Orgasm V's HRT

Oestrogen is an important female sex hormone that’s responsible for regulating the female reproductive system, the menstrual cycle and fertility. It exerts its control from puberty to menopause but also plays a vital role in bone health, cognitive function, mental health and the cardiovascular system. As a woman ages, her natural levels of oestrogen decline, triggering the start of the perimenopause and the menopause and their associated symptoms.

It’s long been understood that the vast majority of the oestrogen in a female body is produced by the ovaries, with a little coming from the fatty tissues of the body and the adrenal glands, located near the kidneys.

But evidence now exists that oestrogen can also be produced by the brain. This has major consequences for the consideration and treatment of the symptoms of the menopause. Especially considering that there’s also research that proves that sexual pleasure and orgasm release oestrogen.

So why is no one linking these two critical research findings and doing anything about it?

The perimenopause and menopause are complex biological events. Put simply, the perimenopause is the time leading up to the menopause and could last ten years or more, while the menopause is the time in a woman’s life when her periods and therefore her fertile years, are coming to an end.

Both are triggered by the natural decline in oestrogen that occurs in a woman’s body as she ages. During the perimenopause, this decline is relatively slow, becoming steeper during the menopausal years.

A decline in oestrogen causes uncomfortable and distressing symptoms for many women that can severely impact her quality of life, both in a personal and a professional capacity. These symptoms include changes (often unpredictable) to the menstrual cycle, weight gain, hot flushes, night sweats, brain fog, difficulty sleeping, tiredness, mood swings, a decline in self-confidence, vaginal dryness and painful sex.

Interestingly, it’s also been discovered that neurones in part of the hypothalamus called the infundibular nucleus undergo a process of hypertrophy (an increase in the size of the cells) during the menopause.

This is thought to be secondary to the loss of oestrogen, supporting the hypothesis that hormonal changes are only part of the menopause story and that more studies are needed in order to both understand, and manage the emotional effects of the menopause. ^{[1] [2]} Especially so, since changes to oestrogen receptors in the brain are “related to the occurrence of Alzheimer’s disease neuropathology”. ^[3]

For many years, it’s been understood that even though the ovaries produce oestrogen, this hormone has a powerful impact on the brain. Oestrogen is actively involved in brain, influencing learning and memory and impacting our moods.

But research published in 2013 in the Journal of Neuroscience revealed that the hypothalamus, the part of the brain responsible for keeping the body in a stable state of homeostasis, can and does produce and release oestrogen. ^[4]

The study was the work of Professor Ei Terasawa at the Wisconsin National Primate Research Centre at the University of Wisconsin-Madison. Professor Terasawa’s team, supported by Brian Kenealy PhD, performed three experiments in rhesus monkeys.

During the first, the monkeys had their ovaries removed, so that they could no long produce oestrogen from the genital area. They then administered large amounts of oestrogen to the monkey’s hypothalamus which the team hypothesised might "trigger the hormonal pathway that signals to the ovaries to produce large amounts of oestrogen". And they were right. Without the ovaries, the brain took control and produced high levels of oestrogen.

In the second experiment, the team found that stimulating the hypothalamus with a mild electric current led it to release oestrogen.

The third experiment proved that the brain can switch oestrogen production on and off. They injected the brain with a drug that blocks the activity of the enzymes that produce oestrogen – and the brain stopped releasing the hormone.

Female rhesus monkeys have a very similar reproductive, immune and neurological systems to humans and as such “have proven to be excellent biomedical models for humans over several decades” according to Professor Terasawa, who admitted that the discovery that the brain can produce oestrogen independent of the ovaries was surprising.

One of which could well be the menopause.

A research paper published in the Journal of Sexual Medicine in 2009 looked at how sexual arousal and oestrogen (as well as testosterone and the stress hormone cortisol, both also present in female bodies) were linked. ^[5]

The study focused on 40 healthy premenopausal women who were not taking hormone-based medications and used visual erotic stimuli, self-reported genital arousal and vaginal photoplethysmography (a device that uses light to measure the amount of blood in the walls of the vagina) readings. They also used saliva samples before, during and after showing the women visual erotic stimuli to measure hormone levels.

It found that oestrogen levels “increased in response to sexual stimuli and self-reported orgasms”. (Testosterone stayed the same and interestingly, cortisol reduced.)

The report therefore concluded, “The results indicate that these hormones are associated with self-reported genital arousal (via the Detailed Assessment of Sexual Arousal scales) and sexual desire in different domains, and oestrogen is associated with self-reported orgasms".

Pretty conclusive – if a woman can orgasm, then she can produce oestrogen and lower her stress levels.

In addition, we know that oestrogen is released by the hypothalamus, but it isn’t the only hormone released there. It’s known that feel-good, pain-relieving endorphins, the pleasure hormone dopamine and the “cuddle hormone” oxytocin are all also produced in some part by the hypothalamus. This supports the hypothesis that the female orgasm is significantly more important than pleasure alone. ^[6]

Separate research also points to the role of a form of oestrogen called oestradiol, alongside sexual arousal, in an increase in so-called consummatory behaviour – any behaviour that leads directly to the satisfaction of an innate drive such as eating, drinking or, in this case, sex. ^[7]

A further study reveals that just like the brain is capable of switching oestrogen production on and off, if the oestrogen receptors are indeed switched off via lab-based gene deletion in mice that have had their ovaries removed, so is sexual behaviour.

