top of page

         
          Menopause

Menopause begins in the body with hormonal changes. Perimenopause begins for people in their 40’s but can begin earlier. Some of these effects continue into menopause.

​

Possible Symptoms of Perimenopause:

Irregular periods or periods that are either lighter or heavier than before

Vaginal dryness

Hot flashes/night sweats

 Sleep problems

Slower metabolism

Thinning hair and dry skin

Loss of breast fullness

Breast pain or tenderness

Racing heart

 Headaches

Joint and muscle aches and pains

Worsening of PMS

Changes in mood

​

Menopause usually begins for people in their early 50’s. It is defined by the absence of a period for one year. These are the additional “systemic” effects caused by the decrease in both estrogen and testosterone throughout the body in menopause.

​

Possible Symptoms of Menopause:

Loss of libido

Fatigue

Decreased orgasms

Weight gain

Osteoporosis

Memory problems

Dry skin, dry eyes or dry mouth

Difficulty concentrating

Depression or anxiety

​

The GSM (genitourinary) effects of menopause will progress with age. These are caused by the decline in estrogen and testosterone in the genitourinary region.

​

GSM Symptoms of Menopause:

Urinary incontinence

Painful urination

Nocturia

Vaginal dryness

Vaginal atrophy

Increase in UTIs

Prolapse

Vaginal wall thinning

Labia atrophy

Vaginal shortening

Vaginal contractions become fewer and weaker during orgasm

Weakening of pelvic floor muscles

​

Menopause Resources:

​

What Fresh Hell is This? Perimenopause, Menopause, Other Indignities and You By Heather Corinna

Estrogen Matters: Why Taking Hormones in Menopause Can Improve Women’s Well-Being and Lengthen Their Lives—Without Raising the Risk of Breast Cancer by Avrum Bluming and Carol

Tavris

​

Reference List

​

  1. ACOG Committee Opinion No. 659: The Use of Vaginal Estrogen in Women With a History of Estrogen-Dependent Breast Cancer. Obstet Gynecol. 2016;127(3):e93-e96.

  2. Aden U, Jung-Hoffmann C, Kuhl H. A randomized cross-over study on various hormonal parameters of two triphasic oral contraceptives. Contraception. 1998;58(2):75-81.

  3. Ågren UM, Anttila M, Mäenpää-Liukko K, et al. Effects of a monophasic combined oral contraceptive containing nomegestrol acetate and 17β-oestradiol in comparison to one containing levonorgestrel and ethinylestradiol on markers of endocrine function. Eur J Contracept Reprod Health Care. 2011;16(6):458-467.

  4. Ågren UM, Anttila M, Mäenpää-Liukko K, Rantala ML, Rautiainen H, Sommer WF, Mommers E. Effects of a monophasic combined oral contraceptive containing nomegestrol acetate and 17β-oestradiol compared with one containing levonorgestrel and ethinylestradiol on haemostasis, lipids and carbohydrate metabolism. Eur J Contracept Reprod Health Care. 2011 Dec;16(6):444-57. 

  5. Aschwanden, C.  Hormone therapy, long shunned for a possible breast cancer link, is now seen as a short-term treatment for menopause symptoms. The Washington Post. 2020.

  6. Asi N, Mohammed K, Haydour Q, et al. Progesterone vs. synthetic progestins and the risk of breast cancer: a systematic review and meta-analysis. Syst Rev. 2016;5(1):121.

  7. Avis NE, Crawford, S. Cultural Differences in Symptoms and Attitudes toward Menopause. Menopause Management. 2007;17(3).

  8. Beckmann MW, Jap D, Djahansouzi S, et al. Hormone replacement therapy after treatment of breast cancer: effects on postmenopausal symptoms, bone mineral density and recurrence rates. Oncology. 2001;60(3):199-206.

  9. Belisle S, Fluker MR, and the Consensus Conference Writing Group.  Canadian Consensus Conference on Menopause and Osteoporosis. J Soc Obstet Gynaecol Can 1998;20:1243-1272 (part I) and 1998;21:37-70 (part II). 

  10. Bergink EW, Holma P, Pyörälä T. Effects of oral contraceptive combinations containing levonorgestrel or desogestrel on serum proteins and androgen binding. Scand J Clin Lab Invest. 1981;41(7):663-668.

  11. Bluming, A. and Tavris, C. Estrogen Matters: What Taking Hormones in Menopause Can Improve Women’s Well-Being and Lengthen Their Lives–Without Raising the Risk of Breast Cancer. Little Brown and Spark, 2018.

