# Menopause

Category: Conditions

Also known as: perimenopause, post-menopause

Menopause is not a state of estrogen deficiency caused by the ovaries running out of eggs, but rather a systemic condition driven by progesterone deficiency and unopposed estrogen action. Peat argued that the pharmaceutical industry created and promoted the false definition of…

11 passages · 2 authors · 1997–2021 · Most-cited: [Ray Peat](https://bioenergeticoracle.com/md/voices/ray-peat/index.md)

Canonical page: https://bioenergeticoracle.com/concepts/menopause

## Synthesis

**Menopause** is not a state of estrogen deficiency caused by the ovaries running out of eggs, but rather a systemic condition driven by *progesterone deficiency* and unopposed estrogen action. [Source 1, 5, 9] Peat argued that the pharmaceutical industry created and promoted the false definition of menopause as an estrogen deficiency to expand the market for estrogen replacement therapies. [Source 5, 6] In reality, the repeating cycles of ovulation expose the hypothalamus and pituitary gland to cumulative estrogen, which desensitizes and "ages" these regulatory tissues, disrupting normal gonadotropin cycles. [Source 1, 4] The failure to produce progesterone, while estrogen production continues at normal or even elevated levels, results in a great functional excess of estrogen because it is no longer opposed. [Source 4]

The central mechanism of menopause involves the **aromatase enzyme**, which is present in fat cells, fibroblasts, smooth muscle cells, and virtually all other tissues, and continues to produce estrogen locally throughout the body even after ovarian function ceases. [Source 6, 7] This local production means that while serum estrogen may appear low, the *tissue-bound estrogen* is actually elevated because, in the absence of progesterone, the enzymes that normally inactivate estrogen for excretion are impaired. [Source 3, 9] Progesterone activates the enzymes that attach a sugar or sulfuric acid molecule to estrogen, making it water-soluble and allowing it to leave the cell for excretion; without this, the active, oil-soluble estrogen accumulates inside cells. [Source 9] Stress, cortisol, and prolactin all increase aromatase activity, while **thyroid** and **progesterone** inhibit it, creating a vicious cycle where declining thyroid function and rising stress amplify local estrogen production. [Source 6, 7]

The symptoms and degenerative changes of menopause are driven by this estrogen dominance and the loss of progesterone's protective effects. Progesterone normally protects against cortisol, prolactin, and adrenal androgenic hormones, and its decline leads to increased inflammatory processes, lower body temperature, and a sudden increase in degenerative diseases. [Source 2, 4, 6] The drop in body temperature at menopause occurs because progesterone is thermogenic, and estrogen independently causes vasodilation and increased heat loss. [Source 6] Peat demonstrated that if young ovaries are transplanted into estrogen-exposed old animals, they fail to function, but if ovaries are removed in youth and transplanted into old animals that were spared cumulative estrogen exposure, they function normally, proving that the brain and pituitary, not the ovaries, are the primary site of menopausal change. [Source 1, 4]

Perimenopause is characterized by decreasing progesterone production at a time when estrogen may be at a lifetime high, leading to symptoms such as migraines, weight gain, and premenstrual headaches. [Source 2, 5] The sluggish intestine resulting from declining thyroid function increases endotoxin absorption, which further poisons the ability to burn calories and suppress estrogen. [Source 8] Postmenopausally, the cycling pituitary continues to affect the adrenal glands and other organs, and progesterone remains an important regulator of pituitary and brain function, with protective effects against osteoporosis, hypertension, and hirsutism. [Source 2] Dinkov has emphasized that the postmenopausal state is specifically a deficiency of progesterone with an excess of **estrone sulfate**, which can easily convert into all other estrogens, and that studies giving postmenopausal women progesterone have shown a reversal of osteoporosis, while estrogen studies have not even stopped bone loss. [Source 11]

