In my opening blogs I have hoped that you would accept my observation that the menopause was a critical time in a women’s life cycle. By this I meant that the menopause occurs at a time of life when warning signs of future illness, or even early onset of major diseases, begin to be expressed, even though in some instances these have nothing to do with the menopause itself. Certainly there are some conditions that are the direct consequence of the hormonal changes around menopause. But in both circumstances, my point was that the menopause is an ideal marker in a women’s life cycle for her to be encouraged to be evaluated for these conditions. Where positive diagnoses are made, this is the time for the introduction of preventive care, early therapy, or both.
To know what it is we need to screen for, we need to be cognizant of two things:
1. What are the potential true health-related effects directly associated with the menopause?
2. What are the important diseases associated with aging in women coincidental with the time around menopause?
HORMONAL CHANGES AT MENOPAUSE
There is a constant, albeit cyclic, ability of the ovary to produce estrogen and progesterone throughout the reproductive years. What these hormones actually do around the body is explained below (and in greater detail in my book, CHANGE YOUR MENOPAUSE – why one size does not fit all).
The real issue is that after menopause the cyclic production of estrogen and progesterone from the ovary ceases. Remember, the ovary is presented before birth with all the eggs it will ever have, and no new ones will ever be formed again. Following some 35 years of regular menstrual cycles, interrupted only by any pregnancies and breast-feeding that may have occurred, the ovary runs out of its supply of eggs. I am often asked if taking birth control pills results in saving eggs. Unfortunately, the answer is no. Even on the pill, there is a constant loss of eggs. The difference is that the pill blocks any one follicle from reaching maturity and releasing an egg.
Very occasionally, one final follicle with an egg may accept the FSH signal, and a breakthrough ovulation may occur (with risk of possible pregnancy as well). When the ovary has failed to do even that, and 12 months have gone by without ovulation and a period, the official diagnosis of menopause can be made. The hormonal changes can be truly dramatic.
SO WHAT IS SO IMPORTANT ABOUT THE SEX STEROIDS?
The sex steroids have a major impact on the structure and function of virtually every body tissue and organ. This is best explained by considering their effect on the most important of these tissues and organs.
DIRECT EFFECTS ON THE SEX ORGANS BEFORE MENOPAUSE:
Think of the sex steroids as being building contractors. Estrogen is a growth-promoting hormone. In the building analogy, it would be responsible for building the basic structure of a house, that is, the walls, floor, roof, and so on. Progesterone is the decorator, putting in carpets, light fittings, furniture, ornaments, and the rest. Just as a decorator would have nothing to do if the house was not built, progesterone would likewise be jobless if the tissues had not first been primed by estrogen.
Vulva: Before puberty, the vulva of a child has a flat slit-like appearance with tiny labia. With the onset of production of sex steroids at puberty these tissues undergo a dramatic change. The first event is the appearance of hair on the mons pubis, and this is followed by an increase in the size of the labia, and a slight increase in the size of the clitoris.
Vagina: Estrogen stimulates growth and thickening of the vaginal lining. The real effect is an increase in the thickness, pliability, and potential sex function of the vagina.
Uterus: The lining of the uterus, named the endometrium, thickens during the first half of the reproductive cycle, stimulated by estrogen. This is therefore called the proliferative phase, and the lining at this time has a classic appearance under the microscope, called the proliferative endometrium. In the second half of the cycle, progesterone, the decorator, converts the proliferative endometrium into the secretory endometrium. What has happened is that the progesterone has prepared the lining to be a welcoming place for a fertilized egg to move into. In unsuccessful cycles, that is where there is no resultant pregnancy, the levels of estrogen and progesterone fall; the endometrium shrinks, and then begins to break away. This of course presents as the period, or menstrual flow. These hormone effects will occur irrespective of whether the hormone comes from the ovary itself, or a woman is taking hormones as medication. Too much estrogen will cause too much thickening of the endometrium, and this can result in abnormal bleeding patterns.
Breasts: Many women feel changes in their breasts during their normal monthly cycle. This too is the result of the changing level of the sex hormones. These symptoms are usually most marked in the second half of the cycle. Here what is happening is that estrogen only increases the size of the ducts in the first half of the cycle. Progesterone, the decorator, stimulates the breast glands during the second half of the cycle to get ready to produce milk in the event of a possible pregnancy. But the role of progesterone in the breast is different in that it stimulates both growth and development during this process.
EFFECTS ON THE REST OF THE BODY:
The sex steroids impact every organ and bodily function. Consequently, after menopause, their reduced levels will have many possible negative effects on body tissues and functions.
Some of the important areas affected are listed below.
2. Body weight
8. Skeleton (bone)
10. Heart and blood vessels
11. Brain function – body temperature control, sleep, mood, and memory
12. Sexual behavior
This is quite an impressive list. Alteration of hormonal effects can change function to such an extent that serious symptoms or disease can result.
As I develop the narrative and go into the detail of what may occur after the drop in hormone levels post-menopause, I cannot emphasize enough that not everyone gets everything. Secondly, I will be clearly showing you how many of these negative changes can be avoided or ameliorated by a combination of healthy living practices, supplements, and if appropriate, medications.
I will explain the impact on these tissues in upcoming blogs where I will address the critical question –“What are the true effects of menopause?”
Wulf Utian MD PhD DSc
Author; CHANGE YOUR MENOPAUSE – Why one size does not fit all. https://www.amazon.com/Change-Your-Menopause-size-does/dp/0982845723/