Hormones are chemicals that coordinate different functions in your body by carrying messages through your blood to your organs, skin, muscles and other tissues. These signals tell your body what to do and when to do it. Hormones are essential for life and your health, and during different stages of life, they naturally fluctuate—such as during puberty, your menstrual cycle, during pregnancy, and more. 

If you're perimenopausal, you might be experiencing a range of physical and mental symptoms, such as decreased sex drive, irregular periods, hot flashes, sleep problems, weight gain, or mood changes. Good news is, you can blame all of these less-than-lovely experiences on hormonal fluctuations due to changes in the ovaries' function. The ovaries produce less estrogen and progesterone, two hormones that play key roles in the menstrual cycle and overall reproductive health. 

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Key Hormones Affected During Perimenopause

Estrogen

Estrogen is the primary female sex hormone responsible for regulating the menstrual cycle, maintaining bone density, and supporting cardiovascular health. During perimenopause, levels of estrogen fluctuate unpredictably, often leading to the following common symptoms:

• Irregular Menstrual Cycles: As estrogen levels decrease, the menstrual cycle becomes irregular. Periods may become shorter, longer, heavier, or lighter, and the time between periods may vary significantly.
• Hot Flashes and Night Sweats: A study published in The Journal of Clinical Endocrinology & Metabolism found that fluctuating estrogen levels are closely linked to vasomotor symptoms like hot flashes and night sweats, which affect up to 75% of women during perimenopause.
• Mood Swings: Estrogen influences the production of serotonin, a neurotransmitter that regulates mood. Lower estrogen levels can lead to mood swings, anxiety, and even depression.
• Vaginal Dryness: Reduced estrogen can lead to thinning of the vaginal walls and decreased lubrication, causing discomfort during intercourse.

Progesterone

Progesterone is another key hormone that regulates the menstrual cycle and supports pregnancy. In perimenopause, progesterone levels also decline, particularly because ovulation (the release of an egg from the ovaries) becomes less frequent. This decline can lead to:

• Heavier Periods: With less progesterone to balance estrogen, the uterine lining may thicken more than usual, leading to heavier periods and increased risk of endometrial hyperplasia.
• Sleep Disturbances: Progesterone has a calming effect on the brain. Lower levels during perimenopause can contribute to insomnia or disrupted sleep.

Follicle-Stimulating Hormone (FSH)

FSH is produced by the pituitary gland and plays a critical role in the menstrual cycle by stimulating the growth of ovarian follicles. During perimenopause, as the ovaries become less responsive, the body produces more FSH in an attempt to stimulate the ovaries. Elevated FSH levels are often used as an indicator that a woman is in perimenopause.

A study published in Menopause found that FSH levels increase significantly during perimenopause, especially in the late stages, and are associated with more pronounced menopausal symptoms.

What causes hormonal changes during perimenopause?

The hormonal changes in perimenopause are complex and influenced by several factors, including genetics, lifestyle, and overall health. Research has shown that the fluctuations in estrogen and progesterone are not gradual but rather occur in unpredictable patterns.

A longitudinal study conducted by the Study of Women’s Health Across the Nation (SWAN) followed over 3,000 women of different ethnicities through their menopausal transition. The study revealed that estrogen levels could swing dramatically from one cycle to the next during perimenopause, contributing to the variability in symptoms experienced by different women .

Additionally, the decrease in ovarian function leads to changes in the production of other hormones, such as androgens (e.g., testosterone), which can affect libido, energy levels, and body composition. This hormonal interplay underscores the complexity of perimenopause and the need for personalized approaches to managing symptoms.

Lifestyle changes can also help manage perimenopausal symptoms:

A Healthy Diet

A diet rich in phytoestrogens (plant-based estrogens) found in soy, flaxseeds, and whole grains may help balance hormone levels naturally. A study published in *Menopause* found that women who consumed higher amounts of soy experienced fewer hot flashes.

Exercise

Regular physical activity can help manage weight, improve mood, and reduce the risk of osteoporosis, which becomes more prevalent as estrogen levels decline. Weight-bearing exercises, in particular, are beneficial for maintaining bone density.

Stress Management

Techniques such as yoga, meditation, and deep breathing exercises can help manage stress and reduce cortisol levels, which can exacerbate perimenopausal symptoms.

Some women find relief from perimenopausal symptoms through alternative therapies, such as acupuncture, herbal supplements and bioidentical hormone therapy. While research on these treatments is still evolving, some studies suggest they may offer benefits. For instance, a study published in Maturitas found that acupuncture significantly reduced the frequency and severity of hot flashes in perimenopausal women.

Perimenopause is a natural yet complex transition marked by significant hormonal changes that can affect a woman’s physical and emotional well-being. Understanding these changes and how they manifest in symptoms can empower women to seek appropriate treatment and make lifestyle adjustments that improve their quality of life. As always, it’s important to consult with a healthcare provider to tailor an approach that best suits your individual needs.

Next up: Everything you want to know about perimenopause, plus how perimenopause impacts fertility. 

References:

1. Menopausal Symptoms and Their Management. 
2. A review of hormonal changes during the menopausal transition: Focus on findings from the Melbourne Women's Midlife Health Project. 
3. Perimenopause and cognition. 
4. Influence of soy intake on circulating estrogen levels. 
5. Acupuncture for menopausal hot flashes: A randomized trial.

This article is for informational purposes only. It is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and we recommend that you always consult with your healthcare provider. To the extent that this article features the advice of physicians or medical practitioners, the views expressed are the views of the cited expert and do not necessarily represent the views of Perelel.