Menopause
What women need to know about testosterone during menopause
By Sarah Bolt, Forth
Following recent approval from the Medicines and Healthcare products Regulatory Agency, testosterone is set to become much more widely available to women in the UK.
Offering greater access to testosterone treatment through their GP, the move marks a significant shift in how menopause symptoms are recognised and treated.
However, despite the increased access, many women are still in the dark about the role testosterone plays.
As conversations around women’s health continue to evolve, testosterone is becoming an increasingly important part of the menopause discussion.
Already licensed in Australia, New Zealand and South Africa, the UK becomes among only a handful of countries making testosterone more accessible for women.
The development marks a significant step forward in recognising the full impact hormonal changes can have during midlife and menopause and the benefits that taking testosterone can have.
Testosterone is often misunderstood, and more closely associated with men, but it also plays a vital role in women’s health.
From energy levels and cognitive function to mood and libido, its influence on the body is far-reaching.
Here are the eight things women need to know about testosterone:
1. Testosterone is a vital female hormone
Testosterone is essential for women.
Produced naturally in the ovaries and adrenal glands it supports a wide range of functions in women including maintaining libido, energy levels, mood, concentration and overall wellbeing.
It also contributes to muscle strength and bone health, both of which become increasingly important during later life.
For many women, low testosterone can leave them feeling a bit out of sorts, impacting confidence, memory, motivation and other areas of life.
Because symptoms are often gradual these are often dismissed as part of ageing or the pressures of life and juggling everything that comes with it.
2. Testosterone levels decline with age
Like oestrogen and progesterone, testosterone levels naturally decline as women get older, particularly during perimenopause and menopause.
Our research found that testosterone levels in women decline by more than 51 per cent with age.
These changes can have a significant impact on daily life, affecting everything from relationships and self-esteem to work performance and sleep quality.
Despite this, many women are unaware that low testosterone may be contributing to how they feel.
3. Signs of low testosterone can vary
Low testosterone symptoms show up differently for everyone. This is why diagnosis and treatment can sometimes be overlooked.
Common symptoms include fatigue, low energy, hot flushes, night sweats, thinning hair, dry skin, muscle weakness, weight gain, mood swings and difficulty concentrating.
Some women may also experience reduced confidence, lower motivation or a loss of interest in sex.
Because many of these symptoms overlap with menopause itself, it is important that women have access to informed conversations and personalised medical advice to determine whether testosterone could help.
4. Testosterone supports more than libido
One of the biggest misconceptions surrounding testosterone is that it is only linked to sex drive.
While testosterone can help improve libido, its benefits extend much further, helping to regulate energy, motivation, emotional wellbeing, muscle strength, bone density and much more.
For some women, restoring testosterone levels can contribute to feeling more energised, confident and mentally sharp again.
5. Testosterone can support cognitive function
One of the main struggles with menopause is brain fog and difficulties with memory and concentration.
Taking testosterone can help protect brain health by supporting communication between brain cells and increasing blood flow.
As awareness around the cognitive impact of menopause continues to grow, testosterone is increasingly being recognised as a tool that helps women better manage these symptoms.
6. Testosterone does not make women masculine
Many concerns around testosterone come from the misconception that it will cause women to develop masculine features.
However, when prescribed appropriately at the right dosage by a qualified healthcare professional, this is unlikely.
The aim of testosterone for women is to help restore hormones to a healthy female range, supporting wellbeing and symptom management.
7. Testosterone is not linked to an increased risk of breast cancer
Another common myth is that testosterone increases a woman’s risk of breast cancer. Current evidence does not support this.
Testosterone does not stimulate breast tissue growth and studies have not shown an increased risk of breast cancer linked to testosterone therapy in women.
In fact, some research has suggested a lower occurrence of breast cancer among women taking testosterone, although more long-term research is still needed in this area.
8. The benefits of testosterone can take time
Testosterone therapy tends to work gradually.
Many women will start to notice improvements in mood, motivation and energy levels within the first few months with the full benefits building over time.
Because testosterone has a cumulative effect, consistent use and regular medical monitoring is important.
Patience is key and ongoing support from healthcare professionals can help ensure treatment remains safe and effective.
Despite growing awareness around hormone replacement therapy, testosterone remains one of the lesser understood hormones.
Our own research shows that testosterone levels in women decline by more than 51 per cent with age with a debilitating impact for many.
Knowledge is power and it’s really important that women are aware of the role testosterone plays in their health, particularly in midlife, so they can see their GP armed with the information they need.
Hormones will fluctuate but hormone mapping is a great place to start and will give women a greater insight into what is happening in their bodies.
