Many women and men notice their bodies changing in unexpected ways after turning 40, but they often dismiss these changes as normal aging. Hormonal imbalances after 40 can cause weight gain, mood swings, sleep problems, memory issues, and changes in energy levels that significantly impact daily life. These shifts happen because key hormones like estrogen, progesterone, and testosterone naturally decline with age.
Women entering perimenopause may experience irregular periods and other menstrual changes as their first noticeable signs. Men can also face hormonal changes, though their symptoms often develop more gradually. Both groups may notice unexplained fatigue, difficulty losing weight, or feeling emotionally different than before.
The good news is that recognizing these hormonal imbalance symptoms early allows people to take action. Understanding what your body is telling you helps you make informed decisions about treatment options and lifestyle changes that can restore balance and improve how you feel.
Key Takeaways
- Hormonal changes after 40 cause recognizable symptoms like weight gain, mood changes, and sleep disruption in both men and women
- Early recognition of hormonal imbalance signs allows for faster treatment and better management of symptoms
- Multiple treatment options exist to help restore hormone balance and improve quality of life after 40
Understanding Hormonal Imbalance After 40
Women over 40 experience significant changes in estrogen, progesterone, and thyroid hormone production. These hormonal fluctuations begin during perimenopause and continue through menopause, affecting nearly every body system.
What Are Hormones and Their Role in the Body
Hormones act as chemical messengers that control vital body functions. They travel through the bloodstream to target organs and tissues.
Key hormones affecting women over 40:
- Estrogen – Regulates menstrual cycles, bone density, and skin health
- Progesterone – Balances estrogen and supports sleep quality
- Thyroid hormones – Control metabolism and energy levels
- Cortisol – Manages stress response and inflammation
These hormones work together in a delicate balance. When one hormone changes, it affects the others.
Estrogen plays the biggest role in reproductive health. It keeps bones strong and supports heart health.
Progesterone helps prepare the body for pregnancy each month. It also has calming effects on the brain.
Thyroid hormones control how fast the body uses energy. They affect weight, temperature, and heart rate.
How Hormonal Changes Occur With Age
Hormonal fluctuations typically begin around age 40 as the ovaries start producing less estrogen and progesterone. This process happens gradually over several years.
The ovaries contain a finite number of eggs. As women age, fewer eggs remain and hormone production declines.
Estrogen levels can swing wildly before they drop permanently. Some months may have high estrogen, others very low levels.
Progesterone often decreases before estrogen does. This creates progesterone imbalance relative to estrogen levels.
Timeline of hormonal changes:
- Ages 35-40: Progesterone begins to decline
- Ages 40-45: Estrogen levels start fluctuating
- Ages 45-55: More dramatic hormone swings occur
- After 55: Hormone levels stabilize at lower amounts
Stress, diet, and lifestyle factors can speed up these changes. Poor sleep and high cortisol levels worsen hormonal imbalance.
Difference Between Perimenopause and Menopause
Perimenopause and menopause represent different stages of the same process. Understanding the distinction helps women know what to expect.
Perimenopause begins when hormone levels start changing but menstrual cycles still occur. This stage can last 4-10 years.
During perimenopause, periods may become irregular. They might be heavier, lighter, or skip months entirely.
Estrogen levels fluctuate dramatically during this time. Women may experience symptoms even while still having periods.
Menopause occurs when periods stop completely for 12 consecutive months. The average age is 51 in the United States.
At menopause, estrogen and progesterone production drops to very low levels. Symptoms may actually improve as hormone levels stabilize.
Key differences:
| Perimenopause | Menopause |
|---|---|
| Periods still occur | No periods for 12+ months |
| Hormone levels fluctuate | Hormone levels stay low |
| Symptoms come and go | Symptoms may be more consistent |
| Can last several years | Marks the end of reproductive years |
Many women don’t realize they’re in perimenopause because they still have periods. The hormonal changes can cause symptoms years before periods stop.
Key Signs and Symptoms of Hormonal Imbalance
Hormonal imbalance symptoms become more noticeable after 40 as estrogen, progesterone, and other hormone levels naturally decline. The most common signs include unexplained weight gain, persistent fatigue, mood changes, and disrupted sleep patterns.
