Sue:
There are some people in the medical community who believe that perimenopause is merely a time of "estrogen dominance".  These folks tend to encourage women to use over the counter progesterone creams and actively discourage the use of estrogen products.    How do you feel about this?

There is no one solution for everyone or even for the same woman month to month.  The problem is that the perimenopause is a time of great and erratic hormonal fluctuation for many women.  Something that works consistently is therefore hard to find.  When a woman produces an egg that lacks the ability to trigger the full hormonal effect or she fails to ovulate, progesterone levels can be low.  Giving such a woman progesterone may be helpful in that it restores a more normal hormonal balance.  But hormone levels vary and low progesterone may not be the case.  If progesterone levels are adequate, adding more may actually make her feel worse since it can have a sedative effect and produce PMS-like symptoms.  Low-dose birth control pills even out the levels of estrogen and progesterone, reducing symptoms.

Estrogen has more than 400 actions in the body.  Post-menopausally most women are rarely estrogen dominant and they live with the proof--wrinkles and dry skin and hair. Some women adjust quite readily to functioning with a lower level of estrogen than in their youth.  Others find symptoms annoying Replacement in the form of phytoestrogens, natural estrogens, or conventional hormone replacement may be helpful. I believe replacing with both estrogen and progesterone maintains receptor sites and the natural balance.

Heavier women produce estrogen in their fat cells and generally have fewer menopausal symptoms but higher rates of breast cancer. However, breast cancer is related to a multitude of factors not just estrogen levels. Careful monitoring of hormone levels is always recommended. To assure accuracy the best tests are done over a two or three week span.

"A Woman's Place" Medical Center

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