healthy habits can go a long way in supporting hormone balance and easing perimenopause symptoms: 

• Prioritize nutrition: Eat a diet rich in fiber, whole grains, leafy greens, lean protein, and omega-3 fats. 
• Exercise regularly: Strength training and cardio help stabilize blood sugar and support hormone balance during perimenopause. 
• Sleep and stress management: Consistent rest and mindfulness practices help lower cortisol levels, which affect estrogen and progesterone balance. 
• Medical options: Discuss menopausal hormone therapy (MHT) or non-hormonal alternatives with your provider to see what’s right for you. 
   

“During well-woman visits, we want to know if patients are having problems with intercourse or vaginal dryness, any pelvic pain, or hot flashes, weight changes, or menstrual changes so we can begin treatment,” explains Dr. Lauren Beasley of Centre OB/GYN in Raleigh, NC.  

Many women don’t realize there are multiple treatment options, both hormonal and non-hormonal, that can help manage these changes. You don’t have to “grin and bear it.” Relief is possible with the right combination of lifestyle changes and medical care. 

Health Screenings for Women 40 and Over 

Your 40s aren’t just about managing hormones—they’re also the decade to prioritize preventive screenings that can protect your long-term health. During this decade, start paying close attention to your heart, bone and metabolic health, as those tend to start shifting, and women are at an increased risk for things like Type II diabetes, heart disease, and other chronic conditions. 

Annual Mammogram Screening 

Starting at age 40, women should begin screening mammograms every 1 to 2 years, depending on their risk factors. “When we find breast cancer early, there are less invasive treatment options and an excellent chance for survival,” says Dr. Beasley. 

Women with dense breasts or a family history of breast cancer may also need breast MRIs or ultrasounds for more detailed imaging. It is also a good idea to practice breast self-awareness, which means taking note of any changes to the texture, size and tenderness of your breasts. 

Colon Cancer Testing Recommendations 

Previously, colon cancer screenings began at 50—but now, guidelines recommend starting at age 45 for those at average risk. 
Screening options include:  

• FIT test: Stool-based test done annually. 
• Stool DNA test (Cologuard): Every three years. 
• Colonoscopy: Every 10 years through age 75, allows removal of precancerous polyps during the procedure. 
  Flexible sigmoidoscopy or CT colonography: Every 5 years. 
   

These colorectal screening guidelines help detect cancer early or prevent it altogether. 

Other Screenings You Should Have at 40+ 

Around this time, women may see an increase in other chronic conditions. Luckily, if you stay up to date with your screenings and catch warning signs early, you can often manage, or even reverse, many conditions. Ensure you stay on top of the following: 

• Blood pressure: Have your blood pressure checked at least once every year or more often if you have a family history of hypertension, or have heart disease, diabetes, or are overweight 
• Cervical cancer: Women ages 30-65 should have either a Pap test every three years, an HPV test every five years, or both every five years.  
• Cholesterol: If you have no known risk factors, you should begin cholesterol screening at age 45 

When to See Your Doctor About Hormonal Changes 

Some hormonal changes after 40 are expected, but talk to your provider if you experience: 

• Heavy or prolonged bleeding 
• Missed periods before age 45 
• Hot flashes interfere with daily life 
• Unexplained weight gain or fatigue 
• Pain during intercourse or sudden libido changes 
   

Your provider can help determine whether symptoms are part of perimenopause or another health condition that needs attention. 

FAQs About Hormonal Changes and Women’s Health in Their 40s 

1. What are the first signs of hormonal changes after 40? 
    Irregular periods, mood swings, and disrupted sleep are common early signs of perimenopause. 
    
2. At what age does perimenopause start? 
    Usually between 38 and 45, but it varies by individual. 
    
3. Can I still get pregnant during perimenopause? 
    Yes—until you’ve gone 12 months without a period, pregnancy is still possible. 
    
4. Should I test my hormone levels? 
   Because hormone levels fluctuate daily, most tests aren’t reliable unless your provider suspects another issue, such as thyroid dysfunction. 
    
5. When should I start colon cancer screening? 
    At 45 for average-risk women, or earlier with a family history of colorectal cancer. 
    
6. Do I need a mammogram at 40? 
    Yes—annual mammogram screening is recommended beginning at age 40. 
    
7. How can I balance hormones naturally? 
    Eat well, exercise, reduce stress, and get enough sleep to support your body’s natural hormone rhythms. 
    

The Bottom Line: Embrace the Changes With Confidence

Hormonal changes after 40 may feel unpredictable—but they signal your body’s incredible evolution. By staying proactive with your screenings, supporting hormone health naturally, and seeking guidance from your healthcare provider, you can move through your 40s stronger, wiser, and fully in tune with your body.