Estrogen and progesterone are two key hormones made mostly by the ovaries. They play significant roles in the menstrual cycle, pregnancy and menopause. When their levels are off, they can cause symptoms or lead to health concerns. Understanding how these hormones work and change over time can help you better manage your health. 

How estrogen and progesterone work in the body

Estrogen rises in the first half of the menstrual cycle. It helps thicken the lining of the uterus, called the endometrium, and triggers ovulation. Progesterone rises after ovulation to prepare the uterus for a possible pregnancy. If pregnancy does not happen, progesterone drops, which triggers a period.

Estrogen supports:

• Breast development and other puberty changes.
• Mood and emotional balance.
• Sleep and brain function.
• Bone strength and density. 

Progesterone helps:

• Prepare and maintain the uterus for pregnancy.
• Support pregnancy.
• Regulate bleeding during menstruation.
• Protect the uterine lining from overgrowth (which can lead to uterine cancer).

“Progesterone helps balance estrogen and keep the uterine lining from becoming too thick,” says Dr. Sydney Randall, Nebraska Medicine obstetrician and gynecologist. “Without it, the risk of endometrial or uterine cancer can increase.”

Hormone changes over time

Estrogen and progesterone naturally rise and fall at different stages of life:

• Pregnancy: Both hormones increase throughout pregnancy and then peak in the third trimester. This can cause symptoms like breast tenderness, nausea, mood swings and fatigue—particularly in early pregnancy.
• Postpartum: After delivery, hormone levels drop quickly. This can lead to hot flashes, night sweats and mood changes.
• Menopause: During perimenopause—the years leading up to menopause—hormone levels can swing up and down. This may cause irregular periods, brain fog, low libido and sleep issues. After menopause is complete, both estrogen and progesterone levels remain consistently low.

What happens when hormone levels are off

If your hormone levels are off, you may experience:

• Irregular menstrual cycles or heavy bleeding.
• Difficulty getting pregnant.
• Pelvic pain, vaginal dryness or sexual discomfort.
• Low sex drive.
• Mood changes.
• Sleep problems or fatigue.
• Hot flashes or night sweats.
• Headaches.
• Bloating or weight gain.

“We don’t typically recommend checking hormone levels unless you’re having specific issues,” explains Dr. Randall. “Hormones can change hour to hour, so we typically treat based on symptoms, not numbers.”

Hormone replacement therapy and lifestyle tips

Hormone replacement therapy can help ease symptoms like hot flashes, night sweats and vaginal dryness. If you still have a uterus, your doctor may recommend supplementing with estrogen and progesterone. If you’ve had a hysterectomy, you may only need estrogen. Vaginal-only treatments are also available for dryness or discomfort. It’s best to work with your doctor to find the solution that’s right for you.

“There are several options,” says Dr. Randall. “It may take some trial and error to find what works best for your body.”

While some patients turn to testosterone therapy or compounded hormone pellets, these may not be necessary or safe for everyone.

“We often see people who start hormone therapy, including testosterone, without fully understanding the risks,” says Dr. Randall. “That’s why it’s so important to work with a doctor or trusted health care provider before starting a hormone regimen.”

To support healthy hormone levels naturally:

1. Eat a well-balanced diet.
2. Exercise regularly—especially strength training.
3. Manage stress.
4. Prioritize sleep.
5. Maintain a healthy weight and BMI.

“I like to give patients several resources so they can educate themselves and feel more confident about what’s happening in their bodies," says Dr. Randall. "Addressing insulin resistance and being informed can really help women navigate hormonal changes."

Know your body and speak up

Hormone imbalances are common, but that doesn’t mean they should be ignored. If you’re experiencing symptoms that affect your daily life, reach out for help. If there's something you're too embarrassed to ask your doctor, you can ask us here.