NATUROPATHIC DOCTOR IN ONTARIO
The Role of Estrogen and Progesterone in Perimenopause
Why Hormonal Balance Matters
Hormones in Perimenopause
When women begin to notice changes in their menstrual cycles, energy levels, mood, or sleep, one of the most common explanations—yet least understood—is the changing balance of estrogen and progesterone. These two hormones are central to the perimenopausal transition, and fluctuations between them are often at the root of the most frustrating symptoms.
Naturopathic Doctors can help women navigate this transition by educating them about what’s happening in their bodies, identifying imbalances, and offering holistic, personalized solutions. In this post, we’ll break down how estrogen and progesterone shift during perimenopause, how these shifts impact your health, and how to support your body through the changes.
Understanding the Hormonal Symphony
In a typical menstrual cycle, estrogen and progesterone rise and fall in harmony to prepare the body for ovulation and a potential pregnancy. Estrogen helps build the uterine lining, regulate body temperature, and support mood and brain function. Progesterone, on the other hand, has a calming effect, stabilizing the endometrial lining and promoting restful sleep.
But in perimenopause, that balance begins to shift. Ovulation becomes weaker and less consistent. The ovaries don’t always respond to brain signals in the same way. And the result? A hormonal rollercoaster that can leave you feeling out of sync with your own body.
What Happens to Estrogen in Perimenopause?
Estrogen doesn’t drop off immediately. In fact, it can become more erratic—spiking higher than usual one month and plummeting the next. These fluctuations can cause symptoms such as:
- Breast tenderness
- Bloating
- Mood swings
- Brain fog
- Heavy or irregular periods
Estrogen also affects nearly every system in the body, so even subtle imbalances can be felt in a big way. Healthy levels of estrogen support:
- Bone health by increasing bone mineral density
- Cognitive function including memory and focus
- Mood stability through serotonin receptor activity
- Metabolism and insulin sensitivity
- Vaginal lubrication and tissue health
- Skin elasticity and cardiovascular health
When estrogen spikes or drops suddenly, these systems can take a hit—leading to symptoms that are often misattributed to stress, aging, or poor lifestyle habits.
What Happens to Progesterone in Perimenopause?
Progesterone is the first hormone to decline in the perimenopausal years. Because it’s only produced after ovulation, and ovulation becomes more erratic with age, progesterone levels can drop even when estrogen remains high. This leads to a relative estrogen dominance—where there’s too much estrogen compared to too little progesterone.
Lower progesterone levels are associated with:
- Anxiety and irritability
- Difficulty sleeping
- Heavier periods (due to less regulation of estrogen’s endometrial growth)
- Bloating and water retention
- Breast tenderness
Progesterone also has calming effects on the brain as a GABA agonist—which means it helps us feel calm, sleep deeply, and manage stress more effectively. When levels fall, it’s not uncommon to feel more on edge or overwhelmed.
Why Hormonal Balance Is So Important
It’s not just about the absolute level of each hormone—it’s about how they work in relation to one another.
Estrogen dominance (which doesn’t always mean “too much” estrogen, but rather “not enough” progesterone to balance it out) is one of the most common patterns we see in perimenopause. It’s a key contributor to symptoms like heavy periods, mood swings, and disrupted sleep.
Without enough progesterone to counter estrogen’s stimulating effects on the uterine lining, heavy or prolonged menstrual bleeding can occur. This can lead to iron deficiency, fatigue, and a major decline in quality of life.
In the later stages of perimenopause, both estrogen and progesterone decline. This is when symptoms like vaginal dryness, hot flashes, and joint pain often become more noticeable.
What Can You Do to Support Hormonal Balance Naturally?
At Sequence Wellness, we take a root-cause approach to restoring balance. We look at the whole picture—your symptoms, lifestyle, lab results, and goals—to craft a tailored support plan.
Some key strategies include:
🌿 Lifestyle & Nutrition
- Anti-inflammatory diet (like the Mediterranean diet) to stabilize blood sugar and reduce cortisol
- Cruciferous vegetables (broccoli, kale, cauliflower) to support estrogen metabolism
- Adequate dietary fiber (25–35g per day) to help eliminate excess estrogen
- Regular movement (especially resistance training) to support hormone balance and improve insulin sensitivity
🧘♀️ Stress Support
- Chronic stress raises cortisol, which can further suppress progesterone
- Mindfulness, yoga, and breathwork can help regulate your nervous system
- Supplements like magnesium or herbal adaptogens may support this as well
🌙 Sleep Hygiene
- Lack of sleep worsens hormone imbalance and inflammation
- Prioritize winding down at night, consistent sleep/wake times, and limiting screens before bed
🧪 Lab Testing When Appropriate
- While hormone levels fluctuate, cycle-mapping or targeted hormone testing (like the DUTCH test) can provide insights
- We often test estradiol (E2), progesterone, and FSH to help understand where you are in the transition
🌸 Targeted Supplements
- DIM (Diindolylmethane) can support estrogen metabolism
- Calcium D-glucarate helps with estrogen detox through the liver
- Vitex, magnesium, and B6 may support healthy progesterone levels
- Evening Primrose Oil or Omega-3s may ease estrogen-dominant symptoms
How Sequence Wellness Can Help
We know this stage can feel overwhelming—but it doesn’t have to be. Our team of Naturopaths in Ottawa Ontario provides compassionate, evidence-based care to help you understand what’s happening and guide you through a plan that’s tailored to your body and your lifestyle.
Whether your goal is to reduce heavy periods, improve sleep, feel more emotionally balanced, or prepare for menopause in a healthy way, we’re here to support you every step of the way.
Final Thoughts
Hormonal shifts in perimenopause aren’t just a nuisance—they’re signals from your body asking for support. By understanding how estrogen and progesterone work together (and what happens when they don’t), you can take meaningful steps toward feeling better.
If you’re ready to uncover the root of your symptoms and bring your hormones back into balance, book a consultation with Sequence Wellness today. We’ll help you move through this season with clarity, confidence, and care.
Your Doctor: Meet Dr. Sarah
Dr. Sarah Goulding is a licensed naturopathic doctor in Ontario and has a BSc in neuroscience and biology from Dalhousie University (2004), and did her 4-year naturopathic training at the Canadian College of Naturopathic Medicine (2010). She’s since accumulated over a decade of clinical experience, and refined her practice to focus on women’s health and digestion. She is licensed and registered as a Naturopathic Doctor in Ontario by The College of Naturopaths of Ontario (CONO) and is a member of the Canadian Association of Naturopathic Doctors (CAND) and the Ontario Association of Naturopathic Doctors (OAND).
Dr. Sarah Goulding blends science and compassion, and acts as a personal health researcher to help you navigate your health. Tools that she uses include nutrition, supplements and botanicals, bioidentical hormones, and lifestyle modifications. The closer you get to the root cause, the gentler the therapies needed to resolve the issue.
