If you’re approaching or experiencing menopause, chances are you’ve found yourself suddenly drenched in sweat without warning. These intense bouts of flushing, sweating and skin temperature rises are infamously called hot flushes (aka hot flashes) and 75% of women endure them.

At the most basic level, hot flashes are the result of decreasing oestrogen. Oestrogen assists an area of the brain called the hypothalamus, in regulating body temperature. When oestrogen levels decline during perimenopause and menopause, the hypothalamus has trouble accurately sensing and maintaining a normal body-temperature set point – it’s as if the body’s thermostat misbehaves.

Signals telling blood vessels when to expand and contract (to cool or heat the body) misfire. The most minor trigger from external temperatures, stress, foods, etc. can set off an intense body heat wave, and a bout of extreme sweating.

Dropping oestrogen levels also hamper key centres in the brain driving our circadian rhythms. Some women frequently suffer severe hot flushes at night, as falling oestrogen impairs the body’s ability to regulate its daily bio-patterns. You may find yourself waking up in wet sheets and the sleep disruption then exacerbates daytime hot flushes…feeding a frustrating cycle.

Many menopausal women experience vaginal dryness and pain with intercourse due to declining oestrogen levels. This vaginal atrophy often causes distress and interrupts intimacy.

Oestrogen typically maintains vaginal health by promoting thick, well-lubricated tissue with robust mucus production and elasticity to stretch without injury. As oestrogen drops during menopause, the vaginal lining thins dramatically. Cells generating protective mucus die off, eliminating moisture and defences. The outcome is fragile vaginal skin, and the dryness creates friction that heightens discomfort. Many women find their natural lubrication fails even when they feel sufficiently aroused.

Oestrogen plays a key role in maintaining muscle tone and mucosal lining of the urethra and bladder while promoting beneficial bacteria. This keeps tissues elastic while preventing infection and facilitating holding a full bladder.

With the onset of menopause, depleted oestrogen levels lead to thinning of the entire urethral tract. Just as ageing skin loses collagen, the bladder and urethra are also affected, and tiny, microscopic tears may form in their walls, creating pathways for infection.

Many women will experience:

Frequent urination ➝ signals to empty come too often

Sudden urgency ➝ limited time to reach a bathroom

Leaking ➝ especially with coughing/exercise

Pain ➝ from recurrent infections

Awakening at night ➝ to empty

Brain fog is a common menopausal symptom, and it can show up in several ways:

Problems with memory – Forgetting things more often, difficulty recalling details, struggling to remember words or names

• Focus issues – Easily distracted, difficulty staying on task, problems multi-tasking
• Slow processing speed – Trouble following conversations, takes longer to understand information and make decisions
• Lack of mental clarity – Feelings of mental confusion or disorientation, struggles to articulate thoughts
• Poor concentration – Difficulty concentrating for long periods, easy to feel overwhelmed with too much stimulus
• Haziness in thinking – Not feeling sharp mentally, feelings of being in a mental “fog”

Oestrogen plays a crucial role in brain health; it influences neurotransmitters, brain structure, and blood flow, all of which are essential for cognitive function.

Oestrogen helps regulate neurotransmitters like serotonin, dopamine, and norepinephrine, which are essential for mood, memory, and concentration. As oestrogen levels decline during menopause, the balance of these neurotransmitters can be disrupted, leading to difficulties with focus and memory.

Oestrogen also influences the structure of the brain, particularly in areas associated with memory and cognitive function, such as the prefrontal cortex and the hippocampus. Studies have shown that lower oestrogen levels can lead to changes in the size and activity of these brain regions, contributing to cognitive difficulties.

In addition, oestrogen also has a vasodilatory effect on blood vessels, promoting healthy blood flow to the brain. As oestrogen levels drop, blood vessels may constrict, reducing the flow of oxygen and nutrients to the brain. This decreased blood flow can impair cognitive function and contribute to brain fog.

Oestrogen enhances the transmission of brain signals across key pathways, boosting serotonin, dopamine and norepinephrine (hormones and neurotransmitters responsible for mood stability). So as oestrogen production declines in perimenopause, critical communication channels grow vulnerable to disruption – emotional imbalance ensues.

The decline in oestrogen levels creates dysregulation of healthy stress hormone responses and impairs communication between brain regions moderating mood and motivation. Many women report mood swings, sudden tearfulness, anxiety and panic attacks.

As oestrogen levels decline during menopause, there is reduced collagen and sebum reduction in the skin, creating dryness and wrinkling.

Lower oestrogen levels make hair follicles more sensitive to naturally occurring androgens, increasing hair thinning and loss.

In low-risk women, and if started within 10 years of menopause or below the age of 60, there are several benefits that HRT may confer in addition to the improvement of menopausal symptoms.

After menopause, women’s risk of heart disease rises because oestrogen helps reduce LDL cholesterol, and this protective effect is much-diminished post-menopause. The benefits of oestrogen on heart health are well established. Link to https://www.dralicescott.co.uk/2022/07/08/the-benefits-of-oestrogen-on-the-heart/

The hormonal fluctuations during perimenopause can lead to unstable blood sugar levels, making diabetes management more challenging for some women during menopause.

As women undergo menopause, fat storage patterns in the body shift, depositing more fat in the abdomen. This abdominal fat can reduce insulin sensitivity, impairing the body’s response to insulin and leading to high blood sugar.

Many women with type 2 diabetes find their blood sugar control improves after starting hormone replacement therapy (HRT). In addition, oestrogen has protective cardiovascular effects.

Oestrogen and progesterone both impact brain activity and epilepsy. During perimenopause, hormones can fluctuate erratically.

Women prone to frequent seizures may undergo menopause earlier. Catamenial epilepsy is a form of epilepsy where seizures increase in the first half of the menstrual cycle.

As menopause occurs, women with catamenial epilepsy may have fewer seizures. Reassuringly, studies show hormone replacement therapy does not appear to increase seizures.

Since some epilepsy medications can raise osteoporosis risk, HRT can help mitigate bone loss through positive bone effects. Anyone with epilepsy considering HRT should consult an expert. I have extensive experience treating perimenopausal/menopausal women and those with epilepsy.

Oestrogen plays an integral role in bone remodelling, which is the process of bone tissue being broken down and rebuilt over time. With less oestrogen, bone resorption (breakdown) happens faster than bone formation. Over time, this makes bones more fragile and at greater risk of fractures – the hallmark consequence of osteoporosis. Osteoporosis is typically symptomless until such a fracture reveals its presence.

HRT helps stimulate bone rebuilding and slow bone loss to maintain healthy bone density. Numerous studies show HRT cuts fracture risk by 30-50% in post-menopausal women, helping prevent osteoporosis.

Osteoporosis link to https://www.dralicescott.co.uk/what-is-osteoporosis/

The drop in oestrogen during menopause is also tied to declines in muscle mass, leading to feeling physically weaker. HRT-containing oestrogen can help inhibit muscle loss. A study has shown that HRT has significant beneficial effects on skeletal muscle mass, strength and protection from damage in older women.- link to https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4261347/ The muscle maintenance effects of HRT aid strength, mobility and reduce the risk of age-related injuries from falls.

Many women report stiff, painful joints as they enter menopause, which may be related to shifting oestrogen influencing connective tissue and fluid around the joints. Multiple studies have shown postmenopausal women receiving HRT for as few as six weeks have significant reductions in chronic joint pain.

Several major studies have found the use of HRT significantly decreases the risk of colorectal cancer. The protective effect seems directly related to the length of time HRT is used. Long-term oestrogen replacement therapy can cut colorectal cancer risk by over 30%, especially when started shortly after menopause.