Sue:
Some health professionals have been citing “estrogen dominance” as the cause of all perimenopause symptoms.  They go on to say that perimenopausal and menopausal women produce too much estrogen and therefore do not need estrogen replacement therapy - whether in HRT or birth control pill form. How do you feel about this?

Dr. Goldstein
To merely say that all perimenopausal symptoms are secondary to estrogen dominance is a gross over simplification.  It is true that perimenopausal patients have become sporadic ovulators and are therefore making mostly unopposed estrogen.  Clearly, many perimenopausal patients have relatively high levels of estrogen as well, therefore they certainly do not need estrogen replacement therapy.  I have seen patients inadvertently treated this way whose symptoms became worse.  I believe it is the fluctuations in unopposed estrogen and thus estrogen withdrawal that often results in many of the symptoms both bleeding and psychosocial.  The use of birth control pills therefore is totally different.  A main thrust of the pill is the fact that it suppresses ovarian function and substitutes a small amount of estrogen and progesterone all month long therefore giving the patient back a steady state equilibrium. Patients and many physicians need to be clear on the differences between replacement therapy (when estrogen is absent) and "turn off and substitute" which is what birth control pills will do in perimenopausal patients.

back | next

Differing opinions on "Estrogen Dominance"

click here to join HotFlash & ask a question

• HotFlash News
• Interview 1
  • Estrogen Dominance
  • Estrogen vs. Progesterone
  • Replacement vs. Substitution
  • Perimenopause Diagnosis
  • Menstrual Calendar
  • What are SERM's
  • Future of Ultrasonography
• go to interview 2
• Ask Dr. Goldstein