  12. Boardman HM, Hartley L, Eisinga A, et al. Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database Syst Rev. 2015;(3):CD002229. 

  13. Boyd RA, Zegarac EA, Posvar EL, Flack MR. Minimal androgenic activity of a new oral contraceptive containing norethindrone acetate and graduated doses of ethinyl estradiol. Contraception. 2001;63(2):71-76.

  14. Brotman RM, Shardell MD, Gajer P, et al. Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy. Menopause. 2014;21(5):450-458. 

  15. Cagnacci A, Venier M. The Controversial History of Hormone Replacement Therapy. Medicina (Kaunas). 2019;55(9):602. 

  16. Cauley JA, Seeley DG, Ensrud K, et al. Estrogen replacement therapy and fractures in older women. Study of Osteoporotic Fractures Research Group. Ann Intern Med 1995;122:9-16. 

  17. Coenen CM, Thomas CM, Borm GF, Hollanders JM, Rolland R. Changes in androgens during treatment with four low-dose contraceptives. Contraception. 1996;53(3):171-176.

  18. Corinna, Heather. What Fresh Hell is This: Perimenopause, Menopause, Other Indignities and You. Hachette Books, 2021.

  19. David A. Decker MD. JPettinga, JE. Cox, TC.  Burdakin, JH.  Jaiyesimi, IA. Benitez, PR. Hormone Replacement Therapy in Breast Cancer Survivors. 2007;3(2):63-68.

  20. Davison SL, Bell R. Androgen physiology. Semin Reprod Med. 2006;24(2):71-77.

  21. Dew J, Eden J, Beller E, et al. A cohort study of hormone replacement therapy given to women previously treated for breast cancer. Climacteric. 1998;1(2):137-142.

  22. DiSaia, PJ. Brewster, WR. Hormone replacement therapy for survivors of breast and endometrial cancer. Curr Oncol Rep. 2002;2:152–158.

  23. Durna EM, Heller GZ, Leader LR, Sjoblom P, Eden JA, Wren BG. Breast cancer in premenopausal women: recurrence and survival rates and relationship to hormone replacement therapy. Climacteric. 2004;7(3):284-291.

  24. Durna EM, Wren BG, Heller GZ, Leader LR, Sjoblom P, Eden JA. Hormone replacement therapy after a diagnosis of breast cancer: cancer recurrence and mortality. Med J Aust. 2002;177(7):347-351.

  25. Felson DT, Zhang Y, Hannan MT, et al. The effect of postmenopausal estrogen therapy on bone density in elderly women. N Engl J Med 1993;329:1141-1146. 

  26. Fern M, Rose DP, Fern EB. Effect of oral contraceptives on plasma androgenic steroids and their precursors. Obstet Gynecol. 1978;51(5):541-544.

  27. Gambacciani M, Levancini M. Management of postmenopausal osteoporosis and the prevention of fractures. Panminerva Med. 2014;56(2):115–131. 

  28. Gaspard UJ, Dubois M, Gillain D, Franchimont P, Duvivier J. Ovarian function is effectively inhibited by a low-dose triphasic oral contraceptive containing ethinylestradiol and levonorgestrel. Contraception. 1984;29(4):305-318. 

  29. Gass, MLS. Is ET avoidance associated with early death in women with hysterectomy?. First to Know. NAMS. 2013. 

  30. Genant HK, Lucas J, Weiss S, et al. Low-dose esterified estrogen therapy: Effects on bone, plasma estradiol concentrations, endometrium, and lipid levels. Estratab/Osteoporosis Study Group. Arch Intern Med 1997;157:2609-2615. 

  31. Gliniewicz, K, Schneider, GM, Ridenhour, BJ, Williams, CJ, Song, Y, Farage, Miller, K, Forney, LJ. Comparison of the Vaginal Microbiomes of Premenopausal and Postmenopausal Women. Front. Microbiol. 2019.

  32. Goodman MP. Are all estrogens created equal? A review of oral vs. transdermal therapy. J Womens Health (Larchmt). 2012;21(2):161-169. 

  33. Gordon JL, Rubinow DR, Eisenlohr-Moul TA, Xia K, Schmidt PJ, Girdler SS. Efficacy of Transdermal Estradiol and Micronized Progesterone in the Prevention of Depressive Symptoms in the Menopause Transition: A Randomized Clinical Trial. JAMA Psychiatry. 2018;75(2):149-157.