The practical approach to menopause involves restoring the balance between estrogen and progesterone by supporting thyroid function, ensuring adequate dietary protein and cholesterol, and using cyclic or continuous progesterone supplementation. [Source 2, 8, 10] Progesterone supplementation, typically 10 to 15 milligrams daily during the second half of the cycle for perimenopausal women, or continuously for postmenopausal women, helps restore normal thyroid function and opposes the unopposed actions of estrogen, cortisol, and prolactin. [Source 2] Even after ovarian removal, the adrenal glands and brain continue to produce progesterone, and maintaining adequate cholesterol levels is essential because cholesterol is the precursor for both progesterone and testosterone. [Source 2, 10] The goal is to prevent the local production of estrogen from getting out of control, as stress activates the aromatase enzyme inside every cell of the body, producing estrogen that will not be measured in the bloodstream but will drive tissue degeneration. [Source 10]

## People also ask

### What causes menopause according to Ray Peat?

Peat argued menopause is a systemic condition of progesterone deficiency and unopposed estrogen, not ovarian failure. Cumulative estrogen exposure desensitizes the hypothalamus and pituitary, disrupting cycles while tissue estrogen production continues.

### How does aromatase contribute to menopausal symptoms?

The aromatase enzyme in fat, fibroblasts, and other tissues produces estrogen locally even after ovarian function ceases. Without progesterone to activate estrogen-excreting enzymes, active estrogen accumulates in cells, driving degeneration.

### Why is progesterone used for menopause instead of estrogen?

Progesterone opposes estrogen, cortisol, and prolactin, protecting against tissue degeneration. The corpus describes studies where progesterone reversed osteoporosis in postmenopausal women, while estrogen did not even stop bone loss.

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## Cited passages

Passage numbers match the `[Source N]` markers in the synthesis above.

### Source 1 — Gender, Aging & Disease Susceptibility

Ray Peat · Newsletter · 2021

> I occasionally hear doctors say that menopause occurs when the ovaries run out of eggs, or that the depletion of primary oocytes causes menopause, or that aging ovaries cause menopause. This is usually followed by claims that, in the absence of eggs that develop into follicles, there is a failure to produce and that the lack of estrogen leads to disease. Mainstream medicine and biology have accepted two dogmatic ideas held by August Weisman in the late 19th and early 20th century — the wear and tear theory of aging, and the Weissman Barrier, an absolute separation of the “germ line” from the body cells. When any part of the system “wears out,” it can’t be replaced, and results in aging. There no valid evidence for any of these ideas, but they have been taught in universities for several generations, and shaped the preferred explanations for the occurrence of menopause. In recent decades, very clear evidence has shown that something other than intrinsic aging of the ovaries is responsible for their changed function in midlife, that is, that something in the ovaries’ environment is responsible for the changes of menopause. The repeating cycles of ovulation expose the brain, especially the hypothalamus and the pituitary gland to estrogen, and cumulative estrogen exposure (especially when it isn’t offset regularly by adequate progesterone secretion) causes tissue changes, “aging” the tissues. The hypothalamus and pituitary functions are “aged” in proportion to their exposure to estrogen, disrupting the normal cycles of gonadotropin excretion (Rodriquez, et al., 1993; Desjardins, et al., 1992; Brawer, et al., 1992; Rossmanith, 1995). Intermittent exposure to progesterone protects against the estrogen neurotoxicity (Schipper, et al., 1990). If young ovaries are transplanted into estrogen-exposed old mice, they fail to function. If an animal’s ovaries are removed in youth, those changes in the brain and pituitary don’t occur, and if ovaries are transplanted these “estrogen deprived” old animals they function normally. Despite evidence of this sort, the great majority of physicians continue to believe that menopause is a state of estrogen deficiency, resulting from intrinsic ovarian failure.

