Vasomotor/Excess adrenaline production – these include flushes, sweats, palpitations, feelings of agitation and anxiety. Sleep is disturbed and often light and can be broken and a sign of this is waking up exhausted and unrefreshed. Feelings of panic and heart racing can also occur due to the excess adrenaline and this can be often labelled as anxiety.
Psychological/Fatigue – the lack of oestrogen affects both sleep quality and also serotonin metabolism. Falling levels of oestrogen in the peri and post menopause will affect mood profoundly and it is difficult to unravel whether this is due to impaired sleep quality or serotonin effects or both. Some doctors will give medications to slow serotonin excretion (SSRI’s) such as fluoxetine, paroxetine etc. with good effect but often without oestrogen, symptoms may not completely improve. It is not unusual to take oestrogen with SSRI’s very effectively.
Mood Changes – this can include low mood, loss of confidence, increased paranoia, irritability, anger and short fuse and lack of interest in life generally.
Collagen Symptoms – loss of oestrogen results in weakening of the collagen matrix and this can affect many parts of the body as collagen is throughout the tissues in our bodies both externally and internally. Loss of oestrogen can results in stiffening and weakening of the ligaments supporting the joints with increasing pain -particularly after resting, along with dry eyes, nose, ears. The bladder and pelvic floor can also be affected due to weakening of the collagen in that area with the increased likelihood of prolapse. Other external areas of collagen that can be affected will be thinning scalp hair. Internal collagen that can be affected can include the artery wall with an increase of aneurysms and of course, bone with increased risk of osteopenia and osteoporosis.
Vascular Symptoms (arterial constriction and loss of blood supply) – the artery walls in females are very sensitive to oestrogen and falling or permanent low levels of oestrogen will results in arterial stiffening and reduction in blood flow. In the shorter term, this can translate to symptoms such as loss of memory and concentration, migraines and headaches, leg cramps and restless legs particularly at night, cold peripheries, poor healing and occasionally chest pain due to arterial spasm particularly during stress.
Vaginal and Bladder symptoms - The bladder base and the vagina as well as vulva are very sensitive to oestrogen and loss of oestrogen, which can result in poor bladder emptying as well as weakening of the bladder neck. This can contribute to either bladder irritability (urgency, frequency and getting up at night to empty the bladder) and also leakage on coughing and straining. The pelvic floor collagen can weaken with an increased risk of prolapse or worsening of a pre-existing prolapse. Loss of oestrogen in the pelvic floor will also results in a change in pH due to the loss of lactobacillus with a rise in pH encouraging overgrowth of abnormal organisms. This can contribute to odour but also recurrent urinary tract infections.
Libido/ Sex drive – loss of oestrogen results in a reduction in supply to the pelvic floor and the vulval skin can become very thin with poor blood supply. Re-oestrogenising can therefore help to reverse the symptoms using topical oestrogen as well as general HRT. Supplementing with testosterone replacement can also help with this.
Metabolic/Insulin Resistance – Loss of sex hormones in the peri and post menopause results in worsening insulin sensitivity. This can lead to insulin resistance which predisposes to many adverse metabolic factors including weight around the abdomen externally and around the internal organs around the abdomen (heart, liver, kidneys), increased inflammation, PCOS in younger women, increased cancer risk and increased vascular symptoms, increased neurodegenerative conditions. Correcting oestrogen can therefore help reduce insulin resistance in the post menopause but sometimes this needs to be treated separately in tandem with oestrogen replacement.
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