By: Dr. Jo Ann Santiago
Over the course of a woman’s life, the body experiences a series of hormonal shifts that impact physical health, emotional well-being, and even productivity at work. In Puerto Rico, over 50% of women aged 40–59 say they experience symptoms of the menopausal transition, or perimenopause, like changes in sleep, joint discomfort, and anxiety. While these are normal symptoms, they can have a big impact on quality of life and work performance.
Menstruation and the Reproductive Cycle
Menstruation marks the start of reproductive life. Although it can vary, it usually begins between the ages of 11 and 14. The average menstrual cycle lasts 28 days and is divided into four phases:
- Menstruation: Shedding of the endometrium when pregnancy does not occur.
- Follicular phase: The egg matures with the help of the follicle-stimulating hormone (FSH).
- Ovulation: The egg is released, stimulated by an increase in luteinizing hormone (LH).
- Luteal phase: The body prepares for a potential pregnancy; if this does not occur, hormone levels drop and the cycle restarts.
Routine tests to consider
- Blood tests to evaluate hormone levels (FSH, LH, estrogen, and progesterone)
- Cervical-vaginal cytology (Pap smear) to detect abnormalities in the cervix
- A transvaginal ultrasound to assess the shape and condition of the uterus and ovaries
- Screening tests to detect sexually transmitted infections (STIs)
Many women experience symptoms such as cramps, fatigue, mood swings, and migraines over the course of these years. Having a balanced diet, exercising, and monitoring the regularity of your cycle are key to maintaining hormonal health.
Contraceptives and Their Hormonal Effects
Contraceptive methods have transformed women’s reproductive lives by enabling them to plan their families and manage their menstrual symptoms. However, each of these methods impacts hormonal balance differently:
- Hormonal contraceptives: These include pills, patches, injections, or intrauterine devices containing progesterone. They regulate estrogen and progesterone levels, which can stabilize the menstrual cycle. However, they may also cause side effects, such as water retention and mood swings.
- Non-hormonal contraceptives: These include copper IUDs and barrier methods. They do not affect the endocrine system, but they require more consistent use.
Routine tests to consider
- Assessment of liver and kidney function for women using hormonal contraceptives
- Blood tests to detect thrombophilia in women using hormonal contraceptives
This decision should be made by each individual after consulting with a healthcare professional. Age, medical history, and personal preferences should be taken into account.
Perimenopause: The Silent Transition
The phase leading up to menopause is called perimenopause, and can begin between the ages of 40 and 50. It is a period of hormonal fluctuations where the ovaries gradually reduce estrogen production.
The most common symptoms include irregular menstrual cycles, hot flashes, changes in sleep habits, weight gain or difficulty losing weight, and emotional changes. Although many women see this as a natural part of life, perimenopause can last between 4 and 8 years, and it helps to seek medical support during this time.
Routine tests to consider
- Blood tests to evaluate hormone levels (FSH, LH, estrogen, and progesterone)
- A transvaginal ultrasound to assess the shape and condition of the uterus and ovaries
- Bone density assessment to screen for osteoporosis
Menopause: A New Balance
Menopause is medically defined as 12 consecutive months without menstruation. In Puerto Rico, menopause occurs at an average age of 51.3 years. Because estrogen levels decrease significantly with it, it can lead to symptoms such as hot flashes, vaginal dryness, diminished libido, mood swings, joint pain, and bone loss.
Routine tests to consider
- Blood tests to evaluate hormone levels (FSH, LH, estrogen, and progesterone)
- Bone density assessment to screen for osteoporosis
- A transvaginal ultrasound to assess the shape and condition of the uterus and ovaries
- Screening for cardiovascular function to detect risks of cardiovascular disease
In the long term, estrogen deficiency increases the risk of developing osteoporosis and cardiovascular disease. This stage requires comprehensive care. This includes medical checkups, proper nutrition, exercise, and stress management.
Impact on productivity and well-being at work
This hormonal transition has a very real effect on women’s professional lives, beyond the physical symptoms. Studies from around the world show that 65% of women reported that menopause symptoms affected their work performance, and about 18% had to take time off work for this reason.
Strategies to improve quality of life
- Ongoing medical care: Evaluating hormone levels and discussing treatment options
- Regular physical activity: Improves sleep, mood, and bone health
- Balanced nutrition: Incorporating foods high in calcium, magnesium, and omega-3
- Psychological support and women’s groups: Sharing experiences can help relieve stress
- Inclusive workplaces: Promoting understanding and flexibility at work
The stages of the female reproductive system reflect the power and resilience of the female body. From the first menstruation until menopause, every stage presents challenges, lessons, and opportunities for reconnecting with health and well-being.
Openly discussing these issues is an act of collective empowerment. It reduces stigma, improves medical care, and fosters healthier work environments.
TSS-MKT-6114-2025-B