Estrogen Dominance Isn’t What You Think: Understanding the Real Hormone Imbalance in Perimenopause
Anna Harrelson • June 11, 2025
You may feel estrogen dominant, but still be estrogen deficient. Here’s how that works.

If you’ve ever been told that your mood swings, breast tenderness, or heavy periods are due to "estrogen dominance," you’re not alone.
But the truth? The phrase "estrogen dominance"
is often misunderstood and oversimplified—especially in midlife.
In perimenopause, the problem is usually not that your body is producing too much estrogen. It’s that it’s not
making enough progesterone
to balance the estrogen you do have. And that fluctuating estrogen (sometimes high, sometimes low) can create chaos
in your body and brain.
Let’s dig in.
What is Estrogen Dominance, Really?
The term originally described a state where estrogen effects outweigh progesterone effects, either because estrogen is too high, or progesterone is too low.
But in clinical practice—especially during perimenopause—we more often see the second scenario:
- Progesterone production drops first (due to fewer ovulations)
- Estrogen levels swing wildly (some months high, some months low)
- You end up with unbalanced estrogen, not necessarily excessive estrogen
Symptoms can include:
- Mood swings or irritability
- Sleep disruption
- Heavy or irregular bleeding
- Breast tenderness or fibrocystic breasts
- Bloating
- Anxiety
- Brain fog
If this sounds like your monthly reality in your 40s, you’re not broken—you’re probably in perimenopause.
The Progesterone Problem
One of the earliest hormone shifts in perimenopause is reduced ovulation. And if you’re not ovulating regularly, you’re not making enough progesterone.
Progesterone is our calming, anti-anxiety, sleep-supporting hormone. It helps balance estrogen in the uterus, the brain, and the nervous system. When it's low, estrogen has no counterweight. Even normal estrogen levels can feel overwhelming without enough progesterone to buffer them.
This is why so many women in perimenopause feel like their emotions are more intense, their PMS is worse, and their sleep is disrupted—even if their estrogen levels aren't technically high.
Fluctuating Estrogen: The Rollercoaster
Estrogen doesn't decline gradually in perimenopause. It swings. You might have:
- One month with a sky-high estrogen surge (hello, swollen breasts and heavy periods)
- The next month with almost none (hello, hot flashes and low libido)
This is normal. But it’s not easy.
And these fluctuations are often missed on bloodwork because hormone levels change hour to hour, not just month to month. That’s why we treat you, not just your labs.
What About Estrogen After Menopause?
Once you hit menopause (12 months without a period), your estrogen levels tend to stay low—but the symptoms may continue. Many women assume they are still estrogen dominant if they have weight gain, mood issues, or breast tenderness, but the truth is:
- You are likely estrogen deficient
- You may also be progesterone and testosterone deficient
- Some of your receptors may be more sensitive, or inflamed, giving you exaggerated responses
This is where hormone therapy can play a powerful role in restoring balance.
What You Can Do
- Track your symptoms: Patterns can tell us more than one-time labs
- Consider bioidentical progesterone: Especially if sleep, anxiety, or PMS are your biggest issues
- Support your liver: Detox pathways help metabolize estrogen safely
- Strengthen your gut: Your microbiome (especially the estrobolome) helps regulate estrogen levels
- Reduce stress: Cortisol can suppress progesterone and worsen hormone chaos
- Strength train: Builds resilience, stabilizes blood sugar, and helps with hormone receptor sensitivity
WonderCreek Health Blog

Many of the women who find their way to me share a common story: They’ve seen multiple specialists. Their labs are “normal.” Their symptoms are scattered across systems—joints, gut, mood, hormones, skin—and yet every provider focuses on one piece at a time, never the whole picture. They’ve often been told they’re anxious, dramatic, or “too sensitive.” And yet, they’re also some of the most intuitive, self-aware, and relentlessly curious patients I’ve ever met. They know their bodies. They know something isn’t right. And they won’t stop searching until someone finally sits down and helps them connect the dots. That’s where connective tissue disorders come in. What Do We Mean by “Connective Tissue Disorders”? When I talk about this group of conditions, I’m referring to women who often fall somewhere on the spectrum of: Hypermobility spectrum disorder (HSD) Ehlers-Danlos features Mast cell activation (MCAS) Endometriosis PMDD and other hormone sensitivities POTS or other dysautonomias The common thread? Their connective tissue is different—looser, more fragile, more reactive. And when the scaffolding of the body isn’t as stable, symptoms spill over into every system: joints, vessels, immune response, mood, hormones, digestion, even the brain. Why Midlife Feels Like a Breaking Point Estrogen has always been a stabilizer. It strengthens collagen, calms mast cells, and helps buffer the nervous system. So, it’s no surprise that perimenopause—when estrogen begins to fluctuate dramatically—can feel like the rug is being pulled out. I see women who: Once held things together with sheer willpower Managed PMDD, migraines, or endometriosis in their younger years Suddenly feel like everything has intensified: joint pain, bloating, histamine reactions, mood shifts, insomnia, brain fog For women with sensitive connective tissue and sensitive nervous systems, hormonal shifts don’t just cause hot flashes—they destabilize the entire body. Hormone Therapy for the Orchid Patient Many of my patients have tried hormones before. Sometimes birth control left them moody, swollen, or miserable. Sometimes a patch or pill was prescribed quickly, with no attention to how sensitive their system might be. So when they hear “hormone therapy,” they’re understandably hesitant. This is where my orchid theory comes in. Orchids are not weak flowers—they’re strong, beautiful, and resilient. But they need careful tending. They don’t thrive when thrown into the same soil or light as every other plant. They require patience, precision, and a slower hand. My connective tissue–sensitive patients are orchids. Their bodies respond to hormone therapy, but they need a methodical, gentle approach: Always bioidentical hormones Introduced slowly, step by step Carefully monitored, with adjustments made gradually Combined with lifestyle strategies to support the nervous system and reduce inflammation This is not a “one patch fits all” process. It’s a partnership. And when done thoughtfully, hormone therapy can bring profound relief and stability. Why Sensitivity Is a Strength The women I see are often neurodivergent—ADHD, autistic traits, or simply highly perceptive. They’re often told their sensitivity is a liability, but I see it differently. That very sensitivity is what helps them notice patterns others miss. It’s what fuels their curiosity to keep searching, even after being dismissed. Their intuition about their own bodies is spot on. Yes, their connective tissue is different. Yes, their mast cells fire more easily. Yes, their hormones seem to create more chaos. But these women are also some of the most resilient, resourceful, and insightful people I know. Moving Forward If you see yourself in this description, please know: You’re not “too sensitive.” You don’t have 27 different diagnoses—you have a pattern that makes sense. Hormones are not off the table for you—they may just need to be approached differently. Your lived experience matters as much as your lab results. This isn’t about fixing you—you are not broken. It’s about giving your body the tailored support it’s been asking for all along. This is just the beginning of a series I’ll be writing on connective tissue–related conditions: MCAS, PMDD, endometriosis, and more. Each deserves its own spotlight. But the first step is recognition. You deserve to be seen in your wholeness—not dismissed as “normal” when everything in your body is telling you otherwise.


