Updated on June 27, 2023.
Hot flashes, irregular periods, sleep disturbances, mood changes—these symptoms can combine to make menopause an uncomfortable experience for many people. As estrogen levels wane in the postmenopausal phase, symptoms may subside. But without the protective effects of estrogen, many women may be at increased risk for a variety of conditions. Here's what to know about the effects of falling estrogen levels and how to maintain optimal health during and beyond menopause.
Estrogen and menopause
Estrogen is mostly produced in the ovaries, but other places in the body create small amounts, as well. It affects many other systems of the body besides the reproductive system, such as the circulatory system, the urinary tract, the musculoskeletal system, mucus membranes, and the brain.
During the menstrual cycle, estrogen levels increase, thickening the lining of uterus. Meanwhile, an egg, produced by the ovaries, matures. During months where the egg does not meet sperm, the uterine lining and the egg are expelled. A woman is born with a finite number of eggs, and as the number of eggs declines and hormone levels diminish, a person enters menopause and stops having menstrual periods.
Once menopause arives, on average, around age 51, the ovaries stop producing estrogen and another female hormone called progesterone.
The effects of estrogen decline
Estrogen not only helps to maintain one's fertility, it also has a number of protective effects that may diminish once a person experiences menopause. Here are some of the ways a menopause-related estrogen decline can effect your health.
Greater risk of heart issues
“Before menopause, estrogen protects the heart,” says Sudha Purohit, MD, an internal medicine doctor in Troy, Michigan.
Estrogen is believed to help keep the walls of the arteries flexible. When hormone production decreases, it can increase the risk of stiffening of the arteries. After menopause—but not necessarily due to the decrease in estrogen—heart disease risk factors like blood pressure and cholesterol increase for most people. Other factors, like obesity and smoking, contribute to the risk.
A January 2017 study published in the Journal of the American Heart Association suggests that estrogen also helps keep a certain type of fat, known as paracardial fat, off the heart. An increase in paracardial fat is often seen postmenopause and raises the risk of heart disease.
Increased risk of osteoporosis
Estrogen also protects the bones, so menopause raises the risk for osteoporosis, says Dr. Purohit. One study found that women had lost more than 9 percent of their bone mass in their hip and more than 10 percent in their lower back by 10 years after menopause.
“People with early menopause—age 40 or before—are at an even higher risk,” says Purohit.
Painful sex
Sex can be difficult after menopause. When estrogen levels go down, tissues in the vagine can become thinner and drier, and sex may become more painful, says Purohit. Painful sex may lead to a less than desirable sex life, which Purohit says can be a contributor to postmenopausal depression.
“Sex is a great stress reliever,” she says. “I always advise my patients to lead a normal, healthy sex life.”
What you can do about side effects of menopause
Menopausal hormone therapy (MHT) is available to people experiencing menopause. The most bothersome symptom for most women experiencing menopause is hot flashes. MHT is an effective option to help ease this symptom.
But because of the risks associted with MHT—which can include breast cancer, endometrial cancer and other problems, depending on what form of MHT a patient takes and when they take it—experts advise people to take MHT for the shortest time possible and at the lowest dose needed.
It’s important to get plenty of exercise and manage one's weight postmenopause, adds Purohit.
“After menopause, women tend to gain weight,” says Purohit. “One pound per year is not uncommon. To maintain a healthy weight, get enough exercise and practice portion control.”
The Centers for Disease Control and Prevention recommends that most adults get 150 minutes of moderate-intensity exercise per week or 75 minutes of vigorous-intensity exercise per week. About 20 percent of women become depressed some time during menopause, and exercise can help with that as well.
“When people are physically fit, they’re mentally fit as well,” says Purohit.
It's no surprise that menopause brings many changes, but with the proper treatment plan, symptoms and side effects can be eased. Discuss with a healthcare provider what makes the most sense for you.
