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Perimenopause: Master the signature of your hormones and titrate your HRT According to your symptoms

Updated: Jun 14

As an example, here's a detailed breakdown of the menstrual cycle for a 48-year-old perimenopausal woman using estrogen therapy, with a baseline dose of 2 pumps and a top-up dose of 3 pumps for better symptom management during specific weeks. The specific weeks are labelled week A,B, C, D

Case Study: 48-Year-Old Perimenopausal Woman


- Age: 48 years

- Stage: Perimenopausal (transitioning into menopause)

- Estrogen Therapy: Uses estrogen gel to manage hormonal fluctuations

- Baseline Dose: 2 pumps

- Top-Up Dose: 3 pumps during certain phases for symptom management

Week A: Ovulation Week

- Days: Approximately Days 12-16 (mid-cycle)

- Hormones: Peak estrogen levels

- Symptoms:

- Physical: Peak energy, clear skin, high libido, and overall sense of well-being.

- Emotional/Mental: Enhanced mood, increased sociability, confidence, and cognitive sharpness.

- Explanation: Estrogen reaches its highest levels around ovulation, making this the time when women typically feel their best.

- What to do with Estrogen: Lower your dose of estrogen back to baseline (2 pumps).

Week B: Post-Ovulation (Early Luteal Phase)

- Days: Approximately Days 17-21

- Hormones: Estrogen levels slightly decline after ovulation, then rise again but not as high as during ovulation.

- Symptoms:

- Physical: Mild bloating, breast tenderness, moderate energy levels.

- Emotional/Mental: Mild mood fluctuations, slightly reduced social energy compared to ovulation week.

- Explanation: Estrogen levels drop slightly after ovulation but rise again during the early luteal phase, leading to moderate physical and emotional symptoms.

- What to do with Estrogen: Keep your dose of estrogen at baseline (2 pumps).

Week C: Late Luteal Phase / Premenstrual Phase

- Days: Approximately Days 22-28

- Hormones: Declining estrogen levels

- Symptoms:

- Physical: Increased bloating, significant breast tenderness, fatigue, and more pronounced PMS symptoms.

- Emotional/Mental: Irritability, mood swings, anxiety, and difficulty concentrating.

- Explanation: Estrogen levels continue to decline, leading to typical premenstrual symptoms as the body prepares for menstruation.

- What to do with Estrogen: This is the point you up your dose of estrogen above your baseline dose (3 pumps).

Week D: Menstrual Phase

- Days: Approximately Days 1-7 (first day of bleeding marks the start)

- Hormones: Low estrogen levels

- Symptoms:

- Physical: Cramps, bloating, back pain, headaches, and fatigue.

- Emotional/Mental: Low mood, irritability, and sometimes feelings of depression.

- Explanation: Both estrogen and progesterone levels are at their lowest, causing the shedding of the uterine lining and the onset of menstrual bleeding, leading to the most

What to do with Estrogen: Keep the dose the same as for week 3.

By Dr Purity Carr

GP and Menopause Doctor

Harvey, WA


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