Menopause causes vaginal mucosa to disintegrate. Hormone replacement therapy (HRT) can help with sexual dysfunction and a loss of sexual desire that often accompany menopause. According to epidemiological surveys of women aged 40-69, 75 percent of women stay sexually active after menopause. Women nowadays are spending one-third or more of their lives in a postmenopausal state, a period during which healthy sexuality can be essential to their quality of life, thanks to longer life spans.
Hypoactive sexual desire disorder (HSDD) is a condition in which postmenopausal women experience decreased libido and sexual dysfunction. HRT can help with both the signs and symptoms of HSDD. Several hormonal changes occur at this time, including an increase in follicle-stimulating hormone and a reduction in estrogen. Most women have the majority of change during the late perimenopausal and postmenopausal phases. There are additional decreases in sex hormone-binding globulin (SHBG) and inhibin (A and B). Women’s testosterone levels are lower than men’s, peaking at 30 and progressively falling with age; there is less change during the menopausal transition compared to estrogen and progesterone.
According to a global consensus position statement, postmenopausal testosterone restoration to premenopausal levels can help with HSDD. However, there is no information on the safety of testosterone administration after two years of continuous therapy, and a dose above physiologic levels is not recommended. Testosterone medication has been discovered to help postmenopausal women regain their sexual desire. With most trials including women receiving concomitant estrogen and progesterone and testosterone therapy itself being very short in length, there is inadequate data to evaluate the impact of testosterone replacement on heart disease and breast cancer. In the light of this limited evidence, testosterone therapy has not been linked to any negative side effects.
Not all women, especially those who have had previous sexual troubles, are responsive. Estrogen therapy can help to restore vaginal cells, pH levels, and blood flow, all of which degrade as menopause sets in. The main sensitive component to estrogen appears to be sex pain or discomfort. It has also been demonstrated to be helpful to the urinary tract. Estrogen can also improve sexual desire, frequency, and orgasm while reducing vaginal atrophy.
Hormone replacement therapy’s effectiveness may decrease in certain women after long-term use. Several studies have also discovered that the combined effects of estrogen and androgen replacement therapy can boost libido and arousal when compared to estrogen alone. Tibolone, an estrogenic, androgenic, and progestogenic synthetic steroid marketed in European countries has been shown to improve mood, libido, and physical symptomatology. Improvements in vasomotor symptoms, emotional reactivity, sleep problems, physical symptoms, and sexual desire have been found in numerous placebo-controlled studies, yet it also has a risk profile similar to conventional Hormone replacement therapy.
In terms of dementia prevention, the Women’s health initiative found that hormone replacement therapy may raise the incidence of dementia if started after 65 years of age, but that it had a neutral or neuroprotective effect in those aged 50–55 years. Hormone replacement therapy has also been linked to a decreased incidence of Alzheimer’s disease in other perimenopause studies. The bulk of clinical and epidemiological investigations on Parkinson’s disease have found either no link or equivocal results. In cyclical dose patterns, a Danish study found an increased incidence of Parkinson’s disease.
In terms of treatment, randomised trials have indicated that hormone replacement therapy improves executive and attention processes in postmenopausal women, both asymptomatic and with mild cognitive impairment, outside of the context of dementia. In postmenopausal women with Parkinson’s disease, estrogen replacement appears to enhance motor symptoms and activities of daily living, with significant improvements in UPDRS scores.
In postmenopausal women, testosterone replacement has been linked to small but statistically significant gains in language learning and memory in clinical trials. After menopause, Dehydroepiandrosterone has not been demonstrated to increase cognitive ability. Endogenous estrogen and testosterone, according to preclinical studies, are neuroprotective and can reduce amyloid accumulation in the brain.
Muscle and bone
During treatment, there is a considerable reduction in the risk of hip fracture, which maintains to a lesser extent after hormone replacement therapy is stopped. It also aids collagen production, which increases the strength of the intervertebral disc and bones.
Hormone replacement therapy, such as estrogen and androgen, can help reverse the effects of ageing on muscle. In elderly women, reduced testosterone is linked to lower bone density, while higher free testosterone is linked to lower hip fracture rates. Testosterone therapy, which can help with sexual function issues, can also help with bone mineral density and muscle mass.
Reproductive factors and Parkinson's disease: A multicenter case-control study | Semantic Scholar