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Why Do Estrogen Levels Fall After Menopause

Menopause: Changes And Challenges

Bleeding After Menopause

Alta Bates Summit Medical CenterBerkeley, California

US Pharm. 2018;43:13-16.

Menopause is the cessation of menstruation in a woman, typically occurring between the ages of 45 and 55 years. Smokers and women with chronic diseases may experience earlier menopause.1 This is a natural biological process, not a disease.

Menopause and perimenopausethe period of transition beginning 2 to 8 years before and lasting up to 1 year after a womans final menstrual periodoccur because as women get older, the ovaries begin to shut down.1 Eventually, ovaries stop producing estrogen and other hormones. Since the body has depended on these hormones for years, when hormone levels decrease, the changes are noticeable and may result in emotional reactions and bodily changes.2 These may include physical symptoms, such as hot flashes, decreased energy levels, and sleep disruption, as well as mood-related symptoms, such as anxiety and depression. Over time, these symptoms gradually disappear.1 Although menopause ends fertility, women can stay healthy, vital, and sexual. This article will briefly review the physiology and types of menopause, signs and symptoms, and symptomatic treatment.

What Happens After Menopause

Will the hot flashes, mood swings, and other symptoms of menopause come to a halt when your periods are finally finished? Find out what to expect in the years after menopause.

Though you may have some idea of whats in store for you as you head toward menopause, the stage of life when the ovaries stop producing eggs and menstrual cycles dwindle, you may not quite know what to expect when your periods are officially over.

A woman is medically defined as being in menopause when she has not had a menstrual cycle for at least 12 months, says Kevin Audlin, MD, a gynecologist at Mercy Medical Center in Baltimore.

At that point, the transition into your non-child-bearing years is complete.

What Is Premature Menopause

Menopause, when it occurs between the ages of 45 and 55, is considered “natural” and is a normal part of aging. But, some women can experience menopause early, either as a result of a surgical intervention or damage to the ovaries . Menopause that occurs before the age of 45, regardless of the cause, is called early menopause. Menopause that occurs at 40 or younger is considered premature menopause.

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Prioritize Sleep And Relaxation

In addition to a hormone balancing diet you can help balance hormones naturally with simple lifestyle changes, starting with a sleep routine and schedule that spans over the weekend. Theres a significant relationship between cortisol and sleep, the infamous stress hormone can leave your adrenal glands depleted when its overactive.;

Our Tip: Leave the phone one hour before bed, avoid caffeine after 2:00 PM, and make relaxation time part of your schedule.

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Potential Roles Of The Hypothalamus And Pituitary In Menopause

How Long Does Menopause Last?

In rodents, ovaries from old donors undergo folliculogenesis and ovulation when transplanted to young ovariectomized hosts, providing evidence for a central contribution to reproductive failure with aging in rodents. Further studies have pointed to the importance of age-related alterations in estrogen positive feedback on GnRH secretion as at least one contributing mechanism. An important question is whether similar central mechanisms contribute to reproductive failure in women.

Studies in younger and older postmenopausal women suggest that there are effects of aging on the hypothalamus and pituitary that are independent of the loss of steroid feedback. After menopause there is a 3040% decrease in LH and FSH between the ages of 50 and 75, . Underlying these gonadotropin changes are complex effects of aging on GnRH secretion with a 22% decrease in GnRH pulse frequency that is partially compensated by a 14% increase in the overall amount of GnRH secreted over that due to the loss of ovarian function alone. There are also age-related effects at the pituitary with a 30% decrease in both LH and FSH responses to GnRH in older compared to younger postmenopausal women.

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Your Circadian Rhythm Is Off

The pineal gland is a small endocrine gland that is located in the brain. It produces melatonin, which affects circadian rhythm and the levels of other hormones in the body. A pineal cyst is a disorder of the pineal gland that may not produce any symptoms. If the cyst is large, it may produce symptoms including water on the brain , headache, eye problems, and vision problems. Large pineal cysts that cause problems usually affect women who are in their second decade of life.

