Menopause Survival Guide

By Shaun Denise Biggers, MD

Posted on | By Shaun Denise Biggers, MD

Many of us think of menopause as something that happens to a woman during her 50s. While it is true that the median age that a woman stops having her menstrual cycle is 52, menopausal symptoms often begin up to 10 years before a woman’s menstrual cycle stops. What that means is that during her 40s, many women experience significant symptoms of menopause. These symptoms can be as obvious as a hot flash or as subtle as mild fatigue. They also include mood changes, sleep disturbances and decreased libido.

Although 40 is the new 30, it is hard to feel that way while having a hot flash! If these symptoms start to affect your quality of life, there are some treatments and therapies that can help.

What’s Happening to My Hormones? 

A woman is born with all of the eggs that she will ever have. These eggs are located in the follicles, which are found within the ovaries. The main hormones produced by the ovary are estrogen and progesterone. As the last of these follicles either ovulate or die, ovarian function fails and menopause occurs. During this time, levels of the female hormone estrogen decreases. Many of the typical symptoms of menopause are directly related to this decrease. Most physicians have focused on estrogen replacement when treating symptoms of menopause, and this does resolve most of these symptoms. For perimenopausal women who are still having their menstrual cycle, this time is more complicated than a mere decrease in estrogen. Progesterone levels decrease as well.  

As the menstrual cycles start spacing out or skipping months, there can be virtually no progesterone production for months at a time. Estrogen and progesterone are like the yin and yang of the female reproductive system. Prior to menopause, they must exist in an appropriate balance. Progesterone is actually a precursor on the steroid pathway to the production of estrogen, so progesterone is important for the body’s normal production of estrogen. Progesterone also affects the androgen (testosterone and DHEA) and cortisol pathways as well.  

The bottom line is that there are reasons why the symptoms of menopause can be wide-ranging. Changing ovarian hormones affect a variety other hormones. There are also receptors for these hormones on a variety of tissues in the body. That is why what seems like a simple change in reproductive hormones can have such a significant effect on the rest of the body.

Article written by Shaun Denise Biggers, MD