4 long term risks of low sex hormones for women

The British Menopause Society (BMS) guidelines indicate that prolonged low levels of estrogen, progesterone, and testosterone have serious long term risk for women's health.

Here are the top 4:

1. Bone Health (Osteoporosis): The reduction in estrogen levels significantly accelerates bone turnover, resulting in weaker bones and a heightened risk of osteoporosis. One in 3 women over age 50 will experience osteoporosis fractures.

    

2. Cardiovascular Disease (CVD): CVD is the leading killer of women worldwide. A deficiency in estrogen raises the risk of heart disease and stroke approximately threefold. Low estrogen affects blood vessel health and cholesterol levels. The additional of visceral fat (fat around organs) and a decrease in muscle mass (sarcopenia), raises the risk of type 2 diabetes and metabolic syndrome - both major risk factors for CVD.

   
   

3. Genitourinary Syndrome of Menopause (GSM): This chronic condition, resulting from a lack of estrogen, leads to the thinning of the vulva-vaginal wall, bladder, and urethra, often causing vaginal dryness, pain during intercourse (dyspareunia), and increased urinary tract infections (UTIs) or incontinence.

   
   

4. Cognitive Decline and Mental Health: Estrogen is vital for brain function. Prolonged deficiency has been linked to a higher risk of cognitive impairment, dementia, and Alzheimer's disease, especially when menopause occurs early. More research is needed on women's brain in menopause, which is scant.

   
   

So what can you do to replace sex hormones? We will explore hormone replacement therapy in an upcoming post.

See my deeper dive into Heart Health and Bone Health in perimenopause.

Here are the sources I used for the above

1. Harper-Harrison G, Carlson K, Shanahan MM. Hormone Replacement Therapy. 2024 Oct 6. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 29630243.

2. Nappi R, Simoncini T, Menopause transition: a golden age to prevent cardiovascular disease. The Lancet Diabetes & Endocrinology, 2021; 9, 135-137

3. Carlson K, Nguyen H. Genitourinary Syndrome of Menopause. [Updated 2024 Oct 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan

4. Mosconi, Lisa. The Menopause Brain: The New Science Empowering Women to Navigate Midlife with Knowledge and Confidence. Atlantic Books, 2024