The Role of Hormones in Menopause
The female menstrual cycle is closely regulated by multiple hormones that work in sync to bring about monthly periods. At puberty, the ovaries produce estrogen and progesterone that stimulate the onset of periods and mark the beginning of the reproductive phase of a woman’s life. At around 50 years, the reproductive phase ends – marking menopause.
After menopause, women stop having the monthly menstrual cycle and can no longer become pregnant. Estrogen and progesterone levels dip significantly due to the depletion of eggs in the ovaries and this marked reduction of hormones becomes permanent for post-menopausal women.
Women can also undergo menopause early in life if they have had a hysterectomy (surgical removal of the uterus). Once the uterus is removed, women can no longer have periods and are in menopause. Read on to find out how hormone replacement therapy with progesterone can benefit postmenopausal women.
Symptoms of Menopause
The decrease in estrogen and progesterone levels causes a variety of menopausal symptoms and even increases the chances of heart disease and osteoporosis in women. For some women, transitioning to menopause can be a breeze. For others, the symptoms can be intense and bothersome. Women may experience:
- Vaginal dryness
- Night sweats
- Weight gain
- Difficulty sleeping
- Reduced libido and pain during sex
Symptoms usually appear in the peri-menopause period (a year before the last period) and continue for up to four years after the last period. Some women may even experience these for longer.
What is Progesterone?
Progesterone is a female hormone derived from cholesterol that is primarily made and secreted from the ovaries. It is important for the maintenance of the uterine lining (the endometrium) and thus supports implantation of the embryo and further maintenance of the pregnancy till birth. During pregnancy, the placenta also produces this hormone and so progesterone levels rise to ten times the normal levels in the body. This is why it is also called the pregnancy hormone.
The main roles of progesterone in pregnancy are:
- Maintenance of the uterine wall to support the implanted embryo,
- Inhibition of contractions of the uterus to prevent miscarriage or pre-term labor,
- Development of breast tissue for preparation of breast milk, and
- Inhibition of prolactin to prevent lactation before delivery.
In non-pregnant women, progesterone thickens the uterine lining every month in anticipation of implantation. When the egg fails to fertilize and implant, progesterone levels drop and the endometrium is sloughed off – marking the start of your period.
When progesterone levels start dipping during peri-menopause, women may experience irregular periods or abnormal uterine bleeding due to the lack of hormonal support.
Hormone Replacement Therapy (HRT) For Menopause
Symptoms of menopause are brought about by the lack of sufficient estrogen and progesterone in the female body and can be uncomfortable for years into the menopausal period.
Hence, the most successful method of relieving symptoms of menopause is hormone replacement therapy. Taking estrogen and progesterone eases menopausal symptoms by stabilizing the hormonal imbalance, as well as reducing the chances of others developing other disorders.
For women that have undergone a hysterectomy and do not have a uterus, estrogen replacement has proven to be sufficient. But for most women with a uterus that are undergoing menopause, the most effective therapy is a combination of estrogen and progesterone.
Why is Progesterone an Important part of Hormone Therapy?
Why is progesterone an important aspect of hormone therapy to relieve the disruptive symptoms of menopause? In theory, estrogen should be enough to maintain female physiology after menopause as the woman can no longer become pregnant, and therefore, should not require the pregnancy hormone.
However, taking estrogen alone can cause endometrial hyperplasia (abnormal thickening of the uterine lining) which increases the chances of developing uterine, cervical, or vaginal cancer. Progesterone thins the uterine lining and reduces this risk. It has been noted that taking a combination of progesterone and estrogen reduces the risk of colorectal cancer, too!
Benefits of Progesterone in HRT
There are significant benefits of taking progesterone, some of which are discussed below.
Helps with hot Flashes
Taking progesterone regularly eases postmenopausal symptoms like hot flashes and night sweats. A study conducted on 133 postmenopausal women concluded that taking a progesterone pill every day significantly reduced the frequency and intensity of hot flashes and night sweats.
Better Quality Sleep
Another benefit of progesterone is that it helps postmenopausal women sleep better. Taking the progesterone pill at night enhances the quality of sleep by promoting deep sleep. The occurrence of hot flashes and night sweats does not interrupt sound sleep as those symptoms are already mitigated and women are deeper in sleep on progesterone.
Improves Mental Health
Progesterone profoundly affects the central nervous system – it plays a crucial role in coordinating cognition and emotional states. It is also a natural antidepressant that stimulates the limbic system in the brain, which manages your mood and makes you feel good.
This explains why postmenopausal are more prone to developing anxiety as their ‘feel-good’ center in the brain lacks hormonal stimulation. When the body is not producing enough progesterone, women may also experience migraines, and moodiness, and develop depression in menopause.
Taking progesterone in HRT has proven to relieve postmenopausal anxiety, nervous tension, and moodiness. As opposed to taking anti-anxiety medication, progesterone does not induce fatigue or brain fog, or any adverse side effects.
Some studies also found an improvement in visual and verbal memory in postmenopausal women that regularly took progesterone. However, the results were not replicated in other studies.
Who Should Not Use Progesterone?
Although the benefits of progesterone are impressive, there are some cases in which women should not be taking progesterone. A healthcare provider should be consulted for alternative options if:
- A woman has exceeded 60 years of age
- It has been 10 years since the last period
- There is a genetic disposition for breast cancer
- Have a history or risk for heart attack, dementia, osteoporosis, blood clots, and liver disease.
Dosage and Methods of Delivery
Women can take HRT for however long a doctor recommends, but the course usually spans two to five years or until postmenopausal symptoms subside.
- The oral dosage for adults is 200mg every day at bedtime.
- It is to be taken for 12 consecutive days within a 28-day menstrual cycle.
- If a dose is missed, take it as soon as possible. However, if it is almost time for the next dosage then do not double dose.
Different women prefer different delivery methods for progesterone therapy. Oral micronized progesterone in a pill is one of the most popular forms as it is the most familiar for most people. Transdermal progesterone cream that absorbs through the skin, injectable progesterone, and implanted pellets under the skin that cause a slow release of the hormone in the bloodstream is also available.
The Bottom Line
Estrogen and progesterone are important female hormones that significantly reduce after menopause. HRT with estrogen is effective, but taking progesterone after menopause has shown some important benefits. It significantly reduces the risk of uterine, cervical, and vaginal cancer in women on HRT. Progesterone also mitigates the symptoms of menopause, like night sweats, hot flashes, anxiety, and insomnia.
Family Medicine Austin provides top-notch healthcare for women, including consultation for menopause. Contact us today to discuss hormone replacement therapy and the lifestyle changes you need to make to seamlessly transition to your best postmenopausal life!