Understanding Menopause

Excerpt from How to Acheive Healthy Aging by Neal Rouzier, MD.
As a woman’s estrogen levels begin to decrease, usually during her mid- to late-forties, she may start to experience discomfort. Many women complain of hot flashes, vaginal dryness, insomnia, poor concentration, weight gain and changes in skin and hair texture. Some of these troublesome symptoms disappear late into menopause. However, at this point, there is an increased risk of cardiovascular disease, stroke, osteoporosis, and Alzheimer's. All of these are severe problems most newly menopausal women are unaware of until it’s too late.

Seventy-five percent of all peri-menopausal, menopausal, and late menopausal women suffer from hot flashes. A hot flash is a sudden shock of warmth followed by perspiration and sometimes heart palpitations. For some women, these sudden jolts of heat are minor, but for others they can be absolutely debilitating. We're not exactly sure of the mechanism behind this surge of heat, but we are positive it is directly linked to the sudden shortage of estrogen. Women report that it strikes without warning and is gone before they know it. Although they may be quick, they can be disorienting and embarrassing.

This is the main reason estrogen replacement therapy got underway. It would allow women to ride out menopause without experiencing the bothersome symptoms. Estrogen supplementation eliminates these flare-ups in a matter of days, restoring a woman's self-confidence and composure in everyday situations. Unfortunately, too many women used estrogen as a temporary fix for menopause, rather than a long-term means to increase their quality of life. The advantages of this extended health benefit far outreaches the convenient quick-fix estrogen offers during early menopause.

Along with hot flashes and night sweats come menstrual irregularities. For most women their period is a sign of health, but during perimenopause the monthly cycle goes awry. Periods can range twenty five to sixty days apart. Some periods are light, others are heavy. Don’t let this alarm you. Your body is adjusting to the sudden lack of hormones. This stage is termed perimenopause. Abnormal or irregular menstruation during this phase is considered normal.

Many women also complain of mood swings, and this symptom seems to receive more press than any other trait of the menopausal process. Since estrogen interacts with beta-endorphins in the brain (the neuropeptides that curtail pain while enhancing a sense of well-being), the amount of its levels in the body influence how a woman will view and react to her surroundings. Good moods and balanced emotions in the beginning of the menstrual cycle are attributed to estrogen's high levels. Loss of estrogen causes unprovoked episodes of crying even at a minor irritation.

As a woman gets older and estrogen levels begin to decline, it's no surprise her mood deteriorates. With the erratic aspect of a woman's hormones during perimenopause, and the intersection of these crazed hormones with the ongoing process of life, some women become overwhelmed and depressed.

I remember, in particular, a woman sitting in my office with a balled-up tissue in one hand and a bottle of prescription mood-stabilizers in the other. I'll call her Rebecca. She had been put on Prozac to curtail her "mood disorder" when she was forty-five. At age forty-six she was sitting in my office at the urging of a co-worker with tears streaming down her face.

Rebecca believed she was doomed, and her husband believed he had married Dr. Jeckyl and Mr. Hyde. After having her blood drawn and tested, I was able to assure Rebecca she did not have a split personality, she was simply lacking the proper levels of the hormone essential for her emotional health.

After three weeks on a combination of estriol and estradiol, she visited me without her Kleenex and gone was the hopelessness that seemed to enshroud her less than a month before. She mentioned that she felt as if a heavy wool blanket had been removed from her shoulders, like she could breathe again.

Estrogen has proven itself to be a veritable solution to the menopausal blues. In a double-blind, placebo-controlled study, women supplemented with estrogen and progesterone demonstrated an increase of well-being via their results on the Profile of Adaptation to Life test and a decrease in depression measured via their results on the Beck Depression Inventory.

Other symptoms, vaginal dryness and urinary infections can also be side-stepped with estrogen supplementation. Since the entire genitourinary tract is lined with estrogen receptors, an estrogen deficiency creates negative changes in the vagina's environment. The mucosa does not as readily lubricate the vagina when sexually aroused, compromising the prospect of intimacy. It is just too painful, and therefore uninviting. I've had many patients tell me they felt guilty because they no longer desired sex, and with the mood swings they felt they were on totally different planets than their husbands. The husbands remained intimate, yet the women wanted nothing of the sort. Not only does the mucosa stop functioning correctly, but the vaginal entrance becomes smaller and thinner. This process makes sexual intercourse not only painful but impossible for many women. This is called "vaginal atrophy," where the walls become insubstantial and the actual vagina becomes shorter and narrower. A woman at thirty may have fifty to sixty vaginal layers, while a woman of eighty years of age may only have eight. As the skin thins, the cells that maintained the delicate acidic balance become more alkaline, putting the vagina at risk for bacteria to cause infection. The thinning also exposes the vagina to chafing, leaving a woman prone to develope urinary and vaginal infections. Estrogen limits this effect by restoring vaginal tone and elasticity. It increases blood flow and enhances the vagina's lubricating ability. Sex is a natural human hunger, and menopause should not be the final curtain on such an essential and enjoyable aspect of a woman's life.

Another benefit to estrogen therapy is the positive influence it has on the skin. We have heard the phrases, "aging gracefully" or she "ages well." The cardinal physical signs of aging reside in the skin, which becomes dry, thin, and wrinkled – changes which are emotionally unsettling for some women. This especially happens to women after menopause. For years, the dermatology literature has demonstrated estrogen’s protective benefits on skin by prevention of the severe atrophy and thinning commonly seen after menopause. The paper-thin skin found on the arms of all older women not on hormones is due to loss of collagen when there is no estrogen or testosterone to maintain it.

How estrogen therapy helps women maintain thicker, healthier skin is quite simple. Estrogen stimulates the production of hyaluronic acid on collagen which helps hold water and moisture in the inner layer of skin. This in turn supports the outer layer of skin allowing more elasticity while maintaining the overall firmness. This is truly encouraging news to every disheartened woman who notices her skin beginning to sag. Women no longer have to spend their life's savings on creams,sprays and cosmetic treatments. Estrogen naturally tightens and firms sagging skin.

Natural estrogen inhibits the common symptoms a large number of women feel as they pass through the menopausal years. Forty years of successful therapy have proven that hot flashes, insomnia, mood swings, vaginal dryness, and skin atrophy can be eliminated through estrogen supplementation.

What estrogen does for the body before and during menopause is truly amazing. My primary concern as a doctor and your uppermost interest as a maturing woman are the years after menopause, where aging without estrogen can truly undermine your health.