Unexplained Weight Gain or Difficulty Losing Weight
Weight gain around the midsection is one of the most frustrating symptoms of hormonal imbalance women experience after 40. Declining estrogen levels slow metabolism and change how the body stores fat.
Many women notice their clothes fitting differently even when eating the same foods. The body begins storing more fat in the abdominal area instead of the hips and thighs.
Common weight-related symptoms include:
- Gaining 1-2 pounds per year despite no diet changes
- Difficulty losing weight with previous methods
- Increased belly fat and bloating
- Loss of muscle mass
Insulin resistance often develops alongside hormonal changes. This makes the body less efficient at processing carbohydrates and can lead to blood sugar spikes.
Weight issues are associated with hormone-related conditions such as thyroid disorders, PCOS, and Cushing’s syndrome. These conditions require medical evaluation and treatment.
Persistent Fatigue and Low Energy
Chronic fatigue affects nearly 80% of women going through hormonal transitions. Unlike normal tiredness, this exhaustion doesn’t improve with rest or sleep.
Declining progesterone levels disrupt the body’s natural energy production. Progesterone helps convert food into usable energy at the cellular level.
Energy-related symptoms include:
- Feeling tired upon waking
- Afternoon energy crashes
- Needing caffeine to function
- Difficulty completing daily tasks
Adrenal glands often become overworked during hormonal changes. Chronic stress forces these glands to produce excess cortisol, which eventually leads to adrenal fatigue.
Thyroid function commonly declines after 40. An underactive thyroid slows metabolism and causes persistent tiredness, brain fog, and cold intolerance.
Iron deficiency anemia becomes more common during perimenopause due to heavy periods. Low iron levels directly impact energy production and oxygen transport.
Mood Swings, Anxiety, and Depression
Emotional symptoms often appear years before physical changes become obvious. When estrogen levels drop, so does serotonin – the brain chemical that stabilizes mood.
Progesterone has natural calming effects on the nervous system. As levels decline, many women experience increased anxiety and irritability.
Emotional symptoms include:
- Sudden mood changes without triggers
- Increased anxiety or panic attacks
- Feeling overwhelmed by normal tasks
- Depression or persistent sadness
- Short temper and irritability
The brain becomes more sensitive to stress during hormonal transitions. Small problems may feel overwhelming or cause emotional reactions.
Many women report feeling like strangers to themselves. Personality changes and emotional unpredictability can strain relationships and work performance.
Sleep Disturbances and Night Sweats
Sleep quality deteriorates significantly during hormonal changes. Falling estrogen and progesterone levels disrupt the body’s natural sleep-wake cycle.
Night sweats affect up to 75% of women experiencing hormonal imbalance. These episodes can occur multiple times per night, soaking pajamas and bedsheets.
Sleep-related symptoms include:
- Difficulty falling asleep
- Waking frequently during the night
- Early morning awakening
- Hot flashes disrupting sleep
- Feeling unrefreshed after sleep
Progesterone acts as a natural sedative. Lower levels make it harder to fall asleep and stay asleep throughout the night.
Hormonal imbalance can affect sleep by causing night sweats and temperature regulation problems. The hypothalamus, which controls body temperature, becomes less stable.
Racing thoughts and anxiety often worsen at bedtime. Cortisol levels may remain elevated when they should naturally decrease for sleep.
Specific Hormonal Symptoms in Women Over 40
Women over 40 experience distinct hormonal changes that create specific physical symptoms. The most noticeable changes include disrupted menstrual patterns, temperature regulation problems, and significant hair texture alterations.
Irregular Periods and Menstrual Changes
Menstrual changes are one of the most noticeable signs of hormonal shifts after 40. Women may notice their cycles becoming unpredictable as estrogen and progesterone levels fluctuate.
Common menstrual changes include:
- Cycles becoming shorter or longer than usual
- Heavier or lighter bleeding
- Spotting between periods
- Missing periods entirely
These irregular cycles often signal the start of perimenopause. Some women experience periods every 21 days while others may go 45 days between cycles.
Flow changes can be dramatic. Heavy bleeding may last longer than normal, while some women notice their periods become very light or brief.
The timing becomes unpredictable. Women who previously had regular 28-day cycles may find it impossible to predict when their next period will arrive.
These changes can continue for several years before menopause begins. Tracking symptoms helps women understand their personal patterns and discuss concerns with healthcare providers.
