Understanding the changes in hormones that happen in the years leading up to and during menopause can be overwhelming. Women can spend up to 10 years in the perimenopausal period prior to menopause when they finally reach the “end” and don’t have a period for 12 consecutive months. The hormonal fluctuations during that time can cause a lot of symptoms and many of them can be bothersome enough that treatment is necessary. This is too often either not discussed, overlooked, considered a part of aging that as women we just need to “deal with”, or not treated effectively because of a lack of knowledge on the part of health care providers.
The short version is that our ovaries are the main producers of estrogen and progesterone. These aren’t the only important hormones, but are the two primary female sex hormones. Estrogen is produced, we ovulate, and ovulation results in the production of progesterone. Around 35 our follicles begin to fail, ovulation begins to slow, and so we produce less progesterone. Estrogen production also begins to slow. It is believed that estrogen drops by about 60% at menopause, this is usually a gradual decline. Progesterone often drops very quickly. No ovulation, no progesterone, and it is believed that it drops by 90% or more, often to almost zero.
The real problem with our hormones isn’t as simple as estrogen is low or progesterone is low. The balance between estrogen and progesterone is the real issue.
What is Estrogen Dominance
Estrogen dominance – refers to an imbalance where there is not enough progesterone to balance the amount of estrogen. This does not necessarily mean that estrogen is too high. It just means that there isn’t enough progesterone for the amount of estrogen that is present. Sometimes estrogen dominance is really a Progesterone deficiency. Your estrogen level is normal, but your progesterone level is so low that the estrogen is unopposed and dominant.
Consider that your estrogen level may be lower than the “normal” lab range, but if your progesterone level is zero, then you have estrogen with NO progesterone to balance it. One requires the other. They balance each other and either without its counterpart will cause problems. Many of the symptoms of menopause can be caused by estrogen dominance. The most frequent assumption is that if a woman is menopausal and has these symptoms then their estrogen level must be low. While this may be true, it is often not that simple.
Symptoms of Estrogen Dominance
Symptoms of estrogen dominance include:
- Irregular periods, heavy periods, infertility
- Mood changes, depression, anxiety
- Breast tenderness
- Hot flashes
- Vaginal dryness
- Fluid retention
- Weight gain especially in the hips, thighs, and abdomen
- Sleep disturbances and fatigue
- Decreased sex drive
- Memory Problems or difficulty concentrating
- Thinning hair
- Facial hair on chin or upper lip
- Joint or muscle aches and pains
Symptoms can be managed safely and effectively but treatment with progesterone alone or estrogen and progesterone together should only be started after a thorough history and evaluation. Every situation is not the same and there is no “standard” plan. It is critical that you consider the whole picture and look not at individual levels but at the balance of hormones as well to feel your best. There is far more to the entire hormone picture than I have discussed here. Cortisol, DHEA, testosterone, and many other hormones and health factors play a role in our hormone health. My goal in this quick article was to give you a basic understanding of the importance of the balance between estrogen and progesterone as the two primary female sex hormones.