126. Mood Swings & Anxiety: Could Estrogen Be The Missing Piece?

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Estrogen often gets a bad rap, but it’s one of the most powerful and protective hormones in a woman’s body, especially in midlife.

In this episode of Perimenopause Simplified, we’re unpacking what estrogen does, how it changes after 40, and what you need to know about supporting it through perimenopause and beyond. Whether you’re dealing with brain fog, vaginal dryness, or mood swings, this episode will help you understand whether low estrogen might be at play – and what you can do about it.

We also dive into hormone replacement therapy (HRT), the different forms of estrogen available, and why progesterone is essential if you choose to supplement. Estrogen isn’t the enemy; let’s set the record straight.

What’s covered in this episode:

• The benefits of estrogen for your brain, heart, bones, and mood
• How estrogen levels fluctuate and decline during perimenopause and menopause
• Signs and symptoms of low estrogen vs. estrogen excess
• When to consider estrogen HRT and the different types (patches, gels, Biest & more)
• Why progesterone is needed when taking estrogen HRT
• How to support healthy estrogen detoxification through liver, gut, and lifestyle strategies

Links Mentioned:

Ep. 31: How Endocrine Disruptors Impact Perimenopause

For a deeper dive into estrogen, listen to Ep. 36: Estrogen: Why We Love It & Need It w/ Jill Chmielewski, RN, BSN

Estrogen Isn’t the Villain

Estrogen gets a lot of blame in the online hormone space — for weight gain, mood swings, bloating, fibroids, and breast cancer. But let’s be clear: estrogen isn’t the villain. In fact, it’s one of the most protective, powerful hormones we have. The issue isn’t estrogen itself — it’s unopposed estrogen or poor estrogen detoxification that can cause problems.

Today, I’m breaking down what estrogen actually does in the body, how it fluctuates in our 40s, the signs of low and high estrogen, and how to support it — whether naturally or through hormone replacement therapy.

What Is Estrogen and What Does It Do?

Estrogen is a group of hormones — the main ones being estradiol (E2), estrone (E1), and estriol (E3). Estradiol is the most potent and dominant form before menopause.

Estrogen plays a major role in:

• Bone density and strength

• Brain function (including memory and mood)

• Skin elasticity and collagen production

• Vaginal and bladder health

• Cardiovascular health

• Metabolism and insulin sensitivity

What Happens as Estrogen Declines?

As estrogen declines, especially in late perimenopause and postmenopause, we often see issues like:

• Vaginal dryness and painful sex

• Brain fog and forgetfulness

• Night sweats and hot flashes

• Anxiety and low mood

• Increased cholesterol and blood pressure

• Bone loss

Estrogen isn’t something to fear — it’s something to respect and support.

Estrogen Fluctuations in Perimenopause

In early perimenopause, estrogen can spike and crash unpredictably, sometimes swinging wildly from day to day. That’s why women in their 40s may feel like they’re on an emotional or physical rollercoaster.

Eventually, estrogen production starts to decline overall, especially after cycles become less regular. By the time we’re in menopause, estradiol levels can drop by up to 90%.

But here’s the kicker — symptoms of low estrogen can show up before you fully stop ovulating. Remember, in this stage, we can have anovulatory cycles, meaning we don’t ovulate every month. That happens because we don’t have enough estrogen, which needs to peak in order for us to ovulate.

Signs of Low Estrogen

You may have low estrogen if you notice:

• Vaginal dryness or discomfort during sex

• Recurrent UTIs or bladder sensitivity

• Dry, thinning skin

• Mood swings or depression

• Poor memory or focus

• Hot flashes or night sweats

• Decreased interest in sex

• Joint pain or stiffness

How Low Estrogen Impacts Eye Health

Low estrogen can even cause dry eyes! Someone commented on one of my videos asking how estrogen is tied to eye health. So I want to dive into that a bit…

The eyes, especially the meibomian glands (which help produce the oily layer of your tears) and the lacrimal glands (which produce the watery layer), have receptors for estrogen, progesterone, and testosterone.

As estrogen and testosterone decline, tear production can decrease, and the composition of your tears changes—causing dry eye, redness, discomfort, and even light sensitivity or blurry vision.

