What Happens to Your Body When Estrogen Declines
From puberty onward, estrogen plays a central role in women’s health. As levels rise during adolescence, estrogen helps drive key developmental changes, including the start of the menstrual cycle and physical changes such as breast and hip development. These hormone levels continuously change as a part of the menstrual cycle and in response to life stressors, pregnancies, environmental changes and in response to other endocrine changes that may occur throughout most of a woman’s life.
During perimenopause and menopause, however, the ovaries gradually reduce and eventually stop producing estrogen and progesterone. This shift not only brings common symptoms like hot flashes, night sweats, irritability, and urinary changes, but also has broader effects on long-term health.
Here’s what current research suggests about how estrogen impacts key systems in the body:
Brain Health
- Women are at higher risk for Alzheimer’s disease and dementia as they age, prompting increased research into the role of hormones
- A 2024 study of nearly 275,000 women found that longer lifetime exposure to estrogen was associated with a 28% lower risk of dementia
- Research also suggests that starting hormone therapy within the first five years of menopause onset may help support cognitive health
Heart Health
- Estrogen supports cardiovascular health in part by helping reduce oxidative stress
- Before menopause, women tend to have a lower risk of heart disease compared to men of the same age
- Risk of heart disease increases during and after menopause, in some cases exceeding that of men
Blood & Metabolic Health
- Estrogen plays a role in supporting healthy blood vessel function and insulin activity
- Lower estrogen levels have been associated with increased insulin resistance, which is linked to a higher risk of type 2 diabetes
Bone Health
- Estrogen helps maintain bone density
- After menopause, the risk of osteoporosis increases significantly as estrogen levels decline
Hormone Replacement Therapy (HRT): What to Know
What is HRT?
Hormone replacement therapy is used to help restore declining hormone levels, which may ease symptoms of menopause and support overall well-being, including energy levels and mood.
Why the conversation is evolving
Ongoing research and updated clinical perspectives have shifted how hormone therapy is understood. There is now greater emphasis on individualized care, appropriate timing, and evaluating risks and benefits on a patient-by-patient basis.
How IMC approaches HRT
At IMC, we specialize in bioidentical hormone replacement therapy, an approach designed to more closely mimic the body’s natural hormones. Our process includes comprehensive testing, a review of each patient’s symptoms and health history, and ongoing monitoring to help create personalized treatment plans.
Lesser-Known Benefits of Hormone Replacement Therapy (HRT)
While many people associate hormone replacement therapy (HRT) with relief from hot flashes, night sweats, and other common menopause symptoms, research has also explored a number of additional ways HRT may support overall health throughout the body.
Some lesser-known potential benefits of HRT that have been discussed in emerging research include:
Genitourinary Health
- Support for genitourinary syndrome of menopause (GSM)
- May help reduce recurrent urinary tract infections (UTIs) in postmenopausal and geriatric patients
Dermatology / Skin Health
- Support for skin elasticity and hydration
- May help with prevention and treatment of wrinkles
- May help support skin integrity and prevention of decubitus ulcers (pressure ulcers)
Ophthalmology / Eye Health
- Research has explored possible protective effects related to macular degeneration
- Potential support in prevention of glaucoma
- Possible neuroprotective effects on retinal cells
Rheumatology / Joint Health
- Research has explored a possible relationship between estrogen and reduced risk of rheumatoid arthritis (RA)
Internal Medicine / Metabolic Health
- Potential support for insulin sensitivity
- Research has explored possible roles in prevention of obesity and insulin resistance
Gastroenterology / Gut Health
- Possible protective effects on the gut microbiome
Oncology
- Some research has explored potential associations between estrogen therapy and reduced risk of certain cancers, including kidney cancer
- Certain forms of estrogen replacement therapy (ERT) have also been studied in relation to breast cancer risk
Dental Health
- HRT may help support bone health and prevention of tooth loss after menopause
Neurology / Brain Health
- Some studies have investigated potential relationships between estrogen and reduced risk of Parkinson’s disease and Alzheimer’s disease
Dominguez-bali, et al (2023). (105) The Discovery of New Incredible Positive Actions of Hormone Replacement Therapy and Sex in Menopause. The Journal of Sexual Medicine.
