Menopause Hormones: What Changes and Why It Matters

If you're anywhere between your 40s and 60s, you've probably heard a lot about "hormones" and felt their effects, too. Maybe your periods are changing, your sleep feels off, your mood surprises you, or your body just doesn't respond the way it used to. None of this is in your head.

Hormones and menopause are closely connected. Three hormones in particular — estrogen, progesterone, and testosterone — shape our reproductive years and our menopause experience. Understanding what's happening with these menopause hormones can make this stage of life fee less overwhelming and more manageable. 

The big picture: Hormones 101

Hormones are chemical messengers. They travel through your bloodstream and tell different parts of your body what to do. When it comes to menopause, estrogen and progesterone usually get the most attention, but testosterone matters too.

The ovaries are the main organs that produce all three hormones. But they're not working alone. The adrenal glands (on top of your kidneys) and fat tissue also help produce small amounts of estrogen, especially after menopause.

As menopause approaches, these hormones don't just decline in a straight line. They rise and fall (sometimes sharply) during perimenopause. These shifts are what drive many menopause symptoms. These changes are normal and manageable for most people.

What is estrogen?

Estrogen is best known as a reproductive hormone, but it affects many systems throughout the body. Estrogen helps support:

• Breast health.
• Vaginal moisture and elasticity.
• Sexual comfort and arousal. 
• Brain function and mood.
• Bone density and heart health.
• Growth and shedding of the uterine lining during the menstrual cycle.

The main forms of estrogen

The three main forms of estrogen (also called types of estrogen) are:

• Estradiol (E2)
• Estriol (E3)
• Estrone (E1)

Here's how each one works.

Estradiol (E2): The most active estrogen

Estradiol has the greatest effect on the body of the 3 estrogens. It's the type your body relies on during your reproductive years. Its main role is to help the reproductive system mature and then work properly. During a menstrual cycle, increased estradiol helps:

• Trigger the release of an egg from the ovaries (ovulation).
• Build the uterine lining each month.
• Support vaginal health and lubrication.
• Protect bones.

During perimenopause, hormone levels (including estradiol) often swing up and down and become unpredictable. One month you may feel fine, and the next you may notice hot flashes, headaches, or mood changes. Over time, as the ovaries are slowly being depleted of eggs, estradiol levels steadily decline.

This will continue to decrease throughout the menopausal transition. When someone no longer has their periods (postmenopause), estradiol is present only in very small amounts.

This drop in estradiol often causes many of the symptoms associated with menopause, such as:

• Mood swings.
• Feeling down or having a depressed mood.
• Vaginal dryness.
• Heart palpitations, which are common and often benign, fast or skipped heartbeats.
• Headaches.
• Trouble sleeping.
• Physical and mental exhaustion.
• Hot flashes and night sweats.

Estradiol is also one of the primary hormones used in menopausal hormone therapy (MHT) — as a potential treatment for menopause symptoms.

Estriol (E3): The gentler estrogen

Estriol plays a major role during pregnancy, when it becomes the dominant estrogen. It helps the uterus grow and stay healthy, supports the fetus, and helps prepare the body for childbirth and breastfeeding.

Outside of pregnancy, estriol levels are very low, often almost undetectable.

Because estriol is weaker than estradiol, synthetic (laboratory-made) versions are sometimes used in menopause hormone therapy (MHT) to help ease menopause symptoms, particularly vaginal symptoms.

Estrone (E1): The postmenopause estrogen

Estrone is the weakest estrogen, but it becomes the main estrogen after menopause. Unlike estradiol, estrone is made mostly in fat tissue and the adrenal glands. 

Postmenopause, estrone is only made by fatty tissue, so people with more fatty tissue will make more estrone.

What does progesterone do?

Progesterone is a hormone made during a menstrual cycle by the corpus luteum. The corpus luteum is a temporary structure that’s created within the ovary after the release of an egg (ova) during a menstrual cycle. Progesterone is released from the corpus luteum for 14 days after an egg is released from the ovary (ovulation). 

Progesterone initially triggers the lining of the uterus to thicken and become softer to prepare for a possible pregnancy. It also prevents muscle contractions in the uterus.

If there’s a pregnancy, progesterone levels stay high. This helps keep the lining of the uterus thick and soft, and it also stops the uterus from having any contractions. This is important for keeping the pregnancy safe and healthy.

If pregnancy doesn't occur, progesterone levels will drop. This drop signals the body to shed the uterine lining, resulting in a period.

During perimenopause, the body starts making less progesterone. This can lead to less predictable ovulation, heavier periods, short cycles, or more PMS-like symptoms.

After menopause, progesterone production largely stops.

What is progestin?

Progestin is a synthetic (man-made in a lab) form of progesterone. It's commonly used in birth control pills and menopause hormone therapy.

If someone with a uterus takes estrogen alone, the endometrial lining (the lining inside the uterus) can grow too thick over time. This can even lead to cancer. So, medical providers usually prescribe progesterone or progestin along with estrogen to help protect the uterus. Think of progesterone as estrogen's built-in safety check.

What does testosterone do in women?

Testosterone is the main sex hormone that controls male physical features. But it isn't just a "male hormone". People born with ovaries naturally produce testosterone, just not as much. Testosterone plays a role in:

• Estrogen production.
• Sex drive (libido).
• Muscle mass.
• Bone density.

Testosterone levels over time

Testosterone levels peak in our 20s. The ovaries continue to make testosterone even after they stop making estrogen. But by the time we're in menopause, the amount of testosterone the body produces drops by more than half.

Testosterone side effects

When testosterone is used medically, dosing matters. Too much can lead to side effects such as acne, voice changes, or increased facial or body hair. That's why testosterone therapy should always be prescribed and monitored by a qualified healthcare provider.

While many menopause and sexual health experts recommend testosterone therapy in certain cases, the FDA hasn't approved it for use in females yet.

Why menopause hormones matter

As you can see, hormones play a crucial role in our bodies. They control many things when it comes to sexuality, fertility, and menopause. And menopause isn't caused by just one hormone dropping. We notice symptoms when the balance between estrogen, progesterone, and testosterone shifts. And hormone levels can change a lot. This can influence symptoms like:

• Mood swings and anxiety.
• Vaginal dryness and sexual desire.
• Hot flashes.

Understanding what your hormones are doing doesn't mean you have to "fix" them. But it does help you make more informed choices.

If menopause symptoms are affecting your quality of life, you're not weak. You're responding to real biological changes. A healthcare provider can help you understand your options and discuss ways you can manage your symptoms.

Start with your gynecologist or consider talking to a virtual menopause care provider.