Updated 21 July 2014

Menopause: causing grievious bodily harm

Without oestrogen, it’s just a matter of time before everyone will start experiencing conditions such as atherosclerosis, osteoporosis and decreased mental ability.


Oestrogen is the hormone that protects you against osteoporosis, cardiovascular disease and the external signs of ageing. Without oestrogen, it’s just a matter of time before everyone will start experiencing conditions such as atherosclerosis, osteoporosis and decreased mental ability.  Atherosclerosis and osteoporosis are both potentially lethal and dementia isn’t something anyone looks forward to.

It’s therefore clear that menopause is the warning you get before your quality of life starts diminishing. It’s therefore a good idea to ward off these threatening conditions before they become serious.

1. Effect on the skeletal bones

Osteoporosis can be a serious long-term health consequence of the menopause. Osteoporosis is a silent disease until a bone breaks.

Oestrogen deficiency accelerates the bone depletion that occurs during the normal ageing process. About 25% of women gradually experience bone fragility and fractures with declining oestrogen production. A decrease in bone mass may lead to curvature of the spine, vertebral compression fractures, height loss and pain. Bone loss in the femur bones occurs at a slower rate, and women who don’t take hormone therapy (HT) may not experience femur fractures until 70 -75 years.

Hip fractures are a common injury in women with osteoporosis at an advanced age. About 20% of white women at the age of 80 who don’t take HT may develop hip fractures and usually require a long recovery period. Up to a quarter of those who do recover need to enter a long-term care facility, while 15% with hip fractures in this age group will die within six months, either from the fracture itself or from complications.

It has been proven that oestrogen replacement can slow the development of osteoporosis.

Factors that increase risk for osteoporosis:

  • Caucasian or Asian ethnicity
  • A slim build (decreased weight in relation to height)
  • A prior fracture
  • A family history of hip fractures or osteoporosis
  • Cigarette smoking, high alcohol intake, high caffeine consumption
  • Rheumatoid arthritis
  • Early menopause (either spontaneously or after removal of the ovaries)
  • No or minimal exercise
  • Deficient intake of calcium and vitamin D, high protein intake
  • Endocrine disorders such as diabetes mellitus, Cushing’s disease, hyperthyroidism (overactivity of the thyroid gland) and corticosteroid therapy

2. Effect on the heart

After menopause the risk of a heart attack rises steadily. Generally, the incidence of heart attacks rises in both sexes with advancing age. But the rate of increase is greater in women older than 50 than in men. As a result, the ratio of heart attacks in women to men after 50 decreases to 2:1 by age 65 and 1:1 by age 80.

In addition, the first heart attack is more likely to be fatal for women than for men. Oestrogen decrease is thought to cause unfavourable changes in levels of cholesterol and other blood fats, as well as in fibrinogen, a substance that affects blood clotting. These changes may increase the risk of heart disease and stroke. Heart disease is a leading cause of death among women.

3. Effect on fat distribution, muscle mass and skin

As age advances and oestrogen levels decline, muscle mass decreases, body fat increases and skin collagen gradually becomes thinner and less elastic.

The increase in body weight and total body fat is associated with a shift of fat from the peripheral sites of the body to the abdomen. In certain women this causes a change in shape from the more gynaecoid (female-like) to the android (male-like) fat distribution, which is thought to carry an increased risk for the development of cardiovascular disease.

Breasts: The glandular tissue becomes less and is replaced by fat.
Skin: As oestrogen levels decline, skin collagen gradually becomes thinner and less elastic. This causes sags and wrinkles. The skin also becomes drier.

Hair: Oestrogen stimulates hair growth. When oestrogen levels fall, hair growth slows down and the hair becomes thinner and less manageable.

Teeth: Decreased levels of oestrogen can lead to dental problems such as tooth loss, gingival bleeding and inflammation and loosening of the teeth. Tooth loss could also be due to an underying bone disease such as osteoporosis.

4. Effect on the brain

Oestrogen has definite effects on the functioning of the brain. It affects the blood flow to the brain, growth and survival of nerve cells and the way in which impulses are transmitted along nerve cells.

Low levels of oestrogen have been linked to a decrease in mental abilities and alertness, such as in Alzheimer's disease.

Oestrogen replacement may decrease one’s risk of developing Alzheimer’s disease.

5. Effect on fertility

As the number of ova (eggs) in the ovaries is reduced and ovulation becomes irregular and the ability of perimenopausal women to conceive decreases. Pregnancy is still possible, however, and to avoid it, you should use contraception until you’ve had 12 period-free months. 


Reviewed and updated by Dr Alan Alperstein, obestetrician and gynaecologists in Cape Town, in February 2011. 
Previously partly reviewed by Dr Mike Davey, President of the South African Menopause Society & Dr Tobie de Villiers, gynaecologist and committee member of both the South African Menopause and International Menopause Societies.  




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