During the course of their lives, women must navigate varying hormonal imbalances and changes. Hormones are used throughout the body to control various functions, and from puberty to pregnancy and through perimenopause and menopause, these fluctuations never stop. In this article, we’ll provide information on perimenopause and menopause, as well as a complicating condition – estrogen dominance – that every woman should know.


Both perimenopause and menopause are normal and natural stages usually occurring when a woman is in her forties and fifties, nearing the end of her reproductive life. Regarding perimenopause, the prefix “peri” comes from the Greek word meaning “about” or “around,” and this is the stage around menopause but before you actually go through it. This stage of a woman’s life is also called the menopausal transition.  During perimenopause, or the menopausal transition, menstrual cycles become irregular and fertility declines, though it is still possible to conceive a child.

All women are different, and the age at which perimenopause begins varies, but in the United States the average age is 49. However, some women are in their mid-30s when it begins, and a few don’t reach perimenopause until their mid-50s.

Two stages of perimenopause

Scientists commonly divide perimenopause into two stages, early and late. Early-stage perimenopause occurs when your menstrual cycle starts to become erratic, and if you’ve always been erratic it can be difficult to tell when you’ve entered this stage. Generally speaking, however, you enter early-stage perimenopause when in the course of several months, your period comes a week or more later than usual.

Late-stage perimenopause begins when there are at least 60 days between some periods. This stage can begin soon after a woman enters the early-stage, but more commonly, it does not occur for several years.

Common symptoms

Throughout this menopausal transition the level of estrogen – the main female hormone  in a woman’s body – rises and falls, and in addition to irregular periods, other changes, some subtle, others not so subtle, may occur.

  • Hot flashes and sleep problems – Hot flashes are common during perimenopause, varying in frequency and intensity. The hot flashes and night sweats sometimes cause sleep problems, but sometimes sleep becomes erratic and unpredictable without them. It should also be noted that some women continue to have hot flashes beyond the perimenopause stage. Research published in the journal Menopause in 2014 found that many women continue having hot flashes for nearly a decade after menopause, though the severity of the symptoms begins declining after about two years.


  • Mood changes – Mood swings, irritability or increased risk of depression can also occur. Hot flashes and sleep problems may contribute to these, but they may also be caused by things not related to a woman’s hormonal changes.


  • Vaginal and bladder problems – When estrogen levels decline, vaginal tissue may lose lubrication and elasticity, making intimacy painful. Low estrogen levels can also leave you more vulnerable to urinary or vaginal infections, and loss of tissue tone may lead to urinary incontinence.


  • Decreasing fertility – As ovulation becomes irregular, a woman’s ability to conceive decreases, but as long as you’re having periods it is possible to become pregnant. To avoid pregnancy, you should use some form of birth control until you’ve had no period for 12 months.


  • Changes in sexual function – Sexual arousal and desire may change during perimenopause, but if you’ve had satisfactory sexual intimacy before perimenopause, this will likely continue through perimenopause and beyond.


  • Bone loss – With declining estrogen levels, women begin losing bone more quickly than they can replace it, increasing the risk of osteoporosis – the disease that causes fragile bones.


  • Changing cholesterol levels – Declining estrogen levels may lead to unfavorable changes in blood cholesterol levels. Low density lipoprotein (LDL, the bad cholesterol) may increase, contributing to an increased risk of heart disease. At the same time, high density lipoprotein (HDL, the good cholesterol) may decline, also increasing the risk of heart disease.

 When, exactly, do you reach menopause?

Menopause is identified after the fact. When you look back at the calendar and see that you’ve had absolutely no menstrual bleeding for 12 months, you are then in menopause. You might go several months without a period, but if one occurs before 12 months have passed, you are still in perimenopause.

Typically, women enter menopause about the same age as their mothers or other female relatives. In the United States the average age for women is 51, according to the North American Menopause Society.

Estrogen dominance, a complicating factor

Estrogen dominance is a common health concern for many women and occurs when the level of estrogen is relatively high compared to the level of another important hormone, progesterone, in a woman’s body.

Estrogen is actually a collective term for various types of hormones, including estrone, estradiol and estriol, and these play an important role in a woman’s body not only related to reproduction but other important functions as well. Estrogens contribute to cognitive, bone and cardiovascular health, as well as bodily processes like immune function and the aging process.

In contrast, progesterone plays a role in bone development, cognitive function, sleep quality, blood sugar balance, and energy production, and as women age overall progesterone production gradually decreases.

Although the condition known as estrogen dominance can occur at any time, because of the declining levels of progesterone related to aging, symptoms of estrogen dominance usually become more noticeable in middle age.

The conditions commonly associated with estrogen dominance include PMS, tenderness and fibrocystic lumps in the breasts, uterine fibroids, and ovarian cysts, as well as mood swings and irritability, headaches, bloating and weight gain, cold hands or feet, fatigue, trouble sleeping, hair loss and memory problems.

Assistance is available

If you’re suffering from any of the symptoms we’ve described related to perimenopause, menopause or estrogen dominance, treatment is available at WeCare Integrative Medicine in Frisco. Working together, we can formulate a plan to manage your symptoms either through lifestyle changes or bio-identical hormone replacement therapy, or some combination of the two. 

There is no reason for you to struggle with these issues alone and on your own, and we urge you to call us today at (972) 668-2636 to schedule your initial consultation.

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