This drop in hormone levels, especially oestrogen, is the cause of menopausal symptoms, the specificity and intensity of which vary from woman to woman.
Being informed about the relationship between oestrogen and menopause, knowing how they influence symptoms, and knowing about treatment options, such as hormone replacement therapy, is essential to alleviate the effects of decreased oestrogen.
What is oestrogen and what is its function?
Oestrogen is a female sex hormone2 produced by the ovaries and adrenal glands. It is responsible for the maturation of the female reproductive organs and for the development of secondary sexual characteristics in women during puberty. It is also responsible for preparing the body for fertilisation and ovulation throughout menstrual cycles.
However, the functions of oestrogen go beyond what is strictly related to reproduction and sex. Therefore, it is important to maintain a balance in hormone production and to avoid an excess of oestrogen.
These hormones influence, for example, the distribution of body fat, the maintenance of muscle mass, and the regulation of cholesterol levels. Therefore, when oestrogen levels are low, changes occur in metabolism or weight, among other things.
Likewise, when there are high levels of oestrogen, it contributes to the protection of bones3, which explains why there is a progressive loss of bone mass during menopause. The same thing happens with collagen production, and that’s why many women experience changes in the appearance of their skin during this stage.
How do oestrogen levels change during menopause and perimenopause?
During perimenopause, a stage defined as the transition to menopause, oestrogen levels fluctuate irregularly. These variations in oestrogen levels during premenopause can cause symptoms such as irregular periods, sweating, sleep disorders, mood swings, lack of sexual desire, and many others.
Usually, when menopause arrives, between the ages of 45 and 55, the drop in the level of oestrogen production causes a wide variety of symptoms4, such as hot flushes, insomnia, vaginal dryness, weight gain or alterations in the skin and hair, among others.
Hormone replacement therapy: what does it consist of and what benefits does it have?
Hormone replacement therapy (HRT) is a treatment that consists of the administration of oestrogen and progesterone during menopause to replace the hormones that the body has stopped producing naturally, and thus relieve the symptoms that this entails.
If the required dose is high, it can be administered systemically, either as oral tablets or through the skin using patches, creams or sprays. When a lower dose is required, it is administered locally with creams, gels or rings directly through the vagina.
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In what cases is hormone replacement therapy recommended?
HRT is especially indicated for women who suffer from frequent or severe hot flushes, sleep disorders, night sweats and premature ovarian insufficiency or early menopause, whether naturally or after surgery. It is also recommended for women with genitourinary syndrome, that is, with vaginal dryness, incontinence, itching, burning and discomfort during sexual intercourse that do not improve with non-hormonal treatments.
We recommend that you speak to a gynaecologist specialising in menopause or visit a clinic with a specific unit to assess the treatment. This is a therapy that must be studied on a case-by-case basis, and to do so, the patient’s clinical history, family history, and circumstances must be evaluated.
In what cases is it contraindicated?
It is contraindicated for women with a history of thrombosis or hormone-dependent cancers, such as breast or endometrial cancer, and in some cases for those who have migraines with aura, active liver disease or coagulation disorders, so they should speak to a professional to assess their situation in a personalised way.
Does it have side effects?
The side effects of administering progesterone and oestrogen during menopause are rare and usually appear during the first few months, disappearing as the body adjusts to the treatment. These side effects may include light vaginal bleeding and breast tenderness or pain.
Does HRT delay menopause?
No. Even if you receive this treatment, your body will still experience the hormonal changes associated with menopause. If you stop taking it, you will have the symptoms you would have had if you had not started HRT.
I’ve read that HRT increases the risk of cancer. Is that true?
Twenty years ago, the publication of an American study that linked HRT with a higher risk of breast cancer and cardiovascular problems caused it to fall into disuse. However, this study was conducted on women with an average age of 63 and did not take into account whether they had other health problems. Furthermore, the study was not designed to assess the risk–benefit impact of hormone therapy for treating menopausal symptoms, but rather to determine the preventive effect of hormone therapy on chronic diseases.
Nowadays, national and international medical and scientific societies support the safety and efficacy of HRT, although they say that its use should be assessed on an individual basis.
In conclusion, the decrease in oestrogen during menopause affects various aspects of women’s health. Hormone replacement therapy is an effective option for relieving symptoms in some women, but its administration should be carefully evaluated, taking into account the risks and benefits for each patient. Fortunately, there is a clear relationship between oestrogen, menopause, and exercise. If you adapt your lifestyle by practising some sporting activity or consuming natural oestrogen through foods with phytoestrogens5, you will be taking steps in the right direction to minimise the symptoms of this important stage.
References
1 https://medlineplus.gov/spanish/ency/article/000894.htm
2 https://www.dexeus.com/fertility/blog-fiv/que-sabes-de-las-hormonas-femeninas/
4 https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=8874
5 https://www.segg.es/ciudadania/2013/12/27/fitoestrogenos-los-grandes-aliados-de-la-mujer
Oriol Gili
A chemist specialised in dermopharmacy and women’s health with more than 5 years of experience in pharmaceutical advice applied to skin care.
