In a woman’s younger years, the pituitary gland and ovaries engage in a cyclical feedback cycle that allows the pituitary gland to release FSH and LH so that the uterine lining can thicken in preparation for a fertilized egg. The ovaries respond by maturing and then releasing an egg each menstrual cycle. FSH and LH are responsible for sending the signal to the ovaries to make estrogen and progesterone to support the female reproductive system. Estrogen especially is a female hormone responsible for female secondary sexual characteristics and for stimulation of the uterine lining.
Eventually, the ovaries give out and quit producing much estrogen, progesterone and the small amount of testosterone it normally produces to enhance female libido. The periods become irregular and stop so that, once a woman has had no periods for 12 consecutive months, she is considered in menopause.
The time before menopause occurs is called peri-menopause. During this phase, the hormones fluctuate widely, even from day to day, and the woman gets the classic menopausal symptoms including the following:
• Hot flashes
• Night sweats
• Low libido
• Breast tenderness
• Irregular periods
• Worsened PMS symptoms
• Vaginal dryness
• Mood swings
• Urinary leakage or urinary urgency
While all of this is happening, the amount of estrogen the ovaries produce is gradually decreasing as the woman approaches menopause. The length of time a woman is in peri-menopause is about 4 years. A woman can begin menopause in her 40s but some women can start as early as in their 30s.
The average age at menopause is 51 but some women can have menopause between 40 and 59 years of age. If a woman has a lack of menstrual periods and failed ovaries before the age of 40, it is called “premature ovarian failure.”
Effects Of Hormone Loss
By the time a woman reaches menopause, many of the symptoms of hot flashes, night sweats disappear, and the hormone levels remain relatively stable. The FSH and LH from the pituitary gland are relatively high because the ovarian production of testosterone, estrogen, and progesterone are low. The predominant estrogen in menopause switches from estradiol to estrone.
The female body had, up until the time of menopause, been relying on estrogen to be protective against bone loss and heart disease. The risk of these things begin to increase as the woman reaches and passes menopause.
Bone loss leads to osteoporosis. Postmenopausal women at highest risk for osteoporosis are small-framed women and women who are inactive or are of Asian descent. The risk of getting osteoporosis is less if the woman had a good bone density at around age twenty. The higher the bone density at age 20, the lower is the risk of osteoporosis at age 65.
Without estrogen, the balance of calcium in bones is diminished and calcium begins to leach from the bone. If the bones begin to thin enough, the woman can develop fractures that occur without much provocation. Spinal fractures lead to dorsal kyphosis, commonly called the “dowager’s hump.” Hip fractures or wrist fractures can occur with a minor fall in the home. It is suspected that some of the time, the bone actually fractures before the fall and the woman falls because her hip has fractured.
The best way to counteract the bone loss is to take calcium supplementation through vitamin D-fortified milk or through calcium and vitamin D supplementation. This can decrease the rate of bone loss. There are medications called antiresorptive medications that help slow down the rate of bone loss and anabolic drugs that can actually put calcium back in bones.
The other risk factor that increases after menopause is the risk of heart disease. Without the protective effect of estrogen on the heart, women who reach menopause begin to catch up with men when it comes to getting heart attacks, strokes, and peripheral vascular disease. This is a time when women should otherwise decrease their risk for heart disease by exercising, lowering blood pressure, lowering cholesterol and being screened for diabetes.
Without estrogen, many women suffer from a loss of desire in sex. This can lead to problems in relationships, and all too often can lead to divorce. Recently, the FDA, after much persuasion from women with just such issues has decided to approve a new “Viagra” for women, the final approval process is not pending.