Common Myths About Hormone Replacement Therapy (HRT)
There is a lot of outdated or conflicting information surrounding hormone replacement therapy, and many long-standing beliefs about HRT are now being revisited as newer research emerges. Here are a few common myths that deserve a closer look:
Myth #1: HRT is automatically contraindicated in women at increased risk of blood clots
Estrogen does have prothrombotic effects, meaning it can influence blood clotting factors in the body. Because of this, traditional medical thinking has often discouraged HRT use in women with increased clotting risk, including some women with migraines, obesity, smoking history, or other cardiovascular risk factors.
However, newer research suggests that clotting risk may vary significantly depending on the type of hormone therapy used. Oral estrogens have been associated with increased risk of venous thromboembolism (VTE), while some studies suggest that transdermal estrogen may carry lower thrombotic risk. Research has also suggested that micronized progesterone may carry lower VTE risk compared to some synthetic progestogens (Hamoda et al., 2020). Additional studies have found that transdermal menopause hormone therapy did not increase thrombotic risk in women with obesity (Palacios et al., 2024).
Myth #2: Women should stop HRT after age 65
There is no universal age cutoff at which all women must discontinue hormone therapy. Research continues to support the idea that timing, overall health, symptom severity, and individualized risk assessment all matter.
Some studies suggest that women who begin HRT closer to menopause may experience cardiovascular and quality-of-life benefits, while decisions about continuing therapy later in life should be personalized and carefully monitored. Research surrounding the “timing hypothesis” has suggested that hormone therapy started before age 60 or within 10 years of menopause may be associated with reductions in cardiovascular disease and overall mortality (Hamoda et al., 2020; Nudy et al., 2019).
Myth #3: Women with heart disease should never use HRT
Historically, hormone therapy has often been considered high-risk in women with cardiovascular disease or elevated cardiovascular risk factors. However, more recent research suggests the relationship between HRT and cardiovascular health is more nuanced.
Current evidence indicates that certain forms of hormone therapy—particularly transdermal estrogen—may be considered in some patients after careful risk assessment and shared decision-making with a healthcare provider. A 2021 review noted that hormone therapy may be safely prescribed in some women with intermediate cardiovascular risk when risk factors are appropriately monitored and treated (Maas, 2021). Additional research has suggested that transdermal estradiol may be considered in selected patients with persistent symptoms after non-hormonal options have failed (Bontempo et al., 2023).
Myth #4: Women at risk for breast cancer—or with a history of breast cancer—should never consider HRT
Breast cancer and hormone therapy remain complex and highly individualized topics. Research findings have varied depending on the type of hormone therapy studied, including differences between estrogen-only therapy and combined estrogen-progestogen therapy.
Long-term follow-up from the Women’s Health Initiative found that estrogen-only therapy was associated with a statistically significant reduction in breast cancer incidence in some women with prior hysterectomy (Chlebowski et al., 2020). Other studies have suggested that micronized progesterone may carry lower breast cancer risk compared to certain synthetic progestins (Rozenberg et al., 2021).
Research involving breast cancer survivors has produced mixed findings, highlighting the importance of individualized risk-benefit discussions. Some reviews have concluded that evidence does not definitively render HRT universally contraindicated in all breast cancer survivors, particularly when symptoms are severe and decisions are made collaboratively with the healthcare team (Ugras et al., 2021).
Interested in Learning More about Hormone Replacement Therapy?
As research continues to evolve, so does our understanding of hormone therapy. The most important thing is having access to accurate information, individualized care, and thoughtful discussions about risks and benefits based on your unique health history.
If you’re navigating perimenopause or menopause and want to better understand your options, our team is here to help you make informed, personalized decisions about your care.
To learn more or schedule a consultation, book your appointment online or call us at (984) 999-0902.
