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What happens to estradiol and hormone levels during menopause?

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Posted by Alex Daly on Aug. 5, 2019

During menopause, a phase that usually starts for women in their late 40s and early 50s, hormone levels fluctuate in the body and can cause symptoms such as hot flashes, depression, sleep disorders, night sweats, and more. These symptoms are, in part, caused by a drop in levels of a hormone called estradiol, which is a type of estrogen. 

Signs of menopause are typically fairly apparent, but your doctor may want to do a blood test to check your estradiol levels, especially if you are experiencing menopause symptoms earlier than normal, or if your periods have become irregular. Depending on your age and overall health, doctors can use a variety of medications to help raise or normalize estradiol levels and ease the symptoms of menopause. 

Read on to learn more about estradiol and other hormone levels, and possible treatment options during menopause. 

In general, what happens to a woman’s hormones during menopause?

Every time a woman gets her period, whether she is 23 or 43, a hormone in the brain called follicular stimulating hormone (FSH) sends a signal to the woman’s ovaries that instructs the ovaries’ follicles to start producing a certain amount of estrogen. 

As a woman ages, however, the process gets more complicated, and it becomes harder to stimulate the follicles. As a result, her estrogen levels decline. Lower estrogen levels cause the level of FSH to rise, as there is no longer enough estrogen being produced to switch off the brain’s production of FSH. 

How does estradiol factor into the menopause process?

Estradiol is a type of estrogen, which is a female sex hormone. During a woman’s reproductive years, estradiol plays a role in the menstruation process. Commonly known in the medical industry as E2, estradiol is produced by the dominant ovarian follicle during a woman’s monthly menstrual cycle. When a woman enters menopause, however, estradiol levels drop and create a hormone imbalance in the body, which causes women to experience symptoms such as hot flashes. 

In addition to its role as a sex hormone, studies show that estradiol has an important effect on plenty of other body parts, including the skin, blood vessels, bones, muscles, kidneys, gastrointestinal tract, brain, lungs, and pancreas. 

What is considered a normal estradiol level?

For menstruating women, normal levels of estradiol hover between 30 and 400 picograms per milliliter (pg/ml). When a woman enters menopause (usually defined as the absence of a period for an entire year), the level of estradiol usually falls below 30 pg/ml. The level of estradiol in the body can be detected with a blood test. 

How do estradiol and estrogen levels affect menopause and women’s bodies? 

The first natural decline in estradiol levels happens during perimenopause, which is the phase just before menopause. Estradiol levels fall much more during the actual menopause phase. 

The drop of estrogen levels during menopause can cause symptoms such as: 

  • Hot flashes
  • Night sweats
  • Vaginal dryness or itching
  • Loss of libido or sex drive
  • Painful sexual intercourse
  • Insomnia
  • Weight gain
  • Depression
  • Anxiety

All women experience menopause differently, and some women may have certain symptoms but not others. There are medications, available with a doctor’s prescription, that can help manage these symptoms. Consult with a healthcare professional if you believe you’ve entered menopause, or if over-the-counter remedies aren’t helping lessen your uncomfortable symptoms. 

Does just having an estradiol level below 30 pg/ml mean menopause has started?

Not necessarily. Many gynecologists base their decision about whether someone is perimenopausal or postmenopausal by looking at a woman’s menstrual history, as well as the presence of typical menopausal symptoms. Sometimes women in the early stages of the menopause transition actually have high estrogen levels. This happens when, during a particular month, the remaining follicles she has in her ovaries are able to respond to the high levels of FSH and produce more estrogen. Thus, menopause can include both very high and very low levels of estrogen. Menopause is different for every woman, and some medical professionals who are not satisfied with the measurement process are calling to improve the accuracy and consistency of estradiol measurements. 

Are there drugs that raise or normalize estradiol levels?

Yes. Estrogen therapy, also known as hormone therapy, is the most effective treatment option for relieving menopausal hot flashes, according to the Mayo Clinic — but only a doctor can help you decide if hormone therapy is right for you. 

Estrogen can also be applied locally to the vagina to help with dryness and urinary symptoms, as well as ease discomfort during sex. The advantage of this method is that by applying estrogen only in the vaginal area, the estrogen is localized to where it is needed without being active in the rest of the body and causing unwanted side effects. 

In addition, there are other treatments and medications, such as steroids, ampicillin, phenothiazines, and tetracyclines, that may increase estrogen levels and manage uncomfortable menopause symptoms.

Are there any natural remedies that can help with menopause symptoms?

Some healthcare professionals say that botanical supplements occasionally provide relief for menopause symptoms. But you should consult with a medical professional before trying any new treatments, even herbal or botanical supplements.  

If you are experiencing menopause symptoms, there are doctors and pharmacists available online to discuss your situation, offer advice and, if necessary, send a prescription to your pharmacy to help alleviate your symptoms and get you back to feeling like yourself.

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