All You Need to Know About Estrogen and Perimenopause

Oct 25, 2023
Estrogen, a pivotal hormone, extends beyond reproduction. Fluctuations in perimenopause trigger uncomfortable symptoms and pose chronic disease risks in menopause. Dive into understanding estrogen, its detoxification, and integrative support.

Estrogen is a critical hormone for women, and the benefits of estrogen go well beyond reproduction. Estrogen fluctuations and decline in perimenopause contribute to a host of uncomfortable symptoms. In menopause, low estrogen levels may increase the risk for chronic diseases.

Understanding estrogen helps us understand the changes women undergo in perimenopause and beyond. Today’s article will dive deep into estrogen and offer integrative solutions for finding balance and ease during this hormonal transition.

Keep reading to learn more about:

  • Estrogen’s role in the body
  • Estrogen metabolism and detoxification
  • Estrogen changes in perimenopause and menopause
  • Estrogen dominance
  • Estrogen deficiency
  • Holistic estrogen support

Let’s jump into this essential women’s health topic!

What is Estrogen? Role of Estrogen and Estrogen Receptors

Estrogen is a steroid hormone, primarily produced in the ovaries, that promotes female characteristics, reproduction, and total body health.

Estrogen is a general term that encompasses all estrogens. The three main estrogens are:

  • Estrone (E1)
  • Estradiol (E2)
  • Estriol (E3)

Estradiol is the most abundant estrogen during the reproductive years; it’s also found in bioidentical hormone replacement therapy.

Hormones travel through the bloodstream. Free estrogen enters cells and binds to estrogen receptors, which regulate many complex processes within cells and tissues. There are several types of estrogen receptors, with alpha and beta the most prominent. Abnormal estrogen signaling may play a role in endometriosis, breast cancer, and other diseases.

Healthy estrogen signaling supports:

  • Breast tissue development and feminine curves
  • Pregnancy and lactation
  • Thickening of the uterine lining in the first half of the menstrual cycle (follicular phase)
  • Vulvar and vaginal lubrication
  • Strong bones
  • Heart health
  • Brain health
  • Skin structure and elasticity
  • Robust immunity
  • Balanced mood

Estrogen Detoxification

When estrogen has played its role, the body clears what is no longer needed. The liver detoxifies estrogen in two phases of chemical reactions, and then the estrogen metabolites leave the body via the colon. If the liver or digestive tract is sluggish or imbalanced, the body may have difficulty clearing estrogen, contributing to hormonal imbalances.

The gut microbiome plays a significant role in maintaining healthy estrogen levels. The gut microbiome refers to the trillions of microorganisms inhabiting the digestive tract, primarily the large intestine. The estrobolome is a subset of the microbiome involved with estrogen metabolism. This collection of bacteria is involved in estrogen regulation, either allowing it to be excreted or to recirculate. 

Estrogen in Perimenopause and Menopause

During the reproductive years, estrogen levels rise and fall in a predictable pattern. Estrogen increases in the first half of the menstrual cycle, promoting the growth of the uterine lining. It drops before ovulation and then rises again after ovulation. If the egg isn’t fertilized, it will fall again and the period comes.

In perimenopause, the years leading up to menopause and the end of the monthly cycle, estrogen is unpredictable. In fact, estrogen swings can feel like a hormonal rollercoaster; like you are in puberty, only in reverse.

Menstrual cycles become irregular in perimenopause, and you may experience times when estrogen levels are high and other times when estrogen is low. As you get closer to menopause, the one-year mark without a cycle, estrogen levels will decline and remain low through the post-menopause years.

Estrogen Dominance

Estrogen dominance describes the hormonal landscape where estrogen is high relative to progesterone. This imbalance can happen in the reproductive years (hello PMS) and is more likely in perimenopause as progesterone levels decline. There are two cases of estrogen dominance:

  1. High estrogen and normal progesterone. High estrogen may be due to poor estrogen clearance in the liver or gut. Endocrine-disrupting chemicals that act like estrogens in the body are another cause of elevated estrogen.
  2. Normal estrogen levels and low progesterone. When progesterone is low, you can experience the same symptoms of elevated estrogen.


Symptoms of elevated estrogen or estrogen dominance may include:

  • Heavy periods
  • Menstrual cramps
  • Irregular periods
  • Breast tenderness
  • Bloating and water retention
  • Headaches and migraines
  • Mood swings
  • Irritability
  • Fertility challenges
  • Weight gain
  • Fatigue
  • Fibroids
  • Worsening PMS symptoms

Low Estrogen

Symptoms of low estrogen include many of the classic perimenopause and menopause symptoms:

Estrogen plays a protective role in women’s health. In menopause, when estrogen levels are steadily at their lowest, women’s risk for chronic diseases like dementia, heart disease, and osteoporosis increases.

