What Happens to your Hormones during Menopause: Taking a Closer Look

Many women have a lot of confusion during the menopause period. They often find themselves in the dark, unable to decipher the signals their body is trying to convey.  

In this blog, we discuss the role of hormones during menopause and the various hormonal changes you may experience during menopause. 

Menopause and Hormones

 
Menopause occurs when you go 12 consecutive months without a menstrual cycle. It’s confirmed when blood tests reveal that ovaries are no longer responsive to the hormonal messages from the pituitary gland in the brain. This results at the end of ovulation and the menstrual cycle. Hence, menopause marks a significant portion of your life: the end of your reproductive period.  

The age of menopause generally ranges from 45 to 55 years, 50 on average. The average age of menopause for women in the US is 52. For women in the UK, the average age for menopause is 51.  

Menopause is a natural part of ageing and can last for an average of 7 years. Natural menopause, i.e., not caused by surgery or any other treatment or medication occurs in stages. They are 

Perimenopause (or menopause transition) - This usually occurs 8–10 years before menopause and usually starts in your 40s. During this phase, your ovaries produce fewer amounts of estrogen (one of the primary hormones for the female reproductive system). 

This usually accelerates in the last 1–2 years of menopause. This is also when the symptoms of menopause, such as hot flashes, mood changes, itchy skin, etc., usually show up. However, the menstrual cycles are not at a complete stop, and you can get pregnant during this time. 

• Menopause – This is the time when your menstrual cycle stops completely. Your ovaries stop releasing eggs and producing estrogen.  
   
• Postmenopause – This phase coincides with the period when you haven’t had your menstrual cycle for over a year. Most of the menopausal symptoms usually subside during this phase. However, for some people, these symptoms can continue for a decade or even longer, post the menopause transition. Low levels of oestrogen also make you prone to health risks such as osteoporosis or heart disease. 

The period during which a woman shifts from a reproductive to a non-reproductive stage is called climacteric. It usually lasts 5–10 years and covers the periods before, after, and during menopause. 

Ovaries are the key producers of reproductive hormones. So, during the climacteric period, when the ovaries reduce the production of these hormones, it causes hormonal imbalances and fluctuations. This gives rise to symptoms such as hot flashes, vaginal dryness, night sweats, mood swings, etc.

Before moving on to how hormones react specifically during each stage, let’s look at the different hormones at play during menopause. 

Which hormones play a role during menopause?

There are several hormones which are at play during the climacteric period.  They have a great physical and psychological impact on women during this period. 

The primary hormones are oestrogen, progesterone, and testosterone. There are a few others, such as follicle-stimulating hormone (FSH) and luteinising hormone (LH). 

Let’s take a look at them: 

Oestrogen

Also known as the “feminine hormone”, oestrogen is primarily produced in the ovaries, and also in smaller amounts in the adrenaline glands. It’s one of the two main sex hormones in women, the other being progesterone. 

There are usually 4 types found in females:

• Oestrone (E1): The only form of oestrogen the body produces after menopause, derived from body fat. 
   
• Oestradiol (E2): The most common form of oestrogen found in women during the reproductive phase, hence widely referred to by the term estrogen in various contexts. 
   
• Oestriol (E3): Secreted by the placenta during pregnancy, otherwise barely detectable in the body. 
   
• Oestetrol (E4): Native oestrogen in fetal life, produced exclusively in the fetal liver, detected in the mother at lower levels during pregnancy.  

Role of oestrogen in the body

It’s a key hormone that helps control the menstrual cycle. It is at its peak during the menstrual cycle and lowest during your periods. 

• It helps maintain your pregnancy
• Oestradiol helps in the development and release of eggs, also known as ovulation
• It also helps control moods 
• It has an important contribution in your bone and heart health
• It controls cholesterol levels. Hence the fall of oestrogen levels during menopause coincides with a rise in cholesterol levels 

Oestrogen levels in menopause

As you age, the response from your ovaries reduces. This leads to fluctuations in oestrogen and progesterone levels. This continues until you reach menopause. Oestrogen levels usually fall during menopause. The body may produce less oestrogen when progesterone levels fall when women reach their early 30s to mid-40s. This is when you’ll notice erratic periods or even miss many. 

Oestrogen directly relates to bone health. Low oestrogen levels can make your bones weaker and more brittle, increasing the risk of osteoporosis. 

Progesterone

Progesterone is one of the quintessential steroidal hormones in the reproductive phase. It has a pivotal role in developing the uterine lining for the nurture and life support of the fertilized egg if implanted.

Role of progesterone in the body

Progesterone helps prepare your body for pregnancy. 

• After ovulation, a clump of cells known as the corpus luteum form produces progesterone. This helps prepare the body for pregnancy.  
   
• In case an egg is not fertilised, the corpus luteum disintegrates, the progesterone levels decrease, and a woman has her period.  
   
• In case an egg is fertilised, the corpus luteum produces progesterone. During the pregnancy period, the placenta becomes the main source of progesterone. 
   
• During pregnancy, progesterone helps prepare your breasts for milk production and lactation

Progesterone levels in menopause
 

Normally, oestrogen and progesterone complement each other and work in opposite ways to create a balance. During perimenopause, though, the progesterone levels start to fluctuate. Low progesterone levels can cause menstrual bleeds and other symptoms such as vaginal dryness. 

During menopause, progesterone starts declining and fails to balance estrogen out. This makes oestrogens dominant before they, too, decline. 

