Hormone therapy has been shown by many studies to be very beneficial for improving a woman’s and a man’s sexual performance, libido, and satisfaction. In my practice, I have many women who complain, that they have concerns about sex or libido, i.e. a decrease in sexual desire. Many have very low levels of sex hormones. Without hormones, sex goes out the door and is noticeably decreased most of the time. (more…)
Oestregen (also spelled Estrogen) is a group of compounds, that act as the primary female sex hormone. The name oestrogen is derived from ‘oistros’ meaning the fertility period of female and ‘gonos’ means to generate.Natural oestrogens are steroid hormones. The main function of Oestrogen is to mantain and regulate menstruation cycle and oestrous or reproductive cycle in woman. Oestrogen also helps in other physiological functions like temperature regulations, controlling bone density etc. Oestrogens are synthesized in the theca interna cells present in the ovary and are released by the follicles on the ovaries by the stimulation of Luteinizing hormone (LH), that is secreted from anterior pituitary gland. Oestrogen is secreted by the corpus luteum after the egg has been released from the follicle. Besides ovary some estrogens are also produced in smaller amounts by liver, adrenal glands, and the breasts.
Biosynthesis of oestrogen : As stated above, biosynthesis of oestrogen starts in theca interna cells in the ovary. The first step of oestrogen synthesis is the synthesis of androstenedione from cholesterol. Androstenedione is the precursor of testosterone and estrogen. While crossing the basal membrane into the surrounding granulosa cells, androstenedione either immediately convert into estrone (catalyzed by the enzyme aromatase), or into testosterone and then estradiol. Androstenedione is converted to testosterone in presence of the enzyme 17β-hydroxysteroid dehydrogenase, testosterone then further converted into estradiol in presence of aromatase.
Types of oestrogen : There are three natural oestrogens namely estrone (E1), estradiol (E2), and estriol (E3).
Oestrone : Oestrone is the least abundant oestrogen and it is predominant during menopause. The molecular formula of estrone is C18H22O2 and the structural formula is
Oestradiol : Oestradiol is the predominant estrogen during reproductive years i.e. non-pregnant females who are between the menarche and menopause and it is strongest among the three oestrogens. Oestradiol is about 80 times as potent as estriol and 10 times as potent as estrone. The molecular formula of Oestradiol is C18H24O2 and the structural formula is
Oestriol : Oestriol remain predominant during pregnancy. The molecular formula of oestriol is C18H24O3 and the structural formula is
Another kind of oestrogen called Estetrol (E4) found in maternal serum at around 20 week of pregnancy.
There are some non steroidal compounds that also possess estrogenic activity. These are xenoestrogens (artificial oestrogen ), phytoestrogens (produced by plants ), mycoestrogens (produced by fungi).
Functions of oestrogen : Oestrogen enters all cells but the response of oestrogen depends on the presence of oestrogen receptor (dimeric nuclear protein ) in the particular cell. Generally ER is expressed in female sex organs like ovary, uterus and breasts. Oestrogen enters passively in the target cells and bind with the estrogen receptor and then activate the transcription of target genes.
The primary functions of oestrogen are development of female secondary sex characteristics (development of breasts, growth of underarm and pubic hair, widening of hips and distribution of fats around buttocks and thigh) maintaining menstruation cycle and oestrous cycle (thickening of the endometrium, thickening of the vaginal wall, increased uterine growth and increased vaginal lubrication). Oestrogen with Progesteron prepare uterus for pregnancy and the development of the foetus. Hike in oestrogen level induce the release of Lutenising hormone, that triggers the release of ovum from Graafian follicle in the ovary.
Other functions of oestrogen include as follows:
- Increase or preservation of bone formation
- Increase vaginal lubrication and estrogenization of vaginal mucosa
- Increase adhesiveness of the platelates
- Increase in the level of High Density lipoproteins and triglyceride and decrease Low Density Lipoproteins
- Reduce bowel movement
- Increase of cholesterol in bile
- Maintaining maintain healthy libido
- Stimulating collagen in the skin
It is found that oestrogen plays an important role in mental health of women. Withdrawal of oestrogen or fluctuation in oestrogen level or menopause (decrease in oestrogen level) may cause depression, mood swing and anxiety.
Medical Application of oestrogen :
Contraceptives : Synthetic oestrogen with synthetic progestin used as oral contraceptives. These hormones togather gave negetive feedback to supress the release of luteinizing hormone and follicle stimulating hormone, the gonadotrophins that are necessary for ovulation thus preventing pregnancy. Moreover progestin inhibits the penetration of sperm through the cervix into uterus and fallopian tubes.
Hormone Replacement Therapy : The production of oestrogen drop significantly after menopause or hysterectomy. Due to the decreased level of oestrogen many women suffers from various physical and mental problems like hot flushes, night sweat, vaginal dryness, mood swing, depression etc. To mange this problem oestrogen is given externally to restore normal level of the said hormone. Oestrogen may given as tablets, skin patches or gels.
Menopause literally means the end of monthly menstruation cycle. More accurately menopause is the cessation of the primary function of the ovaries, i.e. when women no longer ovulate, signaling the end of the fertile phase in women’s life cycle. Menopause usually begins around the age range of 42–58. The transition from reproductive to non-reproductive phase occur due to the reduction in the production of female hormones (estrogen, testosterone and progesterone ) by the ovaries. In many women this transition may be accompanied with various mental and physical signs and symptoms (menopausal syndromes), that in some cases may disrupt their daily activities and sense of well-being.
