Hormones in the menopause

Menopause, also known as climacteric or perimenopause, is the years before the last spontaneous menstrual period (menopause) until one year after the last spontaneous menstrual period. This means that the menopause describes the transition from the fertile phase to the non-fertile phase in a woman’s life. This is a phase in life that is characterized by changes in the hormone balance. The most important of these are the control hormones secreted by the pituitary gland (hypophysis), also known as gonadotropins, LH (luteinizing hormone) and FSH (follicle stimulating hormone), but also progesterone, estrogen, inhibin and the male sex hormones (androgens). However, the physical complaints are mainly explained by the decreasing production of the female sex hormone estrogen.

Progesterone

Even before the last menstrual bleeding (menopause), progesterone production decreases in the second half of the cycle (luteal phase) until it finally stops. The drop in progesterone levels results in a reduced ability to conceive, i.e. the probability of pregnancy is reduced by the low progesterone level. Cycle disorders with irregular bleeding can also be explained by the reduced progesterone level. If this is to be determined in the blood, the blood sample must be taken in the second half of the cycle. The reduced progesterone level, like the estrogen deficiency, can cause menopausal symptoms such as irritability or sleep disorders.

Oestrogen

With menopause, i.e. the last menstrual period, the production of the female sex hormone estrogen ceases due to increasing functional weakness of the ovaries. The majority of the complaints complained of by women during the menopause can be explained by the rapidly decreasing estrogen level. At the center of the complaints are episodic hot flashes, sweating, headaches, forgetfulness and psychological symptoms such as depression, anxiety, nervousness, insomnia and mood swings.

Heart rhythm disturbances, joint and muscle pain, a loss of libido and a drop in performance can also occur. In addition, estrogen deficiency leads to urogenital atrophy, i.e. a change in the tissue and function of the female external genital organs and the lower urinary tract caused by the hormone deficiency. This in turn leads to the following clinical symptoms: Another oestrogen deficiency is a loss of collagen and minerals, which is manifested in accelerated skin aging and an increased risk of osteoporosis.

In addition, the woman’s figure also changes with increasing estrogen deficiency, which is often accompanied by weight gain, although eating habits have not changed. Arteriosclerosis (hardening of the arteries), which is associated with an increased risk of heart attack and stroke, is also favored by a lack of estrogen. Finally, increased hair loss and facial hair (facial hypertrichosis) can be explained by the reduced estrogen level or the relative predominance of male sex hormones (androgens).

All these clinical complaints can be summarized with the term climacteric syndrome. The individual manifestation of the symptoms varies from woman to woman.

  • Drought
  • Itching
  • Outflow
  • Pain during sexual intercourse (dyspareunia)
  • Vaginal infections
  • Urge to urinate
  • Frequent urination
  • Repeated urinary tract infections and
  • Urinary incontinence.

The secretion of the hormone inhibin, which is produced in certain cells of the ovaries, the so-called granulosa cells in women and in the testicles in men, also decreases. Normally, Inhibin inhibits the release of the control hormone FSH (follicle stimulating hormone) from the pituitary gland without affecting the release of LH (luteinizing hormone). The reduced release of inhibin also causes an increase in the FSH level, as does the lower oestrogen level.