Women are led to believe that menopause is a time of decreasing estrogen. And although that may be true in one sense, it's not completely true. Estradiol (E2) is the main hormone that is made during a woman's reproductive life. And it is true that E2 declines during menopause. But women make at least two other kinds of estrogen. Pregnant women make estriol (E3), but women make little E3 at any other time. After menopause, women mostly produce estrone (E1), which is 10x less potent than E2 so even if total estrogen remains stable, E1 simply doesn't work as well as E2. Too many doctors check a woman's "estrogen" level to determine whether she could benefit from menopausal hormone therapy (MHT) and determine how much she should be prescribed, but as is now more clear, total estrogen is a poor indicator.
Since E2 is important for muscle growth in women, the lack of it in menopause partly explains women's loss of muscle mass during that time. Low E2 also results in greater fat storage, especially around the waist. High E1 and low E2 cause systemic inflammation which leads to sore joints, impaired gut performance, and fluid retention. Low E2 also can lead to moodiness, restlessness, irritability, fatigue, and brain fog. E2 regulates hunger and satiety (explaining why menopausal women feel more hungry) and manages temperature control mechanisms like skin blood flow and sweating (anyone wonder where those hot flashes come from?) Drops in E2 also trigger headaches through changes in blood vessels, blood pressure, and serotonin levels. Talk to your gynecologist about whether menopausal hormone therapy might help you with your transition into menopause. Hopefully, a better understanding of the myriad of ways in which estrogen is important, not only for our reproduction but also many other bodily functions, will demystify menopause and how we manage it.
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