A Survival Guide to Menopause Hormones: Find Out What You Need to Know

Hormonal changes in menopause have become part of your routine. Wake up at three a.m. drenched in sweat. Chug ice water, contemplate dumping it on your head. Move through the day on autopilot – your brain is too foggy for any curveballs. If you’re lucky, you make it to lunch without a hot flash… or before losing your cool on a coworker. Bonus points for both.

In menopause, your hormones play a cruel game – and it’s impossible to know how long it’ll last. Is it time to start menopause hormone therapy? In this blog, we share what happens with your hormones before, during, and after menopause. Read on to decide if hormone therapy is right for you.

The Role of Estrogen and Progesterone in Women 

Menopause marks the end of your reproductive years through a full twelve months without a menstrual period. To understand what happens to your hormones as fertility comes to a halt, it helps to know their role before then.

Your menstrual cycle prepares you for the possibility of pregnancy. Month after month, the ovaries release an egg during ovulation to be fertilized. Hormones rise and fall to make this happen. In general, estrogen supports ovulation and progesterone supports a pregnancy. But they do so much more…

Estrogen

In a normal menstrual cycle, estrogen peaks around ovulation and near the end of the cycle. High estrogen causes a heightened sense of smell, increased energy, and uplifted mood. It helps maintain a healthy vagina, supplying plenty of blood flow to the area. (Spoiler alert: menopausal symptoms like vaginal dryness and mood changes are caused by low estrogen.)

Beyond ovulation, estrogen affects nearly every tissue or organ system. It plays a major role in heart health. Estrogen regulates cholesterol and promotes blood circulation and clot formation. [1] 

It also helps with bone density. As women age, the risk of bone fractures increases due to low estrogen.[2] 

Progesterone

In your fertile years, progesterone prepares the womb for pregnancy each cycle. It peaks several days past ovulation – creating a healthy environment for a fertilized egg to grow. It thickens the uterine lining and prevents contractions that could reject an egg.  

Due to its presence in the later half of the cycle, progesterone is associated with PMS. Changing progesterone causes symptoms like mood swings, breast tenderness, cravings, and bloating. [3]  In menopause, signs of low progesterone are similar to PMS symptoms. 

Hormonal Changes During Menopause

As your body prepares to stop reproducing in perimenopause, your hormone levels change. The hormones that once played an important role in fertility now have less to do. They fluctuate and drop until settling into a new low in menopause.

In perimenopause, your periods become unpredictable as they taper to an end. They may be heavier, lighter, shorter, or longer than normal. Eventually, they stop altogether – once it’s been a year with no period, you’ve hit menopause. 

Sounds simple enough, right? If only it weren’t for fluctuating hormones, which cause those aggravating menopausal symptoms…

Changing progesterone affects your periods, making them irregular, heavier, or longer during the transition. Low progesterone and estrogen can cause mental changes. The drop in hormones causes decreased serotonin production. It’s common to experience depression or anxiety during menopause as a result.

Most of the common menopause symptoms are associated with dropping estrogen. Symptoms of low estrogen are: [4] 

  • Irregular periods
  • Hot flashes
  • Depression or anxiety
  • Mood swings 
  • Mental fogginess 
  • Low sex drive
  • Vaginal dryness and painful sex
  • Sudden or frequent need to pee 

Navigating symptoms is a challenge – especially when they’re unpredictable. The good news is symptoms will resolve once your hormones stabilize post-menopause. Until then, it’s a wild ride. 

Hormone Replacement Therapy 

Maybe you’ve gotten used to menopausal symptoms – or maybe they’re keeping you up all night. If they’re affecting your quality of life, it may be time to consider medical treatment. Hormone therapy (HT) is commonly used to treat symptoms of low hormones in menopause. 

Hormones are replaced through different delivery methods, depending on the type and severity of the symptoms. Delivery methods include: [5]

  • Oral. Estrogen-only pills are recommended for women without a uterus (hysterectomy). For women with a uterus, combination therapy is preferred. Estrogen plus progestogen (the synthetic form of progesterone) is a combination therapy. Oral treatment is taken every day. 
  • Skin. Patches applied to the skin are changed once or twice a week.
  • Vaginal: Gels, creams, sprays, or rings are applied directly into the vagina. They help provide relief for symptoms like vaginal dryness and painful sex. The vaginal ring is changed every three months. 

What are the signs that you need hormone replacement therapy? It depends on the severity of your symptoms. Talk to your gynecologist about how your symptoms are affecting your daily life. 

Benefits and Risks of Hormone Therapy 

The North American Menopause Society (NAMS) says the benefits of HT outweigh the risks. [5] That is, if you’re under 60 and within ten years of menopause. Starting hormone therapy later increases the risk of hormone-dependent cancers. 

