Menopause is the point at which a woman stops ovulating and menstruation ceases, indicating the end of fertility. It is important to remember that menopause is not a disease.
Menopause is as natural a progression in life as is puberty.
Importance of Estrogen
Three estrogens are naturally made by the body: estradiol, estrone, and estriol. Estradiol is the dominant estrogen produced by the ovaries. Levels of estriol are highest during pregnancy, and this form of estrogen has been shown to have a protective effect against breast cancer. Estrone is formed from estradiol and appears to be the estrogen responsible for estrogen-dependent breast cancer.
Many years before a woman stops ovulating, her ovaries slow their production of the hormones estrogen, progesterone, and testosterone. Estrogen and progesterone are commonly thought of as sex or reproductive hormones. While Estrogen is indeed essential for reproduction, it also acts on many non-reproductive organs and systems in the body. Cells in the vagina, bladder, breasts, skin, bones, arteries, heart, liver, and brain all contain estrogen receptors and require this hormone to stimulate these receptors for normal cell function. Estrogen is needed to keep the skin smooth and moist, and the body’s internal thermostat operating properly. It is also necessary for proper bone formation.
Although estrogen levels drop sharply after menopause, the hormone does not disappear entirely. Other organs take over from the ovaries and continue to produce a less potent form of estrogen. The organs known as endocrine glands secrete some hormones from fatty tissue to maintain bodily functions.
Function of Progesterone
Progesterone works as a counterpart to estrogen. During the second half of the menstrual cycle, it stimulates changes in the lining of the uterus to complete its preparation to act as a “home” for a fertilized egg. If no egg is fertilized, the uterine lining is broken down and expelled. The cycle then begins again. Progesterone too has effects beyond the reproductive system. It has a calming effect on the brain and appears to affect other aspects of nervous system function as well.
Estrogen dominance is an important concept to understand if you are perimenopausal and/or thinking of hormone replacement. This is a situation that can occur if the correct balance between estrogen and progesterone is not maintained. Symptoms of estrogen dominance can include flagging energy, fluid retention and bloating, and weight gain. Estrogen dominance can also increase certain types of cancer, notably endometrial cancer. This is why unless you have undergone a hysterectomy, Hormonal Replacement Therapy regimens usually include both estrogen and progesterone.
Function of Testosterone:
Testosterone is the essential hormone for continuing sexual desire in both sexes. It also supports the skin, muscles, and bones. Women produce much less of this hormone than men do – about 80% less – but it is the driving force for maintaining a healthy libido (sexual appetite).
If sexual desire diminishes, women may want to add this hormone to their replacement therapy. Natural testosterone or methyl testosterone is available for use as part of hormone therapy. There are also synthetic versions of testosterone, but these appear to cause problems more often than the natural hormones. Also, with synthetics, dosage must be carefully controlled, as too much can produce side effects.
Transitioning into Menopause
Perimenopause is the period when a woman’s body is preparing for menopause. For most women, hormone production begins to slow down when they reach their thirties and continues to diminish as they age. Many women experience few if any symptoms during this time but others may suffer from some, or all, of the following:
- Anxiety
- Dry skin
- Fatigue
- Feelings of bloatedness
- Heart palpitations
- Hot flashes
- Insomnia
- Irritability
- Decreased interest in sex
- Loss of concentration
- Mood swings
- Night sweats
- Reduced stamina
- Urinary incontinence
- Vaginal dryness and itching
- Weight gain
Menopause is the time when a woman stops menstruating altogether. By this stage, most of the acute problems a woman may have experienced are actually over and a new balance between all hormones should be established. However, this is the time women become increasingly vulnerable to other, potentially serious health problems. Over the long term, the diminished supply of estrogen increases the likelihood of cardiovascular disease, osteoporosis, and vaginal atrophy.
Osteoporosis is particularly a major problem for women after menopause. An estimated 80 per cent of all hip fractures that occur are due to osteoporosis.
Male Menopause
The term “male menopause” is often used in a joking way, sometimes as a dismissive substitute for “midlife crisis.” But while men do not face the end of fertility in midlife as women do, they too undergo important physical and hormonal changes at that time. Men should not take male menopause – sometimes called andropause – lightly. During male menopause, sex drive may weaken, anxiety may increase, and depression and moodiness may accompany a sense of failure. These symptoms can occur because of falling levels of testosterone.
Men’s testosterone levels begin to decline by the age of forty, earlier in some cases, and this may cause a loss of sexual desire, mood swings, and irritability, and may even increase the risk of heart disease. If low testosterone levels are a problem, testosterone replacement therapy may be prescribed.
Before a man makes a decision about testosterone replacement, he should undergo a prostate-specific antigen (PSA) test to look for signs of prostate cancer, and he should have a frank discussion with his physician about potential side effects. It is advisable to also check DHEA and estrogen levels (estrogen is a male as well as a female hormone) so that if therapy is needed, it can be tailored to the individual’s particular needs.
With a proper diet, nutritional supplements, and exercise, most of the unpleasant side effects of menopause can be minimized, if not eliminated.
Recommended Menopause Tests
| Test Name | Amount in KES |
| Estradiol | 2,000 |
| Progesterone | 2,000 |
| Tostosterone | 2,000 |
| Vitamin D3 | 3,000 |
| Calcium | 500 |
| Alkaline Phosphatase | 500 |
| C-Reactive Protein | 2,000 |
| Electrocardiogram (ECG) | 1,500 |
| Breast/Prostate Ultrasound | 3,000 |
| PSA | 1,500 |
| Pap smear | 1,500 |
| Complete Blood Count | 1,500 |