That is, the mice were no longer sexually receptive to potential mates and in fact, increased their rejection behaviour, if the brain (and ovaries) could no longer produce oestrogen. Which could go some way to explaining a decrease in sexual desire in menopausal women, if vaginal dryness, painful sex and recurrent urine infections are ruled out as a cause. Further studies are clearly needed. ^[8]

Here’s the facts:

1. Oestrogen declines with age, triggering the menopause
2. The menopause, caused by a decline in oestrogen, can lead to unpleasant, quality of life lowering, symptoms
3. Oestrogen is produced by the brain as well as the ovaries (research from 2013)
4. Orgasm releases oestrogen (research from 2009)
5. It’s now .

So, what research is there that can marry these two research papers together to help answer the question, “What if menopausal women could stimulate their brains to produce oestrogen to support their symptoms, via sexual arousal and pleasure?”

So far, we can’t find any research that goes any way to finding an answer. But we’re not the only ones asking.

In fact, back in 2006, a study titled, Oestrogen, Menopause, and the Aging Brain: How Basic Neuroscience Can Inform Hormone Therapy in Women concluded, "Basic neuroscience has a great deal to contribute to the clinical issues surrounding oestrogen, menopause, and the ageing brain”. ^[9]

Indeed

Paul Telford from Emotional Bliss, ends the current discussion on this point,

“What remains clear, is that significantly more research is needed. The full anatomy of the clitoris was only discovered in 2005 by Professor Helen O’Connell ^[10] and the G spot has recently been debunked as a myth perpetuated in part by Cosmopolitan magazine in the early 80s (for which they now apologise).”

“Given this, and the fact that the menopause is only now being given air time, medical science appears to be woefully inadequate when understanding the female body. This is especially disappointing when compared to the comprehensive scientific data available on the male body.”

“At Emotional Bliss, we encourage all women to regularly reconnect with their bodies through sexual pleasure and orgasm in order to maintain their emotional wellbeing. In light of the research highlighted here, to my knowledge, linking oestrogen production in the brain and oestrogen release during sexual arousal, for the first time, this is especially important for perimenopausal, menopausal and postmenopausal women.”

^[1] Rance, N. E., McMullen, N. T., Smialek, J. E., Price, D. L., & Young, W. S., 3rd (1990). Postmenopausal hypertrophy of neurons expressing the oestrogen receptor gene in the human hypothalamus. The Journal of clinical endocrinology and metabolism, 71(1), 79–85

^[2] Maki, P. M., & Thurston, R. C. (2020). Menopause and Brain Health: Hormonal Changes Are Only Part of the Story. Frontiers in neurology, 11, 562275. Frontiers in neurology, 11, 562275

^[3] Hestiantoro, A., & Swaab, D. F. (2004). Changes in oestrogen receptor-alpha and -beta in the infundibular nucleus of the human hypothalamus are related to the occurrence of Alzheimer's disease neuropathology. The Journal of clinical endocrinology and metabolism, 89(4), 1912–1925

^[4] Kenealy, B. P., Kapoor, A., Guerriero, K. A., Keen, K. L., Garcia, J. P., Kurian, J. R., Ziegler, T. E., & Terasawa, E. (2013). Neuroestradiol in the hypothalamus contributes to the regulation of gonadotropin releasing hormone release. The Journal of neuroscience: the official journal of the Society for Neuroscience, 33(49), 19051–19059.

^[5] van Anders, S. M., Brotto, L., Farrell, J., & Yule, M. (2009). Associations among physiological and subjective sexual response, sexual desire, and salivary steroid hormones in healthy premenopausal women. The journal of sexual medicine, 6(3), 739–751.

^[6] Shahid Z, Asuka E, Singh G. Physiology, Hypothalamus. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-

^[7] Micevych, P. E., & Meisel, R. L. (2017). Integrating Neural Circuits Controlling Female Sexual Behaviour. Frontiers in systems neuroscience, 11, 42.

^[8] Musatov, S., Chen, W., Pfaff, D. W., Kaplitt, M. G., & Ogawa, S. (2006). RNAi-mediated silencing of oestrogen receptor {alpha} in the ventromedial nucleus of hypothalamus abolishes female sexual behaviours. Proceedings of the National Academy of Sciences of the United States of America, 103(27), 10456–10460.

^[9] Morrison, J. H., Brinton, R. D., Schmidt, P. J., & Gore, A. C. (2006). Oestrogen, menopause, and the aging brain: how basic neuroscience can inform hormone therapy in women. The Journal of neuroscience: the official journal of the Society for Neuroscience, 26(41), 10332–10348.

^[10] O'Connell, H. E., & DeLancey, J. O. (2005). Clitoral anatomy in nulliparous, healthy, premenopausal volunteers using unenhanced magnetic resonance imaging. The Journal of urology, 173(6), 2060–2063.