How Hormones Cause Menopause Symptoms

Menopause, typically occurring in the late 40s to early 50s, marks the end of menstrual cycles and is defined as twelve consecutive months without menstruation. This natural transition begins with perimenopause when ovarian function declines, altering hormone levels.⁽¹⁾ 

The perimenopausal phase often brings significant changes in follicle development, ovulation, and menstrual patterns, which can cause physical and emotional symptoms. This article discusses the crucial roles of hormones during menopause and outlines effective strategies for managing symptoms to help women maintain quality of life during menopause.

Understanding the Normal Menstrual Cycle

The normal menstrual cycle involves interactions between the brain (hypothalamus), the pituitary gland, and the ovaries. Each cycle begins with the hypothalamus signaling the pituitary gland to secrete hormones that stimulate the ovaries.⁽¹⁾ 

The ovaries respond to these signals by preparing eggs for release and producing estrogen, which thickens the lining of the uterus (endometrium). This preparation is crucial for supporting a potential pregnancy. 

After the release of an egg (ovulation), the hormone progesterone helps maintain the uterine lining in preparation for the implantation of a fertilized egg. If pregnancy does not occur, hormone levels drop, leading to the shedding of the uterine lining, known as menstruation.⁽¹⁾

The Role of Various Hormones in the Menstrual Cycle

The menstrual cycle begins when the hypothalamus secretes gonadotropin-releasing hormone (GnRH), which prompts the pituitary gland to release follicle-stimulating hormone (FSH), initiating the growth of new ovarian follicles.⁽¹⁾

Follicle Maturation

As follicles mature, they produce estrogen, which regulates FSH production through negative feedback to the hypothalamus and the pituitary gland. This negative feedback prevents overstimulation of the ovaries, keeping them from producing too many eggs at once. 

Follicles also release the hormones inhibin B and inhibin A, which further finetunes this feedback process, ensuring (usually) only one egg fully matures and gets released.⁽¹⁾

Ovulation

When estrogen levels rise during the follicular phase, they can cause a surge in luteinizing hormone (LH). This surge plays an important role for ovulation.⁽¹⁾

Menstruation

Following ovulation, the corpus luteum forms from the remnants of the ovulated follicle. It begins to secrete progesterone, which is vital in regulating the frequency of GnRH pulses. This regulation influences the production of FSH and LH.⁽¹⁾ 

During the early and mid-luteal phases, progesterone slows the frequency of GnRH pulses, favoring the production of FSH over LH. However, the secretion of FSH remains inhibited by the levels of estradiol and inhibin A.⁽¹⁾

If pregnancy does not occur, the corpus luteum deteriorates as the luteal phase ends, decreasing progesterone and estrogen levels. This reduction removes the negative feedback on the hypothalamus and pituitary gland, prompting a rise in FSH levels. This increase then initiates the development of follicles for the next cycle, starting the process anew.⁽¹⁾

Anti-müllerian hormone (AMH) also plays an important role in the menstrual cycle. The granulosa cells of the follicles release AMH, which helps regulate the number of follicles that respond to FSH. By ensuring a controlled and gradual activation of ovarian follicles, AMH helps preserve the ovarian reserve and maintain fertility.⁽¹⁾

What hormones are involved in menopause symptoms?

The number of follicles in the ovaries depletes over time as part of aging, leading to reduced ovarian function.

Estrogen

The ovaries produce less estrogen as they age. While this drop in estrogen levels is gradual, it becomes more pronounced as menopause approaches. The decrease in estrogen levels is the primary cause of many physical symptoms associated with menopause, including hot flashes, night sweats, and vaginal dryness.⁽¹⁾

Progesterone

With fewer ovulations occurring, the production of progesterone decreases. Since progesterone is primarily produced after ovulation by the corpus luteum, less frequent ovulation results in lower overall levels of this hormone.⁽¹⁾

Inhibin

The production of inhibin declines as the follicles decrease. Inhibin is crucial for regulating FSH levels, and its decrease leads to higher levels of FSH.⁽¹⁾

FSH and LH

As the levels of estrogen and inhibin fall, the negative feedback on the pituitary gland is reduced, causing an increase in the secretion of FSH and LH. These elevated levels are characteristic of menopause but are ineffective at stimulating the ovaries to produce eggs or significant levels of estrogen and progesterone.⁽¹⁾

