Interviewing my Grandma

I wanted to learn more about menopause so i thought, the person who knows best about this is someone who has gone through it before, and the closest one that I could think of, is my Grandmother! So on one of the Sundays, i visited her and asked for her help on this.

So here's a video to compile all the questions that i asked her regarding Menopause. She's so cute when she's stressed when she forgets her lines. Love her <3

MENOPAUSE VIDEO PART 1

VIDEO PART 2

Estrogens

Structure of different forms of estrogens

Basic overview of conversion of different forms of estrogens

Metabolism of Estrogen 

*All images are from google.com

What is a hormone? Estrogen?

Hormones :

A hormone is a chemical substance. Also known as chemical messengers, it is secreted by one tissue and travels by way of body fluids to affect another tissue in your body.

The levels and amount of hormones change daily. The sex hormones, estrogen and testosterone, are secreted in short bursts or pulses. Hormone release varies between night and day and from one stage of the menstrual cycle to another.

Estrogen

Estrogen are steroid compounds. They play an important role in the development and the functioning of the female human body.

Produced by the ovaries, they are released by the follicles on the ovaries and are secreted by the corpus luteum after the egg has been released from the follicle and from the placenta.
The stimulation for secretion of estrogen comes from the Luteinizing hormone (LH) from the anterior pituitary gland. The estrogen is synthesized in the theca interna cells in the ovary.

Estrogen is an entire class of related hormones that includes estriol, estradiol, and estrone.

Estriol is made from the placenta. It’s produced during pregnancy.

Estradiol is the primary sex hormone of childbearing women. It is formed from developing ovarian follicles. Estradiol is responsible for female characteristics and sexual functioning. Also, estradiol is important to women's bone health. Estradiol contributes to most gynecologic problems, including endometriosis and fibroids and even female cancers.

Estrone is widespread throughout the body. It is the only estrogen present after menopause.

Physical Functions:
Estrogen is responsible for development of the female body. It helps decelerate height increase in females during puberty, accelerates burning of body fat and reduces muscle bulk.
It also stimulates growth of the inner lining of the uterus (endometrium) during the menstrual cycle, increases uterine growth, improves lubrication of the vagina, and thickens the vaginal wall while increasing blood vessels to the skin.

Instances when estrogen levels fall includes:

• Hypogonadism
• Hypopituitarism
• Pregnancy failure (estriol)
• Perimenopause and menopause (estradiol)
• Polycystic ovarian syndrome (PCOS)
• Anorexia nervosa (eating disorder)
• Extreme exercise or training

References:

http://marshanunleymd.wordpress.com/2011/03/04/estrogen-a-hormone-much-maligned/
http://www.macalester.edu/academics/psychology/whathap/ubnrp/estrogen/ert.html
http://www.nebraskamed.com/health-library/232343/estrogens-effects-on-the-female-body

Androgen to Estrogen

All estrogen in humans is synthesized from androgen hormones.

Androgens are a group of chemically related sex steroid hormones. Steroids are a special kind of fat molecule with a four-ringed, carbon atom backbone or core, like their cholesterol predecessor. 

A series of chemical changes turns cholesterol into androgen hormones

A series of chemical reactions spurred by proteins called enzymes remove and add groups to cholesterol's polycyclic core. These actions transform cholesterol first into the steroid pregnenolone, then into testosterone and other androgens.

As you can see from the above image, testosterone can be interconverted to estradiol, a form of estrogen. One type of cell in the ovaries creates the androgens, and another type of cell converts them into estrogen. 

Other parts of the body are also capable of converting androgens to estrogen. Fat tissue is the most significant site of androgen conversion other than the ovaries. In women, the adrenal glands normally produce small amounts of androgens, which are converted by fat tissue into estrogen. In women who are obese or who have a condition called polycystic ovary syndrome, in which the ovaries produce large amounts of androgens without converting them to estrogen, fat tissue can become a significant source of estrogen, disrupting the normal menstrual cycle and increasing the risk of endometriosis and endometrial cancer.