Hot Flashes and Vaginal Dryness
Hot flashes affect up to 80% of women during hormonal transitions. These sudden waves of heat typically last 1-5 minutes and can occur day or night.
Hot flash characteristics:
- Sudden feeling of intense heat
- Sweating and flushing
- Rapid heartbeat
- Chills after the episode
Night sweats disrupt sleep patterns and leave women feeling exhausted. Some experience multiple episodes per night, making restful sleep nearly impossible.
Vaginal dryness develops as estrogen levels drop. The vaginal tissues become thinner and produce less natural lubrication. This creates discomfort during daily activities and intimacy.
Vaginal changes include:
- Decreased moisture production
- Tissue thinning and irritation
- Burning or itching sensations
- Discomfort during intercourse
These menopausal symptoms significantly impact quality of life. Many women find that hormone replacement therapy or topical treatments provide relief from both hot flashes and vaginal dryness.
Hair Loss and Thinning Hair
Hair changes become noticeable as hormone levels shift after 40. Declining estrogen and progesterone combined with stable testosterone levels create male-pattern hair loss in women.
Common hair changes include:
- Thinning at the crown and temples
- Wider part lines
- Increased hair shedding
- Changes in hair texture and thickness
Women may notice more hair in their brush or shower drain. The hair that remains often becomes finer and more brittle than before.
Thinning hair typically follows predictable patterns. The hairline may recede slightly, and the crown area becomes less dense over time.
Hair loss locations:
| Area | Description |
|---|---|
| Crown | Gradual thinning at the top of the head |
| Temples | Slight recession at the hairline |
| Overall | General reduction in hair density |
Some women also notice increased facial hair growth as the ratio of testosterone to estrogen changes. This creates a double concern of losing head hair while gaining unwanted facial hair.
Early intervention with proper treatments can slow hair loss progression and maintain existing hair health.
Digestive and Metabolic Changes Linked to Hormonal Imbalance
Hormonal changes after 40 often trigger noticeable shifts in digestion and metabolism. Women may experience stomach problems, develop insulin resistance, and notice their body stores fat differently than before.
Constipation, Diarrhea, and Gastrointestinal Symptoms
Estrogen and progesterone play key roles in metabolism and digestion. When these hormones drop during perimenopause, many women notice stomach issues.
Common digestive symptoms include:
- Bloating after meals
- Stomach cramps
- Changes in bowel movements
- Nausea or upset stomach
Hormonal imbalances can cause bloating, stomach pain, constipation, nausea, diarrhea, and vomiting. These problems happen because hormone levels affect how the digestive system works.
Women with irritable bowel syndrome often notice their symptoms get worse during hormone changes. Hormone changes can increase gastrointestinal symptoms, especially for those with IBS.
The gut moves food through the body at different speeds when hormones change. This can lead to constipation one week and diarrhea the next.
Signs of Insulin Resistance
Insulin resistance becomes more common as hormone levels shift after 40. This happens when cells don’t respond well to insulin anymore.
Key warning signs include:
- Trouble losing weight despite diet changes
- Increased hunger between meals
- Energy crashes after eating
- Cravings for sweet or starchy foods
Physical signs to watch for:
- Dark patches on the neck or armpits (acanthosis nigricans)
- Small skin tags around the neck area
- Weight gain around the middle section
- Difficulty with weight loss
Women may notice their blood sugar stays higher than normal after meals. The pancreas makes more insulin to try to lower blood sugar levels.
This creates a cycle where high insulin levels make it harder to burn fat. The body stores more energy as fat instead of using it.
Changes in Body Fat Distribution
Hormonal shifts after 40 change where the body stores fat. Many women notice weight moving from their hips and thighs to their stomach area.
During menopause, many women gain weight due to hormonal changes that slow down metabolism. This makes it harder to maintain the same weight with the same eating habits.
Common changes include:
- Fat accumulation around the waistline
- Loss of muscle mass in arms and legs
- Slower metabolism overall
- Harder time losing weight
Age-related hormone decline plays a key role in increased fat mass and decreased lean tissue. This process happens gradually over several years.
The body burns fewer calories at rest when muscle mass decreases. Women may need to eat less or exercise more to maintain their weight.
Cortisol levels often rise during this time due to stress. High cortisol encourages fat storage around the middle of the body.
