During perimenopause, the hormone that usually starts to drop first is progesterone. As ciswomen age, the number of ovarian follicles (which contain eggs) decreases, and this can lead to a decline in progesterone production. This decrease in progesterone can cause changes in the menstrual cycle, such as irregular periods, heavy bleeding, or missed periods.
In addition to a decline in progesterone, estrogen levels can also fluctuate during perimenopause. In some, estrogen levels may increase in response to the decreasing levels of progesterone, leading to symptoms such as breast tenderness and bloating.
However, as perimenopause progresses, estrogen levels may also begin to decline, which can cause symptoms such as hot flashes, night sweats, and vaginal dryness.
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