Breaking the Silence Around Male Infertility

Referring to any health issue that can reduce a man’s chances of impregnating a female partner, male infertility can cause significant emotional distress. By recognizing the signs of infertility in men, patients will have a better idea of when, or if, to seek treatment.

While fertility problems can affect both men and women, male infertility (sometimes called male factor infertility) tends to get less attention. However, research shows that 35% of the time when couples suffer from infertility, the underlying issues have to do with the male partner. And with around 13% of couples experiencing infertility at one time or another, men who wish to have children may find it necessary to undergo infertility testing.

To further understanding of male infertility, we’ll be covering symptoms and causes of male infertility, tests used to diagnose male infertility, and common treatment options for fertility issues in men.

Unlike many medical conditions, infertility in men doesn’t typically result in a lot of noticeable symptoms.

7 Symptoms of Infertility in Men

Before covering some common indicators of male fertility issues, let’s go over the functions of the male reproductive system under normal conditions.

Sperm production, storage, and transportation are the primary responsibilities of the male reproductive system. In order for mature, healthy sperm to be produced, there must be appropriate levels of hormones present—in particular, the male sex hormone testosterone.

Both sperm production and testosterone production occur in the testicles. Sperm then travel to tubes located just behind the testicles called the epididymides. Just prior to ejaculation, sperm move from the epididymides to another set of tubes, the vas deferens, which wrap around the bladder to link up with the ejaculatory duct from the seminal vesicles.

When ejaculation occurs, sperm mix with fluid from the prostate and seminal vesicles to form semen, which then moves through the urethra and out of the penis. Successful fertilization occurs when the sperm travels through a female partner’s vagina, passes through the cervix and uterus into the fallopian tubes and links up with an egg.

Many factors can interfere with healthy male fertility; however, unlike some other medical conditions, infertility in men doesn’t typically result in a lot of noticeable symptoms. That said, some possible indicators of male infertility include:

  1. Sexual function problems, including difficulty ejaculating
  2. Reduced interest in sex
  3. Inability to maintain an erection
  4. Pain, swelling, or lumps around the testicles
  5. Chronic or persistent respiratory infections
  6. Breast growth
  7. Decreased facial or body hair

If you or your partner has been trying to get pregnant for a year without success, it may be time to see a doctor to discover the cause of your fertility difficulties.

What Causes Male Infertility?

There is no single cause of infertility in men. The male reproductive system is quite complex and multiple prerequisites must be in place to guarantee healthy sperm function. Issues can arise that prevent cells from developing into sperm, or prevent sperm from traveling to their biologically programmed destination. Even a seemingly innocuous and constantly fluctuating factor such as the temperature of the scrotum can affect male fertility.

The best way to identify and resolve fertility issues is to speak with a professional in the field of reproductive medicine. That said, the underlying causes of male infertility can be grouped into the following 7 categories.

1. Sperm Production Disorders

The causes of infertility in men often relate to issues with sperm production. This category encompasses multiple fertility issues, from issues with sperm development to low sperm count and beyond.

In some cases, men produce a completely adequate number of sperm, but the sperm themselves are oddly formed, not fully grown, or unable to move well. In others, men may learn they have oligospermia, meaning they produce sperm in low numbers, resulting in an overall low sperm count, or azoospermia, meaning the levels of sperm in their semen are undetectable.

Sperm disorders can be genetic, but they can also be the product of lifestyle choices such as drinking or smoking cigarettes, or a side effect of certain medications. Other potential causes of low sperm counts include chronic illness such as kidney disease, childhood infections including the mumps, and hormonal imbalances.

2. Varicoceles

A varicocele is a medical term used to describe an enlarged vein in the scrotum. A fairly common condition—found in about 16 out of every 100 men—that typically develops during puberty, varicoceles can interfere with sperm production by preventing proper blood drainage. This can lead to lower sperm count as well as lower sperm quality. It can also shrink the testicles.

Varicoceles does not always impair fertility, but they are more common in infertile men (the rate of diagnosis climbs to 40 out of 100). Doctors have not yet identified risk factors for developing a varicocele. It’s also not entirely clear why varicoceles impact fertility. Some theories include that they cause blood to flow back into the scrotum from the abdomen, which causes the temperature in the scrotum to rise. This is a known cause of low sperm count.

In many cases, varicoceles present with no accompanying symptoms. If symptoms do appear, they include a lump in one of the testicles, scrotal swelling, visibly enlarged or twisted veins in the scrotum, and a dull, recurring pain in the scrotum.

3. Retrograde Ejaculation

Retrograde ejaculation is a condition in which when semen travels backward into the body. Rather than exiting the penis, they slide into the bladder. The semen may contain healthy, normal sperm, but since it does not exit the man’s body, it cannot fertilize an egg. This condition is not innately harmful, and typically only requires treatment in order to resolve accompanying fertility issues.

The primary symptom of retrograde ejaculation is orgasms in which a man ejaculates very little or no semen. These are sometimes referred to as dry orgasms. A secondary symptom is urine that’s cloudy after orgasm because it contains semen.