References:
http://www.livestrong.com/article/212632-what-causes-estrogen-in-the-body/

Your body changes with age

All these miseries arise from the fact that ovaries are no longer producing their normal amount of estrogen or female hormone. Lack of normal hormone balance may result in a constant backache, due perhaps to osteoporosis arising from low level of estrogen in the blood stream.

Image from : Healthmango
http://www.healthmango.com/wp-content/uploads/2010/01/symptoms-of-menopause.jpg

Why does hormonal imbalance in perimenopause cause symptoms?

During perimenopause, hormonal imbalance comes about when our sex hormone levels (estrogen, progesterone, testosterone, DHEA, FSH and LH) changes too drastically, usually outside the range that your body can manage.

Although our bodies have back-up systems to compensate for these changes, cumulative effects of poor diet, chronic stress, lack of sleep, too little exercise, and environmental toxins often undermine our bodies, affecting the work of our sex hormones.

With imbalance, symptoms such as irritability, irregular periods, weight gain, menstrual migraines, fatigue, poor sleep will thus surface.

*DHEA: Dehydroepiandrosterone
FSH: follicle-stimulating hormone
LH: luteinizing hormone

Our Article

Menopause

Menopause is a turning point of a woman’s life, it is the absence of menstrual period for 12 consecutive months and marks the permanent end of a menstruation.  It happened to women of age between 45 to 55 years old. It can be categorized into 3 stages, perimenopause, menopause and postmenopause.

Main causes

Aging is the leading cause to menopause. As a woman ages, the function of the ovaries will slowly deteriorate. The eggs will become more resistant to FSH (follicle-stimulating hormone), a reproductive hormone responsible for the growth of ovarian follicles (eggs). This would result in low production of estrogen by the ovaries. This complex series of hormonal changes is one of the causes for menopause to occur. The fluctuating levels of hormones (estrogens and progesterone) would also cause physical, emotional and sexual symptoms related to menopause. Certain Surgeries and medical treatments such as surgical removal of the ovaries (bilateral oophorectomy), chemotherapy, and pelvic radiation therapy could also induce menopause.

In addition, there are other factors which may cause early menopause to women, such as:

·         Smoking

·         Genetic and autoimmune disease

·         Removal of ovaries (oophorectomy, which causes sudden menopause)

·         Living in high altitude

·         Having a vegetarian diet

·         Low body fat

Perimenopause

Perimenopause happens over a period of 12 consecutive months. It is a transition to menopause. The ovaries gradually slow down its function and the periods become unpredictable. The number and quality of the eggs would also decline. However, ovulation still occurs and getting pregnant is still possible at this stage.

Menopause

When estrogen drops past a certain level, the menstrual cycle ends and it is impossible to get pregnant. After 1 year of perimenopause is over, a woman is said to have reached menopause. She will next go into the postmenopause stage.

Postmenopause

Estrogen levels even out at a low level after a year or more into postmenopause. The low levels of estrogens may cause many menopause related symptoms, especially an increased risk of heart disease and osteoporosis. Other symptoms will be discussed later.

Symptoms that affect individuals

Menopause causes a drop in estrogens and progesterone levels which bring about many symptoms to women.

  Hot flashes

It is the most common symptom of menopause. This symptom varies among women. It is a feeling of warmth that spreads over the body making the face and neck flushed, and causes temporary red blotches at the chest, back and the arms. It usually lasts from 30 seconds to a few minutes. Reddened skin, palpitations(irregular heartbeat) and sweating usually accompany hot flashes. Hot flashes increase the skin temperature and pulse and could cause insomnia. This symptom can last from a few years up to as long as 15 years (it varies among women).

  Heart disease

Women having menopause or have premature menopause (because or surgical removal or ovaries at an early age) have a higher risk of getting heart disease due to loss of estrogen.  However, the aging factor also contributes to the higher risk of getting heart disease. Increased in cholesterol level (especially LDL cholesterol) also increases the risk of heart disease.

