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Hormonal Changes During Menopause and the Impact on Fluid Regulation

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Abstract

Reproductive surgeries leave women more susceptible to postoperative hypervolemic hyponatremia because during this period women can retain water at an accelerated pace and much faster than they do sodium. This review proposes that estrogen and progestogen exposure play an important role in the increased risk of hyponatremia in menopausal women. Estrogen and progesterone exposure have important effects on both body fluid regulation and cardiovascular function and both of these reproductive hormones impact blood pressure responses to sodium loads. This article provides information on the effects of female reproductive hormones and hormone therapy (HT) on fluid regulation and cardiovascular function during menopause. Thirst- and fluid-regulating hormones respond to both osmotic and volume stimuli. Aging women maintain thirst sensitivity to osmotic stimuli but lose some thirst sensitivity to changes in central body fluid volume. Thus, older adults are more at risk of dehydration because they may replenish fluids at a slower rate. Estrogen therapy increases osmotic sensitivity for mechanisms to retain body water so may help menopausal women control body fluids and avoid dehydration. Some progestogens can mitigate estradiol effects on water and sodium retention through competition with aldosterone for the mineralocorticoid receptor and attenuating aldosterone-mediated sodium retention in the distal tubule. However, some progestogens can increase cardiovascular risks. Appropriate balance of these hormones within HT is important to avoid the negative consequences of body fluid and sodium retention, including edema and hypertension.

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Authors and Affiliations

  1. The John B. Pierce Laboratory, CT, 290 Congress Avenue, 06519, New Haven, USA

    Nina S. Stachenfeld PhD

  2. Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, CT, New Haven, USA

    Nina S. Stachenfeld PhD

  3. Yale School of Public Health, Yale School of Medicine, CT, New Haven, USA

    Nina S. Stachenfeld PhD

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Correspondence to Nina S. Stachenfeld PhD.

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Stachenfeld, N.S. Hormonal Changes During Menopause and the Impact on Fluid Regulation. Reprod. Sci. 21, 555–561 (2014). https://doi.org/10.1177/1933719113518992

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