It’s imperative that women are able to advocate for themselves and having this information is crucial for this.
Making testosterone more accessible in midlife gives women another treatment option to consider beyond HRT, helping them to manage menopausal symptoms and improve their overall quality of life.
Wegovy is linked to lower risks of migraine and depression in menopausal women than hormone therapy alone, a study has found.
Women across all menopause stages taking semaglutide had a 42 to 45 per cent lower risk of migraine six months after starting the medication and a 25 per cent lower risk of depression than those who took menopausal hormone therapy alone.
The findings are based on a one-year real-world study of more than 34,000 menopausal women in the US who took hormone therapy, Wegovy or a combination of both.
They were announced by Wegovy manufacturer Novo Nordisk, alongside data from the randomised, double-blinded STEP UP and SELECT trials, at the European Congress on Obesity in Istanbul last week.
Semaglutide is the active ingredient in Wegovy, a weight-loss drug.
Dr Emilia Huvinen, a gynaecologist researcher and associate professor at the University of Helsinki, who was involved in two of the three studies, said: “Menopause, associated weight gain and unwanted changes in cardiometabolic markers can significantly impact long-term health and wellbeing of women.
“Still, they remain one of the most neglected areas in obesity research.
“Whether we look at cardiovascular outcomes or weight loss across menopausal stages, semaglutide appears to offer meaningful benefits for women with obesity that extend well beyond weight loss alone.”
Cardiometabolic markers are measures linked to heart and metabolic health, such as blood pressure, blood sugar, cholesterol and waist size.
Analysis of the STEP UP trial found that premenopausal women with obesity lost an average of 22.6 per cent of their body weight when taking a once-weekly dose of Wegovy compared with placebo.
A placebo is a dummy treatment used to compare results against an active medicine.
Researchers said the average waist circumference reduction in premenopausal, perimenopausal and postmenopausal women was 17.5 per cent, 15.6 per cent and 15.3 per cent respectively, indicating a major loss of dangerous visceral fat.
Visceral fat is fat stored around internal organs and is linked to a higher risk of heart and metabolic disease.
The STEP UP trial involved 1,407 adults with a body mass index, or BMI, of 30 or above and investigated the efficacy and safety of Wegovy 7.2mg jabs.
BMI is a measure that uses height and weight to estimate whether a person is in a healthy weight range.
The SELECT trial involved 17,604 participants aged 45 or older with a BMI of 27 or above and assessed the impact of Wegovy on cardiovascular health compared with placebo.
A post-hoc analysis of the SELECT trial found that perimenopausal and postmenopausal women with obesity and heart disease had a reduced risk of heart attacks, strokes and cardiovascular death.
A post-hoc analysis is carried out after a study has finished and can help identify patterns, although it is generally seen as less definitive than the original planned analysis.
Novo Nordisk said obesity affects nearly one in five women globally, and the burden intensifies during menopause because hormonal changes accelerate weight gain, redistribute fat to the abdomen and increase cardiometabolic risk.
It added that the three studies show that when women with obesity lose weight with Wegovy, they improve their body composition with reduced waist circumference, indicating less visceral fat, and also reduce their risk of heart attacks and strokes while improving quality of life, from migraine burden to depression and menopause symptoms.
Abdominal obesity may lead to worse menopause symptoms, including forgetfulness, irritability and night sweats, a new study suggests.
The findings point to a possible link between fat stored around the waist and more severe midlife symptoms.
Researchers said waist-to-height ratio could help identify women who may benefit from more targeted support.
Dr Monica Christmas is associate medical director for The Menopause Society.
Christmas said: “Unintended weight gain during the menopause transition, especially in the midsection, is one of the most commonly reported complaints, with the most significant gains experienced in the years leading up to the final menstrual period and a couple of years after.
“This not only affects self-image but also imposes negative health risks and, as the study highlights, is associated with higher prevalence and severity of menopause symptoms.”
The study used data from more than 1,100 women who took part in the Study of Women’s Health Across the Nation.
Abdominal obesity is a build-up of fat around the waist. It often includes visceral fat, which is deep, active fat surrounding internal organs.
This type of fat releases inflammatory proteins and toxic fatty acids that can contribute to insulin resistance, cardiovascular disease, high blood pressure and a higher risk of some cancers.
Insulin resistance means the body does not respond properly to insulin, the hormone that helps control blood sugar.
The Menopause Society said abdominal obesity is estimated to affect more than 60 per cent of menopausal women.
As oestrogen levels fall during menopause, women tend to store more fat around the waist rather than the hips, even if their overall weight does not change.
