Our Bodies, Our Lives
By Dr. Tristi Muir
The change of life sounds so dramatic. Life is always changing.
Hormonally, we have menarche (starting periods), cyclic changes (including premenstrual syndrome), pregnancy and postpartum hormonal changes, and alas — menopause.
It should probably be called meno‘stop’ rather than meno‘pause,’ because the ovaries have sputtered out and are not likely to get going again.
Women spend about one-third of their lives in menopause. The loss of estrogen in our bodies manifests itself in more ways than hot flashes. Estrogen receptors are present throughout our bodies and impact our mind, mood, heart, waistline and sexual function.
Estrogen receptors are abundant in the areas of our brain that are important for working and episodic memory. Limited clinical trial evidence has shown that women undergoing surgical menopause (having their ovaries removed) may benefit from the prompt initiation of estrogen therapy to preserve their ability to remember words.
Additionally, estrogen promotes neuronal growth and formation of synapses, acts as an antioxidant to protect the brain from damaging free radicals and elevates levels of neurotransmitters in the brain such as serotonin, which can have a profound effect on mood.
Estrogen helps to stabilize our mood through its effect on serotonin. When women are cycling, the raging part of the cycle is the week before the start of menses. This is when estrogen is at the lowest, and all bets are off — just blame it on PMS.
Animal and human experimental models show that estrogen protects against mood and cognitive changes that result from serotonin withdrawal.
If menopause leaves you or a loved one swinging from mood to mood, estrogen therapy may be the perfect mood stabilizer.
Before menopause, women have significantly less heart disease than men. Estrogen lowers the bad cholesterol (LDL) and increases the good cholesterol (HDL).
Estrogen also dilates the vessels of the heart to increase perfusion, decreases atherosclerosis, maintains the integrity of the blood vessels and decreased adhesion molecules.
When estrogen is around, there is less cell death in the heart muscle. After menopause (after the loss of estrogen), women develop more heart disease.
However, follow-up from a large randomized, placebo-controlled study on oral hormone replacement (the Women’s Health Initiative) has shown the timing of starting hormone therapy is crucial to gain heart protective benefits from estrogen.
Starting hormone therapy (estrogen) near the onset of menopause will act to prevent cardiovascular disease. It also appears that the route of estrogen replacement is important — transdermal (patch, gel or spray) will avoid processing in the liver and avoid the release of inflammatory mediators (which may increase the risk of heart disease). The risk of heart attack has been reduced by 38 percent with the transdermal application compared to the oral tablet.
After menopause, women gain an average of 1 pound per year — which can really add up. Hormone therapy is not associated with increased weight or increased belly fat. Hormone therapy is associated with lower overall belly fat, improved insulin sensitivity and a lower of rate of development of type 2 diabetes.
Again, the transdermal application seems the way to go. Transdermal estrogen preserves lean body mass more than oral therapy.
Many women find themselves avoiding sex because of the lack of desire or pain when they do have it. Testosterone is the driver of libido and half of our testosterone comes from the ovary. When the ovaries are surgically removed or wither away, testosterone levels drop.
Estrogen is important for arousal — lubrication and vascular engorgement and maintenance of the vaginal skin. With the loss of estrogen, the vaginal tissue becomes thin, leaving it irritated, less lubricated and painful. A vaginal preparation of estrogen is the most effective method of rejuvenating the vagina.
While hormone therapy can help women overcome the challenges associated with menopause, exercise and diet are important components of graceful aging.
A diet high in antioxidants — fruits and vegetables — keeps the mind sharp and the heart healthy. Exercise increases blood flow to these important organs, builds or preserves muscle and fights off the middle-age spread.
Hormone therapy may be right for women battling the symptoms of menopause from head to vagina. The transdermal application appears to be the safest route of administration.
I recommend a consultation with your physician to see if this is the right approach for you.
Our Bodies, Our Lives focuses on issues surrounding women’s sexual, gynecological and emotional health. Dr. Tristi Muir is the director of the UTMB Pelvic Health and Continence Center at Victory Lakes. Visit www.utmbhealth.com/pelvichealth.