Aspects of menopause

Menopause is a normal transition that occurs when a woman’s eggs are depleted and she stops ovulating. Although the benchmark of menopause is 12 months with no ovulation and no menstrual cycle, menopause symptoms can begin before that happens and can continue for months or even years after a woman’s final menstrual cycle. The average woman’s age for natural menopause to occur is 51. Menopause can also occur for other reasons, such as surgery that removes the ovaries, as a side effect of some medications, and when it’s caused by certain health conditions.

The hormonal changes that occur during menopause can also have an impact on other areas of a woman’s health during and after menopause, including:

• Heart health
• Bone health
• Brain health
• Body weight
• Metabolic function
• Urinary health
• Sexual health

How the biomarkers we measure impact your health

Estradiol (E2)

The hormone estradiol is primarily made in the ovaries, although it is also made in smaller amounts in the adrenal glands and in fat cells. Women make three types of estrogen: estradiol, estrone, and estriol, all of which decline during menopause. Because estradiol is the most powerful and active form of estrogen, it is often the only one measured in an estrogen test.

Progesterone

Progesterone is the hormone that is made in response to an egg being released from an ovary (ovulation). When a woman begins menopause and she stops ovulating, her ovaries stop making progesterone, which eliminates the major source of progesterone in the body. Women continue to make some progesterone in their adrenal glands.

Testosterone

Even though testosterone is thought of as the “male hormone,” a woman also makes testosterone. A woman makes testosterone in her ovaries and in her adrenal glands. Like other hormones made in the ovaries, the testosterone level declines during menopause because the ovaries are ending their primary function, even though the health functions of testosterone will remain important for the rest of a woman’s life.

Dehydroepiandrosterone (DHEA)

DHEA, a hormone made in the adrenal glands, is a precursor to both testosterone and estrogen and is an age-dependent hormone. In a woman, her DHEA level tends to peak during late adolescence and begins to decline naturally starting at age 30, declining by age 70 to just 20 percent of her peak level. Production of DHEA in the adrenal glands is in direct competition with the production of cortisol, because both DHEA and cortisol require the same precursor hormone ‐ pregnenolone.

Cortisol

Cortisol is the body’s primary “stress” hormone made in the adrenal glands. Cortisol has a natural 24-hour rhythm, which, when altered can have a wide variety of adverse health effects, including changes in mood, energy, weight, and immune function. It is not uncommon for a woman to experience changes in her cortisol level during menopause as the functions of her ovaries decline and her body becomes more dependent on the adrenal glands as the source of her hormones.

The Science

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• Dennerstein L, Dudley E, Hopper J, et al. A prospective population-based study of menopausal symptoms. Obstet Gynecol 2000;96(3):351-358.

• McKinlay S, Brambilla D, Posner J. The normal menopause transition. Am J Hum Bio 1992;4(1):37-46.

• Al-Azzawi F, Palacios S. Hormonal changes during menopause. Maturitas 2009;63(2):135-137.

• Nelson L, Bulun S. Estrogen production and action. J Am Acad Derm 2001;45(3):S116-S124.

• Burger H, Dudley E, Cui J, et al. A prospective longitudinal study of serum testosterone, dehydroepiandrosterone sulfate, and sex hormone-binding globulin levels through the menopause transition. J Clin Endocrinol Metab 2000;85(8):2832-2838.

• Taylor J. Plasma progesterone, oestradiol 17β and premenstrual symptoms. Acta Psych Scand 1979;60(1):76-86.

• Burger H. Androgen production in women. Fertil Steril 2002;77:3-5.

• Davison S, Bell R, Donath S, et al. Androgen levels in adult females: changes with age, menopause, and oophorectomy. J Clin Endocrinol Metab 2005;90(7):3847-3853.

• Woods N, Mitchell E, Smith-DiJulio K. Cortisol levels during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women’s Health Study. Menopause 2009;16(4):708.