"My perspective is that of an endocrinologist who, herself, suffered a long, perplexing and highly symptomatic perimenopause. I am also a clinician-scientist, doing epidemiological, clinical observational and randomized controlled trial research on perimenopause. In the early 1990s, despite my training and roles, I like Emily, struggled to understand the changes I personally experienced – I found the hormonal changes to be the opposite of what I had been taught and always thought; instead, estradiol erratically soared and progesterone progressively decreased. Before we get to that, however, we must first review how we got to a situation where Emily is seeking yet not finding help."

Let's take a look!

Research indicates how many women really suffer from symptoms around this time, with hot flashes, period inconsistencies, sleep disturbance and mood all being key areas - "About 80% of perimenopausal women experience vasomotor symptoms (VMS), 25% have menorrhagia, and about 10% experience mastalgia. The majority of women describe varying intensities of sleep, coping or mood difficulties."

However, the key factor in it, as the head researcher notes is women often think these are caused by estrogen decline, when in fact, estrogen often increases as progesterone sharply declines, "Women are more symptomatic because common knowledge inaccurately says that estradiol (E₂) levels are dropping/deficient. Evidence shows that with disturbed brain-ovary feedbacks, E₂ levels average 26% higher and soar erratically {...} Progesterone (P4) levels become insufficient or absent. The most symptomatic women have higher E₂ and lower P₄ levels."

This suggests that, for women in perimenopause, supplementing with progesterone could be key to making the transition significantly better.

Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987489/