Understanding Menopause

Recent advances in the biology of menopause have helped clarify the importance of female hormones in women’s overall health. Improved patient education that allows women to engage in formal conversations with their care providers helps clinicians to individualize menopause management for their patients. In essence, while menopause is a complex process, it can be understood at a basic level by viewing it simply as a process of hormone withdrawal.  And the hormone of most importance is estradiol, cyclically produced in large amounts by the ovaries during the reproduction years, reflecting the high numbers of eggs that rapidly decrease in number as one approaches menopause.

During reproductive years, estradiol is critical for menstrual cycles and pregnancy. More recently, scientists have found that during these years, estradiol also has an anti-inflammatory action, preventing immune cells and visceral fat cells from releasing certain inflammatory cytokines, including Interleukin 1, Interleukin 6 and Tumor Necrosis Factor alpha. Yet it is these same inflammatory proteins that our scientists have linked to essentially all of the more common menopausal symptoms, such as hot flashes, mood swings, memory loss, dry skin, vaginal dryness, low libido, bone breakdown and cardiovascular risk.

In the past, menopause was considered one full year without any menstruation. We now know that in the several months to years leading up to that one year without menstruation, the ovaries gradually become more resistant to hormone control from the brain. This window in time, previously known as perimenopause, now is formally termed the Menopause Transition. Women may only recognize this by encountering irregular menstrual periods. During this interval, however, fluctuations of estradiol from the ovaries begin to allow immune cells and visceral fat cells to release low levels of these inflammatory cytokines into the blood stream. The result is that these women may begin to experience early menopause symptoms, even though they are still having irregular periods.

The menopause transition represents more than simply the emergence of early menopausal symptoms. This period is associated with significant increases in visceral fat, cholesterol and triglycerides, thickening of the walls of carotid arteries, weight gain and reduced physical activity.

During menopause, estradiol essentially becomes undetectable in the blood. One would expect that all women, therefore, would experience the classic symptoms of menopause, but that is not so.  Despite low levels of estradiol, women entering menopause will differ in how they perceive absence of estradiol. Some will experience only minimal or mild symptoms, while others will feel that they are overwhelmed by new, distressing symptoms.  The duration of these symptoms also differs among women. For some women, symptoms will pass within a few years. Recent longitudinal studies now indicate that for other women, symptoms of menopause may last well into their 60s or even 70s.

Scientists have helped clarified the biology of menopause. Clinicians now better understand the range of responses women experience during menopause. These two revelations have matured the field of menopause medicine. Some women will find that education alone is sufficient. Others will need the education to enter into an adult conversation regarding management. Whether it is through therapeutic listening, complementary and alternative medicines, or hormone replacement, menopause medicine is now a rich, mature, and established field of medicine. Women have always known that menopause is real. The medical community is still working to improve each woman’s menopausal life. 

By James Woods, M.D.
Dr. Woods treats patients for menopause at the Hess/Woods Gynecology Practice.

Disclaimer: The information included on this site is for general educational purposes only. It is not intended nor implied to be a substitute for or form of patient specific medical advice and cannot be used for clinical management of specific patients. Our responses to questions submitted are based solely on information provided by the submitting institution. No information has been obtained from any actual patient, and no physician-patient relationship is intended or implied by our response. This site is for general information purposes only. Practitioners seeking guidance regarding the management of any actual patient should consult with another practitioner willing and able to provide patient specific advice. Our response should also not be relied upon for legal defense, and does not imply any agreement on our part to act in a legal defense capacity.

James Woods | 10/16/2015