Hormonal Imbalance in Men Over 40
Men over 40 experience significant drops in testosterone levels that directly impact sexual function and physical appearance. These changes affect muscle development, body composition, and intimate relationships in measurable ways.
Erectile Dysfunction and Libido Changes
Low testosterone affects approximately 40% of men over age 45, creating noticeable changes in sexual health. Men notice difficulty achieving or maintaining erections during intimate moments.
Common Sexual Health Changes:
- Reduced interest in sexual activity
- Weaker erections that don’t last as long
- Less frequent morning erections
- Decreased sensitivity during intimacy
Hormonal imbalances can interfere with sexual performance beyond just testosterone levels. High cortisol from stress blocks testosterone production. This creates a cycle where stress makes sexual problems worse.
Blood flow to the penis depends on healthy hormone levels. When testosterone drops, the body produces less nitric oxide. This chemical helps blood vessels expand for stronger erections.
Men often feel frustrated or embarrassed about these changes. However, these symptoms signal treatable hormone imbalances rather than permanent aging effects.
Loss of Muscle Mass and Body Hair
Testosterone is responsible for building and maintaining muscle mass throughout a man’s life. After 40, testosterone levels drop by 1-2% each year, causing visible body changes.
Physical Changes Men Notice:
- Arms and legs look less defined
- Belly fat increases despite same diet
- Chest hair becomes thinner and patchy
- Facial hair grows slower
- Body hair on arms and legs decreases
Muscle loss happens gradually over months and years. Men find it harder to lift the same weights at the gym. Recovery time after exercise takes longer than before.
Body hair changes occur because hair follicles need testosterone to grow thick, dark hair. Lower hormone levels cause hair to become fine and light-colored. Some areas stop growing hair completely.
High cortisol levels can suppress testosterone production, making muscle loss worse. Chronic stress from work or relationships accelerates these physical changes.
Men who notice these symptoms should track changes over 3-6 months. Sudden muscle loss or rapid hair changes may indicate more serious hormone problems requiring medical attention.
Common Causes and Risk Factors for Hormonal Imbalance
Women over 40 face several key factors that disrupt hormone production. Age-related changes like menopause create the most significant shifts, while daily stress and certain medications can worsen existing imbalances.
Natural Aging and Menopausal Transition
The body’s hormone production naturally declines as women age. This process accelerates significantly after 40.
Perimenopause typically begins in the mid-40s when ovaries start producing less estrogen and progesterone. Women may experience irregular periods and hot flashes during this stage.
Menopause occurs when ovaries stop producing reproductive hormones around age 50. Estrogen levels drop by 90% within five years of menopause.
Other age-related changes include:
- Decreased growth hormone production
- Reduced insulin sensitivity
- Lower thyroid function
- Declining DHEA levels
The metabolic changes that occur with aging often lead to increased fat mass and decreased muscle tissue. These shifts affect how the body processes and stores energy.
Chronic Stress and Lifestyle Factors
Chronic stress forces the adrenal glands to produce excess cortisol. High cortisol levels disrupt other hormones including insulin, thyroid hormones, and reproductive hormones.
Common lifestyle factors that worsen hormonal imbalances include:
| Factor | Impact on Hormones |
|---|---|
| Poor sleep | Disrupts growth hormone and cortisol |
| Unhealthy diet | Affects insulin and blood sugar |
| Lack of exercise | Reduces insulin sensitivity |
| Excessive alcohol | Interferes with liver hormone processing |
Stress management becomes critical after 40. The body’s ability to recover from stress decreases with age.
Weight gain around the midsection often results from elevated cortisol levels. This type of fat distribution increases inflammation and further disrupts hormone balance.
Medical Conditions and Medications
Several health conditions can trigger hormonal imbalances in women over 40.
Thyroid disorders become more common with age. Both overactive and underactive thyroid conditions affect metabolism and energy levels.
Autoimmune conditions can attack hormone-producing glands. The immune system may mistakenly target the thyroid, adrenals, or ovaries.
Medications that commonly affect hormones include:
- Blood pressure medications
- Antidepressants
- Birth control pills
- Corticosteroids
- Diabetes medications
Growths on endocrine glands such as thyroid nodules or pituitary adenomas can disrupt normal hormone production.
Previous surgeries, radiation therapy, or injuries to hormone-producing glands may cause long-term imbalances. These effects often become more noticeable as women age and natural hormone production declines.
