Hormonal Changes in Menopause and Implications on Sexual Health

Abstract

Introduction The menopause is characterized by an array of changes to the female body caused by modulations which occur in the production of estrogens and androgens. The ovaries are important sites of testosterone production in the peri- and postmenopausal women, but the contribution of testosterone pro-hormones from the adrenal glands falls precipitously to the extent where the ovaries cannot correct the deficit. This results in a net decline in circulating testosterone levels. Aims This paper gives an overview of this interesting subject area. Researchers have cogitated on the relationship between the physical effects of the menopause and the observed declines in testosterone levels, but it is now much clearer that falling testosterone levels cannot explain all of these changes. Main Outcome Measures The cessation of follicular functioning results in a steep decline in the production of estrogens. This modulation is responsible for the physical manifestations of the menopause—hot flushes, sleep disturbances, mood changes, bleeding problems, local urogenital problems, vaginal changes, etc. Methods A review of the pertinent literature was conducted to investigate hormonal changes around the menopause. A précis of the salient information is presented here. Results Although the most obvious and well-known effects of the menopause are due to the decline of estrogen levels, the effects of falling testosterone levels are subtle, but by no means less significant. Reductions in sexual motivation, sexual arousal, vaginal lubrication, etc. are all associated with plummeting androgen levels. Conclusions Today, several options exist for the treatment of the endocrinological changes associated with the menopause. Estrogen deficiency can be corrected with hormone replacement therapy and topical preparations for the genitalia. A new transdermal system for the administration of testosterone shows a great deal of potential for the treatment of androgen deficiency.

Recognizing and Treating Urogenital Atrophy in Postmenopausal Women

“…Patient education should focus on the basic facts about women's sexual health, including genital anatomy and the relationship between genital structural health and changes in hormones associated with menopause. 8 Treatment options, the role of additional diagnostic testing, and a referral, when necessary, should be considered and discussed.…”

“…3 Urogenital atrophy associated with estrogen decline can also lead to lower urinary tract dysfunction and urinary symptoms, such as increased frequency, urgency, dysuria, and recurrent urinary tract infections (UTIs). 1,8 These symptoms can be troubling and can prompt women to make lifestyle changes, such as restricting activity outside the home, using sanitary protection, and altering fluid intake. Urinary symptoms also worsen sexual function either by such factors as embarrassment or from frank distracting pain.…”

Separation of Steroids and the Determination of Estradiol Content in Transdermic Patches by Microemulsion Electrokinetic Chromatography

“…Estrogens have been used as therapeutic drugs to treat female hormonal deficiency diseases [1][2][3]. 17b-Estradiol, (17b)-estra-1,3,5(10)-triene-3,17-diol is the major estrogen in humans.…”

Management of Sexual Dysfunction in Postmenopausal Breast Cancer Patients Taking Adjuvant Aromatase Inhibitor Therapy

“…In the premenopausal female, 50% of the circulatory levels of testosterone represent equal contributions from the ovaries and the adrenal glands, but with increasing age, the contributions of the adrenal glands, the peripheral tissue, and the ovaries to dehydroepiandrosterone (DHEA) sulphate remain about the same, while the contribution of the ovaries to the testosterone pool increases significantly. Nevertheless, overall levels of androgen decrease because of the precipitous decline in production of testosterone prohormones from the adrenal gland-to the extent that the ovaries cannot correct the deficit 72 . The symptoms of low androgen in women are reported to be similar to those in men: a decrease in libido, energy, or sense of wellbeing, and decreased lubrication and arousability even in the presence of estrogens 73 .…”