Menopause: Hormonal Changes & Health Risks

 

Dr. Susan Love's Menopause and Hormone Book: Making Informed Choices

 

As perimenopause turns to menopause, the amount of estrogen and progesterone produced by the ovaries declines to low levels. This has a major impact on the body.

 

Sexual Problems Associated With Menopause

  • Loss Of Libido

Women need their hormones to have some type of sexual arousal. Without the estrogen, progesterone and testosterone produced by the female ovary, libido suffers and you may not feel like having sex in the same way that you did when you were younger.

In some cases, the woman needs to take small amounts of testosterone in order to bring the libido to normal. Talk to your healthcare provider if you think you might benefit from testosterone therapy.

The lack of estrogen affects the skin and connective tissue. The skin becomes drier and you need to apply more moisturizer. The amount of collagen produced by the body goes down as well as the amount of elastin. This causes the skin to have more wrinkles and reduced elasticity. There are many beauty products out there that can increase the collagen levels in the skin.

The lack of estrogen also affects the health of the vaginal tissue. Estrogen is important in having enough vaginal lubrication as well as in the thickness and elasticity of the vaginal lining. Without estrogen, the vaginal lining becomes thinner or atrophies, resulting in very little lubrication. This can cause pain during intercourse and can result in thinning of the urethral tissue so that the woman has an increased risk of bladder infections.

 

How is this treated?

Hormone replacement therapy given orally or by any of the other acceptable routes can increase the thickness of the vaginal mucosa and can prevent the dryness associated with menopause. For women who do not want to take a formal course of hormone replacement therapy, vaginal estrogen therapy can be provided.

Vaginal estrogen therapy is given by prescription. It can be given in several ways, including creams, tablets, or a vaginal ring inserted into the vagina. These provide local estrogen and do not appreciably increase the amount of estrogen in the bloodstream. They can increase the moisture in the vagina and can decrease pain with intercourse.

For those women who do not want to use hormones, there is a variety of over the counter lubricants and moisturizers that can be used to make intercourse more comfortable. Some are used on a regular basis, while others are used just prior to intercourse in order to lubricate the vaginal tissues.

SSRI therapy can be used for mood swings and for sleep deprivation. Other medications, such as mood stabilizers can be used to improve the overall state of your mood and emotions. Medications can be given for sleep and herbal remedies for sleep can be given to combat sleep difficulties in menopause.

 

 

Health Risks Following Menopause

  • Bone Density

Women in menopause also have a risk for developing bone loss, losing approximately 1% of bone mass within the first year, eventually increasing to 2%-3%. Estrogen is required to keep calcium in the bones and without it, the calcium leaches out of the bones and the bones become thin.

Mildly thinning bones is called osteopenia. Severely thinning bones is called osteoporosis. Osteoporosis can sometimes remain undetected until bone fractures occur.

Without the protective effect of estrogen, osteoporosis can result in vertebral fractures, particularly in the thoracic area. This results in the typical “dowager’s hump” seen in women who have had compression of the vertebrae in the thoracic area of the spine.

The bones of the wrist and hip also thin as a result of lowered estrogen levels. This causes an increased risk of fractures to each of these bones during a fall. When it comes to hip fractures, it is unclear as to whether the hip fractures prior to the fall or as a result of a minor fall. Either way, it can be very debilitating to suffer a fracture associated with osteoporosis, as they tend not to heal very quickly.

If a woman does not take extra calcium or has early menopause, she is at a much higher risk of developing thinning of the bones. You can help to alleviate the worst effects of osteoporosis by exercising too. Proper exercise helps to create a lot of calcium that strengthens bone structures, thus preventing bone fractures and breakages.

  • Heart Disease

Women often get heart disease later in life when compared to men but, as the estrogen level drops, the risk for heart disease goes up. As a result, a postmenopausal woman has an increased risk of developing heart disease, including heart attacks, stroke and peripheral vascular disease.

  • Stroke

Women after menopause have an increased risk of stroke. This is because cholesterol and calcium build up in the carotid arteries. Clots can then form in these arteries, resulting in a stroke. Medications to reduce cholesterol can be given to women with elevated cholesterol levels, which may reduce the risk of getting a stroke.

  • Peripheral Vascular Disease

The same is true of peripheral vascular disease. In peripheral vascular disease, however, the blood vessels affected are the arteries leading to the limbs, particularly the legs. Blood clots can form in the narrowed arteries, resulting in a loss of blood flow to the affected leg and a chance of developing gangrene of the leg. This may be treated by urgently removing the clot and expanding the size of the affected blood vessel.

  • Breast Cancer

Women after menopause have a greater risk of developing breast cancer, especially if they take unopposed estrogen for their hot flashes. Up to 1 in 8 women will develop breast cancer sometime in their lives and the risk goes up with age.

Regular mammograms can detect the presence of early breast cancer so that, if breast cancer is detected, it can be treated without having the cancer metastasize to other body areas.

  • Dementia or Alzheimer’s Disease

Estrogen may have an effect on a woman’s cognition. The reasons for this are unclear. Women past menopause are at a greater risk of developing age-related dementia or Alzheimer’s disease. Taking hormone replacement therapy may reduce the risk of these diseases from occurring.

 

 

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