18/06/2026
This might be controversial, but hear me out.
One of the most common prescriptions I see women given in perimenopause is oestrogen gel.
Yet many of these women are already experiencing what I would consider signs of relative oestrogen dominance:
• Breast tenderness
• Heavy or clotty periods
• Fluid retention
• Anxiety
• Irritability
• Migraines
• PMS-like symptoms
In my opinion, adding more oestrogen to this picture can sometimes make the situation worse rather than better.
Why?
Because in the early stages of perimenopause, the issue is often not a lack of oestrogen.
Oestrogen levels can fluctuate dramatically and frequently spike higher than many women realise.
What commonly starts to decline first is progesterone.
Progesterone is the calming hormone.
When this drops down we can start to experience sleep changes, mood changes and an overreactive nervous system.
Progesterone helps balance some of oestrogen’s more stimulating effects.
We start to feel overwhelmed, anxious, wired, emotional and exhausted at the same time.
This is where progesterone becomes a completely different conversation.
In my clinical opinion, many women may benefit from assessing whether progesterone support is actually needed instead of more oestrogen.
Supporting the body with the changes that are actually happening is key.
And understanding this difference can change everything.
Tash xx