### Source 2 — Progesterone Summaries - Progesterone Deceptions - Progesterone Supplementation - Dosage of Progesterone

Ray Peat · Article · 2007 · https://raypeat.com/articles/articles/progesterone-summaries.shtml

> An average person produces about 30 milligrams daily during the 2nd two weeks. The solution I have used contains approximately 3 or 4 milligrams of progesterone per small drop. Three to four drops, or about 10 to 15 milligrams of progesterone, is often enough to bring the progesterone level up to normal. That amount can be taken days 14 through 28 of the menstrual cycle; this amount may be repeated once or twice during the day as needed to alleviate symptoms.
>
> Since an essential mechanism of progesterone's action involves its opposition to estrogen, smaller amounts are effective when estrogen production is low, and if estrogen is extremely high, even large supplements of progesterone will have no clear effect; in that case, it is essential to regulate estrogen metabolism, by improving the diet, correcting a thyroid deficiency, etc. (Unsaturated fat is antithyroid and synergizes with estrogen.)
>
> **PERIMENOPAUSAL**
> The symptoms and body changes leading up to menopause are associated with decreasing production of progesterone, at a time when estrogen may be at a lifetime high. The cyclic use of progesterone, two weeks on, two weeks off, will often keep the normal menstrual cycle going. Three to four drops, providing ten or twelve milligrams of progesterone, is typical for a day, but some women prefer to repeat that amount. Progesterone is always more effective when the diet contains adequate protein, and when there isn't an excessive amount of unsaturated fat in the diet.
>
> **POSTMENOPAUSAL**
> Some women continue the cyclic use of progesterone after menopause, because the pituitary gland and brain may continue to cycle long after menstruation has stopped, and progesterone is an important regulator of pituitary and brain function. The cycling pituitary affects the adrenal glands and other organs, and progesterone tends to protect against the unopposed actions of prolactin, cortisol, and adrenal androgenic hormones.
>
> Progesterone's effects on the pituitary apparently contribute to its protective effect against osteoporosis, hypertension, hirsutism, etc. But some women prefer to use progesterone without interruption after the menopause, for its protective antistress effects. Slender people usually find that two or three drops are enough, but this amount may be repeated once or twice as needed to relieve symptoms.

### Source 3 — Biology, Health, and Humanness with Ray Peat

Ray Peat · Interview · May 21, 2021

> **Ray Peat:** All of these tissues are internally producing estrogen and the enzyme systems that normally should be inactivating that locally produced estrogen for preparing it for excretion in the urine or bile. Those enzymes activity is changed in the absence of progesterone so that now those systems intensify instead of part of the estrogen being inactive estrone, the balance shifts towards the powerful estradiol. And instead of being sulfated or glucuronidated to inactivated for excretion, any that your liver has already inactivated is reactivated by cutting off the sulfate and the glucuronic acid. and restoring the full active estrogen. All of this because of the loss of progesterone and the increase of stress after menopause. So the fact that women are, the difference between menstruating women and menopausal women is great. Women after menopause become similar to men and there's susceptibility to the dangerous COVID infections. And in old age, I think women are even slightly more at risk than very old men of the same category.

### Source 4 — From PMS to Menopause: Female Hormones in Context

Ray Peat · Book · 1997

> **Ray Peat:** This is the central mechanism by which the estrogen-containing contraceptives work: at any stage of pregnancy, a sufficient dose of estrogen kills the embryo. Polvani and Nencioni,5 among others, found that in women, the onset of menopause (the first missed period, suddenly increased bone loss, nervous symptoms such as depression, insomnia, and flushing) corresponds to the failure to produce progesterone, while estrogen is produced at normal levels. This results in a great functional excess of estrogen, because it is no longer opposed by progesterone. Typically, it takes about four years for the monthly estrogen excess to disappear. They suggested that the bone loss sets in immediately when progesterone fails because cortisol then is able to dominate, causing bone catabolism; progesterone normally protects against cortisol. Other researchers have pointed out that estrogen dominance promotes mitosis of the prolactin-secreting cells of the pituitary, and that prolactin causes osteoporosis; by age 50, most people have some degree of tumefaction of the prolactin-secreting part of the pituitary. But estrogen dominance (or progesterone deficiency) also clearly obstructs thyroid secretion, and thyroid governs the rate of bone metabolism and repair. Correcting the thyroid and progesterone should take care of the cortisol/prolactin/osteoporosis problem. P. M. Wise 4 has demonstrated that the "menopausal" pituitary hormones, high levels of LH and FSH, are produced because the regulatory nerves in the hypothalamus have lost their sensitivity to estrogen, not because estrogen is deficient. In fact, he showed that the nerves are desensitized precisely by their cumulative exposure to estrogen. If an animal's ovaries are removed when it is young, the regulatory nerves do not atrophy, and if ovaries are transplanted into these animals at the normally infertile age, they are fertile.

