Menopausal Hormones / Hormone Testing

As women enter menopause, various changes occur and symptoms may arise due to declining estrogen levels. Some women experience no symptoms or only mild and short-lived symptoms, while others may suffer from severe symptoms that interfere with daily life. Hormonal changes during menopause can lead to several important symptoms, including the following:

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Changes in Menstrual Patterns

Menstrual characteristics vary among women entering menopause. Some may experience missed periods that eventually stop altogether, while others may have gradually lighter periods until they cease, which is considered normal. However, prolonged bleeding (more than 7 days) or abnormal spotting requires thorough evaluation, and malignancy must be ruled out before attributing symptoms to menopause. Some women mistakenly assume these symptoms are normal for their age and delay seeking medical evaluation, or they may take medications, supplements, or certain herbal products marketed for “detoxification,” which can lead to complications such as abnormal bleeding or lower abdominal pain. By the time they see a doctor, the condition may already have significantly progressed.

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Hot Flashes and Night Sweats

These are changes related to the autonomic nervous system. Hot flashes typically begin in the chest and spread to the neck and face and are often accompanied by sweating followed by chills. When these symptoms occur at night, they can significantly disturb sleep and daily functioning.

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Irritability and Mood Changes

Estrogen deficiency affects mood and mental health, potentially causing irritability, mood swings, poor concentration, headaches, fatigue, and depression.

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Vaginal Dryness

Estrogen deficiency causes atrophy of the tissues and muscles surrounding the urethra and bladder. Symptoms include vaginal dryness, burning or pain during urination, urinary frequency, stress incontinence (leakage when coughing, sneezing, or laughing), and increased susceptibility to bladder infections.

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Osteoporosis

Normally, bone formation and bone resorption occur continuously. During childhood and adolescence, bone formation exceeds bone resorption. Research in Thailand shows that peak bone mass in Thai women occurs between ages 30–34. After age 35, bone density gradually declines by approximately 0.3–0.5% per year. This accelerated bone loss lasts about 5–10 years and may lead to osteoporosis if preventive measures are not taken. Osteoporotic fractures can occur even with minor injuries. Osteoporosis often presents no symptoms until a fracture occurs, making it a “silent threat” in menopausal women.

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Increased Risk of Coronary Artery Disease

Estrogen decline adversely affects lipid metabolism and blood vessels. Total cholesterol and LDL (“bad cholesterol”) levels increase, while HDL (“good cholesterol”) decreases, promoting plaque formation along blood vessel walls—particularly coronary arteries—leading to coronary artery disease.

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Memory Impairment

Menopausal women may experience forgetfulness or reduced ability to recall names and important information. Alzheimer’s disease—caused by degenerative brain cell changes—accounts for about 70% of dementia in older adults. Its incidence increases rapidly after age 65 and is more common in women. It tends to occur more frequently in individuals who do not regularly engage in cognitive activities. Therefore, menopausal women should keep their minds active through tasks such as arithmetic or puzzles.

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Insomnia

Some women may have difficulty sleeping through the night or may wake up repeatedly. Poor sleep prevents adequate mental rest, significantly affecting overall health and potentially contributing to other medical conditions.

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What Is Hormone Replacement Therapy? (HRT)

Hormone replacement therapy treats menopausal symptoms using hormones—primarily natural (bio-identical) estrogen that is structurally identical to endogenous female hormones. It may be used alone or combined with natural progesterone. Although most commonly taken orally, estrogen may also be administered via transdermal patches, gels, vaginal preparations, or nasal sprays. These routes may be considered for patients with liver disease, gastrointestinal problems, diabetes, hyperlipidemia, or migraine.

In men, hormone replacement may also be used, typically with testosterone in oral or injectable forms, to improve overall well-being, vitality, and symptoms of erectile dysfunction. However, erectile dysfunction has multiple causes, not just low hormone levels.

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Benefits of Hormone Replacement Therapy
In Women

HRT helps relieve menopausal symptoms, particularly genitourinary symptoms such as vaginal dryness, thinning of the vaginal lining, and reduced elasticity and moisture that can lead to inflammation.

In Men

HRT may help improve fatigue, low libido, erectile dysfunction, and muscle weakness.

Additional benefits in both men and women may include reduced depression, decreased fatigue, relief from palpitations, improved sleep, firmer and more hydrated skin, reduced dermatitis, enhanced memory and concentration, and increased bone density. However, responses vary depending on individual health factors.

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Contraindications and Side Effects of Hormone Replacement Therapy

HRT is prescribed at physiological doses, not exceeding the natural hormone levels, so side effects are generally minimal. In women, the most common side effect is vaginal bleeding, primarily during the initial phase of therapy, which typically resolves with continued use. Other possible side effects include breast tenderness and migraine headaches, usually occurring only early in treatment.

In men, testosterone therapy is contraindicated in patients with prostate cancer because testosterone can accelerate cancer progression. Physicians will assess suitability and monitor treatment outcomes accordingly.

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Lifestyle Still Matters

HRT alone does not ensure good health; it is merely one component of overall well-being. Essential lifestyle measures include regular exercise, a balanced diet, avoiding high-fat foods, abstaining from alcohol and smoking, ensuring sufficient rest, and minimizing stress. With these combined approaches, individuals can navigate the menopausal transition more comfortably and with fewer complications.