  Sex problem

Less estrogen leads to vaginal dryness which makes sexual intercourse uncomfortable or painful. Libido (sexual drive) is also affected and it may change for the better or worse. Other factors besides menopause would also affect libido of a woman.

  Osteoporosis

Osteoporosis is a condition whereby bones lose an excessive amount of their protein and mineral content, particularly calcium. Over time, bone mass and bone strength will eventually decrease. As a result, bones become fragile. It is the most common during perimenopause. No pain is associated with bone loss. Osteoporosis causes bone fractures easily, which can be intensely painful and interfere with daily life and this also increases the risk of death.

   Examples of other symptoms:

·         Night sweat during sleep

·         Forgetfulness (in some women)

·         Mood swings

·         Vaginal infections

·         Skin outbreak

·         Headache

·         Weight gain

·         Urinary incontinence

·         Burning sensation upon urination

·         Increased risk for depression

·         Change in shape of breast




Estrogen


During menopause, a woman's ovaries stop making eggs and thus they produce less estrogen and progesterone. Changes in these hormones are what causes menopause symptoms.

There are 3 forms of estrogen, they are; estradiol, estrone and estriol.

Normal ratios are as follows:

Estradiol: 10 - 20%

Estrone: 10 – 20% 

Estriol: 60 – 80%


These ratios is disrupted during menopause and also pre-puberty stage in girls. During this time, estrogen is no longer excreted from the ovaries but the extraglandular sites. Once these estrogen is produced and released into the bloodstream, it then reaches its target tissues and the liver.


Biosynthesis of Estrogen

In women of reproductive age, estrogens is produced by the ovaries which is stimulated by Follicle Stimulating Hormones or FSH.


Synthesis starts in theca internal cells in the ovary, by the synthesis of androstenedione from cholesterol. Androstenedione is a substance of weak androgenic activity which serves predominantly as a precursor for more potent androgens such as testosterone as well as estrogen. This compound crosses the basal membrane into the surrounding granulosa cells, where it is converted either immediately into estrone, or into testosterone and then estradiol in an additional step. The conversion of androstenedione to testosterone is catalyzed by 17β-Hydroxysteroid dehydrogenase, whereas the conversion of androstenedione and testosterone into estrone and estradiol, respectively is catalyzed by aromatase, enzymes which are both expressed in granulosa cells.


Metabolism of estrogen mainly occurs in the liver and gastrointestinal tissues. The estrogen begins as estradiol and is then broken down into estrone. The two types of estrogen must be later be further broken down so that it can be removed from the body. This happens in the liver. Once the estrogen is broken down it is released in bile or urine. This process of estrogen breakdown is known as hydroxylation.

Treatments

There are a few treatments for menopause and relieving menopausal symptoms. Estrogen influence in the building of bones from calcium, maintains healthy levels of cholesterol in the blood and keeps the vagina healthy. On the other hand, progesterone is always taken with estrogen (only when the woman has uterus). Without progesterone, estrogen increases the risk for womb or uterine cancer. 

Hormone Replacement Therapy (HRT)

HRT is given to women to supplement their bodies with adequate levels of estrogen and progesterone. There are 2 main types of of HRT: Estrogen therapy and Progesterone/Progestin-Estrogen Hormone Therapy.

Estrogen therapy

Only estrogen alone is taken. Low dose of estrogen is often prescribed as a pill or patch to be taken every day. It may also be prescribed as a cream. Lowest dosage of estrogen is highly recommended to relieve the menopause symptoms.

Progesterone/Progestin-Estrogen Hormone Therapy

Also known as the combination therapy, combines doses of both estrogen and progesterone. Estrogen and a lower dose of progesterone may be taken in continuously to prevent the regular, monthly bleeding that can occur when the progesterone makes the endometrium shed each month.  It is recommended to take the lowest dose of hormone therapy for the shortest time possible.