What Are The Hormonal Changes During Menopause

The traditional changes we think of as “menopause” happen when the ovaries no longer produce high levels of hormones. The ovaries are the reproductive glands that store eggs and release them into the fallopian tubes. They also produce the female hormones estrogen and progesterone as well as testosterone. Together, estrogen and progesterone control menstruation. Estrogen also influences how the body uses calcium and maintains cholesterol levels in the blood.

As menopause nears, the ovaries no longer release eggs into the fallopian tubes, and youll have your last menstrual cycle.

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Understanding Estrogen Action During Menopause

There is a significant difference in the cardiovascular disease risk between men and women . Epidemiological studies have shown that the risk of atherosclerotic disease is low in premenopausal women and increases dramatically after menopause . The basis of differences in CVD risk has been attributed to declining levels of estrogens in women . In this issue, Schreckenberg et al. provide new insights into the mechanism of action of estrogens on heart tissue, showing that PTHrP is a crucial downstream mediator. The significance of their findings in the context of hormone replacement therapy use is discussed below.

The beneficial effects of HRT were challenged in 2002 with the publication of two studies not only showing a lack of benefit for HRT on CVD but also suggesting the HRT could worsen CVD and lead to strokes and deep venous thrombi . One study in particular, the Womens Health Initiative , was widely publicized, with the New York Times commenting on the Womens Health Initiative findings of increased risks of heart disease, breast cancer, strokes and gallbladder disease .

Combined Hormonal Contraception And Estrogen

How to lose weight after menopause

These types of contraception contain both estrogen and progestin, in different amounts and ratios. Many combined oral contraceptives contain ethinyl estradiol, a synthetic estrogen. In the United States, ethinyl estradiol doses do not exceed 50mcg , and are often lower, even 10 mcg . When the contraceptive pill is taken as prescribed, it works by disrupting the normal communication between the brain and the ovaries, so that:

  • hormonal fluctuations of the menstrual cycle do not happen

  • follicles are less likely to mature to their final stage, meaning less natural estrogen is produced

  • ovulation does not occur

Because follicle growth and ovulation is stopped, the natural production of estrogen is affected, and may be responsible for any side effects or changes you may experience after starting the pill.

The vaginal ring supplies a much lower dose od ethinyl estradiol of 15 mcg per day , and the patch supplies 20 mcg .

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Can Menopause Cause Facial Hair Growth

Yes, increased facial hair growth can be a change related to menopause. The hormonal change your body goes through during menopause can result in several physical changes to your body, including more facial hair than you may have had in the past. If facial hair becomes a problem for you, waxing or using other hair removers may be options. Talk to your healthcare provider about your options to make sure you dont pick a product that could harm your skin.

Elevated Estrogen And Perimenopause Symptoms

  • One study compared two groups of perimenopausal women. Group 1 had heavy, irregular bleeding, while group 2 had normal cycles. The study found that estrogen levels were higher in group 1 .
  • Another study compared estrogen levels in women aged 47 with women aged 19 to 38. That study found that the 47-years old had higher estrogen and lower progesterone, compared to the 19 38 age group .
  • During perimenopause theres a decline in progesterone. And lower progesterone, combined with higher estrogen, causes your endometrial lining to be thicker. As a result, when that lining sheds youre more likely to have heavy bleeding and clots .
  • Most of the hysterectomies that are performed during perimenopause are mainly because of fibroids. And interestingly, fibroids grow when theres more estrogen. Not surprising since estrogen is a growth hormone! In addition, the stress that many of us face each day can make fibroids worse. This is because stress increases cortisol and insulin, and both of these hormones affect estrogen levels.

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Why Do Estrogen Levels Fall

There are many reasons why estrogen levels fall, including:

  • Hypogonadism
  • Anorexia nervosa
  • Extreme exercise or training

Drugs that block estrogen include clomiphene, which tricks the body into thinking it has decreased levels of estrogen. Also, women experience low levels of estrogen immediately after childbirth and also during breastfeeding.

