Menopause is the cessation of the menstrual cycle when the ovaries stop producing eggs. It typically occurs after the age of 40 and after 12 months with no menstruation. In the months to years following the cessation of periods, a woman's estrogen levels gradually begin to decline. In addition to estrogen, other hormones produced by the ovaries including progesterone, another female hormone, and testosterone, a male androgen hormone, also decline during menopause. Such inevitable changes in the hormone levels during menopause can significantly affect a women’s health for years to come. Menopausal women can experience irregular periods, vaginal dryness, fatigue, hot flashes, sweating or night sweats, early awakening or insomnia, thinning of hair, anxiety, dry skin, irritability, moodiness, and a reduced sex drive. These symptoms are caused by the damage brought to the liver and kidney from the physiologic and biochemical changes associated with the decline of estrogen and other hormone levels. Menopausal symptoms impair the quality of life of many women, and although conventional treatments can help to relive some of these symptoms, their use is limited by adverse effects.
Estrogen exhibits a number of beneficial roles in helping to maintain liver function. These include promoting coagulation, maintaining proper fluid balance, and fostering increases in high-density lipoproteins (HDL) and decreases in low density lipoproteins (LDL) that lead to favorable lipid profiles. Within the liver, estrogen protects the liver from fibrotic tissue formation by inhibiting the proliferation of satellite cells and fibrogenesis which can cause liver fibrosis upon activation. Estrogen also protects liver mitochondrial structure and function, inhibits cellular senescence, increases innate immunity, and promotes antioxidants. Menopause represents a state of growing estrogen deficiency. This loss of estrogen in the setting of physiologic aging puts the liver at a great risk of becoming damaged resulting in compromised liver function. Estrogen decline greatly increases the likelihood of liver mitochondrial dysfunction, cellular senescence, declining immune responses to injury, and disarray in the balance between antioxidant formation and oxidative stress. The sum effect of these changes will increase the liver’s susceptibility to the development of significant liver pathology, particularly nonalcoholic fatty liver disease. For patients who already have a liver disease, it will accelerate the progression of fibrosis. Declining liver function can further pose challenges to the kidney causing kidney inflammation and damage as toxins in the blood may not be detoxified properly by the liver.
Hormone therapy (HT) has used to treat symptoms of menopause. While HT helps many women get through menopause, the treatment has many side effects which include increased risk of endometrial cancer, blood clots and stroke, gallstone and gallbladder problems, Alzheimer’s disease and dementia if hormone therapy is started after midlife, and breast cancer.
