Menopause: Understanding Hormonal Changes & Their Effects
Menopause marks the permanent end of menstruation, diagnosed after 12 consecutive months without a period. It typically occurs between ages 45–55, with the average age around 51 in many populations.([turn0search4])
Hormonal Shifts in Perimenopause & Menopause
- Decreasing estrogen and progesterone: Estrogen (especially estradiol) declines rapidly about 2 years before menopause and stabilizes ~2 years after. Progesterone levels also fall.([turn0search13])
- FSH, LH, inhibin B & AMH changes: As ovarian follicles diminish, inhibin B and AMH decrease, while FSH and LH levels rise.([turn0search9][turn0search5])
- Androgens during aging: Testosterone, DHEAS, and androstenedione decline gradually with age but are not driven directly by menopause.([turn0search33])
Common Symptoms Due to Hormone Changes
- Vasomotor symptoms: hot flashes and night sweats are the hallmark; episodes vary in frequency and intensity.([turn0search31])
- Menstrual irregularity: periods may become shorter, skipped, or erratic before stopping completely.([turn0search0][turn0search15])
- Genitourinary syndrome (vaginal atrophy): thinning of vaginal tissues causes dryness, painful intercourse, itching, and urinary issues.([turn0search30])
- Mood and cognitive effects: anxiety, irritability, memory lapses (“brain fog”), sleep disruption, and low mood are common.([turn0search33][turn0search34])
- Metabolic & cardiovascular shifts: weight gain (especially visceral), insulin resistance, dyslipidemia, and endothelial changes raise heart disease risk.([turn0search1][turn0search33])
- Bone loss and fracture risk: accelerated bone density loss occurs starting one year before menopause and into early postmenopause.([turn0search33])
Treatment & Management Strategies
- Hormone therapy (HT/HRT): Estrogen (plus progestogen if uterus intact) is most effective for hot flashes and vaginal symptoms—and offers bone and cardiovascular benefits if started early.([turn0search11][turn0search32][turn0search35])
- Timing matters: Initiating HT within 10 years of menopause or under age 60 yields more benefit and fewer risks.([turn0search35][turn0search8])
- Non-hormonal options: SSRIs/SNRIs (e.g., paroxetine, venlafaxine), gabapentin, cognitive-behavioral therapy, and lifestyle changes can ease symptoms.([turn0search13])
- Lifestyle & diet: Mediterranean-style nutrition, hydration, exercise, stress reduction, and smoking cessation help mitigate symptoms and long-term risks.([turn0news29][turn0news25])
Importance of Menopause Awareness
Perimenopause can last several years, with fluctuating hormone levels and symptoms that may emerge before periods stop—nearly 37% of late-perimenopausal women experience moderate-to-severe hot flashes.([turn0news20])
New calls urge better support: low-dose vaginal estrogen (for genitourinary symptoms) is underused due to FDA warnings that experts say should be revised.([turn0news18])
Framing menopause as “midlife transition” or “cougar puberty” reflects both the physical and emotional upheaval—and the potential for reclaiming well-being.([turn0news17])
Summary & Takeaway
- Menopause reflects a natural hormonal transition marked by estrogen decline and a rise in FSH/LH.
- Symptoms span vasomotor, genitourinary, cognitive, mood, bone and cardiovascular domains.
- Effective management includes hormone therapy (when appropriate), non-hormonal relief, and lifestyle support.
- Early symptom awareness and individualized care improve long-term health and quality of life.