Women's HealthPending review

Menopause and HRT

Depletion of the finite ovarian follicle pool causes oestradiol production to fail despite rising pituitary drive, and the resulting oestrogen withdrawal produces effects across every tissue that depends on it, which HRT works by directly replacing.

In a nutshell

The ovarian follicle pool is exhausted, so oestradiol production fails despite the pituitary raising FSH in a futile attempt to stimulate it. Because oestrogen receptors are distributed throughout the body, this withdrawal produces vasomotor, urogenital, bone and mood effects. HRT works by directly replacing the deficient oestrogen, with progestogen added to protect the endometrium if the uterus is present.

Classic presentation

Hot flushes and night sweats with increasingly irregular periods progressing to amenorrhoea, typically around age 51, plus vaginal dryness and mood or sleep disturbance.

Key points

A raised FSH is a marker of lost negative feedback from a failing ovary, not an independent disease process.

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Educational content pending clinical review. Not medical advice.