The role of menopause in hormonal treatment

A patient's menopausal status plays an important role in determining the appropriate type of hormonal treatment. Menopause is when a woman permanently stops having periods and usually happens naturally around the age of 50. At menopause, the ovaries gradually become less active and eventually stop making estrogen. Menopause can also be brought on by:

• removing the ovaries through surgery (oophorectomy);
• cancer chemotherapy;
• radiation to the ovaries; or
• using luteinizing hormone-releasing hormone (LHRH) agonists, a type of hormonal treatment that makes the ovaries stop working.

Estrogen production is different between premenopausal women and postmenopausal women. In the body, estrogen production is controlled by a number of hormones made by the hypothalamus, pituitary gland, ovaries, and adrenal glands.

• In premenopausal women, estrogen production occurs mainly in the ovaries.
• In postmenopausal women, most of the estrogen production occurs in other body tissues. (This type of estrogen production also happens in premenopausal women, but the amount of estrogen made by other body tissues is small compared to the amount of estrogen made by the ovaries.)
• Because the ovaries produce more estrogen than other tissues in the body, premenopausal women have higher levels of estrogen in their bodies than postmenopausal women.
• One goal of treatment in premenopausal women is to make their ovaries stop producing estrogen by one of the methods previously described.

There are various types of hormonal treatments. Depending on your menopausal status, different hormonal treatments are available. Your doctor will determine which type of hormonal treatment is right for you.