Many women note that their body changes after menopause. Common complaints include changes in vaginal tissue (e.g., dryness, pain, fragility), skin (e.g., thinning, easy bruising), mood (e.g., mood swings, depression), metabolism (e.g., weight gain), thinking (e.g., “brain fog”), sleep (e.g., insomnia), and temperature regulation (e.g., hot flashes). These changes occur all over the body, in many different systems. Their common denominator? They are all regulated by estrogen, the primary female sex hormone.
What is a hormone?
The human body is a miraculous machine made up of cells. Cells communicate with one another in multiple ways, one of which is through hormones. Hormones are small signaling molecules – tiny biological messages that are sent through the bloodstream to instruct distant cells on what to do.
What is estrogen?
Estrogen is a hormone that is produced primarily in the ovaries, the two almond-sized organs on either side of the uterus that hold unfertilized eggs. Estrogen governs many female-specific processes, including the growth and development of the female reproductive system, the menstrual cycle, and aspects of pregnancy.
What is menopause?
Eventually, estrogen production declines, and menopause occurs. Menopause is the cessation of menstruation, usually diagnosed after a year without menstrual periods and fertility. The menopause transition often begins between 45 and 55 but may be considered “induced” menopause which is when a woman has had her ovaries removed or has been treated with chemotherapy or radiation that has damaged the way her ovaries function. After menopause, the female body undergoes substantial changes related to decreased estrogen levels.
When estrogen is around, one of its roles is to maintain the strength and hydration of vaginal tissue. It then follows that an absence of estrogen leads to dry, thin vaginal tissue that is more prone to tearing or bleeding. This phenomenon is more clearly illustrated in the skin, where we can see a similar process occurring. Imagine pinching the arm of a young, healthy female whose body contains high levels of estrogen. The skin would feel thick and tight. If you were to tug or twist the skin, it would spring back to its normal shape like elastic, and it would likely not be torn or bruised in the process. Now imagine doing the same thing with an elderly female whose body does not produce much estrogen. The skin would feel more like paper. It would be looser, and you could see more of the blood vessels underneath its thin surface. If you were to tug or twist this skin, a bruise might develop, or the skin might break. Without estrogen around, the body does not have the signal to continue making the proteins the skin needs to stay elastic and strong.
According to a national study, 57.4%1 of women experience vaginal dryness after menopause and 41.5% experience painful sex related to delicate vaginal tissue. Women who undergo surgical menopause (i.e., the removal of the ovaries) are even more likely to develop vaginal dryness than naturally postmenopausal women. Contrary to popular belief, these vaginal changes are not attributed to reduced intercourse frequency. Rather, they are likely a consequence of low estrogen. Low estrogen affects not only the vagina and skin but also a wide array of other body parts and processes. Understanding estrogen as a hormone, and its natural rise and fall, can help explain many of the changes that happen during life after menopause.
- Waetjen LE, Crawford SL, Chang PY, Reed BD, Hess R, Avis NE, Harlow SD, Greendale GA, Dugan SA, Gold EB; Study of Womenʼs Health Across the Nation (SWAN). Factors associated with developing vaginal dryness symptoms in women transitioning through menopause: a longitudinal study. Menopause. 2018 Oct;25(10):1094-1104. doi: 10.1097/GME.0000000000001130. PMID: 29916947; PMCID: PMC6136974.