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Management of Menopause Type Seminar

Module A: Redefining Menopause


Estradiol - Postmenopausal Activity

The postmenopause estradiol pattern is marked by less dramatic shifts in estradiol levels. There will always be some shifting of hormone levels, but not as severe as those seen in the perimenopause.


One Possible Postmenopause Estradiol Pattern


Postmenopause Fluctuations

Though the estradiol fluctuations seen during perimenopause will decrease in amplitude, hormonal fluctuations will continue for years after menopause1. As noted, these hormonal fluctuations contribute to the migraine headaches, obesity, mood changes, and bleeding irregularities seen in postmenopause women 2 - 5.


These estradiol fluctuations have been observed decades after menopause has occurred. Clinical observations suggest the great the degree of fluctuations, the greater severity and frequency of presenting symptoms. While the medical literature has noted this association with migraines 2, it has also been observed in irritable bowel syndromes, arthritis, and other inflammatory conditions.


Postmenopause Patterns

Estradiol fluctuations of lower amplitude will persist long after the intense fluctuations of perimenopause diminish. There are three estradiol patterns that may present in postmenopause.


1.       Estradiol fluctuations will all be below ideal range, presenting as a consistent estradiol deficiency.

2.       Estradiol fluctuations will shift back and forth between low and ideal range levels presenting as an inconsistent estradiol deficiency. This pattern may need to be treated as an estradiol deficiency if estradiol levels cannot be restored by other means.

3.       Estradiol fluctuations will all be within ideal range, demonstrating consistently adequate estradiol levels.


Clinical Significance

Only through multiple sample assessment can we accurately assess fluctuations. As noted, therapeutic interventions should never be based on a single salivary sample for estradiol assessment.

It still holds true that therapeutic intervention must always include both subjective and objective data analysis.



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