Why Your Chronic Illness Got Dramatically Worse in Perimenopause: The Hormonal Cascade Driving Gut, Mast Cell, Brain Fog, and Fatigue Symptoms in Your 40s — The Perimenopausal Hormonal Cascade

Before describing the five mechanisms by which perimenopause drives chronic illness flares, a more accurate picture of what is actually happening to your hormones in perimenopause is necessary. The standard story (estrogen falls and progesterone falls) is too simple to predict what most perimenopausal women actually experience. Estrogen Becomes Erratic Before It Declines The hallmark of perimenopause is not estrogen decline. It is estrogen volatility. The ovaries become inconsistent producers of estrogen over the years before menopause. Some cycles ovulate strongly and produce high estrogen peaks. Some cycles fail to ovulate and produce low estrogen throughout. Some cycles produce estrogen peaks that are higher than anything the woman experienced in her younger reproductive years (the so called late perimenopausal estrogen spikes). The integrated profile is widening fluctuation, not steady decline. The decline comes in the final two to three years before menopause itself. This matters clinically because the mechanisms that drive perimenopausal chronic illness flares are not driven by low estrogen per se. They are driven by erratic estrogen with high peaks. High estrogen activates mast cells. High estrogen inhibits DAO. High estrogen disrupts the estrobolome. The patient with high spike perimenopause often experiences worse mast cell and histamine symptoms than she will experien