Testosterone

Also known as the “male hormone”, testosterone is the primary sex hormone and an anabolic steroid in males. It promotes masculine, secondary sexual developments. However, it is a lesser-known fact that it is secreted in the female body, with a specific and essential role to play.

Role of testosterone in the body

For women, testosterone is produced in the ovaries and the adrenal gland. 

• It helps control libido, sexual arousal, and orgasm in women
• It also contributes to metabolic functions, muscle, and bone strength
• It impacts moods and cognitive processes

Testosterone levels in menopause

These drop much more gradually than either oestrogen or progesterone. The decline in testosterone can lead to low libido, fluctuations in cognitive capabilities, mood changes, and risk of osteoporosis. In the postmenopause phase, you may also experience acne and growth in facial hair. 

Luteinizing hormone (LH)

It is produced in the pituitary gland and helps control the menstrual cycle. Post 2 weeks during your cycle, the LH increases, causing the ovaries to release eggs during ovulation. 

Follicle-stimulating hormone (FSH)

They are also produced by the pituitary gland. FSH works in tandem with LH to control the menstrual cycle. It also stimulates the formation of eggs during the ovulation period. They reach their peak right before the ovulation stage. 

What hormonal changes occur during menopause?

Although hormonal imbalance causes a significant change in a woman’s life and menstrual cycle, not many women are aware of them. 

A survey by the American Association of Retired Persons (AARP) finds out that only 18% of women above 35 years of age are well-informed about the hormonal changes that occur during menopause. Moreover, when shown the symptoms, 16% were unaware that the symptoms were related to hormonal decline due to ageing. Finally, only 7% could make the connection that the symptoms were related to hormones. 

In this section, we discuss the hormonal changes you feel before, during, and after menopause. Let’s begin. 

The hypothalamus and pituitary glands mostly account for a master switch in your body that sets hormonal functions in motion through a cyclic feedback mechanism. When it comes to menopause, the ovarian follicles gradually become resistant to the hormones (gonadotropins) from Follicle-stimulating hormone (FSH) and Luteinizing hormone (LH). This inhibits the formation of new ovarian follicles, reducing oestradiol secretion.

The “hypothalamus-pituitary nexus” generally considers reduced oestrogen levels as a sign to produce more FSH and LH to jump-start the ovaries (obviously not knowing that the terms have changed!). As a result, this is when exactly you start experiencing irregular menstrual activity and early symptoms of imminent perimenopause. Meanwhile, the impairment in the menstrual routine affects the formation of the corpus luteum and hence the hormonal secretion of progesterone.

Ultimately, this leads to a point where no more ovarian follicles exist or reduce to very few that might be gonadotropin resistant by now. Oestradiol is replaced by oestrone as the primary form of oestrogen. However, the higher concentration of LH in the absence of follicles promotes ovarian androgen secretions—mainly testosterone.

Oestrogen, progesterone and testosterone play the lead roles in the cascade of symptoms experienced in menopause.

Source

How do hormonal changes during menopause impact the body?

Menopause causes a whole lot of symptoms in the body. These vary from woman to woman and can change in severity as well. 

Here are the prominent bodily changes you may feel during menopause:

Physiological Changes

• Decreased bone calcium – susceptibility to fractures
• Increased lipids – weight gain, obesity
• Altered thyroid function due to irregular estrogen levels, leading to hypothyroidism
• Impact on adrenal glands causing a constant feeling of tiredness, lack of focus, and anxiety
• Thinning, drying, and inflammation of the vaginal walls
• Hypertension

Emotional Changes

• Depression
• Excitability
• Irritability
• Lack of sleep
• Blackouts

Vasomotor Symptoms

• Hot flashes
• Night sweats
• Sleep disturbances

Disease Susceptibility

• Infections – vaginitis, UTI
• Malignancies – cervical, uterine, breast
• Genital prolapse, hernias – due to laxity of the abdominal wall.
• Arthritic changes

4 myths around menopause and hormones that need to be busted

Myth #1: Menopause is the end of sexual life

As the name suggests, it is just a pause, not the end. On the contrary sexual life can be more active devoid of pregnancy risk or lesser parental concerns allowing more time and freedom to devote to oneself.

Myth #2: Menopause jump starts automatically by the age of 50

Not exactly. The hormones of our body don’t work by a thumb rule. Menopausal symptoms are reported even from the late thirties to as late as the early 60s.

Myth #3: You can’t get pregnant when experiencing irregular periods before menopause

A big no! It is advised to follow any form of Contraception even during irregular periods. No matter if you are late by a month or two, your hormones are technically active, it is perimenopause, and you have a fair chance of getting pregnant.

Myth #4: Menopause is all blues

There is this widespread misconception equating menopause to depression. Hormonal variations can only cause temporary mood swings or blackouts. Proper counselling, therapy, emotional support and understanding can get things back on track.

Ancient Wisdom around Menopause

You are not the first and definitely not the last to go through this particular phase of life.

In Ayurveda, Menopause or Rajo-nivritthi (Raja means menstrual blood in this context, and nivritthi means cessation) is never considered an ailment but a phase at the threshold of senescence. Ayurveda promotes a healthy lifestyle and food habits over medical interventions in this particular context.

Incorporating yoga, meditation and mild exercises can limit many psychosomatic ailments and body aches, reduce stress and improve focus.

Consider this phase of life as an opportunity or a duty call from your body to restructure your life and reassign your priorities.