Perimenopause can feel like an unpredictable season of change. One moment, everything seems normal, and the next, your body and mind feel completely different. If you’ve started noticing shifts in your energy, mood, sleep, or menstrual cycle, you’re not alone. These changes are often the result of hormonal fluctuations which occur as a natural part of the transition towards menopause.

Understanding what’s happening in your body can be both reassuring and empowering. In this article, we’ll explore the key hormonal changes that occur during perimenopause, how they impact your health, and what you can do to feel more balanced and in control.

What happens to your hormones during perimenopause?

During perimenopause, hormones fluctuate with the key reproductive hormones, oestrogen, progesterone and testosterone, rising and falling unpredictably before gradually declining and staying at permanently lowered levels after menopause (1).

This can upset the balance between these hormones and is the reason for many of the physical and emotional symptoms experienced during this transition. Understanding how each hormone functions and what happens to its levels during perimenopause can help you make sense of the changes in your body.

Oestrogen

Oestrogen is the primary female sex hormone, playing a crucial role in regulating the menstrual cycle, supporting ovulation, and thickening the uterine lining to prepare it for pregnancy (2). It also influences bone density, heart health, and brain function.

During perimenopause, oestrogen levels become erratic, sometimes surging higher than usual and other times dropping significantly. This happens because the ovaries, which produce oestrogen, start to decline in function.

Progesterone

Progesterone works alongside oestrogen to regulate the menstrual cycle, preparing the uterus for pregnancy and supporting early pregnancy if conception occurs (3). It also has a calming effect on the nervous system and plays a role in your mood, energy levels and thyroid function (3).

During perimenopause, progesterone levels start to decline as ovulation becomes less frequent. Since progesterone is only produced in significant amounts after ovulation, irregular ovulation leads to lower overall levels (4). However, the decline in progesterone isn’t necessarily steady and is likely to fluctuate from cycle to cycle.

Testosterone

Although often thought of as a male hormone, testosterone is essential for women’s health, contributing to libido, energy levels, muscle strength, and mood stability (5).

Women produce testosterone in the ovaries and adrenal glands, but levels naturally begin to decline with age. During perimenopause, as ovarian function decreases, testosterone production gradually reduces (3). While this decline is less abrupt than with oestrogen and progesterone, lower testosterone levels can contribute.

Learn more about testosterone levels in menopause.

Common signs of hormone imbalance in perimenopause

Hormonal imbalances in perimenopause can affect mechanisms and organs throughout the body, leading to a broad array of symptoms. While many of these are mild and short-lived, some can have a severe impact on your physical health and quality of life.

Find out more about perimenopause and menopause symptoms.

Symptoms of high oestrogen in perimenopause

When oestrogen is high, particularly in relation to its usual balance with other hormones, it can lead to undesirable symptoms and increase the risk of certain health conditions.

Symptoms of a high oestrogen-to-progesterone ratio include:

Breast tenderness
Water retention
Weight gain
Migraines and headaches
Mood swings
Unwanted hair growth
Digestive issues
Brain fog
Irritability
Irregular periods, including anovulatory cycles
Breakthrough bleeding/spotting (6)

Health conditions that can occur when oestrogen is unopposed (where progesterone levels do not balance oestrogen levels) include:

Uterine fibroids
Heavy menstrual bleeding
Worsening of endometriosis
Breast cancer
Ovarian cancer
Uterine cancer
Menstrual migraines
Ovarian and adrenal tumours (6,7)

Symptoms of low oestrogen in perimenopause

Declining oestrogen levels are a natural part of ageing, but your body can respond in ways that feel unfamiliar and are disruptive to day-to-day life.

Signs of low oestrogen in perimenopause:

Irregular periods or no periods
Dry skin
Breast tenderness
Mood changes and irritability
Vaginal dryness and atrophy
Hot flushes
Night sweats
Headaches
Fatigue
Insomnia
Difficulty concentrating
Weight gain, especially around the abdomen
Decreased sex drive
Pain during sex
Bone loss
Genitourinary symptoms including urinary incontinence (8,9)

High progesterone symptoms in perimenopause

While many symptoms of menopause are associated with fluctuating oestrogen levels, there are symptoms linked to changes in progesterone levels too.