The researchers noted that obesity patterns and menopause symptom burden can vary by region, but research into the effect of abdominal obesity on these symptoms remains limited.
They also said earlier studies have mainly looked at single symptoms, rather than how symptoms connect with each other.
In this study, researchers used network analysis, a method that looks at how symptoms are linked, to compare symptom patterns in women with and without abdominal obesity.
They identified abdominal obesity using waist-to-height ratios, which compare waist size with height and can be used as a simple measure of health risk linked to body fat around the middle.
The researchers concluded that women with abdominal obesity had both a higher prevalence and greater severity of a range of symptoms, as well as a distinct symptom network structure.
In particular, women with abdominal obesity reported a higher prevalence and greater severity of dizziness, hot flashes and night sweats than women without abdominal obesity.
Sleep disturbances and palpitations were also reported more often in women with abdominal obesity. Palpitations are feelings of a fast, fluttering or pounding heartbeat.
The researchers said assessment of abdominal obesity using waist-to-height ratios may help stratify women who are likely to benefit from targeted, network-based interventions rather than isolated symptom management.
Christmas said: “Educating women early about healthy lifestyle interventions to prevent midlife weight gain is key to improving mental and physical well-being during a tumultuous time frame.”
Perimenopause may offer a key window to spot heart disease risk earlier, with women in the transition twice as likely to have low heart health scores, new research suggests.
The findings suggest the transition to menopause could be an important time to reassess risk and prompt lifestyle changes.
Garima Arora is senior author of the study and professor of medicine in the division of cardiovascular disease at the University of Alabama at Birmingham.
Arora said: “Mid-life women should think of the perimenopausal period as a ‘window of opportunity.’
They should be proactive and not wait until they reach menopause to start checking their blood pressure, cholesterol and blood sugar levels.
“Women should talk with their health care team about their reproductive status and any changes they are experiencing. It may be the perfect time to get a baseline for their heart health.”
The analysis included 9,248 women aged 18 to 80 who took part in the National Health and Nutrition Examination Survey between 2007 and 2020.
Researchers used Life’s Essential 8, a heart health score developed by the American Heart Association. It measures diet, physical activity, tobacco use, sleep, blood pressure, cholesterol, body weight and blood sugar on a 100-point scale.
Median scores fell as women moved through reproductive stages, from 73.3 out of 100 in premenopausal women to 69.1 in perimenopausal women and 63.9 in postmenopausal women.
Among the individual Life’s Essential 8 measures, diet consistently had the lowest scores and continued to decline across all reproductive stages.
After accounting for age, perimenopausal women were twice as likely to have a low overall score as premenopausal women.
They were also 76 per cent more likely to have a low cholesterol score and 83 per cent more likely to have a low blood sugar score.
The researchers said fluctuations in oestrogen levels during perimenopause may contribute to lower cardiovascular health because they may affect cholesterol, insulin resistance, blood pressure and weight management.
Insulin resistance means the body does not respond properly to insulin, the hormone that helps control blood sugar.
Sleep duration scores remained high across all reproductive stages, despite perimenopausal women reporting difficulty sleeping, suggesting sleep quality may be more affected than sleep length.
Amrita Nayak, lead author of the study and research fellow in the division of cardiovascular disease at the University of Alabama at Birmingham, said the findings highlight a point where risk may begin to rise.
She said: “Our analysis highlights that perimenopause, women’s reproductive transition period to menopause, is the critical time when the increase in cardiovascular risk seems magnified.
“When we compared women’s LE8 scores to the premenopausal baseline, the perimenopausal group was the first to show a significant jump in the odds of having low heart health.”
Arora added that nutrition could be an important area for early intervention.
“Nutrition can be a central factor for early and proactive intervention.
“Focusing on heart-healthy habits early, especially getting regular exercise and following a healthy eating plan like the DASH diet with a focus on lowering salt can help improve cardiovascular health for perimenopausal women in the years to come.”
Stacey E. Rosen, volunteer president of the American Heart Association, who was not involved in the study, said the findings underline the need to consider women-specific risk factors across life stages.
“This research highlights yet another aspect of the unique factors that increase a woman’s risk of cardiovascular disease throughout the stages of her lifespan.
“Significant health changes during pregnancy, perimenopause and menopause make it particularly important to pay close attention to increases in health risk factors during those times.
“I encourage women to talk with their primary care and specialty health care teams to learn about early detection and modification of traditional and ‘female-specific’ risk factors.
“Women can take proven steps to improve their cardiovascular health at all ages.”
The researchers said the next step is to follow women over several years to track hormone levels and heart health, which may help clarify the long-term impact of perimenopause and how lifestyle changes could reduce risk.
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