From the Guidelines
Ovaries are exhausted during menopause due to the natural depletion of follicles throughout a woman's reproductive life, which is genetically programmed and inevitable. This process is characterized by a decline in estrogen and progesterone production, leading to menopause, typically between ages 45-55. According to a study published in the Annals of Internal Medicine 1, the median age of menopause in women in the United States is 51 years, and ovarian production of estrogen and progestin begins to decrease years before the complete cessation of menses.
Some key points to consider about ovarian exhaustion during menopause include:
- The number of follicles in the ovaries decreases naturally over a woman's lifetime, with a significant decline after the age of 35
- By the time a woman reaches menopause, her ovaries have depleted their follicle reserve, leading to a decrease in estrogen and progesterone production
- This decrease in hormone production can lead to various symptoms and health issues, such as osteoporosis, hot flashes, and an increased risk of chronic diseases like heart disease and Alzheimer's disease
- As noted in the study 1, the decline of estrogen production is associated with a reduction in bone mineral density, leading to an increased risk of osteoporosis and fractures
The exhaustion of ovarian follicles is a natural process that cannot be prevented, but certain lifestyle factors, such as smoking, can accelerate the process. Hormone replacement therapy (HRT) has been shown to increase bone density and reduce the risk of fractures, as well as alleviate some symptoms of menopause, but its use should be carefully considered and individualized based on a woman's specific health needs and risk factors.
From the FDA Drug Label
The primary source of estrogen in normally cycling adult women is the ovarian follicle, which secretes 70 to 500 mcg of estradiol daily, depending on the phase of the menstrual cycle. After menopause, most endogenous estrogen is produced by conversion of androstenedione, secreted by the adrenal cortex, to estrone in the peripheral tissues
The ovaries are exhausted in menopause because they stop producing estrogen due to the depletion of ovarian follicles. As a result, the primary source of estrogen shifts from the ovaries to the peripheral tissues, where androstenedione is converted to estrone 2.
From the Research
Ovarian Exhaustion in Menopause
The exhaustion of ovaries in menopause is a complex process that occurs due to the depletion of oocytes. Key points to consider include:
- The clinical manifestations of menopause result from the eventual exhaustion of oocytes within the ovaries, leading to a chronic hypo-estrogenic state 3.
- This hypo-estrogenic state causes menopausal symptoms and has a long-term impact on bone and cardiovascular health 3, 4, 5.
- The menopause transition is usually a gradual process occurring over many years, caused by the cessation of ovarian reproductive function, resulting in the end of menstrual bleeding 6.
- The perimenopause is characterized by the gradual loss of oocytes, altered responsiveness to gonadal steroid feedback, wide hormonal fluctuations, and irregular menstrual patterns 7.
Causes of Ovarian Exhaustion
The causes of ovarian exhaustion in menopause include:
- The depletion of oocytes, which leads to a decrease in estrogen production 3, 7.
- The gradual loss of ovarian function, resulting in the end of menstrual bleeding 6.
- The altered responsiveness to gonadal steroid feedback, leading to wide hormonal fluctuations 7.
Effects of Ovarian Exhaustion
The effects of ovarian exhaustion in menopause include:
- A chronic hypo-estrogenic state, leading to menopausal symptoms such as hot flushes and vaginal atrophy 3, 4, 5.
- A long-term impact on bone and cardiovascular health, increasing the risk of osteoporosis and cardiovascular disease 3, 4, 5.
- A decrease in quality of life, due to the presence of bothersome vasomotor symptoms, mood disruption, and genitourinary symptoms 6, 7.