68. Estrogen: What Every Woman Over 40 Needs to Know

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In this episode of Perimenopause Simplified, we’re diving deep into cortisol, the stress hormone that plays a significant role in our health, especially for women over 40.

If you’ve been feeling exhausted, anxious, or wired at night, it’s time to understand what might be going on with your cortisol levels.

Cortisol can become dysregulated during perimenopause, making stress management even more crucial, as your body’s hormonal landscape shifts. Tune in to learn how to support your cortisol, manage stress, and feel your best during this transitional phase of life.

What’s covered in this episode:

What cortisol is and why it’s essential for your survival
How chronic stress and hormone fluctuations in perimenopause can disrupt cortisol
Why cortisol testing may not give you the full picture and the symptoms to recognize
The impact of poor sleep, blood sugar imbalance, and stress on your cortisol levels
Simple, actionable tips to support your nervous system and optimize circadian rhythm
Why trauma and feeling unsafe in your body can cause cortisol issues and how to heal

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.

🧐Got questions about perimenopause? You’re in luck! I’m hosting a (free) Live Q&A: Ask Me Anything About Perimenopause!

🗓️ Save the date: June 18th at 3 pm EST / 12 pm PST and CLICK HERE to save your spot.

Can’t attend live? No problem? Submit your questions ahead of time and we’ll send out a replay.

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

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Claudia Petrilli is a Functional Health Coach, Integrative Nutrition Coach, Women’s Health Educator, and creator of The Perimenopause Method. Having experienced debilitating periods, digestive issues, a sluggish thyroid, a pituitary tumor, and perimenopause symptoms in her late 30s, she knows exactly what it’s like to get dismissed by doctors and spend years searching for answers.

After making the decision to advocate for her health years ago and investing in her education, she changed her life. Now, she’s changing the lives of countless women by teaching them to advocate for themselves and improve their hormone health, so they can feel and look their best — in their 40s and beyond!

When she’s not digging into client cases and learning about women’s health, you’ll find Claudia with her life partner of 15 years, Mike, and their rescue pup, Dawson, the love of their life.