The ultimate goal of managing menopausal health is to impart optimal health and vigor until death, and to stave off the diminution of function that can occur, such as impaired eyesight, hearing, cognitive function, memory, and decreased strength and stamina. Although some age-related functional impairment is unavoidable, it can be mitigated by lifestyle and pharmacologic interventions. More than ever before, the perimenopausal woman can plot a course for a healthier old age. It is at this time that symptoms associated with estrogen loss begin to surface. These symptoms can result in psychological effects such as sleep disturbances, irritability, and mood disorders, including depression.
Current theories indicate that estrogen has extraordinarily complex biological effects.
Clinically, this translates into a variety of actions in diverse tissues. There is growing scientific evidence that estrogen exerts its beneficial actions on tissues of the skeletal, urogenital, digestive, cardiovascular, ocular, and nervous systems. Regardless of receptor subtype, estrogen binding to ER results in receptor activation. The estrogen-activated receptor complex binds to DNA and stimulates gene transcription. Other assumptions regarding what contributes to the biologic activity of an estrogen have recently been re-evaluated.