What is Up with Your Hormones During Perimenopause?

Medically reviewed by Dr. Tamara Neuhaus MD

If you're struggling to make sense of the far-reaching effects and symptoms of perimenopause, join the club. The menopause transition is one of the least understood and discussed topics in women’s health. While there are still plenty of unsolved menopause mysteries, there’s one thing we know for certain: hormones play a pivotal role. They aren’t the root cause of menopause—we’ll get to that in a minute—they’re more like messengers caught in the midst of a communication breakdown. Understanding how they work can demystify your symptoms and make sense of some of your treatment options. Plus, it’s just really interesting (if you ask us). So grab your favorite readers, sit back and join us as we geek out on hormones.

Surely you’re familiar with many of the systems at work in your body: digestion, respiration, circulation, etc. Your endocrine and nervous systems lord over all of these, directing their every activity. Hormones are part of the endocrine system but are really just messengers, dispatched through your bloodstream to carry instructions to cells throughout your body. Because your blood passes through all parts of your body as it circulates, hormones can deliver information to every single one of your cells.

Here’s how it works: Your body makes and distributes 50 different types of hormones that deliver messages to cells all over you, all the time. And each cell is designed to grab onto a certain hormone as it passes by. Once the cell has grabbed its hormone, it receives the hormone’s message and does its bidding. The message is simple: it tells the cell either to speed up or slow down its work.

You’ve probably heard of serotonin and cortisol. These are the hormones that regulate things like your metabolism, your mood, or how your body handles stress. So when, for instance, serotonin is coursing through your bloodstream, it’s telling certain brain cells to be happy and certain muscle cells to relax, and certain cells in your digestive tract to feel sated, among many other things. When your serotonin tank is running low and not delivering those messages, those cells never get their marching orders. That’s when things can start going off the rails.

Now, there are four female sex hormones responsible for bringing your reproductive system online, managing it and eventually retiring it: estrogen, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). The first two have starring roles in the dramedy of menopause because cells all over your body have receptors for them. FSH and LH play supporting roles as their receptors are local, in your ovaries and uterus. They’re the ones telling your body how much estrogen and progesterone to produce and when. As any of these hormone levels change, areas all over your body are affected.

Think of your endocrine system as a home thermostat. If you set your thermostat to 70 degrees, its sensor tracks the climate in your house and switches heating and cooling systems on and off as needed to maintain the set temp. Imagine that the thermostat sensor degrades a bit, and there’s a heatwave. If the sensor doesn’t notice that it’s 85 degrees inside your home, it won’t turn off the heater, and the system will keep pumping out warm air. During perimenopause, your ovaries are like that thermostat sensor, they stop responding consistently to the messages sent by your endocrine system. But instead of turning on and off heat and AC, they’re turning on and off estrogen and progesterone. Throughout perimenopause, your ovaries alternate between over-reacting and under-reacting, consequently flooding or starving your body of these two hormones. When we talk about your hormones being erratic in perimenopause, this is why.

So all those cells with receptor molecules for estrogen or progesterone are either being inundated with, “Giddy-up!” or “Whoa Nelly!” messages, or not getting any messages at all. No wonder you feel the way you do!

The spotty communication period where your ovaries are only occasionally picking up the signals is the reason perimenopause symptoms tend to come and go with no discernible pattern. When your ovaries stop functioning for good, hormonal activity will shift again and the symptoms you experience tend to change or level out.

If most perimenopause symptoms are caused by fluctuating hormone levels, restoring balance to your body’s estrogen and progesterone supply is one solution. That’s exactly what hormone therapy (HRT) does. It also happens to be one of the most misunderstood topics in the menopause space. While it’s the most effective treatment for managing all of the various symptoms of perimenopause, it’s not right for everyone. If you have a history of breast cancer, liver disease, or blood clots, the risks that come with adding hormones to your body will generally outweigh the benefits. But there are exceptions there, too. You can dive deeper into this treatment and The Cusp’s perspective on it.

Hormones wield tremendous power in our bodies and our lives. But that doesn’t mean we have to grin and bear our dwindling or erratic estrogen and progesterone. Even if hormone therapy isn’t for you—for any reason—there’s a plethora of other treatment options out there, from non-hormone prescription meds to herbal supplements. And if you prefer taking matters into your own hands, exercise, meditation, and a diet featuring more produce and less processed foods can help support your entire endocrine system. So the other 46 hormones can pick up some slack already.

Your Sex Hormone Playbill


Origin: ovaries, adrenal glands, and fat tissue

Role: Develops female sex organs–breasts, wider hips, vagina, fallopian tubes, uterus; stimulates monthly egg follicle growth; preserves bone strength and prevents bone loss; regulates cholesterol production in liver (providing protection for heart + arteries); promotes pliability of skin and other tissues throughout the body; boosts production and function of neurotransmitters that affect sleep, libido, mood, memory and other cognitive functions; may trigger heightened emotions around fluffy animals and holiday nostalgia.


Origin: ovaries, adrenal glands, and placenta during pregnancy

Role: Prepares body for conception; stimulates growth of uterine lining; regulates monthly cycle; maintains sex drive; balances effects of estrogen; enhances body’s sensitivity to insulin; safeguards the thyroid function; prepares breasts for lactation and pelvic wall muscles for pregnancy.

Follicle-stimulating hormone (FSH)

Origin: pituitary gland

Role: Signals to the ovaries that it’s time to produce estrogen; develops follicles in your ovaries (tiny egg incubators); triggers ovulation (with LH).

Luteinizing hormone (LH)

Origin: pituitary gland

Role: Triggers ovulation (along with FSH) by causing a follicle to release an egg every month; stimulates production of progesterone in the second half of the menstrual cycle.

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