How to Support Estrogen in Perimenopause and Menopause

On the one hand, perimenopause is a natural hormonal transition. And on the other hand, this transition, especially in a modern context, can significantly affect the quality of life and future health for women.

In integrative medicine, we combine modern and holistic approaches, personalizing the plan for each woman to address her unique symptoms and long-term health goals. Here are some of the integrative tools to consider for estrogen support:

  • Nutrition for estrogen support. Nutrition is foundational for healthy hormones and may even become more critical during perimenopause when changes in estrogen shift metabolic health. Your diet provides the required nutrients for estrogen metabolism and detoxification. Start with a whole-food diet and minimize processed food. Include protein, healthy fats, and colorful produce with each meal. Support estrogen detoxification in the liver with these specific foods: 
    • Leafy greens
    • Eggs
    • Beets
    • Liver
    • Sunflower seeds
    • Pumpkin seeds
    • Lentils
    • Broccoli sprouts
    • Broccoli
    • Cauliflower
    • Cabbage

Read more about the TārāMD food as medicine approach here.

  • Optimize gut health. Daily bowel movements and a healthy gut microbiome (and estrobolome) support estrogen clearance and balance. Support gut health with fiber-rich plant foods and fermented foods as a source of natural prebiotics. Here’s another food list:
    • Onions
    • Garlic
    • Leeks
    • Sunchokes
    • Chicory root
    • Bananas
    • Berries
    • Dandelion greens
    • Yogurt
    • Kefir
    • Sauerkraut
    • Kimchi
    • Miso
    • Kombucha
  • Avoid endocrine-disrupting chemicals. Endocrine disruptors are everywhere; many mimic estrogen in the body, contributing to estrogen dominance. Examples include:
    • Bisphenol A (BPA) found in plastics and receipts
    • Pesticides and herbicides in non-organic food and drinking water
    • Parabens in cosmetics

While you can’t avoid everything, you can take strategic steps to identify and minimize exposures. In addition, you can support the body’s detoxification systems (including the gut and liver) by eating the foods listed above and working with your TārāMD provider for other tools and helpful supplements.

Read more about endocrine disruptors in this article.

  • Try phytoestrogens. Phytoestrogens, plant estrogens, are natural compounds found in plants with an affinity for human estrogen receptors. They may be a good choice for some women who don’t want to use hormone replacement therapy or want to try a plant-based option first.

Phytoestrogens are weaker than human estrogen and can help modulate the estrogen response. During low estrogen, phytoestrogens bind to receptors and elicit a response, but when estrogen is high, these weaker estrogens can displace your body’s estrogen, dampening the response.

Phytoestrogens may be beneficial for managing symptoms during perimenopause and menopause. Use them when estrogen levels are high, low, or fluctuating. You can increase phytoestrogens in food to a therapeutic dose. Options include:

  • Organic soy – 1 cup of edamame or tofu per day
  • Flax seeds – 2 tablespoons ground flax seeds per day

Phytoestrogen supplements are another option to consider. Examples include:

  • Pueraria mirifica
  • Soy isoflavones
  • Black cohosh
  • Resveratrol


  • Adrenal support and self-care. As the ovaries shut down hormone production, you’ll still make hormones, including estrogen, in other parts of the body. The adrenal glands produce DHEA, which converts to both testosterone and estrogen. You’ll also make some estrogen in fat tissue.

Because the adrenals can make estrogen, supporting the adrenal glands by lowering and managing stress becomes very important in perimenopause and beyond. Learning healthy coping strategies that work for you and practicing them regularly is worth the time and dedication. For many women, addressing stress means slowing down, letting go, and clarifying your priorities. Dedicating time to fun and relaxation is also essential.

  • Consider bioidentical hormone replacement therapy (BHRT). BHRT is an FDA-approved treatment for menopausal symptoms. When initiated near the beginning of menopause, BHRT improves quality of life and may reduce the risk of heart disease and osteoporosis.

There continues to be fear about hormone therapy because of the Women’s Health Initiative, but current research supports the benefits of this therapy for women, especially when choosing bioidentical hormones.

We believe in informed consent and that women deserve more options regarding their perimenopausal and menopausal care. BHRT is an effective option for many women, especially with a supportive diet and lifestyle changes. It’s not a fit for every woman, but when it is, it can be life-changing.

If you are in any stage of perimenopause and are dealing with uncomfortable symptoms that impact your quality of life, TārāMD can help you find the strategies and support you need. There’s no need to suffer in silence; supporting your estrogen and overall health can help you feel like yourself and live your most vibrant life. Why wait? Please reach out today to schedule an appointment.


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