AMH

AMH levels decline with the decrease in the number of growing follicles. Since AMH is a marker of ovarian reserve, lower levels indicate reduced follicular activity, which is typical of the perimenopausal and menopausal phases.⁽¹⁾

Common Menopause Symptoms Caused by Hormonal Imbalance

The natural decline in reproductive hormones can cause symptoms that typically last from 2 to 8 years. Below are the most common symptoms associated with this phase:⁽²⁾

Changes in Menstrual Patterns

Due to hormonal fluctuations, changes in menstruation are often the first noticeable symptoms. Menstruation may become unpredictable. Periods may shorten, lengthen, or change in flow intensity.

Vasomotor Symptoms

These symptoms are related to the body's adaptation to fluctuating hormone levels.

• Hot Flashes: Sudden, intense feelings of heat primarily in the upper body and face, often followed by sweating and, sometimes, shivering. These episodes can last from a few seconds to 10 minutes and occur with varying frequencies.

• Night Sweats: These are hot flashes that occur at night, potentially disrupting sleep.

Urinary and Bladder Issues

Changes in hormone levels can affect bladder control and function, leading to symptoms like the following:

• Inability to hold urine

• Urine leakage during activities like laughing or coughing

• Trouble emptying the bladder

Sleep Disturbances

Hormonal changes can disrupt sleep patterns and cause these symptoms:

• Difficulty falling or staying asleep

• Lack of energy

• Increased urge to take daytime naps

Changes in Vaginal Health 

Decreased estrogen levels can lead to the following changes in vaginal health.

• Vaginal dryness 

• Discomfort or pain during sexual intercourse

• Reduced libido

Mood Changes

Hormonal fluctuations can also affect emotional well-being, leading to these symptoms:

• Irritability or mood swings

• Loss of interest in activities

• Difficulty focusing

Physical Changes

The body may respond to hormonal changes with various physical symptoms.

• Weight fluctuations

• Dry and thin skin

• Muscle and joint pains

What can be done if hormone levels are low?

Hormonal changes during menopause are a normal part of aging; therefore, some symptoms may not require treatment. However, if symptoms become severe or significantly affect quality of life, it's important to consult a physician to determine the best treatment option.⁽³⁾⁽⁴⁾ 

Hormone Replacement Therapy (HRT)

HRT involves the administration of estrogen and progesterone during perimenopause and menopause to alleviate symptoms. It is available in various forms, including pills, transdermal patches and creams, and vaginal creams.

Estrogen is the key hormone used to alleviate menopausal symptoms, particularly effective in reducing vasomotor symptoms such as hot flashes and night sweats. It also supports urogenital health and reduces the risk of osteoporosis. Estrogen therapy also plays a critical role in managing the overall decline in estrogen levels that women experience during menopause.

For women who have not had a hysterectomy and still have a uterus, progesterone is prescribed alongside estrogen. The addition of progesterone is crucial as it helps prevent endometrial hyperplasia, which is an overgrowth of the lining of the uterus. This condition can develop when estrogen is given alone, increasing the risk of endometrial cancer. Therefore, the combination of estrogen and progesterone is essential for protecting the health of the uterus while effectively managing menopausal symptoms.

Nonhormonal Medications

There are also various nonhormonal treatments available to help relieve menopausal symptoms:

• Over-the-counter gels and other products can help address vaginal dryness.

• Prescription pills, creams, and rings are specifically designed to treat vaginal dryness and other urogenital changes.

• Low-dose antidepressants may be prescribed to reduce hot flashes, even in women who do not have depression.

Lifestyle Changes

Lifestyle adjustments can significantly help manage menopausal challenges:

• Engaging in regular physical activity

• Practicing stress reduction techniques such as relaxation and deep breathing exercises

• Maintaining a healthy diet rich in fruits, vegetables, and whole grains

• Avoiding smoking and limiting alcohol intake

• Seeking counseling for mood changes and anxiety, if needed

• Establishing good sleeping habits

• Strengthening the pelvic floor with Kegel exercises

Overall, continuous consultation with healthcare providers is essential. Regular check-ins allow for monitoring the effectiveness of any treatment plan and making necessary adjustments. This proactive approach ensures that treatment remains effective and aligned with individual needs, helping women navigate menopause more comfortably and confidently.