Your Action Steps For Preventing Estrogen Dominance:

When does Menopause begin? The symptoms before, during and ...

In my next few blog posts in this series on estrogen dominance, I’ll be giving simple powerful steps you can take to help your body keep estrogen and progesterone in balance. ;

Here’s an overview of how all the pieces of the puzzle fit together. ;Your action steps are to

  • Eat right
  • Avoid the worst hormone-disrupting chemicals
  • Move enough & breathe deeply

Bonus Tip: Include some broccoli sprouts in your diet each day, they have special micronutrients that support estrogen detoxification.

Watch for a blog coming soon on the most important hormone-disrupting chemicals to avoid & where you’ll find them.

Move! ;If you’re sitting, try to get up and move your arms and legs around and take some deep breaths every 30 minutes ;Try walking or bouncing on a rebounder a few minutes a day.;

Get to the root cause! ;Make sure your hormones don’t drop too low by supporting them with HRT or customized herbal remedies. ;There’s simply no substitute for something powerful enough to support your body in keeping your hormone levels, including progesterone, high enough. ;

No hormonal care plan is complete without this hormonal support componenent.; If you’re interested in using herbal remedies for this part of your hormonal care plan, they must be customized to your body and change with your hormones over time.

Learn more with the free resources below.;

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Hot Flashes During Perimenopause

Most women don’t expect to have hot flashes until;, so it can be a big surprise when they show up earlier, during perimenopause. Hot flashes sometimes called hot flushes and given the scientific name of vasomotor symptoms are the most commonly reported symptom of perimenopause. They’re also a regular feature of sudden menopause due to surgery or treatment with certain medications, such as chemotherapy drugs.

Hot flashes tend to come on rapidly and can last from one to five minutes. They range in severity from a fleeting sense of warmth to a feeling of being consumed by fire “from the inside out.” A major hot flash can induce facial and upper-body flushing, sweating, chills, and sometimes confusion. Having one of these at an inconvenient time can be quite disconcerting. Hot flash frequency varies widely. Some women have a few over the course of a week; others may experience 10 or more in the daytime, plus some at night.

Most American women have hot flashes around the time of menopause, but studies of other cultures suggest this experience is not universal. Far fewer Japanese, Korean, and Southeast Asian women report having hot flashes. In Mexico’s Yucatan peninsula, women appear not to have any at all. These differences may reflect cultural variations in perceptions, semantics, and lifestyle factors, such as diet.

Perimenopause: Rocky Road To Menopause

What are the signs of perimenopause? You’re in your 40s, you wake up in a sweat at night, and your periods are erratic and often accompanied by heavy bleeding: Chances are, you’re going through perimenopause. Many women experience an array of symptoms as their hormones shift during the months or years leading up to menopause that is, the natural end of menstruation. Menopause is a point in time, but perimenopause is an extended transitional state. It’s also sometimes referred to as the menopausal transition, although technically, the transition ends 12 months earlier than perimenopause .

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When Estrogen Is Lower During The Late Luteal Phase And The Start Of The Period You May Notice Some Changes

  • Your overall body temperature will increase slightly during this phase.

  • One study found that 2 out of 5 women report more sensitive skin, which researchers suspect could be due to low levels of estrogen during this time .

  • Premenstrual symptoms also show up during this time before the period starts, when estrogen are low.

  • Some people may even get migraine headaches that are related to the drop in estrogen levels .

Why Your Body Needs It

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Estrogen is produced primarily in your ovaries but also in the adrenal gland and fat cells.

During puberty, estrogen plays a central role in promoting sexual development. The way your breasts and body hair grow is down to estrogen. ;;;

Once youre menstruating, estrogen helps limit the way your uterine lining grows during the first part of your cycle. Then, one of 2 things happen

If the egg is not fertilized, your period will start after estrogen levels sharply drop.

