Oestrogen is the hormone that protects you
against osteoporosis, cardiovascular disease and the external signs of aging.
Without oestrogen, it’s just a matter of time before everyone will start
experiencing conditions such as atherosclerosis, osteoporosis and decreased
Atherosclerosis and osteoporosis are both potentially
lethal and dementia is a distressing condition.
It’s therefore clear that menopause is a signal to have a thorough medical
check up to detect potential problems before they occur or treat existing
conditions early before they become serious.
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
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
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.
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
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 underlying bone disease such as osteoporosis.
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
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.
When to see a doctor
All midlife women are urged to consult their family doctor or gynaecologist
for routine check-ups and advice about these conditions, particularly if you
have a personal or family history of heart disease and/or osteoporosis. It is
important to call a health professional without delay if:
- you have prolonged irregular bleeding. This may be
particularly important if you are overweight.
- You experience bleeding after not having had a period for
six months or more; among other possibilities, it may be a sign of uterine
- Mood changes are causing problems. If depression is severe
or persists for more than two weeks, consult your doctor.
Symptoms of menopause
Causes of menopause
Treating of menopause
(Previously reviewed by Dr Mike Davey, President of the South African
Menopause Society, and Prof B. Schaetzing MD, FCOG (SA), FRCOG, PhD. Part-time
Consultant, Dept of Obstetrics & Gynaecology, Faculty of Health Sciences,
University of Stellenbosch)
Reviewed and updated by Dr Dr Carol Thomas MBChB
(UCT) FCOG (SA) MMed (O&G) (UCT), Specialist Gynaecologist in private
practice, Cape Town, Secretary South African Menopause Society and Director of
the WomanSpace. March 2015.