Perimenopause Comes with "Feast-and-Famine" Swings in Hormone Levels, Says Gynecologist Bruce Dorr, MD

Perimenopause, the transition preceding menopause, is characterized by gradual oocyte loss, altered responsiveness to hormonal feedback, wide hormonal fluctuations, and irregular menstrual patterns, a disruptive process that can last for over a decade and causes symptoms in a majority of women.¹

While menopause itself is clinically defined as 1 year without menstrual cycles, the years leading up to it involve what gynecologist Bruce Dorr, MD, URPS, IFM-CP, describee as a "feast and famine" of estrogen and progesterone that can begin a full decade before periods stop altogether.

Recent research shows that moderate to severe vasomotor symptoms, ie, hot flushes and night sweats, are nearly 5 times more prevalent in perimenopause than premenopause, making them among the most defining markers of this transition.² Despite the significant symptom burden many experience, even women aged 30-45, and high rates of consultation with doctors about perimenopause, this life stage remains poorly understood by many women and clinicians alike.³ In a recent interivew with Patient Care, Dorr, a gynecologist with specialized training in functional and integrative medicine, discussed the hormonal imbalances of perimenopause and why recognizing early signs is essential for effective management. Find a portion of that interview in the video above.

The following transcript has been lightly edited for flow.

Patient Care: I want to start with asking you if there's a working definition of perimenopause that serves as a guide to this early stage of the longer transition.

Dorr: Let's start with menopause, which is defined by no menstrual cycles for a year in a normally menstruating woman. Understand there are variations in that, because some women have hysterectomies, some women have birth control or contraception that interferes with that. But when you look at perimenopause before cycles stop, and the normal ebb and flow of estrogen and progesterone stops altogether, there is kind of a "feast and famine" that goes on with estrogen and the ovulation hormone progesterone. And that can start a good 10 years beofre it stops altogether.

The imbalance that's created between estrogen and progesterone can lead to a whole host of symptoms. On average this feast and famine of estrogen and the cycle of estrogen and progesterone, starts at about age 46. And everybody reacts diffently to hormones, to nutrition; how we react to other people in our lives. So it's a combination of many things, but certainly hormones. I'm a hormone guy, so hormones play a big role, and sometimes, unfortunately, [their effects] are mistaken or are dismissed, unfortunately, for many of my patients. They need to be at the forefront of, or at least a piece of, an evaluation for [women] coming in into this very important timeframe in their lives.

References:

1. Santoro N, Roeca C, Peters BA, Neal-Perry G. The menopause transition: signs, symptoms, and managemenet options. J Clin Endocrinol Metab. 2021;106(1):1-15. doi:10.1210/clinem/dgaa764
2. Islam RM, Bond M, Ghalebeigi A, et al. Prevalence and severity of symptoms across the menopause transition: cross-sectional findings from the Australian Women's Midlife Years (AMY) Study. Lancet Diabetes Endocrinol. 2025.13(9):765-776.
3. Cunningham AC, Hewings-Martin Y, Wickham AP, Prentice C, Payne JL, Zhaunova L. Perimenopause symptoms, severity, and healthcare seeking in women in the US. NPJ Womens Health. 2025;3(12). doi:10.1038/s44294-025-00061-3