High progesterone levels have been linked to:

Breast tenderness
Bloating
Weight gain
Fatigue
Mood swings
Changes to sex drive
Migraines and headaches (10)

Low progesterone symptoms in perimenopause

Low levels of progesterone (which can result in a higher oestrogen to progesterone ratio) in perimenopause can also cause symptoms including:

Irregular menstrual cycles
Missed periods
Breakthrough bleeding/spotting
Intense PMS symptoms such as bloating, mood swings, anxiety and food cravings
Fatigue
Hot flushes and night sweats
Sleep disruptions
Decreased libido
Vaginal dryness
Pain during sex
Breast tissue changes including tenderness, swelling and lumps (10,11)

Symptoms of low testosterone levels in perimenopause

Testosterone levels naturally lower with age, but during perimenopause, the low levels can lead to noticeable changes including:

Reduced sex drive
Less enjoyment during sex
Low energy
Brain fog
Difficulty concentrating (12)

Other causes of hormonal imbalance during perimenopause

Our bodies are complicated and there are so many factors that can impact the levels of hormones and the balances between them.

Although the changes that occur in perimenopause lead to hormone fluctuations, there are many other causes of hormonal imbalances and it’s important to rule out any other underlying health issues.

Other causes of hormone imbalances include:

High-stress levels
Illness
Eating disorders like anorexia and bulimia
Excessive exercise
Treatment for cancer, such as radiation therapy and chemotherapy
Polycystic ovary syndrome (PCOS)
Autoimmune conditions such as Type 1 diabetes, Hashimoto’s disease and Graves’ disease
Genetic conditions including Turner syndrome
Underactive or overactive thyroid (8, 11, 13)

Learn more about thyroid problems and menopause.

Testing and monitoring hormones during perimenopause

Hormone levels fluctuate a lot during perimenopause and aren’t routinely tested to diagnose perimenopause or monitored to manage perimenopause symptoms. In otherwise healthy women, perimenopause can be determined and treatment options identified through symptoms alone.

However, hormone testing may be used to:

Confirm a diagnosis of premature ovarian insufficiency if you’re under 40
To check for other underlying health conditions, such as thyroid problems
To monitor hormone levels if you’ve been prescribed testosterone as part of hormone replacement therapy (HRT) (14)

Balancing hormones in perimenopause

While hormonal changes during perimenopause are inevitable, certain adjustments and treatment options can help support overall balance and ease symptoms.

Hormone replacement therapy

Hormone replacement therapy (HRT) can help balance hormone levels in perimenopause by supplementing declining oestrogen and, in some cases, progesterone and testosterone.

This can not only help relieve symptoms but also support long-term health. HRT options include tablets, patches, gels, and sprays tailored to individual needs.

Find out more about HRT.

Lifestyle changes

Small changes to hormone levels can lead to significant symptoms. Similarly, simple lifestyle changes can have a positive impact on hormone balance and overall health.

Eat a hormone-supportive diet: Include plenty of protein, healthy fats, fibre, and phytoestrogen-rich foods like soy, flaxseeds, and legumes.
Exercise regularly: Strength training, cardio, and yoga can help regulate hormones, maintain muscle mass, and support mood.
Prioritise good sleep: Establish a relaxing bedtime routine, reduce screen time before bed, and create a comfortable sleep environment.
Manage stress effectively: Practices like meditation, deep breathing, and mindfulness can help reduce cortisol, a stress hormone that can disrupt other hormone levels.
Limit alcohol and caffeine: Both can contribute to hormonal imbalances, disrupt sleep, and trigger hot flushes.
Stay hydrated: Drinking enough water supports digestion, energy levels, and overall hormone function.
Maintain a healthy weight: Excess body fat, particularly around the abdomen, can impact hormone regulation (15,16).

Learn more about the best diet for menopause and how to combat menopause belly.

Supplements

If hormone-based treatments are suitable, or preferable, for you, there are natural botanicals and dietary supplements that may contribute to hormone balance and help alleviate perimenopausal symptoms. Ideally many of these vitamins can be found in a healthy balanced diet, but if not possible then they can be taken as supplements.

These include:

Vitamin D
B Vitamins
Calcium
Magnesium
Taurine
Omega-3 fatty acids
Iron
Zinc
Iodine
Vitamin E
Choline
Inositol
Fibre
Glycine
Chromium
Red clover
Ashwagandha
Black cohosh
Soy isoflavones (17)

Find out more about alternative remedies for menopause symptoms and supplements that can help.

Perimenopause is a significant transitional period in a woman’s life, but understanding your hormones and taking steps to support your body can make a big difference in how you feel.

If you’re unsure of the best first steps, Menopause Care can help. Be matched with a menopause specialist who can guide you with tailored care recommendations and expert advice when you take our symptoms quiz.

DisclaimerAt Menopause Care, we ensure that everything you read in our blog is medically reviewed and approved. However, the information provided is not meant to replace professional medical advice, diagnosis, or treatment. It should not be relied upon for specific medical advice.

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