Dramatic estradiol fluctuations in perimenopause may result from the body's difficulty in recruiting eggs, leading to inconsistent ovulation and estrogen surges.

“So why is it that in pmenopause um the fluctuations in estradiol level are so dramatic? 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, you know, sort of bucket of eggs that you're born with and sort of, and that's again controversial on the internet. Um, and then so, 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, you know, or push out two eggs sort of in this permenopause cycle. So we can sometimes see really elev like high elevations which can come with symptoms and that's the challenge of pmenopause 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 on 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 you know that is a lot of pmenopause symptoms”