The Interplay of Menopause Hormones

by | Feb 26, 2022 | Menopause

The Interplay of Menopause Hormones

by | Feb 26, 2022 | Menopause


If we are 40 plus and start to experience exaggerated mood responses, overwhelm, fatigue, menstrual changes, temperature changes, weight gain or sleep issues the first thing we think about is menopause! Or should I say perimenopause? Because some of the main changes in perimenopause are largely neurological in nature (mood, migraines hot flushes, night sweats). The first things we want to check out are our hormones. When it comes to weight changes, estrogen may attenuate them, especially around our abdominal area!

So which hormones are we actually talking about? Whilst estrogen, progesterone and testosterone may come to mind there are a few others worthy of mention.


Estrogen is one of the major female sex hormones and the production of this hormone mainly occurs in the ovaries. Because our egg reserves start to diminish it makes sense that our estrogen levels start to take a dive and this hormone is quicker to go down. After this time it’s our fat cells and adrenal glands that make estrogen.

Interestingly estrogen can be higher during perimenopause than it was before, but it is inevitably going to drop and stay low. The extreme highs and lows of this hormone cause many symptoms along with the drop in progesterone.

Luteinising Hormone and Follicle-Stimulating Hormone

In response to low estrogen levels two other hormones, the Luteinising hormone (LH) and the follicle-stimulating hormone (FSH) both begin to rise. The FSH stays elevated for life and therefore can be tested if confirmation is required – in fact 2 FSH readings >40 IU at least 1 month apart. FSH – stimulates ovaries to produce estrogen, and therefore rises in response to low estrogen. When estrogen is low FSH goes up.

It is not always a slow smooth transition there can be a lot of variability in ovulation, bleeding patterns and symptoms during this time, and hyper and hypo estrogen states occur.


Progesterone is another hormone that is a big player. Before perimenopause, in the luteal phase of our cycle (that is the second half ) progesterone is a lot higher than estrogen but in perimenopause when we are no longer ovulating, we see progesterone dive and interestingly estrogen now is higher than progesterone!

Progesterone decreases because the second half of our cycle shortens or becomes non-existent and this is when progesterone would normally be produced.

There are two significant aspects that cause the majority of symptoms – the first is that estrogen fluctuates dramatically during perimenopause for many women so it the highs and lows and the second issue is that progesterone is now so much lower than estrogen, the opposite to when we are having a normal cycle. So the balance between the two hormones do a “one-eighty” shift

Estrogen dominates over progesterone

We move into an anovulatory cycle, which is a cycle where ovulation is not occurring. This can also be known as hormone imbalance, dysfunctional uterine bleeding, ovulatory dysfunction, estrogen and progesterone imbalance or estrogen dominance.

So we can stop ovulating and still be getting a bleed but these are more like breakthrough bleeds!

Insufficient progesterone is difficult to measure because of the nature of the changes to the cycle. Tracking your basal temperature every morning before you get out of bed is a good way to know what your progesterone is doing. The temperature should rise in the luteal phase, the second half of your cycle, if it’s not it can be assumed that progesterone is low. Generally, women lose around 80 mills of blood this can get progressively greater!


It declines slowly with age, at age 40 it can be half that of when you were 20!  The gradual, imbalance for a time between testosterone and estrogen (can cause acne and facial hair). Blood testosterone does not correlate with low libido so it is important to be mindful of this.

Symptoms can include

  • Absent or greatly diminished sexual motivation and/or desire
  • Persistent unexplainable fatigue or lack of energy
  • Lack of sense of well being

Dehydroepiandrosterone (DHEA)

DHEA has a reputation of being the “fountain of youth” hormone, is produced from cholesterol mainly in our adrenal glands once we hit menopause. DHEA declines slowly as we age as well. Other conditions related to low DHEA levels are acute stress, severe systemic illness, anorexia nervosa, and adrenal failure. 

DHEA supports:

  • muscle mass
  • strength
  • mobility
  • body composition
  • physical performance
  • bone mineral density

Positive effects on mood disorders, cardiovascular issues and sexual function have been seen.

Sex hormone-binding globulin (SHBG)

Finally, there is another hormone called sex hormone-binding globulin, I call this hormone the venue bouncer it binds to some of our circulating male hormones and oestrogen’s rendering them inactive, so basically making sure that these hormones don’t get out of hand in our body!

So SHBG becomes a hormone we can measure to establish somewhat the behaviour of estrogen. Again it’s not completely straight forward but can be useful!

Cortisol is another important hormone but for another discussion! Understanding the interplay of the hormones is complex and other tests are necessary to provide context 🙂



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