You officially reach menopause when you’ve gone 12 consecutive months without having a menstrual bleed, marking the end of your reproductive years. In the UK, most women reach menopause at around 51 years of age (1).
The perimenopause (meaning ‘around menopause’) happens several years before this event and typically lasts between 4-12 years (2). This period marks your body’s natural transition towards menopause, and as you go through it, you may experience a host of physical and psychological symptoms, such as hot flushes, mood changes, itchy skin, and more.
During perimenopause, your levels of oestrogen begin to decline — however, they don’t do so consistently. These fluctuations disrupt the hormonal balance ‘ecosystem’ within your body, causing a range of symptoms that are associated with menopause.
To understand how hormonal fluctuations can cause menopausal symptoms, it is helpful to take a closer look at the hormones that play a critical role in reproductive health, including the menopausal transition.
Which hormones are involved in female reproductive and sexual health?
Oestrogen
Oestrogen is the primary female sex hormone. Produced mainly in the ovaries, with smaller amounts secreted by the adrenal glands and fat cells, oestrogen plays a central role in sexual and reproductive development, menstruation, pregnancy, and menopause (3). Crucially, oestrogen supports the cardiovascular system, cognition, skin, sleep, musculoskeletal system, and hair (4).
Progesterone
After ovulation, the ovaries secrete progesterone, another female sex hormone. Progesterone primes the lining of the womb (endometrium) for a fertilised egg, supports pregnancy, and inhibits oestrogen after ovulation (5).
Testosterone
The adrenals glands and ovaries secrete smaller amounts of testosterone to support libido, bone and muscle strength, and the regulation of the menstrual cycle (6).
Luteinizing hormone (LH)
Produced in the pituitary gland, which is located at the base of the brain, LH helps to control the menstrual cycle. Two weeks into your cycle, a surge in LH triggers the ovaries to release the egg during ovulation (7).
Follicle-stimulating hormone (FSH)
FSH works with LH to control the menstrual cycle by stimulating the growth of eggs in the ovaries (8). FSH levels are at their highest just before ovulation.
What hormone changes occur during menopause?
Oestrogen
As you enter perimenopause, levels of circulating oestrogen in the body start to fluctuate unpredictably and unevenly. By the time you reach menopause, your body is producing deficient levels of oestrogen.
Depending on the nature of your hormone fluctuations, you may have high or low levels of oestrogen at any one time, which can affect the symptoms that you experience. High levels of oestrogen may lead to breast tenderness, heavy menstrual bleeding, and bloating (9). Low levels, on the other hand, may result in night sweats, hot flushes, insomnia, headaches, vaginal dryness, and loss of bone mineral density (10).
Progesterone
Since you ovulate less frequently during perimenopause, progesterone levels remain low. Depleted progesterone may result in heavier, irregular, and longer periods during perimenopause (11).
Testosterone
Levels of testosterone peak in your 20s and start to slowly drop after that — when you reach menopause, the amount of testosterone in your body is at half of its peak (12).
Interestingly, your ovaries continue to secrete testosterone after your oestrogen production ceases. Testosterone production from your adrenal glands also declines as you age, but it continues after menopause.
The effects of declining levels of testosterone remain unclear, although some experts suggest that it may contribute to decreased libido.
Follicle-stimulating hormone
Levels of FSH fluctuate irregularly throughout the menopausal transition. When your FSH levels are high, your ovaries produce more oestrogen. And when FSH levels dip, so too do your oestrogen levels (13). This can bring on some of the symptoms described above.
Luteinizing hormone (LH)
Your LH levels should increase after menopause, because your ovaries no longer function and therefore do not need to take cues from LH.
What is HRT and will it help with my menopausal symptoms?
Hormone replacement therapy (HRT) delivers synthetic versions of the female sex hormones, oestrogen and progesterone, which naturally decline as you approach menopause.