  34. Granger LR, Roy S, Mishell DR Jr. Changes in unbound sex steroids and sex hormone binding globulin--binding capacity during oral and vaginal progestogen administration. Am J Obstet Gynecol. 1982;144(5):578-584.

  35. Greco T, Graham CA, Bancroft J, Tanner A, Doll HA. The effects of oral contraceptives on androgen levels and their relevance to premenstrual mood and sexual interest: a comparison of two triphasic formulations containing norgestimate and either 35 or 25 microg of ethinyl estradiol. Contraception. 2007;76(1):8-17.

  36. Guay A,Davis SR. Testosterone insufficiency in women: fact or fiction? World Journal of Urology. 2002;20:106-110.

  37. Gunter, Jen. The Menopause Manifesto. Citadel Press. 2021

  38. Hammond GL, Hogeveen KN, Visser M, Coelingh Bennink HJ. Estetrol does not bind sex hormone binding globulin or increase its production by human HepG2 cells. Climacteric. 2008;11 Suppl 1:41-46.

  39. Hammond GL, Langley MS, Robinson PA, Nummi S, Lund L. Serum steroid binding protein concentrations, distribution of progestogens, and bioavailability of testosterone during treatment with contraceptives containing desogestrel or levonorgestrel. Fertil Steril. 1984;42(1):44-51.

  40. Harder, H, Starkings, RML, Fallowfield, LJ, Menon, U, Jacobs, IJ, Jenkins, VA, on behalf of the UKCTOCS trialists. Sexual functioning in 4,418 postmenopausal women participating in UKCTOCS: a qualitative free-text analysis. Menopause. 2019;26(10):1100-1009.

  41. Harman SM, Brinton EA, Cedars M, et al. KEEPS: The Kronos Early Estrogen Prevention Study. Climacteric. 2005;8(1):3-12.

  42. Harrison, R. Stopping a Zombie: The Truth about Estrogen and Heart Disease. Yale School of Medicine. 2025. 

  43. Henderson VW. Estrogen, cognition, and a woman’s risk of Alzheimer’s disease. Am J Med 1997;103:11S-18S. 

  44. Hodis HN, Sarrel PM. Menopausal hormone therapy and breast cancer: what is the evidence from randomized trials?. Climacteric. 2018;21(6):521-528.

  45. Hulley S, Grady D, Bush T, et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/Progestin Replacement Study (HERS) Research Group. JAMA 1998;280:605-613. 

  46. Hung, KJ, Hudson, PL, Bergerat, A. et al. Effect of commercial vaginal products on the growth of uropathogenic and commensal vaginal bacteria. Sci Rep. 2020;10(7625).

  47. Hysterectomy & The Menopause Information Leaflet. Liverpool Women’s NHS Foundation Trust. 2017. Available at: https://www.liverpoolwomens.nhs.uk/media/2691/gyn_2018-164-hysterectomy-the-menopause.pdf. Accessed 18 February, 2021.

  48. Hall, A. Understanding Hormonal Contraception. 2013. Available at: https://www.acha.org/documents/Programs_Services/webhandouts_2013/FR4-348-Hall_A.pdf Accessed 27 December,, 2021.

  49. Jung-Hoffmann C, Heidt F, Kuhl H. Effect of two oral contraceptives containing 30 micrograms ethinylestradiol and 75 micrograms gestodene or 150 micrograms desogestrel upon various hormonal parameters. Contraception. 1988;38(6):593-603. 

  50. Jung-Hoffmann C, Kuhl H. Divergent effects of two low-dose oral contraceptives on sex hormone-binding globulin and free testosterone. Am J Obstet Gynecol. 1987;156(1):199-203.

  51. Kalia, N, Singh, J, Kaur, M. Microbiota in vaginal health and pathogenesis of recurrent vulvovaginal infections: a critical review. Ann Clin Microbiol Antimicrob. 2020;9(5). 

  52. Kota K, Brufsky A, Oesterreich S, Lee A. Estradiol as a Targeted, Late-Line Therapy in Metastatic Breast Cancer with Estrogen Receptor Amplification. Cureus. 2017;9(7):e1434.

  53. Kleinplatz PJ, Menard AD Magnificent Sex. Routledge;2020.

  54. Kuhl H, Gahn G, Romberg G, März W, Taubert HD. A randomized cross-over comparison of two low-dose oral contraceptives upon hormonal and metabolic parameters: I. Effects upon sexual hormone levels. Contraception. 1985;31(6):583-593.