### Source 5 — One Radio Network: Ray Peat with Patrick Timpone — October 18, 2021

Ray Peat · Interview · Oct 18, 2021

> **Ray Peat:** Yeah, gold is antiseptic the way amalgam is, but since silver... and the mercury are much more soluble, they're the worst ways to have a permanent filling. But a gold crown intrinsically is powerfully germicidal and it doesn't dissolve toxins into your body to any extent.
>
> **Patrick Timpone:** Yeah, yeah, interesting. Here's a lady. She turned 40 in December. I turned 40. Presently, I'm struggling with the changes in my body. This past winter, I started dealing with migraines around the time of my period. I knew immediately that something was awry and started revisiting Dr. Peat's work. The migraines seemed to be abated. for now, but now I do suffer from premenstrual headaches. The most pressing issue currently is that I gained an unexpected bit of weight over the last year or so, very unusual for me. I feel like I have a pregnant belly. If I let my belly relax, my sex drive is also not where I'd like it to be. So she's really going through it with, I guess, perimenopause, right, going through menopause. Is it possible that I am still recovering from estrogen dominance and now my body is in a healing mode?

### Source 6 — Body temperature, inflammation and aging

Ray Peat · Newsletter · 2020

> Besides the misinterpretation of thyroid physiology, probably the biggest muddle in biological doctrine is the interpretation of the decline in temperature at menopause. Younger, cycling, women have slightly higher average temperatures than men and postmenopausal women. Because of advertising, menopause has been defined as the failure of the ovaries to produce estrogen; the definition created an enormous market for estrogen replacement treatments. When women cycle, their ovaries produce very large amounts of progesterone, and progesterone causes a sharp increase in temperature. Estrogen antagonizes progesterone’s functions, including its thermogenic effect. In rat studies, within a week of removing their ovaries, their serum estrogen level has returned to normal, because all parts of the body produce estrogen. When the menstrual cycles stop, the ovaries stop producing progesterone (while all parts of the body keep producing estrogen), with the result that the body temperature falls, becoming similar to that of men of the same age. Estrogen independently causes vasodilation and increased heat loss (Charkoudian, et al., 2017). Estrogen, in a variety of ways, lowers body temperature (for example, Laudenslager, et al., 1982; Baker, et al., 1994).
>
> Starting suddenly around the time of menopause, cortisol is higher, probably as compensation for the lost stabilizing effects of progesterone, and the increased inflammatory processes resulting from lower body temperature. Aromatase, the enzyme that produces estrogen, is present in muscles, fat, blood vessels, and many other tissues, and its activity is increased by cortisol, and decreased by progesterone. The changed activity of these two steroids at menopause can account for the sudden increase in the degenerative diseases, inflammation, depression, etc. Atherosclerotic blood vessels and osteoporotic bones contain increased amounts of aromatase; the increased aromatase corresponds to increased extracellular matrix and the development of fibrosis. Bright light, which is thermogenic (Danilenko, et al., 2013), suppresses the level of cortisol (Jung, et al., 2020). Thousands of publications have tried to explain all the unpleasant effects of aging in women as the result of a deficiency of estrogen, trying to justify the sale of estrogen supplementation to treat the degenerative processes that are closely associated with the increased aromatase and local production of estrogen.