When the egg is fertilized, estrogen works alongside progesterone, another sex hormone, and together they put a stop to ovulation while youre pregnant.

In addition to its influence on menstruation and pregnancy, estrogen is influential in many other areas

  • Bone Formation: Estrogen is instrumental for optimum bone health. Along with calcium and vitamin D, estrogen helps with the rebuilding of bones. ;;
  • Blood Clotting: Blood clotting can be inhibited when estrogen levels are too high.
  • Ovaries: The hormone helps to drive growth of egg follicles
  • Uterus and Vagina: Estrogen is key for maintenance of the mucous membrane lining your uterus. It also promotes contractions by developing the muscles here. Estrogen in the vagina enhances acidity which in turn leads to fewer bacterial infections

As mentioned there are hundreds of ways in which this hormone affects the female body but theyre outside the scope of todays article. But specifically, whats the deal with estrogen during menopause?

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Changes In Weight Distribution

As estrogen levels decrease in women who are postmenopausal, they may notice they gain more weight around the abdomen and arms. This central obesity, as it is known, is dangerous because it increases a womans risk of cardiovascular disease. In one study, postmenopausal women who received hormone replacement therapy did not experience weight gain in the trunk and arm areas compared to women who did not take HRT. Women treated with hormones gained an insignificant amount of weight during the study in their legs. This pattern of fat distribution is not associated with an increased risk of cardiovascular disease. The treated women had better bone mineral density compared to those who did not receive hormone therapy, too. Talk to your doctor if you notice youre gaining more weight around your middle. Hormone therapy, if its appropriate and safe for you, may help.

What Are The Symptoms Of Menopause

You may be transitioning into menopause if you begin experiencing some or all of the following symptoms:

These symptoms can be a sign that the ovaries are producing less estrogen, or a sign of increased fluctuation in hormone levels. Not all women get all of these symptoms. However, women affected with new symptoms of racing heart, urinary changes, headaches, or other new medical problems should see a doctor to make sure there is no other cause for these symptoms.

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Hormonal Imbalance And Fatigue

Fatigue is a common symptom that may have many potential underlying causes. Just as too little progesterone can make it hard to sleep, too much progesterone can make you more tired. Another common hormonal imbalance that causes fatigue is low thyroid hormone levels . This condition is easily diagnosed with a blood test. If your levels are low, you can take prescription medication to bring your levels back up to normal. Regardless of any hormone imbalance that may exist, practice good sleep hygiene to optimize your sleep. This involves going to bed and waking up at the same time every day, even on the weekends. Avoid alcohol, caffeine, and exercise from the late afternoon on to avoid interfering with sleep. Establish a relaxing nighttime routine to give your body the message that its time for sleep. Take a warm bath, sip a cup of chamomile tea, or listen to relaxing music.

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Hormonal Variability Of The Menopause Transition

perimenopause: the 0

With ongoing follicle loss, the compensatory mechanisms described above are no longer adequate and cycles become irregular, signifying the onset of the menopause transition. Large scale cohort studies describe the overall hormonal changes, characterized by the reciprocal relationship between decreasing inhibin B and increasing FSH levels early on and a later decline in estradiol that may not reach its nadir until one to two years after the FMP, , .

However, these aggregate changes do not reflect the marked variability in hormone levels that occur between women and within an individual woman from month to month over the two to five years of the menopause transition. Estrogen levels may fluctuate between undetectable and many times normal for variable periods of time with these anovulatory hormonal patterns interspersed with ovulatory cycles. While the inconsistent estrogen response to FSH is not well understood, there is evidence of a mismatch between the progressively decreasing and scattered follicles in the ovary and their blood supply; Doppler studies indicate reduced ovarian blood supply in the aging ovary, and there are higher levels of vascular endothelial growth factor , a marker of tissue hypoxia, in older reproductive aged women.

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