Menopause & Estrogen

Menopause represents the time in a woman’s life that menstrual periods stop due to the declining production of estrogen from the ovaries and marks the end of the reproductive years that began in puberty. The average age of menopause is 51 but it is normal to go into menopause anytime after the age of 40. Estrogen is made throughout the entire menstrual cycle with a second hormone, progesterone, being produced after ovulation. As menopause nears the ovaries make less estrogen which produces a change in the menstrual period. One or more periods may be skipped, the amount of flow generally becomes lighter, and the number of days of bleeding may vary.

Even though periods change as menopause approaches, it is not normal to have bleeding between periods, after sex, or more frequent than every three weeks. These problems should be reported to your doctor.

Menopause may also occur due to surgical removal of the ovaries. In this case, symptoms of menopause tend to be severe as hormone levels decrease all at once. Although removal of the uterus or hysterectomy stops menstrual periods, menopause does not occur unless the ovaries are also removed. When the ovaries remain after a hysterectomy menopause usually occurs at the normal time.

Menopause occurs naturally as part of the aging process and symptoms vary widely. Some women notice little difference while others find it difficult to cope. Common symptoms of menopause include hot flushes, sleep problems, vaginal and urinary tract changes, loss of bone mass, and emotional changes.

Hot flushes or hot flashes as some would say are quite frequent. As many as 75% of women will have them. A hot flush is a sudden feeling of heat that rushes to the face and upper body, lasting from a few seconds to several minutes. Hot flushes are not dangerous but may be quite a nuisance and frequently interfere with daily life. Hot flushes can also cause a lack of sleep which in turn affects your mood and ability to cope.

Bone loss occurs naturally with age but accelerates at menopause. Loss of bone mass increases the risk of fractures especially in the wrist, hip, and spine. Calcium supplements and vitamin D will help protect your bones as will weight bearing exercise.

Emotional changes such as nervousness, fatigue, and irritability are common but menopause does not cause depression. These symptoms may be related to a lack of sleep. Stress also makes the symptoms of menopause more difficult to manage.

Hormone therapy can help relieve the symptoms of menopause by replacing the estrogen and progesterone in some cases made in the ovaries. Hormone therapy is most often prescribed in pill form but may also be used in vaginal rings, patches, shots, and creams. Estrogen is used to treat the most common symptom of menopause, hot flushes. Estrogens also relieve vaginal dryness and may help the urinary tract. Estrogen also protects against bone loss and colon cancer. Other effects are more controversial, such as, help with dementia and the relationship to breast cancer.

Like any treatment, hormone therapy also has risks. In women with a uterus, the use of estrogen alone can increase the risk of uterine cancer. Taking a progesterone along with estrogen will help reduce the risk of uterine cancer but may be associated with an increase in the risk of breast cancer. There also is an increase in the risk of stroke and cardiovascular disease, especially in the first year of therapy. Risks also vary based on the amount of time between the onset of menopause and the initiation of hormone therapy. Due to the complexity of issues related to hormone use you should discuss this option with your doctor.

An alternative to hormone therapy is the use of herbal products. Herbal products are also controversial due to the wide variety of products available and the difficulty in establishing a standard dose. Some products contain estrogens, such as soy products and yams. Others are not estrogens, such as black cohosh, dong quai, evening primrose, valerian root, ginseng, and chasteberry. Studies of these products have given inconclusive results, although most seem ineffective in relieving the symptoms of menopause with black cohosh being the best. Please discuss herbal therapy with your doctor before beginning such agents and especially prior to surgery or other treatments.