What Happens to Hormones During Perimenopause?

The hormonal shifts that go along with perimenopause can feel like an ambush.

Suddenly everything feels like it’s falling apart even if you’re not doing anything different! Many women tell me that they just don’t feel like themselves anymore - and they can’t figure out what changed or what to do about it.

Their doctors are typically unhelpful, telling them that everything is fine and that their symptoms are normal.

But there’s nothing normal about rapid fat gain, sudden onset of depression, anxiety, or insomnia, or out-of-nowhere hair loss, just to name a few common perimenopausal symptoms.

And contrary to popular opinion, there are ways to test and treat the hormonal symptoms of perimenopause.

In fact, it’s a really good idea to do so, because it will make menopause itself much easier and healthier if you begin addressing hormonal shifts sooner rather than later.

But before we get into all of that, let’s talk about what perimenopause is, what kinds of symptoms we see during different stages, and what’s actually going on with your hormones.

Perimenopause is the time of hormonal winding down that occurs between your reproductive years and your post-menopausal years, and it can last anywhere from a few years to a decade - with the average being around 5 years.

If you have ovaries, you’ll go through it - even if you’ve had your uterus or fallopian tubes removed, or if you’ve had an ablation.

Only if you’ve had a total hysterectomy, or you’re taking hormone-blocking drugs do you skip perimenopause and go straight into menopause - which is an abrupt shift with it’s own consequences and side effects that I can cover in a different blog post.

Some of the first symptoms that show up in perimenopause may be subtle.

You may have irregular cycles that are shorter at first and then lengthen - periods often become heavier as well.
It’s common to experience sleep disruptions - perhaps you struggle to fall asleep, wake up at 3am and can’t fall back asleep, or toss and turn all night.
Mood changes like anxiety, depression, and irritability can show up, either on their own or triggered by other changes.
Fat gain, especially around the midsection, can happen even if you haven’t changed your diet or exercise habits.

Unexplained weight gain is one of the most baffling and frustrating symptoms that I see happening in early perimenopause - and it’s almost always shrugged off by conventional providers.

Another lesser-known symptom is urinary urgency or bladder changes that happen secondary to hormonal shifting.

Hot flashes or night sweats are the symptoms traditionally associated with the menopausal transition, but they can also happen in any phase of perimenopause, and they often contribute to sleep problems and moodiness as well.

Joint pain, muscle aches, and even itchy ears are also common symptoms of perimenopause.

So what’s going on with your hormones to cause all of this chaos?

Many people think that perimenopause and menopause involve a slow, steady decline in sex hormones. But it’s actually more like a rollercoaster that jerks you around for literal years. The shift typically starts when progesterone begins to decline.

This can happen gradually or intermittently - as a result of skipped ovulation. When an egg is released by the ovary during ovulation, the corpus luteum is formed, which causes the production of progesterone for the second half of the menstrual cycle.

Without ovulation, progesterone stays low. By the time you’re fully menopausal, progesterone will have dropped from 30-40mg to less than 1 mg - so it’s a big deal!

It’s important to note that this decline in progesterone is first triggered by the brain, which is why things like stress, medications, environmental toxicants, and even alcohol can have such a huge impact on your symptoms during perimenopause.

Symptoms of low progesterone can include:

heavier periods
worse PMS
increased anxiety
poor sleep

These symptoms occur because progesterone is the calm, cool, collected sex hormone that balances out your more fiery estrogens.

Progesterone decline can be more intense, causing worse symptoms if you’re already in an estrogen dominant state - perhaps because you’re not detoxing estrogen properly, you have too many xenoestrogens from pesticides or plastics, or your body is overproducing estrogen through an enzyme called aromatase.

Before perimenopause, your progesterone may have held estrogens in check - but during the decline, more estrogenic symptoms can start to break through. I have other videos all about estrogen dominance in my YouTube library, so feel free to check those out once you’re done with this video!

Speaking of estrogens, these hormones are known to swing wildly during perimenopause because the brain isn’t communicating as well with the ovarian cells that make estrogens, so symptoms can vary greatly day-to-day and month-to-month.

Because there are so many hormone receptors in the brain, cognitive symptoms are super common during perimenopause.

