Hormones | Stages | Symptoms | Hormone Therapy | Male Menopause

Menopause is a point of passage that every woman who reaches her 50’s will experience. When a woman reaches about age 50 to 51, the hormones that have driven her menstrual cycles change as the focus on reproduction wanes and she moves to a new phase in her life. Dr. DeMasters has described it as moving from the re-productive to the productive years. Margaret Mead coined a phrase for the energy and new direction that many women feel after menopause: menopausal zest. It can be difficult, however, to focus on this “zest” when fighting a hot flash.

With good health habits, a woman’s life span could reach well into her 80s or many years beyond. Menopause is a time to be proactive. Learning more about how your body works, what risk factors you face, and what options you have for maintaining your health are good ways of reducing the likelihood of health problems like heart disease, osteoporosis and Alzheimer’s disease. Collaboration with your health care providers is essential to making empowered choices about your health that can make the difference in the quality of your life for many years to come.

What is menopause?
Medically speaking, menopause is a discreet, one-time event: your last menstrual period. The ovaries stop releasing an egg every month because the body no longer produces enough estrogen to maintain the reproductive cycle. Progesterone levels also fall, and menstrual cycles usually become irregular before eventually stopping altogether.

When menopause occurs as part of the natural aging process, it comes on gradually. In the months preceding your final period, however, you may experience changes in menstrual flow and irregular periods with months between cycles. You won’t be certain that menopause has occurred until you’ve gone at least 12 months without a period. It is not unusual to think that menopause is here because nine or ten months have passed without menstruation only to be surprised by a menstrual period and then you have to start counting all over again.

There are, however, two very important things to remember during these months of irregular menstrual cycles:
Unexplained vaginal bleeding — This may be a sign of a significant health problem and should be assessed by your health care provider. Don’t assume that “anything and everything is normal in menopause” and don’t hesitate to talk with your health care provider.

Fertility — Pregnancy can occur during the sporadic menstrual cycles that precede menopause. A mid-life baby is a term our mothers and grandmothers used to describe this phenomenon. Remember that contraception remains an issue until menopause is confirmed by twelve consecutive months without a period.

In contrast to the gradual onset of age-induced menopause, surgical removal of the ovaries (such as with hysterectomy) results in a rapid and premature menopause. In these cases, the symptoms of menopause occur quickly and are often more severe than in age-related menopause.

Even if one of the ovaries is left intact following surgery, menopause frequently occurs within two years. Certain treatments for cancer, such as radiation or chemotherapy can also hasten menopause. Sometimes the ovaries unexplainably shut down very early (before age 40.) This is called premature ovarian failure (POF). For women who experience POF but want to have children, a medical specialist called a reproductive endocrinologist should be consulted.

(NOTE: POF has health implications beyond the issue of fertility. There are significant health risks to address – especially in terms of bone health. To determine whether you are in POF, your health care provider will do at least two blood tests measuring Follicle Stimulating Hormone (FSH). If your levels are consistently over 30, if you have gone four months or more without a period, if you are experiencing menopausal symptoms such as hot flashes – POF is suspected and it is time to look at hormone replacement therapy to protect your health.)

Your body tissues respond to hormonal changes--your reproductive organs, the hypothalamus (which regulates body temperature), skin, bone, the digestive and urinary systems, even your brain, all have structures called receptor sites that receive the hormone estrogen. Any tissues with estrogen receptor sites respond to the decline in estrogen, resulting in a variety of body changes.

return to top
What are the hormones of menopause?
Understanding estrogen is essential to unraveling the mysteries of menopause. Women actually produce three different estrogens:

• Estriol
• Estradiol
• Estrone

Estriol is a weak estrogen that’s most abundant during pregnancy, and otherwise is present in small amounts in your blood. Estradiol, which is produced by your ovaries, is the most powerful of the estrogens. After menopause, etradiol levels fall dramatically and estrone becomes the primary estrogen. Estrone is made in your body’s fatty tissues and is a much weaker estrogen than estradiol.

Estrogens serve many purposes in a woman’s body. These active, stimulating hormones were responsible for puberty, and as we age, they increase the body’s production of high-density lipoproteins (good cholesterol) that help protect women from heart disease in the pre-menopause years. Estrogens support the production of collagen, the connective tissue that keeps skin looking young. They also help maintain the strength and elasticity of your vaginal and bladder tissues.

Estrogen protects our bones and even keeps our gums plump and healthy. One of the primary tasks of estrogen is to build up the lining of the uterus in preparation to receive a fertilized egg and establish a pregnancy. As menopause approaches and the levels of estradiol fall, the body tries to “jump start” the ovaries to develop an egg-containing follicle by increasing the level of follicle-stimulating hormone (FSH). As we approach menopause, it takes more FSH to initiate the cycle. This is why rising FSH levels are considered a symptom of approaching menopause. FSH levels, however, can fluctuate and ovulatory cycles can occur sporadically. Eventually, the production of estradiol falls to such a low level that ovulation can no longer occur.

