Why Perimenopause Isn't Just About Low Oestrogen (And What My Own Hormone Test Revealed)
If you've been told your hormones are fine but you still feel exhausted, anxious, unable to sleep and not quite yourself, I want you to read this.
Perimenopause isn't simply about oestrogen dropping. The hormonal picture is far more complex than that, and without looking at the full picture it's almost impossible to know what's actually driving your symptoms. I know this not just as a Registered Nutritional Therapist, but from my own experience. Last year I did a Dutch test on myself and what it showed changed how I understand my own health.
What I expected to find
Like most women, I assumed my symptoms were down to falling oestrogen. Disrupted sleep, the anxiety, the fatigue, the brain fog, the weight shifting around my middle. That's the story we're all told, isn't it? Perimenopause equals low oestrogen, so get your oestrogen up and you'll feel better. I went into the test expecting to see low oestrogen staring back at me from the results.
My oestrogen levels were within a normal range. Not low at all.
What was low was my progesterone, significantly so, and my DHEA, a precursor hormone that supports energy, mood, stress resilience and healthy ageing, was also depleted. Suddenly everything made sense, and it wasn't the story I'd been telling myself.
Why progesterone matters so much and why we don't talk about it enough
I think about oestrogen and progesterone a bit like sisters. Oestrogen is the outgoing one, the one who loves a party, who's loud and full of energy and who you definitely notice when she's not in the room. Progesterone is her quieter sister, the one who stays in with a good book, who keeps things calm and steady and who doesn't get nearly enough credit for the role she plays. When progesterone is around in good amounts, the whole household runs smoothly. When she leaves, things start to unravel in ways that are hard to put your finger on.
In the years running up to menopause, progesterone is actually the first hormone to decline, often well before oestrogen starts to fall significantly. This happens because ovulation becomes less frequent, and progesterone is produced primarily after ovulation, so fewer ovulations means less progesterone, and it can be as straightforward as that.
Progesterone works on the GABA receptors in your brain, which are the same receptors targeted by anti-anxiety medications, and this is why low progesterone can show up as anxiety, irritability, a racing mind and real difficulty switching off in the evenings. It also plays a critical role in sleep quality, particularly in getting you into deep restorative sleep and keeping you there through the night, which is why low progesterone is such a common driver of that classic 2 to 3am wake-up that so many perimenopausal women experience. Beyond that, progesterone supports thyroid function, helps regulate blood sugar, counterbalances the effects of oestrogen and has a natural anti-inflammatory effect, so when it drops, the consequences ripple out across almost every system in the body, and they often get misattributed to stress, poor sleep habits or simply getting older.
What is DHEA and why does it matter?
DHEA is a hormone produced by the adrenal glands that acts as a building block for other hormones including oestrogen, testosterone and cortisol. It's often called the vitality hormone because adequate levels are associated with energy, mood, cognitive function, libido and stress resilience, and it naturally declines with age, but chronic stress accelerates this decline significantly.
When you're running on empty, which most perimenopausal women are, your adrenal glands are under constant demand and over time this depletes DHEA, leaving you feeling flat, exhausted and unable to recover from things the way you used to. The symptoms, fatigue, low mood, reduced motivation, poor stress tolerance and brain fog, are so similar to what many women attribute to perimenopause generally that the DHEA piece often goes unnoticed entirely.
What the Dutch test actually measures
A standard GP blood test will typically check oestrogen and sometimes FSH, which gives you a very basic snapshot of one moment in time and misses enormous amounts of important information about what's actually happening in your body day to day.
The Dutch test, which stands for Dried Urine Test for Comprehensive Hormones, measures a much fuller picture across a whole day rather than at a single point. It looks at oestrogen, progesterone and testosterone along with their metabolites, so not just the levels but how your body is actually processing and breaking them down, because even if your oestrogen levels look normal, if you're metabolising it down an inflammatory pathway it can contribute to symptoms. It maps your cortisol and cortisone throughout the day, revealing your daily stress hormone pattern and whether you're waking with a cortisol spike, crashing by the afternoon or struggling to come down in the evening. It shows DHEA and its metabolites, which tells you how well your adrenal glands are functioning and whether chronic stress has taken its toll, and it also looks at melatonin, giving useful information about your circadian rhythm and sleep quality.
The result is a comprehensive map of your hormonal health that simply isn't available from a standard blood test, and for women in perimenopause where the hormonal picture is complex, shifting and highly individual, that information can change things.
Why clinical training matters when it comes to interpreting results
A perimenopause coach, a personal trainer or a general wellness practitioner can offer really valuable support in many areas, but interpreting hormone test results, understanding metabolic pathways and translating that into a personalised nutritional and lifestyle plan requires a different level of clinical training. Knowing what the numbers mean is one thing. Knowing what to do about them, and understanding how nutrition, supplementation and lifestyle can move those numbers in the right direction for a specific person with a specific history, is quite another.
As a Registered Nutritional Therapist with a PGDip in Nutrition Science and Practice, this is the kind of work I do with clients. Rather than just looking at diet in isolation, I look at the whole hormonal and metabolic picture, try to find the first domino in the chain and build a plan that addresses the root cause rather than just managing symptoms as they appear.
For me personally, knowing that my progesterone was low and my DHEA depleted meant I could take targeted action, with specific nutrients that support progesterone production, adaptogenic herbs with good evidence behind them for adrenal support, dietary changes to support healthy hormone metabolism and stress management approaches that actually make a difference rather than just being told to relax more. It also meant I could stop blaming myself for how I was feeling. The anxiety wasn't weakness. The broken sleep wasn't bad habits. The exhaustion wasn't me not coping. It was my hormones, measurable and addressable.
Should you get a Dutch test?
Not everyone needs one, and if you're early in your perimenopause journey and responding well to general nutritional and lifestyle changes, a Dutch test may not be your immediate next step. But if you've been doing everything right and still not feeling right, if you've had blood tests that came back normal but something clearly isn't, or if you want to understand your hormonal picture in detail before making decisions about HRT or other interventions, it's absolutely worth having a conversation with a qualified practitioner about whether it might be useful for you.
The Dutch test is a private test, not available on the NHS, and the cost varies depending on which panel you choose. I'm always happy to discuss whether it would be a useful option as part of a discovery call.
The bottom line
Perimenopause is not just about low oestrogen. It's about progesterone declining earlier than most people realise, about how your body metabolises the hormones you have, about what chronic stress is doing to your adrenal function and your DHEA levels, and about the full picture rather than a single number. And until someone looks at that full picture with you, you're working with an incomplete map.
If you'd like to talk about whether a Dutch test or a more comprehensive approach to your perimenopause symptoms could help you, I offer a free 20-minute discovery call. No pressure, just an honest conversation about where you are and what might actually help.