Menopause

The loss of estrogen affects more than the reproductive organs. Decreased estrogen leads to increased bone loss and the risk of osteoporosis, with concerns about hip and vertebral fractures. The protection that estrogen provides premenopausal women against heart attack (relative to men) is also lost in menopause. Skin, in general, becomes thinner and more susceptible to trauma, and thinning of the vaginal mucosa leads to decreased lubrication and potentially painful intercourse. A woman's mood can become more unstable around menopause, with greater mood swings and an increased risk of depression.

The use of hormone replacement therapy (HRT) with estrogen (and progesterone to protect against uterine cancer if the woman still has a uterus), helps prevent and treat vaginal atrophy, as well as providing proven benefits such as osteoporosis prevention. The use of HRT to treat post-menopausal mood problems may help some women previously labeled depressed as much as antidepressants do.

Clinical trials currently underway with estrogen replacement may show benefit in reducing the rate of bowel cancer. Further studies are needed to see if estrogen can prevent the risk of heart attack and coronary heart disease. At this point estrogen does not seem to reduce future heart attacks in women who have already had one.

Women who receive estrogen replacement need to also take progesterone if they still have their uterus. Progesterone is produced along with estrogen in the pre-menopausal woman. It is more active in the second half of the menstrual cycle and maintains the lining of the uterus until levels drop to trigger the next period. Progesterone serves a protective function for the endometrial lining, balancing the stimulating effects of estrogen. Post-menopausal women taking estrogen alone are at increased risk of developing endometrial or uterine cancer. This increased risk is eliminated with the combination use of progesterone with estrogen.

Many women have decreased sexual desire and responsiveness in spite of HRT. This is due to a reduction in testosterone and other androgenic hormones. When women enter menopause, they lose half of their testosterone production when the ovaries stop functioning. While traditionally thought of as a "male" hormone; in reality, men and women have both estrogen and testosterone, just in different ratios. More than half of women with post-menopausal decreased desire will respond positively to testosterone replacement. The potential risks of androgen replacement can include possible virilization, with skin changes such as acne, increased and coarser body hair, deepening of the voice, and enlargement of the clitoris.

Adding replacement testosterone increases women's sexual desire, arousal, and ability to orgasm; as well as nonsexual energy and mood levels. Within a few years, triple hormone therapy with estrogen, testosterone, and progesterone may well become the standard of care.