Let’s Talk Hormones
Menopause … We all have heard this word, but do you know what is actually occurring inside your body when menopause is occurring? Many know how to identify this stage of life by the external changes that happen, like hot flashes, night sweats, and noticeable mood swings, but aren’t familiar with what exactly is going on with their hormones internally as they transition from their reproductive years to menopause.
It's a lot and can be confusing for many. If you feel similarly, that’s okay! Continue reading for a little insight into what you are experiencing or could expect when your hormones begin to change with age.
Menopause, Estrogen, & Progesterone … Oh My!
To begin, let’s talk about two of the key hormones involved in menopause.
Estrogen:
When I think of menopause, estrogen is the main hormone that comes to mind. Estrogen is important to vaginal lubrication, vaginal acidity, vaginal muscle strength, uterine contractions, uterine mucous secretion, and milk production. Two types of estrogen involved in menopause are estradiol and estrone. Estradiol is the main estrogen before menopause. It is mainly produced in a developing follicle. Estrone is the main estrogen of menopause and also produced in developing follicles. It is a weaker estrogen than estradiol. Together, estradiol and estrone work alongside each other to regulate the reproductive system and menstrual cycle.
Progesterone:
Another hormone involved is progesterone. Progesterone is produced by the corpus luteum, which is a tissue that forms in the follicle after ovulation. Progesterone prepares the uterus to receive and support and fertilized egg. During the menopause transition, progesterone levels decline because the corpus luteum, which is regulated by ovulation (and subsequently estrogen), becomes less efficient.
Stages of Menopause
Did you know that menopause occurs in three distinct stages? These stages are important to be aware of because your hormones will affect you differently depending on where you are at in your menopause journey.
The first stage is perimenopause, which occurs 3-5 years before menopause. Menopause, or the second stage, is defined as the absence of menstruation for 12 straight months. The final stage is postmenopause. Postmenopause occurs when you have not experienced a period for an entire year.
PUTTING IT ALL TOGETHER!
Okay … that is a lot of information. Let’s put it all together by thinking about the stages and what happens to our hormones during these stages.
What happens during perimenopause?
Once you enter perimenopause, your estrogen levels start to decline. As your estrogen levels decrease, your progesterone is thrown off balance. Throughout the perimenopausal period, it is common for your estrogen and progesterone levels to fluctuate because your ovaries are producing the hormones sporadically. As these hormones directly impact ovulation and menstruation, a hallmark symptom of perimenopause is unpredictable and unreliable menstrual cycles. Your periods may be shorter, longer, or you may skip a cycle.
It has been 12 months since your last period, now what?
At this point, your hormones are less sporadic, fluctuating less and less. Your ovaries are no longer able to release an egg and your menstrual cycle has officially ended. Now that the constant fluctuation of estrogen and progesterone is over, your hormone levels are at their lowest. Despite experiencing hormonal stability, the overall deficiency of your hormones means you can still continue to experience the symptoms of menopause.
TREATMENT OPTIONS:
Now that you have a better understanding of what is happening in your body during menopause, let’s talk about potential treatment options for the not-so-fun symptoms that you might experience throughout menopause.
Hormonal Replacement Therapy (also known as HRT, hormone therapy, menopausal hormone therapy, estrogen replacement therapy) is the most effective treatment for menopause symptoms.
Estrogen Therapy:
Estrogen therapy can come in many forms, including:
Estrogen Pill
Estrogen Patch
Topical Estrogen
Vaginal Estrogen
Combined Therapy:
Combines doses of estrogen and progestin (aka synthetic progesterone)
Oral Progestin
Intrauterine progestin
As you can see, there are many hormonal options available for individuals who are experiencing perimenopause and menopause to reduce their symptoms. It is recommended that you speak with your doctor or someone who specializes in women’s health to determine what is the best option for you. Further … it is important to note that not everyone is a good candidate for Hormone Replacement Therapy. For example, if you are a cancer survivor, allergic to synthetic estrogen, have a clotting disorder, etc., HRT is not safe for you. Talk to your healthcare provided to determine the best route for your care.
Referrals
Contact these providers in the community to learn more and take charge of your menopause journey:
How Can Pelvic Floor Therapy Address Your Symptoms?
If HRT is an option for you or if it is not, you may ask yourself, “What are other approaches to addressing my symptoms?”
Pelvic Floor Therapy could work for you! As noted above, perimenopause and menopause are associated with changes in vaginal lubrication, vaginal acidity, and vaginal muscle strength, secondary to estrogen. There is a reason why incontinence is the second leading cause of women being institutionalized (going into an assisted living or skilled nursing facility); menopause changes our pelvic floor but what we are not told is that pelvic floor therapy can help. A skilled pelvic floor therapist can work with you to identify your symptoms, their causes, and support you throughout these changes. Research shows that pelvic floor muscle training can increase pelvic floor muscle strength and contractility leading to decreases in pain and discomfort, urinary symptoms, bowel symptoms, and pelvic organ prolapse. Further, a pelvic floor therapist can provide you with breathing strategies, positioning tips, tools, and supports that can alleviate your symptoms and improve your daily functioning.
Experiencing perimenopause and menopause can be overwhelming. Check with your provider to see if you would be a good candidate for pelvic floor therapy. The Perinatal Pelvis is here to help and support you as you navigate the changes and symptoms related to menopause. Contact her today!
Citations:
Begum, J. (Ed.). (2023, October 11). Menopause and HRT: Hormone replacement therapy types and side effects. WebMD. https://www.webmd.com/menopause/menopause-hormone-therapy
Cleveland Clinic. (2021). Perimenopause: Age, stages, signs, symptoms & treatment. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21608-perimenopause
Gunter, J. (2021). The Menopause Manifesto: Own your health with facts and feminism. Random House Canada.
Liv HEALTH Team. (2019, September 16). The estrogen family: Estrone, estradiol, estriol. Liv HEALTH. https://livhealth.com/estrone-estradiol-estriol/
Tahery, M. (2022, September 23). Hormones in Perimenopausal and Menopausal Women. Dr. Tahery: L.A. Women’s Health and Wellness. February 21, 2024, https://www.drtahery.com/hormones-in-perimenopausal-and-menopausal-women