However, currently the HRT is not recommended to prevent the risk of heart disease and stroke and other chronic diseases. On a side note, People with active or history of breast cancer records, recurrent or active endometrial cancer, abnormal vaginal bleeding, recurrent or active blood clots, history of stroke, liver disease and known or suspected pregnancy are not suitable for HRT. HRT can also cause side effects such as monthly bleeding, breast tenderness, blood clots and strokes, fluid retention, headaches, migraine and dizziness. To prevent the risk of estrogen therapy, frequent and regular pelvic exams, Pap smears and physical exams (including breast exams and mammograms) are carried out to detect the problems as early as possible.

Bioidentical Hormone Therapy

It is Also known as natural hormone therapy. Bioidentical hormones act in the body just like the hormones women produce. Bioidentical hormones are hormones that are identical in molecular structure to the hormones synthesized naturally in women bodies. They are not found in nature and are synthesized from a plant chemical extracted from yams and soy. Bioidentical estrogens include 17 beta-estradiol, estrone and estriol. Estradiol is the one which decreases at menopause. Bioidentical progesterone is simply progesterone which is micronized in laboratory for better absorption in human body.

Commercially available bioidentical estradiol comes in several forms such as pill, patch and cream. Micronized progesterone comes in capsule or vaginal gel.

However, women taking bioidentical estrogen must also take in bioidentical progesterone together to prevent endometrial cancer.

Prevention

There is no prevention for menopause as it is a natural phenomenon for women and not a disease. Fortunately there are some steps which can help to reduce the risk factors for other problems and relieve the symptoms of menopause. It is recommended for postmenopausal women to consume plenty amount of calcium and vitamin D from diet. Women who are unable to obtain adequate amount of calcium through diet can consider dietart calcium supplements such as calcium carbonate. Whereas other women who take acid-blocking medications (ranitidine (Zantac) or cimetidine (Tagamet) may better absorb calcium citrate. calcium supplements made from bone meal, dolomite or unrefined oyster shells should be avoided as they may contain lead.

In addition, women should avoid taking excessive doses of calcium as too much of them would increase the risk of kidney stones. Same for Vitamin D, although it is important and part of calcium absorption process, too much of it will lead to drastic consequences. All supplements should be taken in adequate amount.

References:

•   David Zieve and Susan Storck, 2011. Menopause. [online] Place: National Institutes of Health. Available at: <http://www.nlm.nih.gov/medlineplus/ency/article/000894.htm>[Accessed 27 December 2012]

•   Laura J. Martin, MD, 2011. WebMD, Slideshow: All About Menopause and Perimenopause. [online] Last Updated on 2012. Available at:<http://www.webmd.com/menopause/ss/slideshow-menopause-overview>[Accessed 27 December 2012]

•   Melissa Conrad Stöppler and William C. Shiel Jr, 2013. Menopause - prevention. [online] Place: emedicinehealth. Available:<http://www.emedicinehealth.com/menopause/page9_em.htm#prevention>[accessed 30 December 2012]

•   Real Age, 2013. All About women's health - 8 signs and symptoms of menopause. [online] last updated on 2012. Available at:<http://www.realage.com/womens-health-guide/signs-and-symptoms-of-menopause-3> [accessed 28 December 2012)

•   Unknown, 2006. What are bioidentical hormones? [online] Harvard Health Publications, Harvard Medical School. Available at:<http://www.health.harvard.edu/newsweek/What-are-bioidentical-hormones.htm>.[29 December 2012]

How is menopause diagnosed?

Menopause can be diagnosed via several methods. Examples of some are listed below.

 Blood testing

Blood test is usually conducted to check the levels of Follicle-Stimulating Hormone (FSH) and estradiol estrogen. The unusual levels of these two hormones would cause menopause symptoms. The level of thyroid-stimulating hormone is also checked because hypothyroidism can cause similar symptoms as those of menopause.

Bone testing

DEXA (dual-energy x-ray absorptiometry) scan is conducted to measure the standard of osteoporosis, a condition associated with menopause. Bone mineral density is calculated and compared to the average value for healthy young women. Osteoporosis is defined as 2.5 more standard deviations below the average value. Osteopenia, a condition which indicates a less severe bone loss, is defined as between 1 and 2.5 standard deviations below the average value. The values are set by WHO (World Health Organization).

