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Menopause and Its Functions—A Case for Hormone Replacement Therapy?

Medically Reviewed by

Menopause, the universal biological event in a woman’s life occurs at about age 51, marking the transition from the reproductive to the non-reproductive phase of life.  As the ovaries become less and less efficient and produce less estrogen, many women begin to experience a range of uncomfortable symptoms that may affect their quality of life.  In some cases, hormone replacement therapy, (HRT) may be a good option for these women.

What Happens As Women Age

Typically, the older women get menstrual periods change in character, becoming irregular until they cease altogether several years later. After the age of about 54, the ovaries become totally nonfunctional as blood levels containing estrogen drop to very low values for the remainder of a woman's life. It is at this time that a woman must decide whether or not to pursue treatment with hormone replacement therapy (HRT).

Logically, this decision should be based on the possible immediate and long-term consequences of having almost no estrogen in the body after menopause, along with the known benefits and risks of HRT.

Common Menopausal Systems

  • Hot Flashes— A sudden sensation of feverish heat occurs in about 90 percent of women during menopause.  There are large differences between women in the frequency and severity of hot flashes, however.
  • Atrophic Vaginitis— This is a thinning of the tissue that lines the vagina.  This also decreases vaginal lubrication so that sexual relations may be uncomfortable.
  • Psychological Symptoms—Many women experience psychological symptoms around the time of menopause. Most of these involve changes in mood such as sadness, irritability, and nervousness or anxiety.
  • Intellectual Function—Research finds that estrogen helps to maintain verbal memory, and possibly enhances the capacity for new learning in women.  This may become impaired during menopause.

Reasons For Menopausal Symptoms

  • Hot Flashes are thought to be due to changes in the concentration of certain neurotransmitters in the brain that occur because of the relative deficiency in estrogen. Hot flashes are usually most intense around the time of menopause (48 to 51 years) and tend to occur less frequently in the postmenopausal phase.
  • Atrophic Vaginitis and the loss of vaginal lubrication are symptoms that are estrogen-dependent and respond reliably to HRT.
  • Mood Disorders—It is known that estrogen is capable of acting in areas of the brain that influence mood. Furthermore, estrogen can increase the concentration of a neurotransmitter, a chemical substance that helps neurons communicate, that acts to enhance mood.

Although it is possible that the decrease in estrogen production around the time of menopause can precipitate depressive symptoms, which are reversed by estrogen replacement therapy, the dose of estrogen conventionally used will not, in itself, alleviate a major depressive illness. It is, therefore, very important to make the distinction between depressive symptoms and a full-blown depressive illness which may require treatment with antidepressant drugs.

  • Intellectual Function—The fact that estrogen increases the amount of an enzyme needed to produce the neurotransmitter acetylcholine, which is known to be important for memory functions, may explain the enhancement of specific aspects of memory that estrogen seems to facilitate. Whether or not estrogen will decrease memory deficits or retard the deterioration of memory in Alzheimer's disease remains to be tested.

Why Hormone Replacement Therapy May Be Beneficial

  • Long-term Benefits—Currently, there are several well-established long-term benefits of HRT. For example, estrogen replacement therapy can reduce the risk of coronary heart disease by approximately 50 percent. Estrogen accomplishes this in several ways, one of them being a favorable modification of lipid metabolism. In addition, estrogen has direct effects on the walls of coronary arteries.
  • Bone Density—There is a gradual loss of bone with increasing age, which is accelerated in women after menopause occurs. Osteoporosis defines a condition in which women have lost so much bone that they sustain fractures spontaneously or following minimal trauma. In fact, 17 to 25 percent of older women will sustain a fracture of the hip or spine respectively. Many studies have shown that estrogen effectively prevents bone loss in postmenopausal women.

Possible Risks Related to Hormone Replacement Therapy

  • Uterine Cancer—In the mid-1970's, an increased risk of cancer of the endometrium, the tissue that lines the uterus, was observed in women who were given estrogen replacement therapy. Since then, it has been demonstrated that the addition of a progestin, a synthetic form of the hormone progesterone, to an estrogen replacement regimen dramatically decreases the risk of endometrial cancer.
  • Breast Cancer—Conclusions regarding a possible increased risk of breast cancer in postmenopausal women receiving estrogen are more tentative. Four studies, which combined results of many smaller investigations, failed to demonstrate a significantly increased risk of breast cancer in postmenopausal estrogen-users compared to nonusers.

A fifth study did find a greater incidence in estrogen-users but it appeared only after 15 years of continuous estrogen use. It is thought that the presence of benign breast disease is not a contraindication to HRT.

While the benefits of HRT would seem to outweigh the risks for many women, several factors must be considered before making a decision with your physician.

These may include:

  • Your personal medical history including:
  • History of certain conditions including breast cancer, liver disease, blood clots, heart disease
  • Age and length of time HRT needed
  • Type of therapy necessary
  • Whether or not menopause is the result of surgical menopause, (hysterectomy) or naturally occurring
  • Severity of menopausal symptoms


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