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Fluctuations in estrogen that affect both body and mind
Dr. Sharon Leshem, a gynecologist and menopause consultant, meets women in her clinic who are functioning, active, and leading full lives. Then, without any dramatic event, something shifts. Sleep becomes fragmented. Mood is less stable. The menstrual cycle becomes unpredictable.
“This is not inevitable,” she says. “But it’s important to understand what’s happening in the body.”
Dr. Hila Raja Nixon, a family medicine specialist and menopause consultant, explains that perimenopause is a phase in which ovarian activity becomes irregular. Ovulation does not occur in every cycle, and levels of estrogen and progesterone fluctuate in a less predictable pattern.
It is important to understand that this is not a linear decline in estrogen, but rather a period of fluctuations. At times, estrogen levels may be higher than usual, and at others they may drop sharply. This instability affects not only the uterus and menstrual cycle, but multiple systems throughout the body.
When ovulation does not occur, progesterone levels do not rise as they normally would. This can create an imbalance between estrogen and progesterone, leading to changes in bleeding patterns, the appearance of premenstrual symptoms, and a general sense of instability.
Estrogen is a multi-system hormone. Beyond its role in the reproductive system, it also acts in the brain. It directly influences areas of the nervous system responsible for emotional regulation, sleep, body temperature, and cognitive function.
Estrogen affects the activity of neurotransmitters such as serotonin and dopamine, which are involved in regulating mood, motivation, and a sense of well-being. When estrogen levels fluctuate rapidly, neurochemical activity changes as well.
This is one of the reasons women may experience emotional fluctuations, increased sensitivity, reduced patience, or a sense of mental overload during this period. These are not only reactions to external circumstances, but also physiological responses of the nervous system to hormonal changes.
In addition, estrogen plays a role in regulating the brain’s temperature control centers. Fluctuations in its levels may affect thermoregulation and contribute to discomfort, even before the onset of the classic hot flashes associated with menopause.
Sleep quality is also affected. Reduced hormonal stability can disrupt deep sleep stages and continuity, leading to cumulative fatigue that further intensifies emotional fluctuations.
Perimenopause is therefore not limited to an unpredictable menstrual cycle. It may also include sleep disturbances, heart palpitations, dizziness, emotional sensitivity, and changes in the sense of control over one’s body.
Dr. Raja Nixon emphasizes that many women do not associate these symptoms with hormonal changes. They often attribute them to stress, workload, or aging. However, when menstrual changes occur alongside systemic symptoms, further evaluation is warranted.
Dr. Leshem explains that while this is a natural stage, there is no need to accept a decline in quality of life. A medical evaluation can help determine whether symptoms are related to hormonal fluctuations and explore appropriate treatment options.
In some cases, hormone therapy or combined oral contraceptives may be considered to help stabilize hormone levels. In others, the focus may be on improving sleep, tailored physical activity, nutrition, and stress management.
Margalit Shilo, Head of Integrative Medicine and Health Promotion, adds that tools such as touch therapies, acupuncture, breathing practices, and mindfulness can support nervous system balance during this period of fluctuation.
If you are experiencing changes that interfere with your daily functioning, it is important to consult your doctor and share what concerns you.
Women who receive a clear physiological explanation along with personalized guidance often report a renewed sense of control and a significant improvement in quality of life.
Perimenopause is a complex but well-understood biological stage. Understanding the connection between estrogen and the nervous system helps place symptoms in the right context and allows for informed, thoughtful management, rather than confusion or self-blame.
