Authors: Katrine Yare, PhD, Medical & Cognitive Research Unit (MCRU), Austin Health, Melbourne, Australia | Editors: Romina Garcia de leon and Shayda Swann
Published: October 20th, 2023
*Throughout this series, we want to acknowledge that not all women will experience menopause, and not all folks who experience menopause identify as women. We understand that different terminology will suit different folks. We hope this information is helpful to folks of diverse genders and identities*
I’m a mum, a researcher, and I study the effects of the primary reproductive hormones, 17-beta oestradiol (also called E2) and cyclical progesterone (P4) on sporadic Alzheimer's disease (AD) in women.
Before I progress, Alzheimer's disease (also called AD) is more prevalent in women, with two-thirds of those exhibiting symptoms of AD being post-menopausal women. My research focuses on an earlier phase of the disease, called the preclinical AD stage (before a person develops symptoms). This can develop years earlier.
A little background on women's hormones
Understanding our bodies and how our hormones work can empower us as women to make informed choices when discussing our menopausal concerns with our health professionals. Knowledge really is power.
There are three primary estrogens in women:
- 17-beta-oestradiol (E2) also called oestradiol or estradiol. It is the most potent estrogen and works together with a cyclical hormone, progesterone (P4), during the reproductive phase of women's lives.
- Oestrone (E1) also called estrone. This is the menopausal hormone, which is much less potent than E2.
- Oestriol (E3) also called estriol. E3 is a pregnancy estrogen and is the lowest potency estrogen. It works together with P4 (and other hormones), to protect the developing baby and to maintain pregnancy.
For this blog, I will concentrate on the hormones E2 and cyclical P4, which are essential in maintaining health during the reproductive phase of women's lives.
The actions of the primary reproductive hormones, E2 and cyclical P4, are not confined to reproductive functions such as the menstrual cycle and pregnancy but play a significant beneficial role in many bodily systems (e.g., central nervous system, cardiovascular system, gastrointestinal tract, urogenital system, muscles, bone, skin, etc.), as well as modulating numerous metabolic processes and neurotransmitters.
When the levels of these hormones fluctuate during perimenopause and drop markedly during menopause, this will impact a multitude of physiological, cellular, and metabolic processes that are modulated by these hormones. As a result, most women will be impacted by this change. Some women will choose hormone therapy (HT) to alleviate symptoms, some women choose to ride through menopause without treatment, and there are also a rare few who won't experience any overt symptoms. With respect to the latter, even though these women don't experience overt symptoms, they are undergoing changes on a cellular and molecular level.
As discussed in the menopause series blog 1, some symptoms women may experience due to a drop in E2 and P4 include difficulty regulating body temperature, hot flushes, night sweats, vaginal dryness, dry and itchy skin, joint pain, muscle aches and pains, digestive problems, weight gain, breast tenderness, loss of breast volume, gum changes, headaches, migraines.
E2 and P4 also modulate a number of neurotransmitters. For example, E2 is a serotonin, dopamine, and cholinergic modulator, and P4 (via its metabolites) is a potent GABA-A receptor modulator. Therefore, when the levels of these two hormones drop markedly during menopause these neurotransmitters will be impacted, and, as a consequence, most women will feel the effects. Some symptoms women may experience include anxiety, depression, restlessness, brain fog, difficulty concentrating, irritability, mood swings, dizziness, and insomnia.
Paying attention to your health and well-being as your body undergoes significant change is essential whether you choose to go on HT or not. Also, establishing a good relationship with your health professional where you can freely discuss your menopausal concerns and they can help by listening and offering options or solutions, including clearly outlining benefits and risks, is extremely important.
As a menopausal woman myself, I had a horrible time during the menopausal transition. Even though I chose HT to alleviate my symptoms, which used hormones that were molecularly the same as what our bodies produced during the reproductive phase (i.e., E2 & cyclical P4) and used a route of administration that closely approximates the way our hormones are metabolized in our bodies (this will be discussed more at length in the next blog), I am vigilant about my health.
I want you to be vigilant about your health, too.