  55. Laughlin-Tommaso SK, Khan Z, Weaver AL, Smith CY, Rocca WA, Stewart EA. Cardiovascular and metabolic morbidity after hysterectomy with ovarian conservation: a cohort study. Menopause. 2018;25(5):483-492.

  56. Lobo RA. Hormone replacement therapy: Current thinking, Nat Rev Endocrinol. 2017;13:220-31.

  57. Lina Al-Imari, L. Wolfman, WL. The Safety of Testosterone Therapy in Women. J Obstet Gynaecol Can 2012;34(9):859–865.

  58. Liu B. Is transdermal menopausal hormone therapy a safer option than oral therapy?. CMAJ. 2013;185(7):549-550.

  59. Mandel FP, Geola FL, Meldrum DR, et al. Biological effects of various doses of vaginally administered conjugated equine estrogens in postmenopausal women. J Clin Endocrinol Metab 1983; 57:133-139. 

  60. Meurer LN, Lená S. Cancer recurrence and mortality in women using hormone replacement therapy: meta-analysis. J Fam Pract. 2002;51(12):1056-1062.

  61. Michaelsson K, Baron JA, Farahmand BY, et al. Hormone replacement therapy and risk of hip fracture: Population based case-control study. The Swedish Hip Fracture Study Group. BMJ 1998;316:  1858-1863.

  62. Moorman PG, Myers ER, Schildkraut JM, Iversen ES, Wang F, Warren N. Effect of hysterectomy with ovarian preservation on ovarian function. Obstet Gynecol. 2011;118(6):1271-1279. 

  63. Muhleisen, AL, Herbst-Kralovetz, MM. Menopause and the vaginal microbiome. Maturitas. 2016;91:42-50.

  64. Mulnard RA, Cotman CW, Kawas C, et al. Estrogen replacement therapy for treatment of mild to moderate Alzheimer disease. JAMA 2000;283:1007-1015. 

  65. Murphy, Ana Alvarez, et al. Effect of low-dose oral contraceptive on gonadotropins, androgens, and sex hormone binding globulin in nonhirsute women. Fertility and sterility 1990; 53(1):35-39.

  66. Naghii MR, Mofid M, Asgari AR, Hedayati M, Daneshpour MS. Comparative effects of daily and weekly boron supplementation on plasma steroid hormones and proinflammatory cytokines. J Trace Elem Med Biol. 2011;25(1):54-58.

  67. Nagoski E, Nagoski A. Burn Out: The Secret to Unlocking the Stress Cycle. Ballentine Books;2019.

  68. Newson L. Books: Oestrogen Matters: Why Taking Hormones in Menopause Can Improve Women's Well-Being and Lengthen Their Lives - Without Raising the Risk of Breast Cancer: Does Oestrogen Really Matter in Postmenopausal Women? It Certainly Does. Br J Gen Pract. 2018;68(676):538. 

  69. North American Menopause Society. Menopause Practice: A Clinician’s Guide; 6th Edition

  70. Odlind V, Milsom I, Persson I, Victor A. Can changes in sex hormone binding globulin predict the risk of venous thromboembolism with combined oral contraceptive pills?. Acta Obstet Gynecol Scand. 2002;81(6):482-490.

  71. Raz R, Stamm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med 1993;329:753-756. 

  72. Robinson L, and the medical advisory council of the British Menopause Society. HRT: Benefits and risks. Women’s Health Concern. 2020.

  73. Salamone LM, Pressman AR, Seeley DG, et al. Estrogen replacement therapy. A survey of older women’s attitudes. Arch Intern Med 1996;156:1293-1297. 

  74. Sarrel, PM. The Role of Estrogen Therapy for Menopausal Women. 2015 https://www.empowher.com/menopause/content/role-estrogen-therapy-menopausal-women. Accessed February 22,2021.

  75. Sarrel, P, Sarrel, L. Estrogen Therapy Reduces Breast Cancer Risk After Hysterectomy: True or False?. 2017. https://www.empowher.com/hormones/content/estrogen-therapy-reduces-breast-cancer-risk-after-hysterectomy-true-or-fal. Accessed February 18,2021.

  76. Schneider DL, Barrett-Connor EL, Morton DJ. Timing of postmenopausal estrogen for optimal bone mineral density. The Rancho Bernardo Study. JAMA 1997; 277:543-547. 