This hormonal unpredictability means more brain fog, mood swings, and even memory issues that come and go. Loss of focus or attention can show up in a big way during perimenopause because of hormone swings.

Now, estrogen fluctuation is a real thing during perimenopause, and it is one of the excuses doctors often give for not testing your hormones during perimenopause.

But despite this argument, accurate and comprehensive hormone testing that includes both hormone precursors and metabolites can really help during perimenopause.

I’m referring to the DUTCH Complete hormone test, my favorite way to accurately assess sex and stress hormones and come up with actionable, data-driven treatment strategies for hormonal issues, including symptoms of perimenopause and menopause.

This at-home urine test not only measures progesterone and estrogens, but it tells us how well your body is detoxifying estrogens - and these patterns don’t change even if your estrogen levels themselves are inconsistent.

Improving estrogen detox can not only help treat symptoms like hot flashes, weight gain, and inflammation, but it can also help prevent chronic diseases like breast cancer and cardiovascular disease.

The DUTCH Complete also measures stress hormones like cortisol and androgens like testosterone, which can both be optimized to minimize perimenopausal problems. You can get more information about the DUTCH Complete - including how you can order your own at-home test kit - by clicking HERE.

You deserve to know what’s going on with your hormones, and I’d like to help!

If you are experiencing symptoms of perimenopause and someone told you that there’s nothing you can do about it, don’t believe them.

There are dozens of scientifically valid strategies you can use, including diet, movement, micronutrients, nutraceuticals, acupuncture, hot or cold therapy, and other lifestyle strategies…you have so, so many options.

I’m going to share three of my favorite evidence-based supports for perimenopause with you here - nutraceuticals that work together to support progesterone, improve estrogen detoxification, and balance the HPA axis or stress response system.

And I’ve even typed up a Free User Guide that you can download, so be sure to grab that at the end.

The first on our list is Chasteberry or Vitex.

This plant extract supports your body’s production of progesterone by talking to the pituitary gland, and helps minimize PMS symptoms, improve cycle timing, and even relieve anxiety.

Chasteberry has been used for over 2000 years and can also help with vasomotor symptoms like hot flashes and night sweats.

I recommend a purified extract in combination with Black Cohosh during perimenopause - you’ll find the specific product I prefer in the downloadable User Guide.

Improving estrogen detoxification is important for a host of reasons, especially related to perimenopausal weight gain. Foods that support healthy estrogen metabolism include: cruciferous vegetables like broccoli, cabbage, and cauliflower, rosemary, raw unpeeled carrots, and flaxseed.

As for micronutrients, iron is crucial for phase 1 of estrogen detox, so it can be helpful to optimize both your iron and ferritin levels. B vitamins, magnesium, choline, and others are helpful for making sure phase 2 estrogen detox happens smoothly.

N-Acetyl-L-Cysteine, Diindolylmethane or DIM, and Indole-3 Carbinol or I-3-C are also powerful detoxification boosters. Again, I like to use a combination of these elements during perimenopause, so you’ll find my favorite in the User Guide.

Cortisol, your chronic stress hormone, can also have a major impact on your hormones and symptoms during perimenopause. One of my favorite ways to help your body balance cortisol is using adaptogenic herbs, specifically Rehmannia, Schisandra, and Jujube.

These adaptogens work together to lower inflammation, decrease your stress response, make your brain work better, and calm other common symptoms of perimenopause like hot flashes, anxiety, irritability, and even heart palpitations.

And because they’re adaptogens, they work with the body and are non-toxic, which means you can take them long-term. In fact, I suggest you do!

The health benefits don’t peak until 6 months of use - though people notice the improvements much sooner than that. You’ll find more details on timing and dosing for all of my favorite nutraceutical supports for perimenopause in the Free User Guide.

I hope all of this helps you have a better understanding of your hormones and open your mind to functional medicine treatment strategies that can help you navigate perimenopause with ease and confidence.

Don't forget to check out the DUTCH Complete hormone test, as well as my favorite nutraceuticals for perimenopause, which you can find in the Free User Guide.

If you’re looking for more in-depth information and additional strategies for balancing female hormones in any stage of life, I think you will like my Hormone Balance Deep Dive Tutorial - it’s an in-depth tutorial to help you better understand your hormones and how they cause tons of symptoms.