Diagnosis and Effective Solutions for Hormone Balance
Getting proper testing helps identify specific hormone problems, while targeted nutrition, regular exercise, stress reduction, and medical treatments can restore balance effectively.
Importance of Hormone Testing
Diagnosing a hormonal imbalance requires specific tests since no single test measures all hormones. Women over 40 should consider testing when they notice multiple symptoms like irregular periods, unexplained weight changes, or mood swings.
Common hormone tests include:
- Blood tests for estrogen, progesterone, and testosterone
- Thyroid function panels (TSH, T3, T4)
- Cortisol levels through saliva or blood
- Insulin and glucose measurements
Healthcare providers may also perform physical exams, pelvic exams, and ultrasounds to check for underlying conditions. They review medical history and current medications that might affect hormone levels.
Testing timing matters for accuracy. Estrogen and progesterone tests work best on specific cycle days. Cortisol testing often happens in the morning when levels peak naturally.
Nutrition and Balanced Diet
Food choices directly impact hormone production and balance. Women over 40 need specific nutrients to support declining hormone levels and maintain healthy metabolism.
Key nutrients for hormone health:
- Omega-3 fatty acids from fish, walnuts, and flaxseeds
- Fiber from vegetables, fruits, and whole grains
- Healthy fats from avocados, olive oil, and nuts
- Protein from lean meats, beans, and eggs
Dark leafy greens like kale provide folate and magnesium. These nutrients support estrogen metabolism and reduce inflammation. Cruciferous vegetables help the liver process excess hormones.
Foods to limit include:
- Processed foods high in sugar and refined carbs
- Excessive caffeine and alcohol
- Trans fats and fried foods
Eating regular meals helps stabilize blood sugar and insulin levels. This prevents cortisol spikes that can worsen hormone imbalance symptoms.
Physical Activity and Strength Training
Regular exercise helps balance hormones by reducing stress, improving insulin sensitivity, and supporting healthy weight. Women over 40 benefit most from combining different types of physical activity.
Effective exercise types:
- Strength training 2-3 times per week
- Moderate cardio like walking or swimming
- Yoga or stretching for flexibility
- High-intensity interval training (HIIT) in short bursts
Strength training builds muscle mass that naturally declines after 40. More muscle tissue improves metabolism and helps process glucose better. This reduces insulin resistance common during perimenopause.
Too much intense exercise can raise cortisol levels. Women experiencing hormone imbalance should avoid excessive cardio. Gentle activities like walking or yoga often work better for reducing stress hormones.
Consistency matters more than intensity. Even 30 minutes of daily movement can improve hormone balance over time.
Lifestyle Modifications and Stress Management
Chronic stress disrupts multiple hormones, especially cortisol and insulin. Managing stress becomes crucial for women over 40 dealing with natural hormone changes.
- Regular sleep schedule (7-9 hours nightly)
- Meditation or deep breathing exercises
- Time in nature or outdoors
- Social connections and support
Poor sleep quality worsens hormone imbalance. Women should create dark, cool bedrooms and avoid screens before bed. Going to sleep and waking at consistent times helps regulate cortisol patterns.
Meditation practices reduce cortisol production and improve mood. Even 10 minutes daily can make a difference. Apps or classes provide guided sessions for beginners.
Limiting alcohol and reducing caffeine intake supports better sleep and hormone balance. Both substances can interfere with natural hormone cycles.
Medical Treatments and Hormone Replacement Therapy
Treatment options depend on the specific hormones affected and underlying causes. Healthcare providers may recommend different approaches based on individual needs and health history.
Common medical treatments:
- Bioidentical hormone replacement therapy (HRT)
- Thyroid medications for underactive thyroid
- Anti-androgen drugs for excess male hormones
- Insulin-sensitizing medications for diabetes
Hormone replacement therapy uses estrogen, progesterone, or testosterone to replace declining levels. Bioidentical hormones match the body’s natural hormone structure exactly.
HRT comes in different forms including pills, patches, gels, and creams. Vaginal estrogen helps with dryness and discomfort without affecting the whole body.
Women considering HRT should discuss risks and benefits with their doctor. Personal and family health history affects whether hormone therapy is safe and appropriate.