Progesterone is another important, multi-purpose hormone in the female lifecycle from adolescence through menopause. Progesterone (also produced in the ovaries) protects us from too much estrogen in our reproductive years. Progesterone helps maintain pregnancies as it prepares the lining of the uterus for implanting the fertilized egg and maintains that lining to sustain the pregnancy. Fluctuating progesterone levels in the peri-menopausal years result in erratic menstrual cycles. Also, progesterone is thought to have antidepressant effects and to impact brain function, which explains the irritability, anxiety and other undesirable side effects of dipping progesterone levels around the time of menopause.

return to top
What are the stages of menopause?

• Peri-menopause begins 8-10 years before menopause, when the ovaries gradually produce less estrogen. Peri-menopause continues until menopause occurs and the ovaries stop releasing eggs. In the last one to two years of peri-menopause, estrogen levels fall rapidly, and many women experience menopausal symptoms (see below).
• Menopause is the point when a woman has gone without a period for 12 consecutive months.
• Post-menopause are the years after menopause. During this stage, menopausal symptoms, such as hot flashes, ease off for many women, but the health-related risks related to estrogen loss increase.

return to top
What are the symptoms of menopause?
Not every woman in the years surrounding menopause experiences hormonal symptoms – but most do have at least some of the following body changes related to falling estrogen levels, and the resulting atrophy of tissues throughout the body:

• Menstrual irregularities
• Hot flashes or hot flushes
• Fatigue
• Vaginal dryness
• Mood changes, tearfulness, anxiety, irritability
• Urinary incontinence and/or urinary frequency
• Increased risk for vaginal infections
• Vaginitis
• Changes in libido
• Short-term memory problems
• Joint stiffness

There’s a very intimate side of menopausal symptoms too. As vaginal tissues become tighter, thinner and drier, and you may notice a decrease in sexual lubrication. This can cause a condition known as dyspareunia, or painful intercourse. You may also experience a reduction in your desire for and enjoyment of sex. Women sometimes report a decrease in the intensity and the number of vaginal contractions during orgasm. Over-the-counter vaginal lubricants specifically designed for vaginal dryness are very helpful. K-Y jelly can also be used, but petroleum jelly is not recommended. Trying different sexual positions can be helpful in re-establishing comfort and enjoyment during intimacy. HRT is also a consideration for treating these menopausal symptoms. Estrogen or estrogen-plus-testosterone may be used to restore libido.

Then there are the subtle changes of menopause—less noticeable but more dangerous to your health including the accompanying alterations in cholesterol (blood lipid) levels put you at equal risk for heart attack as middle-aged men. Your health risk is actually greater because women are less likely to survive a heart attack than men. The risk for losing density and strength in your bones also increases after menopause because of falling estrogen levels, putting you at risk for fractures of the wrist, hip or vertebrae.

You may be one of the fortunate 10 percent of menopausal women who don’t experience any of the common signs and symptoms of menopause. Yet even if you don’t have hot flashes, vaginal dryness or other symptoms, your risks for heart disease, osteoporosis and other menopause-related health problems may still increase just because you are menopausal. Don’t assume that a lack of symptoms signals a lack of health risk.

return to top
Hormone Therapy (HT)
Hormone therapy (previously called “hormone replacement therapy”) — whether by replacing estrogen alone, or estrogen with a combined progesterone — is considered one of the most effective strategies for relieving menopausal symptoms and reducing the health risks that accompany them. Results of clinical research released in the past year shed some doubt on the efficacy of using HT long term. Every woman should become educated on what the most recent research findings say, how they fit with her own health history and personal health needs.

Dr. DeMasters has conducted extensive research on the issue of Hormone Therapy, publishing several chapters and presenting her research around the world. She is knowledgeable about alternative approaches to menopausal health and can help you design a plan that works for you with or without Hormone Therapy. She can help you find the answers to questions like:

• What is my risk for cancer, osteoporosis, etc.?
• Am I at risk for heart disease (the #1 killer of women)?
• If I decide I want HT what are my options?

A consultation with Dr. DeMasters can help you prepare for that important discussion with your doctor so that you are an active participant in decisions about your personal health. During your session, ask for a free copy of the book: Every Woman: The Essential Guide to Healthy Living. It includes the chapter on menopause written by Dr. DeMasters. Click here for contact information for Dr. DeMasters to get immediate assistance in learning about your options, seeking treatment and protecting your health.

return to top
Male Menopause
Can men actually go through menopause? Actually, men can experience the counterpart to menopause: Andropause. In Andropause, men experience the effects of fluctuating hormones (particularly falling testosterone levels) with symptoms that are similar to menopause in women – including:

• Fatigue
• Weakness
• Depression
• Changes in Sexual Function
• Fluctuations in Mood

This change in hormone balance is not a normal part of aging– because men can continue to make testosterone and continue sperm production well into their 80’s (though their fertility does wane a bit, it does not stop). They do not come to a cessation of their reproductive life stage as women do. Quite often this hormonal drop is the result of an illness such as diabetes or cancer.

Andropause can be treated by hormone replacement therapy. As it does in women, this treatment carries some risks. Replacing male hormones can worsen prostate cancer and perhaps atherosclerosis (hardening of the arteries). Depending on what route it is given, it can be hard on the liver as well.

This is a growing focus within the medical community and new information is coming forth all the time. For individualized information about male menopause, or for help in finding a health care provider that specializes in this condition, call for an in office or telephone consultation. Click here for contact information for Dr. DeMasters.