How Perimenopause Changes Your Immune System (and What to Do About It)

You're getting every cold, and it's taking forever to recover

You used to shake off a cold in a few days. Now a minor bug wipes you out for two weeks. Or maybe your asthma is flaring more than it used to. Or a condition you thought was under control, like psoriasis or rheumatoid arthritis, has become harder to manage.

These patterns may not be coincidental. Estrogen is deeply involved in how your immune system functions. As estrogen levels fluctuate and decline during perimenopause, your immune response changes in ways that are measurable, meaningful, and often surprising.

Understanding this connection doesn't make the symptoms disappear. But it does help you make sense of what your body is doing, and it points toward strategies that can genuinely help.

Estrogen's role in your immune system

Estrogen is immunomodulatory. That's the technical term for the fact that it actively shapes how your immune system responds to threats and how much inflammation your body produces.

Estrogen receptors are found throughout the immune system, on T cells, B cells, natural killer cells, and macrophages. These are the cells that orchestrate your body's defense responses. Estrogen tends to enhance the activity of these immune cells, supporting a more vigorous response to pathogens while also helping to regulate the inflammatory process so it doesn't go into overdrive.

When estrogen levels fluctuate unpredictably during perimenopause, immune regulation becomes less stable. The result can go in two directions. Sometimes the immune system becomes less effective at fighting infections. Sometimes it becomes overactive in ways that produce more inflammation. Both can happen in the same person at different times.

Increased infections and slower recovery

Many women in perimenopause notice they get sick more often, take longer to get well, or find that infections that would have been minor now leave them wiped out for longer.

This reflects real changes in immune efficiency. Estrogen supports the production and activity of antibodies and enhances the function of natural killer cells, which are your first-line defense against viral infections. As estrogen levels decline, some of that immune advantage fades.

Sleep disruption, which is extremely common in perimenopause, compounds this significantly. Immune function and sleep are deeply intertwined. Your body does critical immune repair and consolidation during sleep, particularly in the deeper stages. When perimenopause-related night sweats or hormonal shifts are fragmenting your sleep, your immune resilience takes a direct hit.

Stress is another compounding factor. Cortisol, elevated by chronic stress, suppresses immune function. If you're navigating perimenopause alongside significant life demands, which is most women at this stage, the combined load on your immune system is real.

Autoimmune conditions and perimenopause

Autoimmune conditions are significantly more common in women than in men, and a large portion of autoimmune diagnoses occur during the perimenopause transition. This is not a coincidence.

Estrogen has a complex relationship with autoimmunity. At consistent levels, estrogen helps regulate immune tolerance, the process by which your immune system learns not to attack your own tissues. The unpredictable swings of perimenopausal estrogen can disrupt this regulation.

Conditions like rheumatoid arthritis, Hashimoto's thyroiditis, lupus, and psoriasis can flare or become newly apparent during perimenopause. If you have a pre-existing autoimmune condition, your disease activity may shift in ways that catch you or your provider off guard.

If you notice new joint pain, skin changes, thyroid symptoms, or unusual fatigue patterns that don't track neatly with your cycle, bringing this up with your provider is worth doing. Thyroid function in particular is worth checking during perimenopause, since thyroid disorders and perimenopause share many overlapping symptoms, including fatigue, brain fog, weight changes, and mood shifts.

The chronic inflammation problem

One of the most significant immune changes in perimenopause is a shift toward chronic low-grade inflammation. Researchers have begun calling this "inflammaging," a term for the baseline increase in inflammatory signaling that occurs with both aging and hormonal transition.

Estrogen normally suppresses the production of pro-inflammatory cytokines, the chemical messengers that drive inflammation. As estrogen declines, this suppression weakens. The result is a persistent, low-level inflammatory state that doesn't feel like an acute infection or injury. It's subtler than that.

But its effects are widespread. Chronic low-grade inflammation is implicated in joint pain and stiffness, the kind many women first notice in perimenopause. It contributes to brain fog, because neuroinflammation affects cognitive processing. It's involved in gut symptoms, as intestinal inflammation affects motility and comfort. And over time, it is a driver of the cardiovascular and metabolic risks that increase in postmenopause.

Reducing chronic inflammation is one of the most impactful things you can do for your health during and after perimenopause. It's not just about feeling better now. It's about your long-term trajectory.

What helps: the immune support toolkit

Several well-supported approaches can help your immune system navigate the perimenopausal transition.

Sleep is the most important foundation. Aiming for seven to nine hours in a cool, dark room, maintaining a consistent wake time, and addressing night sweats directly (whether through temperature management, layer strategies, or medical treatment) pays dividends in immune function.

Anti-inflammatory nutrition matters significantly. A diet rich in colorful vegetables, berries, fatty fish, olive oil, nuts, and legumes provides the antioxidants and omega-3 fatty acids that directly counter the inflammatory shift of perimenopause. Ultra-processed foods, refined carbohydrates, and excess sugar actively drive inflammation and are worth reducing.

Regular movement, particularly aerobic exercise, has well-documented anti-inflammatory effects. Exercise promotes the production of anti-inflammatory cytokines and supports immune surveillance. Consistent moderate exercise supports immunity; intense training without adequate recovery can temporarily suppress it, which is worth keeping in mind if your energy is already compromised.

Key nutrients with evidence for immune support include vitamin D, which many women are deficient in and which is central to immune regulation. Zinc supports both innate and adaptive immunity. Magnesium is involved in hundreds of enzymatic processes including immune function. Talk to your healthcare provider before adding supplements, particularly if you take prescription medications or have health conditions.

Stress management is not optional at this stage. Chronic psychological stress directly suppresses immune function through cortisol pathways. Practices like mindfulness, gentle yoga, and time in nature have demonstrated immune-supportive effects in research.

Tracking what changes and when

Because perimenopausal immune changes can be subtle and varied, tracking your patterns over time helps you see what's happening. Logging in PeriPlan when you get sick, how long recovery takes, when joint pain flares, and where you are in your cycle can reveal connections that are easy to miss in real time.

For example, you may notice that you're more susceptible to infections in the low-estrogen phase of your cycle, or that joint stiffness is worse when sleep has been fragmented. That kind of pattern recognition gives you and your provider useful information.

If infections are becoming frequent or severe, if an autoimmune condition is flaring in new ways, or if you're experiencing symptoms that feel different from typical perimenopausal patterns, seeing your provider for evaluation is the right move. Some immune shifts in perimenopause are expected. Others benefit from targeted assessment.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.