Menopausal Syndrome : The cause of menopausal syndrome is the body’s response to falling natural hormonal levels. Some common menopausal syndromes are given below :
- Vaginal atrophy or Atrophic vaginitis : The cause of vaginal atrophy is the decrease in the level of estrogen. The common symptoms are due to thinning and shrinking of vaginal tissue, inflammation and itching in vagina and outer urinary tract, overall dryness and decreased lubrication of the said area. This can cause abnormal vaginal discharge, pain with intercourse, dry vagina, itching, irritation, urinary incontinence, increased susceptibility to infection like vaginal candidiasis and urinary tract infections.
- Hot flashes : Another most common symptoms are hot flashes. The symptoms of hot flashes are feeling of intense heat with sweating and rapid heartbeat. The condition aggravated during hot weather or in an overheated room. The main cause of hot flash is lower level of oestrogen. Hot flashes may also happen due to a change in the temperature controlling process, that regulated by hypothalamus.
- Night sweats : Excessive sweating in night or during sleep.
- Decreased cognition; foggy thinking
- Fatigue; lack of motivation
- Decreased libido, or sexual drive/desire
- Decreased ability for orgasm
- Migraine or headaches
- Back pains, joint pains, muscle pains
- Breast tenderness and swelling
- Overall thinning of the skin with drier less elastic skin
- Skin itching, burning or prickling sensations
- Psychological problems like anxiety, depression, mood swing and memory loss.
- Insomnia or sleepiness
- Painful intercourse
Some medical problems that can occur due to lack of these hormones include:
- Atherosclerosis or gradual thickening of arterial wall due to the deposition of cholesterol and triglycerides.
- Osteopenia and increased risk of osteoporosis
- Increased risk of developing Alzheimer’s disease and dementia
- Arthritis and degenerative joint disease.
- Decreased risk of colon cancer
Hormone replacement therapy : The most effective treatment of menopausal syndrome is hormone replacement therapy (HRT). HRT can improve the quality of life in the women suffering from menopausal syndrome.The aim of HRT is to reduce the discomfort associates with menopause due the diminished circulation of estrogen and progesterone hormones. Generally estrogen, and progesterone are given but testosterone may be added for further enhanced therapy.
Estrogen is the most important female sex hormone. During premenopause, estrogen is responsible for improving the lining of the uterus for receiving a fertilized ovum. If no conception occurs, menstruation occurs and the cycle repeats itself. Some other functions are controlling bone density, skin temperature and keeping the vagina moist. The decrease in estrogen levels with menopause causes hot flashes, vaginal dryness, osteopenis or osteoporosis and decreased libido.
Progestorone is also a female sex hormone, that helps to prepare the uterus for pregnancy and supports the pregnancy. It also helps to protect the endometrium or lining of the uterus when estrogen is given potsmenopausally and thus decreases the risk of developing endometrial cancer. Progesterone may not be given if the woman had a hysterectomy, i.e. surgical removal of the uterus.
Progestin is a synthetic progestogen (a groups of steroid hormones similar to progestorone). The two main functions of progestin are hormonal contraception (birth control methods that act on the endocrine system) and to prevent the excessive proliferation of the cells of the endometrium or endometrial hyperplasia, that caused due to the high level of oestrogen. It is given to oppose the excess estrogen in HRT.
Testosterone is a vital hormone that is sometimes forgotten for women. When women are young, they have quite high levels of testosterone. As they get older, the levels drop every year, and are almost none existant in menopause. However, this drop can be associated with fatigue, decreased libido (sexual drive), decreased motivation, depression, lack of muscle tone, and foggy thinking. Replacing testosterone to levels of a young woman can reverse these problems and improve women’s quality of life.
BioIdentical Hormone Therapy (BHT)
The concept of BioIdentical Hormone Therapy is to use hormones that are structurally the same as those hormones of young women, and in doses to provide the similar hormonal levels as young women. Also called “natural” hormone therapy, this is the best method to provide adequate postmenopausal hormone therapy since it has a multitude of the same benefits of HRT as noted above, but at the same time does not have the potential side effects of synthetic hormone therapy. Thus, there is no increased risk of breast cancer nor stroke as one gets older, making its use safer for women.
Generally there are four ways for taking HRT.
- Topical application as a cream or gel : Applied topically to the skin or vagina.
- Tablet : Taken orally (estrogen or progesterone).
- Implant : Small pellets of estrogen and testosterone are inserted under the skin of the tummy, flanks, buttock or thigh.
- Patch : A adhesive patch placed on the skin to give estrogen transdermally (through the skin to the blood stream).
Lack of lubrication is the most common problem during menopause. Application of vaginal gel may help to reduce the problem.
Antidepressants like as paroxetine, Fluoxetine hydrochloride and Venlafaxine hydrochloride may some time use to treat the hot flashes, depression and mood swing associated with menopause.
Gabapentin is also effective for the treatment of hot flashes.
Selective estrogen receptor modulators, also called SERMs, are a category of drugs used to reduce the some menopausal syndromes. However, they may increase other symptoms, such as hot flashes and night sweats. These drugs are either synthetically produced or derived botanically or from plant sources. Generally raloxifene and tamoxifen are prescribed.
Some studies suggests that phytoestrogen or the plant-derived xenoestrogens are useful for the treatment of menopausal syndromes but it is not yet proven.
Lifestyle measures such as drinking cold liquids, avoiding hot and crowded room, using fans, staying in cool rooms, wearing light and cotton clothing may help in managing hot flashes.
Cessation of smoking, regular intake of vitamin D and calcium help to lower the risk of developing osteoporosis after menopause.
It is important to remain well informed about menopause and menopausal syndromes and the effects lack of hormones have on the body. One should seek proper treatment and therapies to improve not only their health but their quality of life as they get older.