Let's talk Hormones

In bone, estrogen helps maintain balance. Your body is constantly breaking down old bone and building new bone. Estrogen keeps that process steady. When estrogen declines, bone is broken down faster than it is rebuilt. Over time, bones become thinner and more fragile, which increases the risk of osteopenia, osteoporosis, and fractures.

Estrogen also supports muscles, tendons, ligaments, and cartilage. When levels fall:

• Collagen production decreases

• Tendons and ligaments lose some elasticity

• Inflammation increases

• Muscle mass and strength decline

This combination can lead to joint stiffness, aching, and injuries that seem to appear “out of nowhere.” Frozen shoulder is particularly common during this transition. Many women also experience low back pain that is actually coming from weakness and instability in the hips and gluteal muscles.

When estrogen levels drop during perimenopause and menopause, it can affect how you feel emotionally and mentally — not just physically.

Estrogen helps regulate brain chemicals that control mood, focus, and motivation. As levels fluctuate or decline, women may notice more anxiety, irritability, low mood, or feeling less emotionally steady than usual.

Estrogen also helps brain cells communicate efficiently and supports healthy blood flow in the brain. When it decreases, some women experience “brain fog” — trouble concentrating, forgetting words, slower thinking, or feeling mentally off. Poor sleep during this time can make these symptoms worse.

These changes are common and are linked to hormone shifts — not weakness, lack of effort, or simply “getting older.”​​​

Estrogen helps regulate the brain’s temperature control center and supports chemicals that promote stable sleep. As it declines, that regulation becomes less steady.

​

Hot flashes and night sweats happen because the brain becomes more sensitive to small changes in body temperature. Even a slight shift can trigger a sudden feeling of heat, flushing, sweating, and sometimes a racing heart. At night, this can cause repeated awakenings, leaving women exhausted even if they were in bed for eight hours.

​

Estrogen also influences melatonin and other sleep-related hormones. When levels drop, it can be harder to fall asleep, stay asleep, or reach deep, restorative sleep. The result is lighter, more fragmented sleep — often accompanied by fatigue, irritability, and difficulty concentrating the next day.

Estrogen helps regulate how the body uses insulin, stores fat, and maintains muscle mass. As levels fall, women often lose lean muscle (which burns more calories at rest) and become more insulin resistant. This means the body stores energy more easily, especially around the abdomen , even if eating and activity levels haven’t changed.

​

Estrogen also influences hunger and fullness signals in the brain. When it drops, cravings and appetite can shift, making weight management feel harder than it used to.

The result is often slower metabolism, increased belly fat, and weight gain that feels disproportionate to effort. This is a hormonal transition — not laziness, lack of discipline

When estrogen declines during perimenopause and menopause, heart health can change in important ways.

Estrogen helps keep blood vessels flexible and supports healthy cholesterol balance. It tends to raise HDL (“good” cholesterol) and help keep LDL (“bad” cholesterol) lower. As estrogen drops, LDL often rises, HDL may fall, and blood vessels can become stiffer. Blood pressure and inflammation can also increase.

Estrogen also plays a role in how the body manages blood sugar and fat storage. As these systems shift, the risk for heart disease gradually increases — even in women who have always been healthy.

This change is hormonal and biologic. It is not because someone suddenly stopped taking care of themselves. It’s why midlife is an important time to pay closer attention to cholesterol, blood pressure, blood sugar, muscle mass, and overall cardiovascular health.

The vaginal tissue depends on estrogen to stay thick, elastic, and well-lubricated. As hormone levels decline, the tissue becomes thinner, drier, and more fragile, a condition often called vaginal atrophy (now more commonly referred to as genitourinary syndrome of menopause). This can cause dryness, burning, irritation, pain with intercourse, and increased risk of urinary tract infections.

​

Libido can also change. Hormonal shifts affect blood flow, nerve sensitivity, mood, sleep, and overall energy, all of which influence sexual desire. When discomfort, fatigue, or mood changes are present, interest in sex often declines.

These changes are biologic and common. They are not a reflection of relationship quality, femininity, or lack of interest in a partner, they are part of a normal hormonal transition that affects tissue health and sexual response.

When estrogen declines during perimenopause and menopause, the skin changes in noticeable ways.

Estrogen supports collagen production, skin thickness, hydration, and elasticity. As levels fall, collagen decreases rapidly — especially in the first few years after menopause. The skin becomes thinner, drier, and less firm. Fine lines may deepen, and healing can slow.

Estrogen also helps maintain natural oil production and blood flow to the skin. With less support, skin can feel rougher, more sensitive, or less resilient.

These changes are hormonally driven. They are not simply about sun exposure or “not taking care of yourself.” Midlife skin changes are largely the result of declining estrogen affecting collagen, moisture, and structure from within.

Estrogen helps regulate inflammation and supports balanced immune responses. As levels fall, the immune system can become less stable, sometimes more inflammatory, sometimes less responsive. This can mean more joint aches, slower recovery from illness, increased susceptibility to infections, or flares of autoimmune conditions.

​

Estrogen also helps maintain the health of tissues like the skin, vaginal lining, and urinary tract. When it drops, these protective barriers thin, which can increase the risk of urinary tract infections and vaginal irritation.

Working with a qualified provider ensures a structured evaluation of your personal risk profile, symptom burden, family history, cardiovascular status, breast health, metabolic markers, and timing since menopause. The benefits and risks of HRT vary significantly depending on age, years since last menstrual period, dose, route (oral vs transdermal), and whether progesterone is required.

A provider-guided approach allows for:

• Individualized risk–benefit analysis

• Selection of the safest formulation and delivery method

• Ongoing monitoring and dose adjustment

• Integration with lifestyle, metabolic, and preventive strategies

Menopause management is clinical, not cosmetic. The goal is not simply symptom suppression—but long-term health optimization.