Estrogen in Perimenopause: The Textbook Truth Doctors Don’t Tell You
Most women are told their estrogen “drops” during perimenopause. But the gynecologic endocrinology textbook by Spiro (Clinical Gynecologic Endocrinology and Infertility) says otherwise:
➡️ Estradiol does not gradually decline in the years before menopause.
➡️ Instead, estrogen often stays normal—or even elevated—until about a year before the final menstrual period.
➡️ During perimenopause, women commonly experience higher overall estrogen levels because the ovaries keep responding to rising FSH, producing multiple follicles that make estrogen—even when ovulation doesn’t occur.
The real issue isn’t low estrogen. It’s progesterone deficiency from chronic anovulation. This creates estrogen dominance—too much estrogen with too little progesterone—leading to symptoms like:
Weight gain
Heavy or irregular bleeding
Mood swings, insomnia, brain fog
Breast tenderness
Blood sugar issues
👉 Adding more estrogen at this stage often makes symptoms worse. The solution is restoring balance—supporting progesterone and helping the body process excess estrogen, not piling on more estrogen.
📚 This is not my opinion. This is physiology, straight from the endocrinology textbook.
