Managing the Symptoms of Menopause

Endocrine Disease/Disorder: Menopause

Menopause is a natural biological process that is regulated by the endocrine system which occurs at the end of a woman\\\\\\\'s reproductive years. The concomitant decline in estrogen and progesterone production that occurs during menopause can result in a range of physical and emotional symptoms, while other hormones also play a role. Although menopause is a natural part of the aging process, it can have a profound impact on women’s health and quality of life. Moreover, because all women experience menopause, developing a better understanding concerning the relationship between the endocrine system and menopause is crucial for managing symptoms and supporting women\\\\\\\'s health during this transitional period in their lives. To this end, the purpose of this paper is to provide a review of the literature concerning the relationship between the endocrine system and menopause, including an overview of the physiological changes that occur during menopause, the role of hormones in menopause, and the management of menopausal symptoms.

Overview of Menopause

Menopause marks the time in women’s lives when their menstrual cycles stop. Although menstrual cycles can become disrupted prior to the onset of menopause, the condition is diagnosed when there has not been a menstrual period for 12 months (Menopause Overview, 2023) but it is defined as “the end of menstruation due to the loss of ovarian follicular activity” (Dawn, 2022, p. 253). The average age of onset of perimenopause, the period in which women’s hormone production begins to fluctuate, is currently 51 years in the United Sates, meaning that the condition can begin when women are still in their 40s or even earlier, but the production of the hormones that cause menopause typically begins to decline during the early 30s (Dawn, 2022). Even though menopause is a natural biological condition that affects all women at some point in their lives, its physical and emotional symptoms can have a severe impact on multiple quality of life factors due to the decreased production of hormones (Menopause Overview) as discussed further below.

The Role of Hormones in Menopause

The change in ovarian follicular activity and the associated decreased hormone production that occurs during perimenopause results in infertility, but it also causes a number of symptoms, some or all of which can be severe (Dawn, 2022). In this regard, Goodman et al. (2011) emphasize that, “Hot flushes, fatigue, joint and muscle pain, headache, urinary problems, depression, and mood swings are all common symptoms” (p. 2). This is not to say, of course, that all women suffer from one or all of these symptoms, but it is to say that the menopausal transition period is characterized by fundamental changes in the production of hormones by the ovaries which invariably cause some type of psychophysiological response. For example, the National Institute on Aging (2023) points out that, “The menopausal transition affects each woman uniquely and in various ways. The body begins to use energy differently, fat cells change, and women may gain weight more easily” (Menopausal transition, para. 4).

In addition, the perimenopause transition period can last as long as 14 years, although the average time is about 7 years (Menopausal transition, 2023). In other words, the gradual decline in the production of estrogen and progesterone by the ovaries can make life truly miserable for women for a long time, and a growing body of research indicates that the age of onset of menopause is decreasing for multiple reason (Levine & Hall, 2023). While the precise reasons for women experiencing perimenopause at earlier ages remain unclear, various environmental factors are believed to be responsible for the most part. For instance, according to Levine and Hall (2023), “Endocrine disrupting chemicals (EDCs) are found widely in the environment and can enter the human body through different means like work, food, water, personal care products, and textiles” (p. 1).

Although lifestyle and genetics also play a role in determining the age of onset of perimenopause and the severity of its symptoms, the heavy metals and harmful chemicals that persist in the environment can affect all women due to their ubiquity. As Levine and Hall (2023) conclude, “Although the variety of sources of exposures and mechanisms of action make it difficult to study the effects of these chemicals, there is evidence linking them to health issues like early menopause, altered hormone levels, and decreased ovarian reserve” (p. 2). Fortunately, there are a number of efficacious treatments available for the symptoms associated with the menopausal transition as discussed below.

Management of Menopausal Symptoms

There are a number of evidence-based treatments available for perimenopausal symptoms, including changes in lifestyle (e.g., smoking cessation) and various types of hormone therapies (Menopause Overview, 2023). The hormone therapies that are used to treat such symptoms include systemic estrogen alone or together with progestogen as well as oral and transdermal estrogen. Nonhormonal treatments include the use of paroxetine and venlafaxine which have proven efficacy in reducing the frequency of menopausal transition symptoms (Crandall et al., 2023).