Early menopause hormone therapy relieves symptoms and is safe for most women. Read about the benefits and risks of HT to decide if it’s a fit for you.

Benefits

HT relieves menopausal symptoms – and it also prevents women’s health conditions associated with age. Estrogen replacement builds strong bones and may prevent osteoporosis. It reduces the risk of diabetes and colon cancer. HT also supports mental health, improving mood and well-being. [2]

And HT helps resolve symptoms like: [5] 

  • Hot flashes
  • Night sweats 
  • Vaginal dryness 
  • Insomnia

Creams and vaginal inserts are easier on the liver than pills; the medication is absorbed directly into the bloodstream from the vagina. This may be a safer option for someone with heart or liver concerns.

Risks

High exposure to estrogen increases the risk of hormone-dependent cancers. If you have a family history of hormone-dependent cancers, you are at an increased risk. 

Taking estrogen and progesterone together reduces the risk. Estrogen therapy causes the endometrium to thicken and grow more cells. This can cause cancer cells to grow. Progesterone encourages the uterine lining to shed, which reduces the risk of cancer. [5] 

In general, the risks of HT increase the later in menopause it’s started. It increases the risk of:  [5] 

  • Heart disease (if started after 60)
  • Dementia (if started after 65)
  • Stroke or blood clots in the legs 
  • Breast cancer
  • Endometrial cancer 

Hormone therapy is a safe and effective way to get relief from menopausal symptoms, but it’s not a fit for everyone. Talk to your doctor about your medical and family history when deciding whether to start.

Hormone therapy may also have side effects which can include: [6] 

  • Dizziness
  • Headaches
  • Blurred vision
  • Mood changes
  • Uterine bleeding
  • Nausea
  • Breast tenderness
  • Swelling of the legs or arms

Most side effects resolve after a few months. Your provider may change the dose or recommend giving treatment time to see if side effects subside. Women typically stop HT after 4-5 years. It’s common to switch from pills to vaginal HT when you’re ready to wean off therapy. 

Nonhormonal Therapies 

If you’re one of the 75% of menopausal women who has hot flashes or night sweats [7] – or the many disruptive menopause symptoms – you may be ready to get relief. But what are your options if you don’t qualify for hormone therapy?

If you are at increased risk for heart disease, stroke, or hormone-dependent cancers, HT may not be for you. Talk to your doctor about non-hormonal therapy options for menopause. 

These are some common medications used to treat menopausal symptoms: [7] 

  • Paroxetine is an antidepressant approved to treat hot flashes. It is the only non-hormonal treatment for moderate to severe vasomotor symptoms. 
  • Gabapentin is also used to treat hot flashes. It affects the part of the brain responsible for thermoregulation.
  • Oxybutynin is typically used to treat overactive bladder. A side effect of oxybutynin is reduced sweating. It has been shown to reduce the severity and frequency of hot flashes in menopausal women.
  • Clonidine is most commonly used to treat hypertension. It treats hot flashes by impacting the body’s temperature control center.

If you’re looking for natural hormone replacement for menopause, consider an integrative approach. According to a study, women have successfully found help with menopause naturally through: [7] 

  • Acupuncture. It’s used to reduce hot flashes, balance hormones, and provide mental rest in menopause. 
  • Cognitive behavioral therapy (CBT). In two studies, CBT was used for hot flash management in breast cancer patients. CBT reduces the severity but not the frequency of hot flashes. 
  • Herbal treatment. Women use herbs like black cohosh and soy isoflavones for hot flashes and night sweats.

Ask your doctor before starting herbal treatments, especially if you’re taking other medications. Learn more about natural ways to navigate your symptoms on Foreverbetty.com.

Decide How You’ll Spend Menopause

Hormones have a sick sense of humor, don’t they? They have you drenched in one area while feeling… quite dry elsewhere. If menopausal hormone changes have you at your wit’s end, take action. Talk to your doctor about treatment options based on your health history. 

Until then, you can join a community of women going through the same experience as you. The Foreverbetty Community is a place to learn, laugh, and share stories and tips with one another. Join the Foreverbetty Community today. 

*Medical disclaimer:

The content in this article is provided for informational purposes only. This is not intended to prevent, diagnose, treat, or cure any health conditions. It is not a substitute for professional medical advice or consultation. Talk to your doctor before making changes to your healthcare regimen. 

Sources
     1. Estrogen & hormones
     2. Hormone therapy for menopause symptoms
     3. Reproductive hormones
     4. Menopause
     5. Deciding about hormone therapy use
     6. Menopause FAQs: Hormone Therapy for Menopause Symptoms
     7. Contemporary Non-hormonal Therapies for the Management of Vasomotor Symptoms Associated with Menopause: A Literature Review

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