Dr. Rachel Rubin

And so you get this LH surge, the egg pops out, and it is the shell of the egg that creates the progesterone surge. So you actually don't make any progesterone really in that first half of your cycle. And then after ovulation, we call the second half the luteal phase, which just means that's when progesterone is around. And so you get this surge of progesterone.

And so you get this LH surge, the egg pops out, and it is the shell of the egg that creates the progesterone surge. So you actually don't make any progesterone really in that first half of your cycle. And then after ovulation, we call the second half the luteal phase, which just means that's when progesterone is around. And so you get this surge of progesterone.

When there is no fertilization, that shell of the egg evaporates and then you lose your progesterone. And it is that withdrawal of progesterone that causes the uterine lining to shed. Now, again, this is very confusing for people because hormones through that time, your progesterone goes from very, very low to after you ovulate, very, very high. And it's that cycle every month.

When there is no fertilization, that shell of the egg evaporates and then you lose your progesterone. And it is that withdrawal of progesterone that causes the uterine lining to shed. Now, again, this is very confusing for people because hormones through that time, your progesterone goes from very, very low to after you ovulate, very, very high. And it's that cycle every month.

Now, estrogen, again, goes from 50 to 150, back down to 50. That's what the book says. I don't know about you, but my patients are not all on the book.

Now, estrogen, again, goes from 50 to 150, back down to 50. That's what the book says. I don't know about you, but my patients are not all on the book.

I agree completely. And so we're super interested in this. We care about how people are feeling. I may say this a lot during our conversation is there's the book answer, there's the Instagram answer, and then my answer is somewhere in the middle is how we sort of talk about it and understand it. Again, I think the numbers are helpful for people to see. When you're pregnant, your estrogen is 3,000.

I agree completely. And so we're super interested in this. We care about how people are feeling. I may say this a lot during our conversation is there's the book answer, there's the Instagram answer, and then my answer is somewhere in the middle is how we sort of talk about it and understand it. Again, I think the numbers are helpful for people to see. When you're pregnant, your estrogen is 3,000.

When you're regularly ovulating, it's 50 to 150. Perimenopause, it could be zero. It could be a thousand and down to zero in two seconds flat.

When you're regularly ovulating, it's 50 to 150. Perimenopause, it could be zero. It could be a thousand and down to zero in two seconds flat.

I think it has to do with the fact that you have a limited number of eggs. You're sort of getting to that end of your bucket of eggs that you're born with. That's, again, controversial on the internet. So your body is really trying to do what it has always done, and it's just having trouble. It's having trouble recruiting the egg, ovulating. You don't ovulate every time.

I think it has to do with the fact that you have a limited number of eggs. You're sort of getting to that end of your bucket of eggs that you're born with. That's, again, controversial on the internet. So your body is really trying to do what it has always done, and it's just having trouble. It's having trouble recruiting the egg, ovulating. You don't ovulate every time.

Sometimes you ovulate twice, push out two eggs in this perimenopause cycle. So we can sometimes see really high elevations, which can come with symptoms. And that's the challenge of perimenopause is sometimes you have symptoms because you're too low. Sometimes you have symptoms because you're too high. And sometimes it's that fluctuation. Like, again, we'll go to the car model.

Sometimes you ovulate twice, push out two eggs in this perimenopause cycle. So we can sometimes see really high elevations, which can come with symptoms. And that's the challenge of perimenopause is sometimes you have symptoms because you're too low. Sometimes you have symptoms because you're too high. And sometimes it's that fluctuation. Like, again, we'll go to the car model.

You're driving 100 miles an hour on the highway and you go to empty gas tank immediately. That is not good for a car. That is inflammation. That is irritation. That is a lot of perimenopause symptoms.

You're driving 100 miles an hour on the highway and you go to empty gas tank immediately. That is not good for a car. That is inflammation. That is irritation. That is a lot of perimenopause symptoms.

I knew you would like this analogy.

I knew you would like this analogy.

I think it's a really important question, and we see this clinically all the time. If you give somebody, say, micronized progesterone or a synthetic progestin, say, in birth control, you will see a wide variety of reactions to these different medications.

I think it's a really important question, and we see this clinically all the time. If you give somebody, say, micronized progesterone or a synthetic progestin, say, in birth control, you will see a wide variety of reactions to these different medications.