Case Study: 42-Year-Old Perimenopausal Woman on Estrogen Therapy
In my practice, I find that women over the age of 45 typically do well with a standard dose of 2 pumps during ovulation week A. However, some may require an increase to 3 pumps during the luteal phase, week D, depending on their individual needs and response
Overview
Age: 42 years
Stage: Perimenopausal (transitioning into menopause)
Estrogen Therapy: Uses estrogen gel to manage hormonal fluctuations
Baseline Dose: 2 pumps
Adjustments: May reduce to 1 pump during ovulation week (Week A)
Symptoms of Too Much Estrogen: Agitation, anxiety
Adjustment for Symptoms:
If experiencing agitation or anxiety on 1 pump, drop to 0 pumps.
If experiencing agitation or anxiety on 2 pumps, drop to 1 pump.
Menstrual Cycle Breakdown & Estrogen Adjustments
Week A: Follicular Phase (Days 8-14, Ovulation Week)
Hormones: Estrogen naturally rises, peaking around ovulation.
Symptoms:
Physical: High energy, clear skin, increased libido, and overall well-being.
Emotional/Mental: Improved mood, sociability, confidence, and sharp cognition.
What to Do with Estrogen:
For women under 44, this is a good time to drop estrogen back.
Reduce to 1 pump or lower if feeling agitated/anxious.
If agitation/anxiety occurs even at 1 pump, reduce to 0 pumps.
Week B: Immediate Post-Ovulation (Days 15-21)
Hormones: Estrogen slightly declines after ovulation before rising again.
Symptoms:
Physical: Mild bloating, breast tenderness, moderate energy levels.
Emotional/Mental: Slight mood shifts, reduced social energy compared to ovulation week.
What to Do with Estrogen:
If symptoms return due to the post-ovulation estrogen dip, briefly increase to 2 pumps for balance.
If stable, remain at 1 pump.
Week C: Luteal Phase / Premenstrual Phase (Days 22-28)
Hormones: Estrogen levels steadily decline.
Symptoms:
Physical: Increased bloating, breast tenderness, fatigue, more pronounced PMS symptoms.
Emotional/Mental: Irritability, mood swings, anxiety, and difficulty concentrating.
What to Do with Estrogen:
Increase to 2 pumps to counteract the decline.
Week D: Menstrual Phase (Days 1-7, Period Week)
Hormones: Estrogen is at its lowest.
Symptoms:
Physical: Cramps, bloating, back pain, headaches, and fatigue.
Emotional/Mental: Low mood, irritability, and sometimes feelings of depression.
What to Do with Estrogen:
Continue 2 pumps if symptoms persist.
This approach tailors estrogen therapy to natural hormone fluctuations, minimizing perimenopausal symptoms while adjusting for sensitivity to excess estrogen.
By Dr Purity Carr
GP and Menopause Doctor
Daily Instagram live at 7am at #drpuritycarr
Harvey, WA
6220
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