### Source 7 — Tissue-bound estrogen in aging

Ray Peat · Article · 2006 · https://raypeat.com/articles/articles/tissue-bound-estrogen.shtml

> The menopause itself is produced by the prolonged exposure to estrogen beginning in puberty, in spite of the monthly protection of the progesterone produced by cycling ovaries. The unopposed action of the high concentration of tissue-bound estrogen after menopause must be even more harmful.
>
> The decline of the antiestrogenic factors in aging, combined with the increase of pro-estrogenic factors such as cortisol and prolactin and FSH, occurs in both men and women. During the reproductive years, women's cyclic production of large amounts of progesterone probably retards their aging enough to account for their greater longevity. Childbearing also has a residual antiestrogenic effect and is associated with increased longevity. Being aware of this pervasive increase in estrogen exposure with aging should make it possible to marshal a comprehensive set of methods for opposing that trend toward degeneration.
>
> [references]

### Source 8 — One Radio Network: Ray Peat with Patrick Timpone — October 18, 2021

Ray Peat · Interview · Oct 18, 2021

> **Ray Peat:** Around the late 30s and into the 40s and 50s, the failure of progesterone is the main problem related to menopause and premenstrual syndrome. And the pharmaceutical industry was responsible for creating the idea that the menopause is a deficiency of estrogen when in reality it's a deficiency of progesterone. And if your thyroid is being blocked progressively by stress or a in adequate diet or rising estrogen, the production of progesterone is largely the consequence of this. So as estrogen rises, thyroid and progesterone decline. That means that your digestive system is going to be sluggish and tend to increase the endotoxins absorbed from a sluggish intestine. And all of those processes interact. So cleaning out the intestine by having a very fibrous food every day. Very often that will break the whole cycle of migraine and related symptoms. But the reason the intestine needs the fiber to work properly is because it's under energized by the decreasing thyroid. And so supplementing thyroid is very similar to supplementing fiber in your diet. It gets the endotoxin down, gets your intestine working.

### Source 9 — #43 - All things hormones, metabolism and health with Dr Ray Peat & Emma Sgourakis

Ray Peat · Interview · Apr 4, 2021

> **Kitty Blomfield:** Yeah, it's really sad, isn't it, how so many doctors just tell women to go on the pill and... From such a young age too.
>
> **Emma Sgourakis:** Oh, and it's very, you know, it's a convenience thing too for women and you'd hear it all the time too. You sort of might allude to them, you know, looking into the pill and perhaps questioning taking it. And one of the first things you'll hear from young women is, oh, but it's so convenient as a contraception, but I'd be terrified to come off it. What if I felt pregnant? And all the concerns that way, but... look at the bigger picture and how dangerous it is and is it worth it for the sake of convenience? You know, there's other ways to avoid conception. Think of your overall health and longevity. And Ray, what about menopause?
>
> **Kitty Blomfield:** So we get a lot of women message us and they've been to the doctor and they're going through menopause and the doctor says, oh, you're low in estrogen, you need more estrogen. Can you talk about what causes menopausal symptoms and about this misconception?
>
> **Ray Peat:** Yeah, in both animal studies, our lab was working on animal aging. And so the equivalent of menopause menopause was the concentration of everyone's work. And people worked on different interpretations. And the official medical view was that the running out of eggs in the ovary, some doctors still talk about that, eggs are depleted and no longer ovulate just because they are used up because you only have as many as you were born with or developed very early in your life. And so they blame the ovary as the source of menopause. But we were, everyone in our lab working on a different Part of the problem showed that it wasn't the pituitary particularly. It definitely wasn't the uterus. But the amount of estrogen exposure that the pituitary received caused the pituitary to age. So it was... ultimately estrogen, aging the pituitary, causing the failure of the uterus to be receptive. But the estrogen effect on the uterus was continued even after the animal's equivalent of menopause. And from the very oldest animals, some of their uteruses showed all of the signs of collagen accumulation, dark coloring, looking like an exaggerated form of the pregnant uterus, which existed because of aging and senescence, not a lack of estrogen. And my concentration was on showing that in the aging hamster, all of their tissues showed increased influence of estrogen with aging. And one of our lab people, Terry Parkening, later went on when the assays for the actual tissue content of estrogen became available. He showed that in other animals, the actual tissue content of estrogen increased in old age. I was just showing that the signs of estrogen were all increased in old age. And when you measure estrogen in the blood, the active form of estrogen is oil-soluble but not water-soluble. That means it stays inside oil-loving cells and doesn't get out into the bloodstream.

