A definition of hormonal health

“Will 100 tampons be enough for six days in space?”

This question, posed to Sally Ride, the first American woman to travel to space in 1983, strikingly illustrates how misunderstood women's hormonal health remains. While there's often a lack of understanding of what women generally experience, this is even more true when they are in caregiving roles. Caring for a parent, a disabled child, or a sick partner, while simultaneously managing one's own body, hormonal cycles, pain, and exhaustion, represents a public health issue that remains largely invisible.

The menstrual cycle, which lasts on average between 25 and 30 days, is marked by hormonal fluctuations. It begins with the menstrual phase, where estrogen and progesterone levels are at their lowest. Gradually, estrogen levels rise, preparing the endometrium for a potential fertilization. During ovulation, estrogen levels drop, then rise again along with progesterone during the luteal phase. In the absence of pregnancy, a new hormonal decline triggers menstruation.

These variations are not insignificant: they influence metabolism, mood, sleep, memory, and pain. Far from being confined to the reproductive system, hormones also influence the brain, particularly the hippocampus, a region involved in learning and emotional regulation. Studies have shown that this structure changes shape throughout the menstrual cycle, affecting memory and cognition (Taylor et al., 2020). These hormonal fluctuations are often accompanied by distressing symptoms. Menstrual cramps affect more than half of women, and about one in five suffers from severe pain during their periods (Iacovides et al., 2015). Added to this are mood disorders, digestive problems, extreme fatigue, insomnia, or even phases of depression often unrecognized as such. Premenstrual syndrome (PMS) can occur a few days before menstruation and is characterized by irritability, sadness, anxiety, as well as physical symptoms like bloating, sore breasts, fatigue, or sleep disturbances. Up to 3 to 8% of women suffer from a more severe form called premenstrual dysphoric disorder (PMDD), characterized by intense psychological symptoms (Halbreich et al., 2003).

For some women, these effects are exacerbated by chronic gynecological illnesses. Endometriosis, which affects about 10% of women of reproductive age, causes chronic pelvic pain, profound fatigue, and can lead to infertility (Zondervan et al., 2020). Polycystic ovary syndrome (PCOS), also present in one in ten women, leads to irregular cycles, pain, acne, weight gain, and mood disorders (Teede et al., 2018). These conditions are rarely diagnosed quickly, and their impact on daily life remains largely underestimated.

Menopause, with its stages of perimenopause and post-menopause, can span over a decade, between the ages of 40 and 60. During this period, hormones such as estrogen decrease, which can be accompanied by various symptoms depending on the woman: hot flashes, joint pain, memory and concentration problems, decreased libido, vaginal dryness, depressive phases, derealization, or even a feeling of disconnection from the body or self (Cloutier, 2021). These symptoms are frequently mistaken for stress, anxiety disorders, or depression, without their hormonal origin being considered.

These realities take on a more critical dimension in women caregivers. About 57.5% of caregivers are women, many of whom are aged 40 to 65 (Observatoire québécois de la proche aidance, 2022). In addition to their paid or domestic work, they provide daily support to a loved one. This role requires significant physical and emotional commitment, often conflicting with the effects of the hormonal cycle.

While their physiological and hormonal needs would require rest, attention, and sometimes specialized medical care, they often find themselves without pause or recognition. The chronic stress associated with caregiving can, in turn, disrupt the menstrual cycle, increase pain, and worsen sleep disorders. The constant mental load, lack of rest, and guilt feed into exhaustion and isolation.

Yet, the hormonal perspective remains scarcely integrated into caregiver support systems. The idea that some mood disorders, pain, or cognitive losses may have a hormonal origin is still too often ignored—even within the medical community. And in the world of research, the situation is concerning: less than 0.5% of studies on brain imaging take women's menstrual cycle into account as a research variable (Jacobs, 2023).