Estrogen helps keep your corneas thick and stiff. When estrogen drops, the cornea becomes less rigid, which can slightly change the shape of the eye and temporarily affect vision clarity, especially during hormonal fluctuations.

Testosterone supports the oil-secreting glands, which help prevent your tears from evaporating too quickly. So lower levels of T may mean your eyes feel drier or more irritated.

Should You Consider Estrogen Therapy?

If you’re in your 40s or early 50s and you’re experiencing these symptoms — estrogen therapy can be incredibly helpful.

The key is personalization. You want to work with someone who can help you weigh risks vs. benefits, symptoms, health history, and your goals.

Delivery Methods for Estrogen

There are several ways to deliver estrogen:

• Patches (e.g., Vivelle-Dot, Climara): fairly steady release, convenient, bypasses the liver

• Gels and creams (e.g., Divigel, Estrogel): applied to skin, daily use

• Sprays (e.g., Evamist): quick drying and convenient

• Injections: more commonly used in bioidentical clinics, helps to get levels up

• Compounded Biest: a mix of estradiol and estriol; estriol is a weaker estrogen that may support the body’s use of estradiol and help it go down safer metabolic pathways

The Role of Progesterone

If you still have a uterus, you must take progesterone with estrogen to protect the uterine lining and prevent endometrial hyperplasia.

But even if you’ve had a hysterectomy, progesterone has benefits beyond the uterus; it supports sleep, mood, and reduces estrogen’s overstimulation of the nervous system.

So if you’re on estrogen HRT and experiencing anxiety, breast tenderness, irritability, or poor sleep, you may not need less estrogen, you might need more progesterone.

Signs of Estrogen Imbalance or Excess

Some signs your estrogen may be too high or out of balance:

• Breast tenderness

• Bloating

• Irritability or anxiety

• Heavy periods or spotting

• Water retention

• Insomnia

• Headaches or migraines

These can occur when estrogen is high relative to progesterone — not necessarily because estrogen itself is too high.

Who Should Avoid Estrogen Therapy?

Contraindications for estrogen therapy:
These are considered red flags where estrogen therapy should generally be avoided:

• Current or recent cancer (e.g., breast cancer, endometrial cancer)

• History of unexplained vaginal bleeding (until evaluated and ruled out)

• Active or recent blood clot (VTE, DVT, or PE), especially if unprovoked or synthetic estrogen-related (e.g., hormonal birth control)

• History of stroke or heart attack, especially within the past year

• Active liver disease or liver failure; estrogen is metabolized in the liver

Note: Transdermal estrogen (patches, gels, sprays) is generally safer for those at risk of clotting because it bypasses the liver and has less impact on clotting factors.

Supporting Estrogen Metabolism Naturally

Your body clears estrogen through the liver and gut, so supporting detoxification is key:

• Cruciferous veggies (broccoli, cauliflower, arugula)

• Good hydration and fiber

• Regular bowel movements

• Avoiding alcohol and xenoestrogens (plastics, fragrance, pesticides)

You don’t want estrogen to recirculate; you want it to be used and cleared effectively.

Final Thoughts

In a nutshell…estrogen is a vital hormone for women’s long-term health…from bones to brain to mood to metabolism. It’s not something to fear or suppress. It’s something to understand, track, and support.

Whether through lifestyle, food, or HRT, you deserve to feel good in your body in midlife. Estrogen, when properly balanced with progesterone and metabolized efficiently, can help you thrive, not just survive, after 40.

Claudia Petrilli is the host of Perimenopause Simplified podcast and an Integrative Nutrition Health Coach helping high-achieving women 40+ navigate perimenopause with clarity and confidence. After being dismissed by doctors in her 20s over debilitating periods and unexplained health issues, she took her health into her own hands and never looked back. When perimenopause brought a new wave of symptoms in her late 30s, she used that same evidence-based approach to feel like herself again.

She’s the creator of The Perimenopause Method, her signature coaching program, where she helps women rebuild the foundations — nutrition, movement, sleep, and stress — that actually support their hormones through this transition, while also teaching them to self-advocate and make informed choices about their care. Because you don’t have to just get through midlife, you can thrive in it.