During perimenopause, fluctuating and declining estrogen levels weaken our immunity, making respiratory and general infections such as colds and flu more frequent and sometimes more severe. This vulnerability is due to several biochemical and immunological changes unique to this life stage.

Estrogen’s Role

Perimenopause increases infection risk due to hormonal changes—primarily the decline in estrogen—that weaken mucosal barriers and impair immune defense mechanisms. Estrogen has profound and complex effects on immunity, contributing to both increased resistance to infections and heightened susceptibility to autoimmune conditions in women.

Estrogen generally has an immune-enhancing effect, stimulating both the production of antibodies and cellular immune responses. Higher estrogen levels, such as during pregnancy or specific phases of the menstrual cycle, are associated with strong immune defenses and anti-inflammatory effects.

Women typically mount stronger immune responses than men, resulting in better pathogen clearance, but also increased rates of autoimmune and inflammatory disorders. These sex-based immune differences are more evident during hormonal transitions such as puberty, pregnancy, perimenopause, and through hormone therapy.

However, as estrogen levels decline with age, the production of protective cytokines and antibodies decreases, impairing effective pathogen clearance. Lower estrogen levels reduce the thickness and moisture of the respiratory tract mucosa, weakening the physical barrier to infection and increasing pathogen entry, which leads to higher infection rates.

Perimenopause and Inflammation

Perimenopause is associated with a rise in systemic inflammatory markers, which fuels chronic inflammation but reduces targeted immune responses against viruses and bacteria. A shift in both oral and respiratory tract microbial communities may further decrease immune resilience and increase susceptibility to respiratory pathogens.

Immune Responses in Clinical Practice

What I see in my clinical practice: Women entering menopause earlier experience increased rates of respiratory symptoms, lower lung function, and accelerated lung function decline—correlated with reduced estrogen exposure.

Pre-menopausal women generally show stronger immune responses to respiratory viruses than postmenopausal women, with clinical reports noting higher incidence and severity of common colds and influenza in the latter group.

Sex differences in virus susceptibility and severity (e.g., influenza, rhinovirus, COVID-19) are partly due to estrogen modulation of respiratory tract immunity; loss of estrogen shifts the balance toward increased risk.

Supporting Your Immune System through Perimenopause and Menopause

Perimenopause heightens risk for respiratory and general infections due to hormonal changes that compromise both immune cell function and mucosal defenses. This translates to greater frequency, duration, and sometimes severity of illnesses like colds and flu—underscoring the clinical importance of immune support during this transitional period.

If you are looking for additional support during this cold and flu season, here is my Free Guide in which I share my favorite supplements and botanicals I always keep on hand to boost the immune system.

Your Next Step

Don’t navigate this chapter alone. Book a Hormone Strategy Session so we can create a plan that helps you move through this transition feeling calm, clear, and powerful.

Be well,
Dr. Talina Hermann