Clinical Implications of the Menopausal Transition

The decrease in estrogen associated with menopause is accompanied by many physical changes, both short-term and long-term (Table 2). Many of the early changes relate to vasomotor instability, and are manifested by hot flushes and night sweats. Some 75% of women experience hot flushes at the time of menopause, and they are the most common reason women seek medical attention.(8-10)

Figure 3

These symptoms can result in psychological effects such as sleep disturbances, irritability, and mood disturbances, including depression. However, many women do not report these symptoms to their provider unless specifically asked, underscoring the importance of provider sensitivity to this transition.

Estrogen loss produces direct effects in a number of body systems (Table 3). As estrogen diminishes, collagen (the major constituent of connective tissue) is lost. Skin collagen and skin thickness decrease significantly and proportionately after menopause (Figure 3).(11,12) Also, the urogenital system begins to atrophy as a result of estrogen deficiency. As collagen decreases, the vulvovaginal area becomes thinner, less elastic, and less able to produce secretions. Vaginitis, painful intercourse, urinary frequency, and incontinence can result.

These symptoms and physical changes can have a major impact on the quality of a woman's life. It is the long-term consequences of estrogen loss, however, that represent the most significant concern in terms of disease. After menopause, a woman's risk increases dramatically for several chronic diseases, including cardiovascular disease, osteoporosis, Alzheimer's disease, and cancer. HRT can play a therapeutic role in managing both the short-term symptoms and the long-term disease risks that accompany menopause.