Frequently Asked Questions
Women over 40 often have specific questions about hormone changes, natural treatments, and how to tell normal aging from serious imbalance. These answers address the most common concerns about symptoms, remedies, and treatment options.
What natural remedies can help with hormonal imbalance in women over 40?
Several natural approaches can help balance hormones after 40. Regular exercise supports hormone production and reduces stress on the adrenal glands.
A healthy diet rich in omega-3 fatty acids, leafy greens, and whole grains provides nutrients needed for hormone synthesis. Women should avoid processed foods and excess sugar that can worsen imbalances.
Stress management plays a key role in hormone health. Yoga, meditation, and deep breathing exercises help lower cortisol levels from chronic stress.
Herbal supplements like black cohosh and evening primrose oil may help with menopausal symptoms. However, women should consult healthcare providers before starting any supplements.
Getting 7-8 hours of quality sleep supports hormone regulation. Creating a cool, dark bedroom environment helps combat night sweats and sleep disruption.
What are the telltale symptoms of hormonal changes in females after 40?
Irregular menstrual cycles are often the first sign of hormonal changes. Periods may become heavier, lighter, or skip months entirely.
Sleep problems become common, including night sweats and insomnia. Hot flashes can start years before menopause officially begins.
Mood swings, irritability, and anxiety increase due to fluctuating estrogen and progesterone levels. Many women also experience brain fog and difficulty concentrating.
Weight gain, especially around the midsection, occurs even without diet changes. The metabolism slows as hormone levels shift.
Hair thinning and skin changes become noticeable. Vaginal dryness and decreased sex drive affect many women during this transition.
Which treatments are effective for hormonal imbalance in post-40 females?
Hormone replacement therapy (HRT) effectively treats severe symptoms like hot flashes and night sweats. Bioidentical hormones offer a more natural option tailored to individual needs.
Thyroid medication helps women with underactive thyroid function that affects energy and weight. Proper thyroid function is essential for maintaining balance in the endocrine system.
Birth control pills can regulate irregular periods in perimenopause. They help stabilize hormone fluctuations before menopause.
Antidepressants may help with mood symptoms and hot flashes. Some medications specifically target menopausal symptoms without hormone therapy.
Lifestyle modifications remain the foundation of treatment. Diet changes, regular exercise, and stress reduction support any medical treatments.
Can hormonal balance be restored within a week, and if so, how?
Hormonal balance cannot be fully restored in one week. The endocrine system requires weeks to months to show significant improvements from treatment changes.
Some symptoms may improve quickly with lifestyle changes. Better sleep habits and stress reduction can help mood and energy within days.
Hormone therapy may provide relief from hot flashes within 1-2 weeks. However, full benefits typically take 4-6 weeks to develop.
Quick fixes like extreme diets or supplements can actually worsen hormone imbalances. Sustainable changes produce better long-term results.
Women should have realistic expectations about timing. Gradual improvement over several months is normal and healthy.
What are the common signs of perimenopause in women?
Perimenopause typically begins in the 40s, though it can start earlier. The transition period lasts an average of 4 years before menopause.
Menstrual changes are the hallmark sign. Cycles may become shorter or longer, with heavier or lighter bleeding patterns.
Hot flashes affect up to 75% of perimenopausal women. These sudden feelings of heat can occur day or night and last several minutes.
Sleep disturbances increase during perimenopause. Night sweats and insomnia disrupt rest even when women feel tired.
Emotional symptoms include mood swings, increased anxiety, and depression. These result from fluctuating estrogen and progesterone levels throughout each cycle.
How can you differentiate between normal hormonal shifts and an imbalance after turning 40?
Normal hormonal shifts happen gradually over several years. Symptoms are mild to moderate and don’t severely impact daily functioning.
Hormonal imbalances cause more severe, disruptive symptoms. Women may experience multiple symptoms simultaneously that affect work, relationships, and quality of life.
The timing of symptoms provides clues about their cause. Normal perimenopause symptoms typically begin in the mid-40s and progress slowly.
Sudden onset of severe symptoms may indicate an underlying condition. Conditions like PCOS or thyroid disorders require medical evaluation and treatment.
Healthcare providers can perform hormone tests to measure specific levels. Blood work helps distinguish between normal aging and medical conditions requiring treatment.
Women should seek medical attention if symptoms severely impact their lives. Professional evaluation ensures appropriate treatment and rules out other health issues.