### Source 10 — One Radio Network: Great Monthly Talk with Ray Peat PhD (August 17, 2020)

Ray Peat · Interview · Aug 17, 2020

> **Ray Peat:** Yeah, too much progesterone in a boy around puberty is able to interfere, prevent the testosterone production that will start around the age of 9 or 10. The testosterone starts rising slowly, so you don't want to be exaggerated and used, but it does help to protect an atrophy process such as dystrophy of the muscles.
>
> **Patrick Timpone:** Do women going through perimenopause in that era tend to need a little testosterone hit?
>
> **Ray Peat:** No. If they are watching their their thyroid and protecting their liver. The main thing is to not let estrogen production get out of control because aging, menopause, all of the stressful changes tend to activate the process of estrogen inside cells, not in the ovaries, but inside every cell of the body. Stress turns on the local production of estrogen, which isn't going to get measured in your bloodstream. But if you took out a piece of tissue from a stressed person over the age of 55 or so, you're going to find a higher amount of internal estrogen and the aromatase enzyme that produces it. And if your cholesterol blood level doesn't increase steadily with age, your ability to produce your own progesterone and testosterone is going to be limited in proportion to the lack of available cholesterol.

### Source 11 — Stress & Weight Gain, Estrogen & Endotoxins w/ Georgi Dinkov

Georgi Dinkov · Interview · Apr 16, 2019 · https://www.youtube.com/watch?v=Wv7pQ71TC1s

> **Georgi Dinkov:** The circulatory system just carries it around and delivers it to tissues. So yes, after menopause, the ovaries fail and they stop producing estradiol and progesterone. But unlike progesterone, which is mostly produced in the ovaries... all the other cells, as I mentioned earlier, can still produce estrone and estrone sulfate. So postmenopause state really is a state of deficiency of progesterone and an excess of estrone sulfate, which can easily convert into all of the other estrogens. This has been proven many times. And by the way, many endocrinologists know about it. But basically the story at this point is so ingrained into people's minds that menopause is a state of estrogen deficiency. And there's also huge money being poured into it. Many companies want to treat menopause with hormonal, basically with a birth control pill. And many studies came out that said this is a bad idea, but these studies are now being attacked. The biggest one is known as the Women Health Initiative. It proved conclusively that giving postmenopausal women estrogen, it increases dramatically the risk of heart attacks, cancer, not just breast cancer, but any cancer. Remember I mentioned estrogen being if making cells grow means you expect it to be a carcinogen, right? It's labeled as a carcinogen. Alzheimer's disease, Parkinson's disease, strokes, osteoporosis, all that's the other thing. So the official version is that women develop osteoporosis after menopause because there's deficiency of estrogen. It's not. If you measure prolactin and estro sulfate, which are two surrogates, very good measurements of the total body load of estrogen, you'll see that both are high. It's progesterone that is low. And a few studies, they're not that many because officially medicine doesn't want to attack the estrogen idea, but the few studies that have been done with postmenopausal women where they were given progesterone showed a reversal of osteoporosis.

_Generated 2026-07-20 from the Bioenergetic Oracle corpus._