Mens Health Blog. Medical Blog

Depending on what is important to you and your general make up, and perhaps how rapidly the oestrogen falls, the turning down in oestrogen production will give rise to a variety of different symptoms throughout your body. Some symptoms occur before your periods become irregular or alter in any way. Your periods vary because there is a variation in oestrogen production – with or without the production of an egg -and therefore the production of progesterone following this also varies. The uterine lining may be thick or thin because of a variation in oestrogen, or come away erratically because of the absence of progesterone. Some people have erratic periods for several years, others may stop menstruating suddenly, without warning. If periods are frequent and heavy your doctor should be consulted and a curette may be advised. This is not only to make sure that nothing abnormal is present, but is often curative, as there may be some irregularity of the lining causing heavy periods to persist.

Symptoms following the downturn of oestrogen production are variable. A Medical Women’s Federation report as far back as 1933 stated that results from a survey showed that only 15 per cent of women had a menopause free of symptoms1 However the intensity of symptoms varies from woman to woman. Symptoms seem to accompany strong variations in hormones, and disappear as the hormones are stabilised. The ovaries, adrenal glands and fat in the female body continue to make variable amounts of oestrogen for years afterwards, and the variation of this production from person to person perhaps explains the variation in symptoms.

When insufficient hormones are produced, artificial hormones are available for replacement therapy.

*3\63\8*

Dyspareunia occurs at varying times in women’s lives and in some instances not at all, for some women continue to produce enough oestrogen after menstruation ceases. Fat women for instance, who manufacture oestrogen in their subcutaneous fat, complain less often of this symptom. However, dyspareunia may gradually increase as the woman ages, unless oestrogen is replaced locally or generally.

Discomfort with intercourse at this time was once thought to be a psychological symptom, and women were blamed for not being interested in intercourse. But there is an actual change in the cells of the vagina that can be observed under a microscope. With the application of oestrogens, these cells revert to their oestrogenised state.

At menopause the tissues atrophy and become dry, and the vagina becomes, in some instances, shorter and more rigid. This condition is aggravated if there is no sexual activity.

Lack of lubrication can certainly affect libido because of sheer discomfort. In addition the oestrogen-deficient, less-acid vagina is more prone to infection, and, with vaginal thinning, it may bleed due to friction during intercourse. This dryness of vaginal tissues in some women comes on gradually, and in others it appears more suddenly. It may occur within weeks if the ovaries are removed surgically.

*13\63\8*

Your periods must have stopped for at least twelve months for you to ignore contraception. If you are on the pill your periods will be pill-induced, and the pill must be stopped to confirm the absence of your periods for this length of time. Pill-induced periods have nothing to do with your own cycle. During this twelve months you should use barrier methods of contraception such as condoms and cream.

What are the alternatives if contraception is still necessary under the age of fifty? Just as in the selection of contraceptives at any age, you and your partner must work out with your doctor what best suits you, taking into consideration the general health factors of your age group. The physical condition of a woman with, for example, raised blood pressure and cardiac disease becomes more important, and if the woman also smokes, problems with these conditions also increase.

The combined pill using the lowest dose possible is a reasonable choice with regard to recent reports of the hazards of the pill to those over thirty-five. With these facts in mind, permanent methods of contraception, such as tubal ligation for women or vasectomy for men, are being suggested to more and more couples. Barrier methods using condoms or diaphragms combined with creams are coming back into fashion.

The intra-uterine device (IUD) has a place if the woman does not experience irregular bleeding. Although it has a 4 per cent failure rate, failure would declare itself by a missed period.

Termination could be sought, if desired, at an early stage.

The mucus method of contraception has a place for the well-trained couple, but again, irregular periods are a problem. In this case a woman who misses a period may suffer undue anxiety that she may be pregnant.

The progestogen-only pill does not usually produce regular periods, therefore pregnancy would not be so obvious so soon. It has a four per cent failure rate. Spotting, which is often associated with this pill, is also a problem with this age group of women as spotting may indicate other problems that should be investigated.

These are only a few basic points. Other considerations must obviously be taken into account, and these can only be assessed by you and your own doctor. One worry that women raise when hormones are used after menopause, and particularly when periods are reintroduced, is ‘Can this mean that I can get pregnant?’ The answer to this is no, provided periods have been absent for twelve months.

*23\63\8*

Bleeding

Bleeding is the most common side-effect of hormone therapy and it is vital that it be clearly distinguished from any other cause of bleeding such as cancer of the genital tract. On continuous oestrogen, with progestogen at regular intervals, you will almost certainly bleed after the progestogen. However, if you bleed at any time other than after the progestogen, you must tell your doctor who will almost certainly suggest dilatation and curettage, or suction curettage-an outpatient procedure. (Your doctor will also almost certainly suggest this if the bleeding is heavy or prolonged, even if it is at the expected time.)

Do not panic if abnormal bleeding occurs. This is almost always due to the oestrogens that you are taking. These bleeds while on oestrogen do not necessarily mean there is any serious cause, and in fact they may be beneficial, as investigation may show up something small, like a polyp, which is easily corrected, or they may alert your doctor to some trouble that might, if no oestrogen had been taken, have remained undetected until much later.

Could oestrogen stimulate a cancer already present? Cancer of the endometrium is stimulated by oestrogens. A full history and medical examination will always be done by your doctor before oestrogens are given. If a history of irregular or excessive bleeding is present the doctor would investigate it by dilatation and curettage or suction curettage.

Does a Pap smear diagnose cancer of the endometrium? A Pap smear is a test only for the cells of the cervix, not for the lining of the uterus. However, cells shed from the lining of the uterus may be present in the smear and may give useful information that an abnormality is present in the endometrium. This would be reported with your smear test and investigated by your doctor.

*33\63\8*

Does oestrogen cause hair growth?

Definitely not, but some tablets given at the menopause are a cocktail of oestrogen (female hormones), and testosterone (male hormones). These certainly may cause hair growth because of the presence of the male hormone. If this has occurred don’t panic. Once the male hormones are stopped and the hair removed, this hair growth will not recur unless the same tablets are recommenced.

Do oestrogens improve the hair on your head?

Hair is said to be improved in texture by oestrogen therapy but this is hard to measure. You can only assess this for yourself. Some patients come to the clinic complaining that their hair is falling out or losing its body and in some instances this condition improves markedly with oestrogen therapy.

Effects of oestrogen on the skin

You have only to look at English skins from moister climates and compare them with our own to see the problem behind our dry and wrinkled skins. With any luck, ours will be the last generation which will be so badly affected by the sun. The next generation have available some wonderful sunscreening creams which have been developed recently, and these are available in pharmaceutical as well as luxury lines. People are more conscious now of the harmful effect of the sun, not only in producing cancer of the skin, which is increasing markedly in this country, but also of the harm it does to the elastic fibres in the deeper layers of the skin, which helps to increase the wrinkles.

There is also, of course, a natural ageing process, and with the decrease in ovarian function this seems to increase.

Can oestrogen replacement improve your skin or prevent it from wrinkling?

Oestrogen increases the layer of subcutaneous fat, giving your skin a softer, smoother texture. The reverse effect occurs when oestrogen levels are falling. Such an effect will occur gradually unless there is a sudden cut off in the supply of oestrogens, as when both the ovaries are removed at operation. Some women in our clinics refuse to give up oestrogen because of the beneficial effects on their hair and skin. These effects difficult to monitor but it is; worth reporting as a clinical fact. Two papers have reported these effects.

*43\63\8*