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The Good, The Bad, And The Ugly: When Estrogen Starts To Walk Out The Door

So long, estrogen. There comes a point in every woman’s life when her primary sex hormone, trusty old estrogen, starts to wane. For most, that time of perimenopause is in a woman’s forties, and with it comes a slew of new experiences, physical changes and emotions. But perimenopause, menopause and postmenopause don’t have to be scary or intimidating. Once you understand what happens when estrogen walks out the door, and all of the side effects that come with its departure, this change of life becomes easier to manage.

Menopause is more than just hot flashes and diminishing menstrual periods. When estrogen leaves the body as part of the process of menopause, all sorts of things begin to metaphorically shift. A woman’s bones, though, can begin to physically shift. Bone remodeling of perimenopausal women was measured in a study published in the Journal of Laboratory and Clinical Medicine. Researchers noticed that postmenopausal women treated with estrogen replacement had a similar remodeling rate as premenopausal women (-.021 g/day Ca). However, postmenopausal women who did not take estrogen supplements had a significantly greater rate of bone loss (-.038 g/day Ca). These negative numbers show that more calcium is being lost (resorption) than is being deposited (accretion) in the bones. Researchers associated estrogen loss at the onset of menopause with “an apparent partial release from an inhibition of skeletal resorption,” which they concluded was “in whole or part, responsible for the negative skeletal balance shift (accretion minus resorption) associated with the postmenopausal years.”

Long term estrogen replacement therapy has been shown to prevent bone density loss in postmenopausal women. Researchers compared the occurrence of fractures in postmenopausal women who were and were not taking estrogen replacement therapy. Their results, published in the Annals of Internal Medicine, showed that those taking estrogen had significantly greater spinal and forearm quantitative mineral assessments, as well as greater metacarpal cortical thickness. This data supports the conclusion that long term hormone replacement therapy can have a very positive impact on the prevention of bone mineral loss and consequent fractures.

Along with the physical changes estrogen loss can trigger, a woman’s mental health can change with a decrease of the hormone. A study published in the American Journal of Epidemiology explores the possibility that estrogen loss associated with menopause is linked to the development of Alzheimer’s. The disease was more prevalent in menopausal women who were not on estrogen replacement therapy than those that were. Researchers concluded that after estrogen production diminishes with menopause, replacing it with hormone therapy could be useful in delaying the onset of Alzheimer’s or dementia.

Estrogen replacement therapy has also been shown to combat the dry skin and fine lines that appear when estrogen hightails it out of a woman’s system during menopause. Estrogen supplements can ease the outward physical symptoms of aging and menopause, as well as the internal. It may even protect against certain dermatological conditions associated with aging.

It may seem like estrogen replacement therapy is a cure-all for estrogen loss-related woes, but the therapy is not without its own risks. Of course, any and all concerns should be discussed with your doctor. In clinical studies, postmenopausal women treated with estrogen supplements were at higher risk for cardiovascular disease. One study of rats suggests that delayed administration of estrogen may be associated with an increased expression of inflammatory genes. Perhaps the negative heart related effects may be prevented by starting hormone replacement early. More research is needed. Again, always discuss your concerns with your doctor.

When estrogen decides to get out of Dodge, it can take a lot of things with it. But by arming yourself with information, you and your health care professional can come up with a plan of action to make sure the changes menopause brings are as smooth and easy as possible.

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