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A Woman’s Guide to Menopause

Women begin to naturally lose their estrogens (estradiol, estriol, estrone) around the age of 50.

Many people feel that this is the natural course of aging for the body. But why then, do many women feel so badly when this happens? The answer is that estrogen is needed throughout the course of life to regain and sustain optimum health.

Hormones, like estrogen, are essential to every function of the body. From mood, to memory, to muscle, to metabolism, estrogens give women energy and the ability to build…

Estrogens build the skin, hair, heart, bone, muscle, and every tissue in your body. When women go through menopause, the ability to grow new tissue is markedly reduced. Low estrogen can lead to the loss of muscle, bone, brain tissue, connective tissue in the skin, and muscle in the heart and artery walls. In fact, these are only a few of the systems impacted for the rest of a woman’s life when her estrogens decline.

The Symptoms of Menopause

Conventional wisdom is that hot flashes, which afflict up to 80% of middle-aged women, usually persist for just a few years. But hot flashes can continue for as long as 14 years! Unfortunately, the earlier they begin the longer a woman is likely to suffer.

For women who get hot flashes before they stop menstruating, the hot flashes are likely to continue for years after menopause, longer than for women whose symptoms began only when their periods had stopped.

Women who started getting hot flashes when they were still having regular periods (or were in early perimenopause) experienced symptoms for a median of 11.8 years. About nine of those years occurred after menopause, nearly three times the median of 3.4 years for women whose hot flashes did not start until their periods stopped.

Hot flashes, which can seize women many times during the day or night — slathering them in sweat, flushing their faces — are linked to drops in estrogens. Studies have found that women with hot flash symptoms also face increased risk of cardiovascular problems and bone loss.

The list of symptoms for women in menopause is extensive! To assist the reader in evaluating which hormone (or hormones) is causing the symptom, we provide a comprehensive list of symptoms and relate them to possible hormone deficiencies or excess.

Trained providers that are knowledgeable in treating women with menopause use this list to relate the symptoms to the hormone deficiency or excess.


Estrogen Deficiency
Hot flashes Night Sweats Sleep Disturbances
Vaginal Dryness/atrophy Dry Skin Headaches
Foggy thinking Memory lapses Heart palpitations
Heart palpitations Yeast infections Painful intercourse
Depression Low libido Bone Loss
Estrogen Excess
Water retention Heavy, irregular menses Breast swelling and tenderness
Fatigue Craving for sweets Weight gain
Fibrocystic breasts Mood swings Uterine fibroids
Low thyroid symptoms Nervousness/anxiety Irritability
Progesterone Deficiency
Weight gain Swollen breasts Headaches
Low libido Anxiety Mood swings
Irregular menses Depression Cramping
PMS Infertility Fuzzy thinking
Acne Joint pain
Progesterone Deficiency
Somnolence Gastrointestinal bloating Mild depression
Breast swelling Candida exacerbations Exacerbated symptoms of estrogen deficiency
Testosterone Deficiency
Fatigue, prolonged Mental fuzziness Memory problems
Depression Decreased libido Blunted motivation
Muscle weakness Diminished feeling of well being Heart palpitations
Thinning skin Bone loss Vaginal dryness
Incontinence General aches/pains Fibromyalgia
Testosterone Excess
Acne Male-patten hair growth Deepening of voice
Clitoral enlargement Irritability/moodiness Insomnia
Loss of scalp hair
Low Thyroid Function
Fatigue (especially evening) Low stamina Cold extremities
Low body temperature Dry skin Intolerance to cold
General aches and pains Weight gain Depression
Anxiety Scalp hair loss Swollen, puffy eyes
Brittle nails Decreased swelling Low pulse rate/blood pressue
Poor concentration Memory lapses High cholesterol
Heart palpitations Infertility Constipation

 Weight Gain during Menopause

As women approach menopause they endure many symptoms, but one that proves the most difficult for many women to accept is menopausal weight gain.

Not only can a few extra pounds (or maybe more) ravage a woman’s self-esteem and self-image, but weight gain can usher in a host of health concerns that put a woman at risk of developing life-threatening conditions. We know, at Hormones by Design in Austin, we see it every day.

About 90% of menopausal women experience some amount of weight gain. As many women can attest, it’s not just about what they are eating and how much they are exercising, as often they are doing both very well.

On average, women gain between 15 and 20 pounds between the ages of 45 and 55, the stage in life when menopause typically occurs. This extra weight generally does not evenly distribute itself throughout a woman’s body. The weight tends instead to accumulate around the abdomen, and women often notice the shape of their bodies slowly lose their hour-glass figure and begin to take on a rounded shape.

Frustrated as women may be at the knowledge that it is their hormone imbalance causing the weight gain, they often find little relief from their frustrations when seeing their doctor. They are often told “It’s part of getting older” and “It’s a natural part of menopause.” So, women seek out alternative advice from practitioners like those at Hormones by Design in Austin.

Hormonal Causes of Weight Gain

As aging progresses the metabolism naturally slows, setting the physiological stage for weight gain. Although age itself can lead to plumped midsections, as a woman’s hormones fluctuate prior to menopause (and preparing for a permanently reduced hormonal level), they are likely to experience weight gain.