  77. Seeley DG, Cauley JA, Grady D, et al. Is postmenopausal estrogen therapy associated with neuromuscular function or falling in elderly women? Study of Osteoporotic Fractures Research Group. Arch Intern Med 1995;155:293-299. 

  78. Shapiro S, Farmer RDT, Mueck AO, et Al. Does hormone replacement therapy cause breast cancer? An application of causal principles to three studies. Part 2. Estrogen plus progesterone. J Fam Plann Reprod health Care. 2011;24:728-53.

  79. Shapiro S, Farmer RD, Mueck AO, Seaman H, Stevenson JC. Does hormone replacement therapy cause breast cancer? An application of causal principles to three studies: part 2. The Women's Health Initiative: estrogen plus progestogen. J Fam Plann Reprod Health Care. 2011;37(3):165-172. 

  80. Shifren JL, Rifai N, Desindes S, McIlwain M, Doros G, Mazer NA. A comparison of the short-term effects of oral conjugated equine estrogens versus transdermal estradiol on C-reactive protein, other serum markers of inflammation, and other hepatic proteins in naturally menopausal women. J Clin Endocrinol Metab. 2008;93(5):1702-1710. 

  81. Sobczak C. Embody: Learning to Love Your Unique Body. GŸrze Books;2014.

  82. Speroff, L, Fritz, MA. Clinical gynecologic endocrinology and infertility. Lippincott Williams & Wilkins;2005.

  83. The North American Menopause Society. What Selective Estrogen Receptor Modulators (SERMs) Can Do for You. 2016. http://www.menopause.org/for-women/what-selective-estrogen-receptor-modulators-(serms)-can-do-for-you. Accessed February 22,2021.

  84. The 2017 hormone therapy position statement of the North American Menopause Society. Menopause. 2017;24(7):728-53. 

  85. Thornton K, Chervenak J, Neal-Perry G. Menopause and Sexuality. Endocrinol Metab Clin North Am. 2015;44(3):649-661.

  86. Traish AM, Vignozzi L, Simon JA, et al. Role of Androgens in Female Genitourinary Tissue Structure and Function: Implications in the Genitourinary Syndrome of Menopause. Sex Med Rev. 2018;6:558–571.

  87. Uršič VM, Baškovič M, Bebar S, Djurišić A, Stržinar V, Vakselj A. HORMONE REPLACEMENT THERAPY AND BREAST CANCER – NEWS AND RECOMMENDATION. Zdrav Vestn. 2008; 77: SUPPL III.

  88. Vassilopoulou-Sellin R. Breast cancer and hormonal replacement therapy. Ann N Y Acad Sci. 2003;997:341-350.

  89. Vassilopoulou‐Sellin, R. Cohen, DS.  Hortobagyi, GN. Klein, MJ. McNeese, M.  Singletary, SE. et al. Estrogen replacement therapy for menopausal women with a history of breast carcinoma. Cancer. 2002;95(9):1817-1826.

  90. van der Vange N, Blankenstein MA, Kloosterboer HJ, Haspels AA, Thijssen JH. Effects of seven low-dose combined oral contraceptives on sex hormone binding globulin, corticosteroid binding globulin, total and free testosterone. Contraception. 1990;41(4):345-352.

  91. van Kammen E, Thijssen JH, Rademaker B, Schwarz F. The influence of hormonal contraceptives on sex hormone binding globulin (SHBG) capacity. Contraception. 1975;11(1):53-59.

  92. Vogel, L. Landmark trial overstated HRT risk for younger women: Results of a major trial of hormone therapy may have been misleading. CMAJ. 2017.

  93. What Does Estrogen Do?, The Journal of Clinical Endocrinology & Metabolism. 2014;9(4):31A-32A. 

  94. When the arrival of menopause brings symptoms of depression. Harvard Women’s Health Watch. 2018.

  95. Wiegratz I, Kutschera E, Lee JH, et al. Effect of four different oral contraceptives on various sex hormones and serum-binding globulins. Contraception. 2003;67(1):25-32.

  96. Zhu M, Brinton R. How Progestin, a Synthetic Female Hormone, Could Affect the Brain. Health. 2012.

  97. Zimmerman Y, Eijkemans MJ, Coelingh Bennink HJ, Blankenstein MA, Fauser BC. The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis. Hum Reprod Update. 2014;20(1):76-105.

bottom of page