The conventional medical mindset is that menopause is an estrogen deficiency disease resulting from ovarian failure. Women have been led to believe that at the slightest symptoms, they should run out and get estrogen replacement. While estrogen levels will decrease during menopause, the truth is, estrogen levels do not fall appreciably until after a woman’s last period. In fact, far more women suffer from the effects of "estrogen dominance" during the transition—that is, they have too much estrogen relative to progesterone. And some women can suffer from the symptoms of estrogen dominance for 10 to 15 years, beginning as early as age 35.

The symptoms listed below, as well as many others, often arise when estrogen overstimulates both the brain and body. All of these symptoms are exacerbated by stress of all kinds. Many women in their thirties and early forties find that they experience moderate to severe symptoms of estrogen dominance as they approach perimenopause.

• Decreased sex drive
• Irregular or otherwise abnormal menstrual periods
• Bloating (water retention)
• Breast swelling and tenderness
• Fibrocystic breasts
• Headaches (especially premenstrually)
• Mood swings (most often irritability and depression)
• Weight and/or fat gain (particularly around the abdomen and hips)
• Cold hands and feet (a symptom of thyroid dysfunction)
• Hair loss
• Thyroid dysfunction
• Sluggish metabolism
• Foggy thinking, memory loss
• Fatigue
• Trouble sleeping/insomnia
• PMS

Estrogen dominance has also been linked to allergies, autoimmune disorders, breast cancer, uterine cancer, infertility, ovarian cysts, and increased blood clotting, and is also associated with acceleration of the aging process.

When a woman’s menstrual cycle is normal, estrogen is the dominant hormone for the first two weeks leading up to ovulation. Estrogen is balanced by progesterone during the last two weeks. As a woman enters perimenopause and begins to experience anovulatory cycles (that is, cycles where no ovulation occurs), estrogen can often go unopposed, causing symptoms. Skipping ovulation is, however, only one potential factor in estrogen dominance. In industrialized countries such as the United States, there can be many other causes, including:

• Excess body fat (greater than 28%)
• Too much stress, resulting in excess amounts of cortisol, insulin, and norepinephrine, which can lead to adrenal exhaustion and can also adversely affect overall hormonal balance
• A low-fiber diet with excess refined carbohydrates and deficient in nutrients and high quality fats
• Impaired immune function
• Environmental agents

Here’s what you can do to decrease estrogen dominance:

Increase nutrients in the diet: Take a high potency multivitamin/mineral combination.

Follow a hormone-balancing diet: Eat lots of fresh fruits and vegetables, adequate protein, and moderate amounts of healthy fat. Remember to get enough fiber. Estrogen is excreted by the bowel; if stool remains in the bowel, estrogen is reabsorbed.

Use transdermal 2% bioidentical progesterone cream: Many of the symptoms of estrogen dominance can be relieved with natural, bioidentical progesterone, available over the counter in a 2% cream (one-quarter teaspoon contains ~20 mg progesterone). Use one-quarter to one-half teaspoon 2% progesterone cream on skin (e.g., face, breasts, abdomen, hands) daily for two to three weeks prior to onset of period. If periods are irregular, use 2% progesterone daily, or from the full moon to the dark of the moon. (That way you’ll be teaming up with the cycle of the Earth itself — the same cycle that governs the tides and the flow of fluids on the planet.)

Lose excess body fatand get regular exercise—especially strength training.

Block excess estrogen with phytohormones from flax, soy, and other sources: Soy helps regulate estrogen, so if you have too much estrogen relative to progesterone, soy will act as an estrogen blocker at the tissue level.

Detoxify your liver: Traditional Chinese Medicine explains that menopausal symptoms are caused by blocked liver and kidney chi. This makes sense. The liver acts as a filter, helping us screen out the harmful effects of toxins from our environment and the products we put in our bodies. When the liver has to work hard to eliminate toxins such as alcohol, drugs, caffeine, or environmental agents, the liver’s capacity to cleanse the blood of estrogen is compromised.

Decrease stress: Learn how to say no to excessive demands on your time. Remember, perimenopause is a time to reinvent yourself. This means investing time and energy in yourself, not everyone else.