Hormones & Menopause: Symptoms, Imbalance, & Treatment

• Excess estrogen can result in increased irritability, mood swings, increased fat storage and, consequently, weight gain or obesity. It can also increase the risk of certain cancers and hyperlipidemia.
• Taking hormone supplements to replace the body’s decreased production of certain hormones can help to reduce symptoms and prevent osteoporosis in the long-term. It may, however, increase the risk of certain cancers and cardiovascular disease. In addition, there are contraindications for use in certain groups of patients. As such, a doctor should be consulted to test hormone levels and consider whether hormone therapy is for you. Do not purchase hormone replacement medications yourself.

Hormones are chemicals produced by the body to help control the normal functioning of various systems in the body. In addition to the differing hormones in females and males that perform different functions, the amount and function of hormones also vary according to age. The main female sex hormones are estrogen, progesterone, FSH, and LH.

Estrogen is an important hormone responsible for regulating the female reproductive system. It is produced primarily in the ovaries, with a small portion produced by the adrenal glands and fat cells. Estrogen affects sexual development, female characteristics, menstruation, pregnancy, and menopause.

Women of childbearing age generally have estrogen levels of 15-350 pg/mL, varying through the menstrual cycle between ovulation and menstruation.  

During menopause, estrogen levels drop to <10 pg/mL. Excess estrogen can lead to increased fat storage resulting in weight gain or obesity, irritability and mood swings. It can also increase the risk of certain cancers and hyperlipidemia.

Symptoms of estrogen imbalance include the following:

• Menstrual irregularities
• Premenstrual syndrome (PMS)
• Mood swings
• Irritability
• Difficulty sleeping
• Lack of concentration
• Brittle bones
• Vaginal dryness and atrophy, which affect sexual intercourse and can cause cysts and tumors in the breasts, uterus, and ovaries

Progesterone is produced mainly by the ovaries after ovulation and to a lesser extent by the placenta. It is responsible for controlling ovulation and menstruation, stimulates increased endometrial thickness, helps prepare the uterus to accept and implant a fertilized egg, helps maintain pregnancy, and regulates some of the basic functions of the body.

Progesterone levels vary between ovulation and pregnancy. If a progesterone abnormality is present in the pre-pregnancy period, this may impact the pregnancy as the fertilized egg will fail to implant. Hormonal abnormalities during pregnancy can result in miscarriage.

Follicular stimulating hormone (FSH) is made by the pituitary gland. It stimulates the growth of eggs in the ovaries and prepares them for fertilization. It also affects sexual development during the reproductive years. Without sufficient levels of FSH, the ovaries lose the ability to mature enough eggs, impacting the ability to reproduce and leading to infertility.

Luteinizing hormone (LH) is produced by the pituitary gland. It is responsible for triggering the release of an egg from the ovary so that it can be ready for fertilization. If LH levels are too low, ovulation will not occur, thus impacting the ability to reproduce. On the other hand, too much LH can result in the formation of ovarian cysts.

• Endorphin
  Endorphin is a hormone that is secreted by the pituitary gland when the body is happy, satisfied and relaxed. If the body is stressed, the level of this hormone will decrease. We can increase our endorphin levels by doing activities that make us feel happy and relaxed, such as fun or enjoyable activities, exercise or meditation.
• Serotonin
  Serotonin is released from the brain as well as in part from the gastrointestinal tract. It helps regulate muscle function, mood and behavior, and plays a key role in helping with sleep patterns.
  Low levels of serotonin can impact sleep and cause irritability, lack of concentration and headaches. Long-term, it may also result in depression.
  Regular exercise and a healthy diet, especially one rich in protein, can help to increase and maintain serotonin levels.
• Cortisol
  Cortisol is a hormone produced by the two adrenal glands. It is secreted when the body perceives stress, a critical event occurs, the individual experiences anxiety or the individual has a physical illness. In these circumstances the cortisol hormone is secreted to prepare the body for recovery, to stimulate the production of more sugar to increase the body’s energy levels and to control water and mineral levels in the body.
• Adrenaline
  Adrenaline, or epinephrine, is a hormone made and released by the adrenal glands. It is released when the body is in a dangerous or emergency situation and is preparing to use energy in response. It makes the heart beat faster and increases blood pressure.
  Normally, the body secretes more of this hormone only when there is an emergency or in response to a specific stimulus. However, an abnormality can lead to continuous or excess secretion of the hormone, causing tachycardia and chronic high blood pressure.

Menopause is a stage in life when women stop menstruating and are no longer able to get pregnant. The age at which menopause occurs varies from person to person, although the average age is between 48-52 years.  

Women will also experience menopause if both ovaries are removed, preventing the body from being able to produce certain hormones. It may also occur as the result of certain diseases or chemotherapy before menopause, causing hormonal changes.  

• Irregular menstruation
• Hot flashes
• Sweating
• Anxiety
• Heart palpitations
• Sleep problems
• Mood changes
• Irritability
• Vaginal dryness
• Infections and itching in the vagina
• Pain during intercourse

These symptoms may last anywhere from 2 to 8 years, though they last on average about 4 years.

When menopause is fully reached, the body’s production of estrogen, progesterone, and testosterone is reduced greatly, while follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels are increased. This can impact sex drive, cause changes to the skin, result in decreased bone mass which means bones become more brittle and can break more easily, and cause increased risk of cardiovascular disease and stroke.  

Hormone levels can be measured to diagnose and confirm menopause, specifically, if elevated FSH levels and decreased estradiol (E2) levels are observed.

While changes in hormone levels are normal as we age, lower hormone levels can result in a number of uncomfortable symptoms such as hot flashes, night sweats, insomnia, mood swings, vaginal dryness, and decreased sex drive and arousal.

In addition, the risk of various diseases such as osteoporosis increases. If symptoms are fairly mild, however, the body can adjust to respond appropriately.

How many types of hormone replacement therapy are there?

In the case of more severe symptoms, taking hormone supplements to replace the body’s decreased production of certain hormones can help to reduce symptoms and prevent osteoporosis in the long-term. The hormones used in this case are both estrogen and estrogen combined with progesterone. They are available in oral, patch, gel, or even lubricant form specifically for the treatment of vaginal dryness. The recommended dosage for each type varies.

Hormone replacement therapy can, however, increase the risk of certain cancers and cardiovascular disease. In addition, there are contraindications for use in certain groups of patients. As such, a doctor should be consulted to test hormone levels and consider whether hormone therapy is suitable for each individual, and then to help adjust the amounts and dosage continuously and appropriately. For this reason, you should never purchase hormone replacement medications yourself.

Also, if you are experiencing menopausal symptoms, a doctor may be able to prescribe other non-hormonal drugs to relieve the symptoms, such as SSRIs, SNRIs, and selective estrogen receptor modulators (SERMs).

Healthcare Advice for Menopause Without the Use of Drugs or Hormone Replacement Therapy

For those who do not have any need for hormone replacement therapy, there are some basic self-care guidelines you can follow:

1. Eat nutritious foods from all 5 food groups, and make sure to eat foods that contain plenty of calcium and vitamin D. Get some sunlight in the morning to prevent the onset of osteoporosis. The body should be getting at least 800 – 1,000 IU of vitamin D per day and 1,000 – 1,200 mg of calcium per day.
2. Exercise regularly to build muscle mass.
3. Reduce or abstain from alcohol consumption.
4. Abstain from smoking.

Continual care of your physical health, careful observation of any changes or symptoms in your body, and early prevention and treatment of hormonal imbalance or deficiency in menopause are key to the long-term prevention of osteoporosis and other serious health conditions.