(And Why The Pg/E2 Ratio Deserves More Attention Than It Gets)
When I posted the screenshot of my saliva test on IG, my DMs lit up with people saying some version of, “Wait… this is me, but no one has ever explained it like this.” Which is exactly why this story matters.
A big turning point for me was talking about all of this on Hit Play Not Pause with Selene Yeager. If you want the deeper conversation on hormones, motivation, and performance in a menopausal body, you can listen to the full episode here:
“Rethinking the Rules: Peak Performance in a Menopausal Body”
That episode cracked open a truth I wish I’d learned years earlier: there is a massive difference between lacking motivation and being physiologically unable to initiate movement. And the Pg/E2 ratio was the missing puzzle piece I didn’t know to look for.
This is the deeper, behind-the-scenes version. The science. The lived experience. The gatekeeping. The path forward.
Let’s get into it.
When The “Motivation Toolbox” Stops Working
By the time all of this hit in 2019, I was already a multi-marathoner. A coach. Someone who had every mental skill available to drag myself out the door on even the worst days.
Except suddenly… none of it worked.
Not the “just walk and turn back if you need to” trick.
Not the count-down-from-five trick.
Not the “reward yourself if you go” trick.
Not discipline, not structure, not habits.
I wanted to run. My body would not respond.
It felt like someone had unplugged me from my own life.
Then I heard another woman on HPNP talk about the same strange paralysis. She didn’t frame it as laziness. She described new hesitations, irrational fears, and a body that suddenly didn’t feel like hers. Her doctors traced it back to extremely low Estradiol.
That episode planted a seed. I started paying closer attention to the whispers athletes never say out loud:
“I can’t make myself drive at night anymore.”
“I freeze on the bike jumps I used to sail.”
“I can’t climb the same routes.”
“I don’t feel like myself.”
It wasn't exactly the same but it sounded very familiar.
Estradiol Isn’t Just About Periods
Here’s what the average person is never told: Estradiol talks directly to the parts of your brain that handle motivation, reward, confidence, mood regulation, and focus. It influences dopamine, serotonin, cognition, and how “switched on” your nervous system feels.
When Estradiol is low, unstable, or out of sync with the rest of your hormonal landscape, you can feel like someone swapped out your brain.
Not depressed.
Not burned out.
Not unmotivated.
Just… shut down.
This isn’t about willpower.
It’s chemistry.
But Estradiol Isn’t Working Alone
(The ratio is the real plot twist.)
Most conversations stop at “low Estradiol.” But that’s not the whole picture.
You’ve also got progesterone, which affects calm, emotional steadiness, and how reactive your stress response feels. And testosterone, which affects confidence, strength, drive, and recovery.
Three major hormones. One shared ecosystem.
When people talk about the Pg/E2 ratio, they’re talking about how progesterone and estradiol are interacting. You can have Estradiol “in range” and progesterone “in range” but still have a ratio that makes you feel:
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Flat or numb
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Paralyzed or hesitant
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Foggy
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Overwhelmed
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Disconnected from your own ability to initiate movement
It’s the relationship between the hormones that determines how your nervous system functions. The interplay. The chemistry between them.
That ratio is where my symptoms finally made sense.
My “There It Is” Moment In The Doctor's Office
My blood work had always come back “fine.” Nothing catastrophic. Nothing concerning. Nothing anyone felt the need to address.
But when my endocrinologist pulled up the saliva test and the Pg/E2 ratio was wildly off, I jumped out of my chair and yelled, “THERE IT IS.”
I scared that poor man half to death. But I also finally understood what my body had been trying to tell me.
He adjusted my estrogen/testosterone cream and within a few weeks, the paralysis began to ease. My ability to initiate movement came back. Not instantly, but reliably. And eventually, I started feeling like myself again.
Not because of discipline.
Not because of hustle culture.
It wasn't my damn identity or that I needed to try harder.
The relief came because we stopped looking at hormones in isolation and started looking at how they were communicating.
Why This Gets Missed
(Spoiler: it’s not your fault.)
The system wasn’t built to evaluate symptoms like:
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sudden hesitations
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loss of drive
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emotional flatness
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unfamiliar fear
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athletic confidence dropping off a cliff
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the inability to start movement
We built hormone care around hot flashes, fertility, and bone density. Everything else gets chalked up to “stress,” “mindset,” or “age.”
Athletes get dismissed even more quickly because they “look healthy.”
People in surgical menopause get dismissed because they’re “too young.”
And everyone else gets told “your labs are fine” as if fine is the same as functional.
It’s not.
Reclaiming Your Agency
You can’t force the system to change overnight, but you can change how you walk into it.
Here’s what helps:
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Track what’s actually happening: energy, sleep, motivation, hesitations, mood shifts.
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Bring clarity to your appointments instead of apologizing for your symptoms.
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Ask about ratios, not just raw numbers.
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Advocate for Estradiol, progesterone, and testosterone to be evaluated together.
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Work with providers willing to treat your lived experience, not just your lab range.
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Adjust training to support your nervous system while you sort things out.
You deserve care that integrates all of this, not care that ignores anything that doesn’t show up neatly on a lab printout.
The Real Message
If you’ve been sitting on the couch, desperate to move but unable to cross your own doorway, please hear me:
You’re not weak.
You’re not lazy.
You’re not broken.
And you’re definitely not alone.
Your hormones influence the very systems that govern motivation. When the Pg/E2 ratio is off, you can feel like you’re losing the spark that used to power you.
This isn’t a flaw.
This is physiology.
Your job is not to push harder.
Your job is to get curious.
You deserve care that reflects your entire internal landscape — not just the parts the medical system decides to measure.
If you want to hear the full conversation, the depth, the nuance, and the lived experience behind all of this, you can listen to my episode on Hit Play Not Pause here:
“Rethinking the Rules: Peak Performance in a Menopausal Body”