Why Is the Climacteric Harsher for Women? [Professor Ahn Cheol-woo's Encyclopedia of Hormones]

[Financial News]Hormones have been transmitted and evolved from species to species alongside the evolution of life. If there is one chemical substance that must exist as long as life exists, it is “hormones.” In this sense, hormones are immortal. Through his column, Professor Ahn aims to explain precisely the hormones that govern the body and suggest ways to live a healthier, happier life. <Editor's note>

Sex hormones are the hormones that make men more masculine and women more feminine in their youth. Thanks to these hormones, men develop strong skeletons and firm muscles, while women develop full breasts and narrow waists. Men also have strong sex drives, while women menstruate and are able to become pregnant.
But sex hormones do not last forever. In men, testosterone levels begin to decline by 1–3% each year from around ages 35–40. By age 60, hormone levels have fallen below the normal range in about 20% of men. By age 80, they have fallen below the normal range in 50% of men. As a result, sex drive declines, sexual function deteriorates, muscle mass is lost, and bone density falls.
In women, these changes occur much more rapidly with menopause. In the first year of menopause, women lose 80% of the estrogen they had been producing. As a result, muscle mass and bone density decline rapidly, making it difficult to move around and increasing the risk of osteoporosis, fractures, and other conditions. Men adapt relatively well as testosterone declines gradually, but women experience various menopausal syndromes as estrogen disappears rapidly.
Menopause means that the ovaries have aged and can no longer ovulate. This means that ovarian function has declined, the follicles have been depleted, and, as a result, not enough estrogen is secreted. It also means that the “hypothalamic-pituitary-ovarian axis,” which has regulated women’s menstrual cycles for decades since puberty, has stopped functioning cyclically.
Medically, menopause is defined as having no menstrual period for one year after the final period. Menopause usually occurs between the ages of 45 and 55. In the United States and Europe, the average age at menopause is known to be 51. A 2021 study of menopause data among Korean women by a research team at the University of Seoul’s Graduate School of Urban Public Health found that the average age at menopause was 49.9. A 2023 study by a research team in the Department of Family Medicine at Korea University found that premature menopause before age 40 accounted for 1.7% of all menopause cases. Women who experienced premature menopause had an approximately 20–40% higher risk of myocardial infarction and cerebral infarction, as well as an approximately 20–40% higher mortality rate, than women who went through menopause after age 50.
Menopause does not happen suddenly overnight; it follows a transition period lasting several years. During this time, women experience changes such as increasingly long menstrual cycles and lighter periods. At the same time, symptoms worsen, including facial flushing that makes the face turn red and episodes of suddenly sweating heavily. Hot flashes and sweating are symptoms of the menopausal transition experienced by 50% of women in Korea. In addition, 20% of women experience severe fatigue, anxiety, depression, sleep disorders, and other symptoms. Atrophy of the urogenital system can also cause vaginal dryness and painful intercourse, sometimes leading women to avoid sex with their spouses.
These symptoms last from the transition period one to two years before menopause through three to five years after menopause—four years at the shortest and seven at the longest. We call this long, tunnel-like period the “climacteric.” The hormone we should pay renewed attention to during this period, when women need to make a fresh start toward a healthy old age without disease, is the sex hormone.
/Ahn Cheol-woo, professor of endocrinology at Gangnam Severance Hospital
 


[email protected] Jung Myung-jin, medical correspondent Reporter