There are different types of HRT available, and your doctor will advise on which type is best for you. Combined HRT involves taking both oestrogen and progesterone, while oestrogen-only HRT contains only oestrogen. (14) Most women take combined HRT as taking oestrogen-only HRT may increase the risk of developing womb cancer (15).
There are several ways you can take HRT: tablets, skin patches, oestrogen gel, implants, or vaginal oestrogen. Your GP will be able to advise on which treatment option is most suitable for you.
What are the benefits of HRT?
There is substantial evidence to suggest that HRT may relieve many of the common symptoms associated with menopause, such as mood swings, insomnia, hot flushes, night sweats, vaginal dryness, and decreased libido (16).
HRT may also help to prevent osteoporosis — a condition where bones become weak and brittle — which is more prevalent in postmenopausal women (17).
Are there any risks involved?
HRT isn’t suitable for everyone. Those with a history of ovarian, womb or breast cancer, liver disease, high blood pressure, or a history of blood clots should consider alternatives.
In the UK, the findings of large cohort study the Million Women Study were published in 2003. The results revealed that HRT increased the risk of breast cancer and stroke in trial participants. (18)
We suggest consulting with your GP before starting HRT to make sure you are aware of all the potential risks and are able to weight these up against the potential benefits of the treatment.
To learn more about the menopausal transition, including menopausal symptoms and how best to manage them, visit our educational Menopause hub.
References:
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nhs.uk. 2020. Menopause. Available online: https://www.nhs.uk/conditions/menopause/
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nhs.uk. 2020. Menopause. Available online: https://www.nhs.uk/conditions/menopause/
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What Does Estrogen Do? The Journal of Clinical Endocrinology & Metabolism. 2014;99(4):31A-32A.
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What Does Estrogen Do? The Journal of Clinical Endocrinology & Metabolism. 2014;99(4):31A-32A.
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Hormone.org. 2020. Progesterone Endocrine Society. Available online: https://www.hormone.org/your-health-and-hormones/glands-and-hormones-a-to-z/hormones/luteinizing-hormone
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Medlineplus.gov. 2020. Follicle-Stimulating Hormone (FSH) Levels Test: Medlineplus Medical Test. Available online: https://medlineplus.gov/lab-tests/follicle-stimulating-hormone-fsh-levels-test/
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Hormone.org. 2020. Estrogen Endocrine Society. Available online: https://www.hormone.org/your-health-and-hormones/glands-and-hormones-a-to-z/hormones/estrogen
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Hormone.org. 2020. Progesterone Endocrine Society. Available online: https://www.menopause.org/for-women/sexual-health-menopause-online/changes-at-midlife/changes-in-hormone-levels
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Reproductivefacts.org. 2020. The Menopausal Transition (Perimenopause): What Is It? Available online: https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/the-menopausal-transition-perimenopause-what-is-it/
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nhs.uk. 2020. Hormone Replacement Therapy (HRT) – Types. Available online: https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/types/
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nhs.uk. 2020. Hormone Replacement Therapy (HRT) – Types. Available online: https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/types/
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Wren B. The benefits of oestrogen following menopause: why hormone replacement therapy should be offered to postmenopausal women. Medical Journal of Australia. 2009;190(6):321-325.
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Wells G. et al., V. Meta-Analysis of the Efficacy of Hormone Replacement Therapy in Treating and Preventing Osteoporosis in Postmenopausal Women. Endocrine Reviews. 2002;23(4):529-539.
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Beral V. Million Women Study Collaborators. Breast cancer and hormone replacement therapy in the Million Women Study. Lancet. 2003;362:419-427.
Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
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Olivia
Olivia Salter has always been an avid health nut. After graduating from the University of Bristol, she began working for a nutritional consultancy where she discovered her passion for all things wellness-related. There, she executed much of the company’s content marketing strategy and found her niche in health writing, publishing articles in Women’s Health, Mind Body Green, Thrive and Psychologies.
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