A drop in estrogen and progesterone can increase a woman’s appetite and cause her to eat up to 67% more, according to one study. An increase in appetite coupled with a slower metabolism with the onset of menopause can cause weight gain in women. This could, perhaps, account for the 12% jump in the number of women who are overweight in midlife compared to women in their 20’s and 30’s.

A woman’s hormones have complex functions in her body, including weight control. Here’s a list of the different hormones that can affect weight gain and how:


As a woman’s ovaries produce less estrogen, her body attempts to find the hormone in places other than the ovaries. Fat cells can produce estrogen, so her body works harder to convert calories into fat to increase estrogen levels. Unfortunately, fat cells don’t burn calories the way muscle cells do, which causes weight gain.


Water retention is often linked to menopause because water weight and bloating decreases progesterone levels. Though this doesn’t actually result in weight gain, clothes can feel a bit tighter, and a woman may feel as though she’s heavier.


Testosterone helps a woman’s body create lean muscle mass out of the calories consumed. Muscle cells burn more calories than fat cells do, increasing metabolic rate. As testosterone levels drop, fewer calories are transformed into lean muscle mass, thus a woman’s metabolism winds down.

Low Thyroid

Women with an underactive thyroid often experience weight gain because their metabolic rate slows down because of the condition. In some cases, hyperthyroidism can also cause weight gain, but that is rare. Thyroid hormones essentially regulate calorie consumption in the body. With an underactive thyroid, fewer calories are burned and converted into energy. Instead, they are stored in the body.

Weight gain does not have to be an inevitable part of aging and menopause. Instead, it is possible to identify common reasons for weight gain during this period, so that the issue can be addressed.

 Emotional Changes of Menopause

At around age 50, the ovaries stop producing estrogens. The ovaries have produced the greatest share of the body’s estrogens for decades, and when they quit, the blood levels of estrogens drop dramatically.

Many women go through this change feeling fine, both physically and psychologically. Nonetheless, some women are bothered by symptoms, including hot flashes, depression, irritability, anxiety, and other problems.

Hormone shifts can affect moods. It can be disturbing to find yourself feeling uncharacteristically nervous or depressed or having memory lapses. Sometimes these feelings can even strain your relationships with others. It helps to know that the psychological effects of menopause are temporary. Likely, you’ll soon get back on an even keel. Here are the most common psychological accompaniments of menopause.

Although the commonly known symptoms of menopause, including hot flashes and night sweats, eventually disappear, the symptoms of anxiety, depression and poor memory may go on indefinitely. Bioidentical Hormone Replacement Therapy (BHRT) may help you conquer many of these symptoms without the aid of other pharmaceutical drugs.


Women who have never had a problem with anxiety before may become more self-conscious and worried about minor events. In some cases, panic attacks occur. Mental health professionals have a variety of effective treatments. Many people feel much better just knowing what the condition is. The most important piece of advice is not to let anxiety restrict your activities. When anxiety or panic disorders cause people to avoid stressful situations, the result can be an ever-tightening leash that keeps them from enjoying life. Anxiety can lead to avoidance of many aspects of normal life. Prompt treatment prevents this.

 Depression and Irritability

Depression can be a problem for menopausal women. Irritability is also common. When considering treatment for depression, irritability, or anxiety, it is important to explore the full range of available options. The first step is to get your diet in order and to get regular exercise to help stabilize hormone shifts and reduce physical symptoms that can aggravate mood problems. Psychotherapy can be very useful, and new short-term techniques have demonstrated their effectiveness at considerably less investment than is demanded by traditional therapies. New antidepressants and anti-anxiety drugs have fewer side effects than older medications.

 Poor Memory and Concentration

Some women find that menopause brings occasional memory lapses, often related to reduced ability to concentrate. This can be upsetting and annoying. Forgetting words which are just on “the tip of the tongue” is a frequent complaint. Being disorganized and unable to multi-task can negatively affect your work performance.

 Safe and Effective Hormone Therapy

Much confusion exists in the general public as well as mainstream medicine that hormone replacement for women is dangerous, and should be avoided, or at least used for only a very short time.

Many women are rightfully concerned about the link between the use of estrogen and cancer. This is an area of intense research and debate. To date, studies such as the Women’s’ Health Initiative have shown us the dangers of using non-bioidentical hormones such as Premarin and Provera (a synthetic hormone). However, to date, there is no study that links BHRT, especially when used in the context of balancing all of one’s hormones, to this risk of increased cancer. Think about it, the time in our lives when we were the healthiest and cancer-free were when we were in our late 20s, the exact same time when our hormones were their strongest!

Some may try to make you believe that an herb or a dietary supplement like soy can replace what a woman is missing. Although a few of these products may relieve some of the symptoms of menopause, they provide no long-term protection against heart disease, osteoporosis, or Alzheimer’s disease. We believe in listening to a woman’s symptoms, testing a woman’s hormonal levels, and then prescribing exactly what she is missing, her hormones!

Hormones by Design in Austin, Texas is now accepting new patients. Get your vitality back, call us to schedule your appointment today!

Picture of  Dr. Melissa Miskell
Dr. Melissa Miskell

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