The test is performed using a special X-ray film taken of the hip and the lower bones in the spine. The scan is repeated in one and a half to two years’ time to measure the response of the treatment to osteoporosis.  DEXA scan is usually performed before a doctor prescribes medication for osteoporosis to rebuild bone mineral density.

Ultrasound machines are also used to conduct simple bone screening test to measure the bone mineral density of the heel. If low bone mineral density is measured, follow-up of the DEXA scan is required for further screening.

Heart Risk testing

Risk for heart disease is associated with menopausal women. Doctors perform blood test to measure the cholesterol levels in women. Women with High cholesterol levels are advised by the doctors to decrease their risk for heart disease.

Besides these 3 methods, women can know if they have begun going through their menopausal transition just by looking at the signs and symptoms related to menopause,.  The most common way to diagnose menopause is having amenorrhea for at least 3 to 12 months at the expected age range of 45 to 55-year-old.

However, on a side note…

References:

About.com, 2013. Menopause, Diagnosis. [online] Available at:<http://menopause.about.com/od/diagnosisofmenopause/Diagnosis_of_Menopause.htm> [Accessed 10 January 2013]

Kirk Shibley, 2011. WebMD-Menopause Health Center, Diagnosing menopause. [online] 2012. Available at:<http://www.webmd.com/menopause/guide/diagnosing-menopause> [Accessed 10 January 2013]

Mayo Clinic Staff, 2011. Mayo Clinic - Menopause, Tests and diagnosis. [online] Available at:<http://www.mayoclinic.com/health/menopause/DS00119/DSECTION=tests-and-diagnosis> [Accessed 10 January 2013]

Mythili Seetharaman. emedicinehealth - bone mineral density tests. [online]. Available at:<http://www.rxlist.com/quiz_menopause/faq.htm#faq-220> [accesses 10 January 2013]

Alternative Medicine

Phytoestrogen rich food

Brown & Golden Flaxseed

There are a few options to reducing menopausal symptoms besides using conventional therapies provided in hospitals and clinics. Here are a few that you may like to try; 

*consult your doctor before trying these options out
        Black cohosh

• Used to treat hot flashes and other menopausal symptoms. 
• Relatively safe, but avoid it if you have a liver disorder. 
• If you'd like to try it, discuss it with your doctor first.
• Phytoestrogens
• Plant-derived compounds that have estrogen-like properties. 
• 2 main types of phytoestrogens : isoflavones and lignans. 
• Isoflavone supplements are generally extracted from soy or red clover. Helpful for mild hot flashes and have a protective effect on your bone density. May also help decrease blood pressure and low-density lipoprotein (LDL or "bad") cholesterol. 
• Lignans are derived mainly from flaxseed. Be careful using phyotestrogen supplements if you have an increased risk of a disease or condition that's affected by hormones, such as uterine fibroids, endometriosis, or breast, uterine or ovarian cancer. 
• Also, be cautious if you're already taking a medication that increases your level of estrogen, such as birth control pills, hormone therapy or tamoxifen.
• Dehydroepiandrosterone (DHEA)
• Natural steroid that's produced by your adrenal gland. 
• DHEA supplements help minimize menopausal symptoms such as hot flashes, vaginal atrophy, sexual dysfunction and bone loss. 

References:

Mayo Clinic. (2012). Perimenopause > Alternative Medicine. Available: http://www.mayoclinic.com/health/perimenopause/DS00554/DSECTION=alternative%2Dmedicine. Last accessed 21 Jan 2013.

Eat Seed. (2012). Black Friday Sale: Free Flax!. Available: http://www.eatseed.com/black-friday-sale-free-flax/. Last accessed 21 Jan 2013.

Crossfit, Athlete Inside. (2013). Phytoestrogens, Not all plants are created equal. Available: http://crossfitai.com/2012/07/phytoestrogens/. Last accessed 21st Jan 2013.