While perimenopause is often associated with erratic hormone levels — including temporarily elevated estrogen — a meaningful gap in the research literature has been the underemphasis of progesterone's decline and its physiological role. This is a crucial oversight in understanding women's health during these stages.

Research has historically conflated perimenopause and menopause, presenting them as having similar experiences and management approaches, which creates confusion. For example, much research asserts that lower estrogen levels are responsible for vasomotor changes like hot flushes — but this does not explain why perimenopausal women, who often have elevated estrogen levels, also notice these changes.

Additionally, there has been a failure to provide data from randomized controlled trials in perimenopausal women to support the use of estrogen-based approaches for these changes, despite acknowledging that hormone therapy is relevant in menopausal women. Overall, a significant body of data has perpetuated an outdated view of menopause as a simple estrogen story, overlooking the more complex hormonal picture women experience during this time.

Learn more: https://www.nature.com/articles/nrdp201531