During a male orgasm, sperm travels through the vas deferens to the prostate to mix with other fluids to form semen. A muscle at the opening of the bladder called the bladder neck muscles contracts to keep semen from entering the bladder as it passes from the prostate into the urethra. For individuals experiencing retrograde ejaculation, the bladder neck muscles fail to tighten and semen can move into the bladder rather than being ejaculated from the penis.

Underlying causes of retrograde ejaculation include:

  • Surgery: Procedures affecting the male reproductive system, such as bladder neck surgery, prostate surgery, or surgery to treat testicular cancer, can result in retrograde ejaculation.
  • Certain medications: Some drugs used to treat high blood pressure, prostate enlargement, and depression can cause side effects that bring about retrograde ejaculation.
  • Chronic conditions: Certain conditions that cause nerve damage, including diabetes, multiple sclerosis, Parkinson’s disease, or a spinal cord injury, can also lead to retrograde ejaculation.

4. Immunologic Infertility

Although this is not a common cause of male infertility, it’s nonetheless a crucial one to address. In certain circumstances, a man’s body can begin to generate antibodies that attack his own sperm.

These antisperm antibodies are immune cells that mistakenly view sperm to be harmful invaders and work to protect the body from that perceived threat. Antisperm antibodies typically result from injury, surgery, or infection. It appears that they lower fertility by making it more difficult for sperm to travel to the fallopian tube and fertilize an egg.

5. Obstruction

It’s also possible for male infertility to be caused by a physical blockage. Repeated infections, surgical complication, swelling, or congenital conditions can damage the male reproductive system and cause obstructions to develop.

Any part of the male reproductive tract can be blocked. With a blockage in place, even healthy, fully-functioning sperm are unable to exit the body during ejaculation, and therefore unable to successfully fertilize an egg.

Experts estimate that for approximately 4 out of every 10 men with azoospermia, the underlying issue is an obstruction that blocks sperm from traveling through the reproductive tubes.

6. Hormonal Imbalances

Anything that affects the hormonal systems—including the hypothalamus, pituitary, thyroid, and adrenal glands—can adversely impact male fertility. The pituitary gland produces hormones that regulate sperm production, including testosterone. When testosterone levels drop, sperm decreases as well.

Low testosterone levels (which doctors call male hypogonadism) and other hormonal problems may stem from a variety of underlying causes, such as:

  • Injury to the testicles: Physical injury to both testicles as well as some cancer treatments can damage the testicles, causing testosterone levels to fall.
  • Pituitary disorders: These can be caused by drugs, kidney failure, or small tumors.
  • Kallmann syndrome: This condition has been linked to abnormal hypothalamus function and altered hormone levels.
  • Inflammatory diseases: Illnesses such as tuberculosis, sarcoidosis, and histiocytosis can impact the pituitary gland and the hypothalamus, thereby impacting hormone levels.
  • HIV/AIDS: This virus can can affect the pituitary gland, hypothalamus, and testes.

7. Chromosome Defects

Researchers have found that chromosomal anomalies and genetic mutations account for between 10% and 15% of all male infertility cases.

Klinefelter’s syndrome—in which a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y)—is one of the most common known causes of male fertility issues. This condition causes men to have smaller testes, lower testosterone levels, and decreased sperm production. Typically, men with this condition must seek out fertility treatments in order to biologically father children.

Another direct cause of male infertility, Y chromosomal infertility occurs in 1 out of every 2,000 men. Men with this condition have genetic deletion in the Y chromosome, which impacts protein production, which in turn causes low sperm production, the production of abnormally shaped sperm, or halts sperm production altogether.

Unlike many medical conditions, infertility in men doesn’t typically result in a lot of noticeable symptoms.

The above list is not intended to be comprehensive, but rather to give an overview of the complexity of the male reproductive system and the many factors that can impact male fertility.

As we’ve touched on in some of the preceding sections, it’s even possible for medications to change sperm production, function, and delivery. Health problems for which these medications might be prescribed (and which have not been referenced previously) include arthritis and digestive problems, as well as:

  • Infections
  • High blood pressure
  • Cancer

And in some rare cases, male infertility can result from celiac disease.

Diagnosing Male Infertility

An initial male fertility examination includes a comprehensive medical history, physical examination, general hormone tests, and one or more semen analyses.

According to resources made available by the University of California, San Francisco, this is what to expect when consulting a doctor about male infertility.

Medical History

The goal here is to identify any elements in a person’s medical history that may be contributing to their fertility issues. To do so, a doctor will typically cover the following areas:

  • Medications
  • Prior surgeries
  • Any family history of infertility or birth defects
  • Lifestyle factors such as smoking and drinking
  • Occupational hazards such as exposure to potentially harmful substances

Physical Exam

After completing the medical history, doctors usually conduct a thorough physical examination. The focus here will be on the pelvic organs: the penis, testes, prostate, and scrotum.

The physical examination is especially helpful when it comes to diagnosing varicoceles.

Semen Analysis

After collecting semen in a sterile cup, doctors can study it to look for issues with volume, count, concentration, motility, shape, structure, and volume and liquidity of ejaculate.

Equipped with all that information, doctors can begin pinpointing whether a patient is suffering from an issue with the seminal vesicles, a blocked ejaculatory duct, and so on.

Other Laboratory Testing

Doctors may use blood tests or other laboratory testing to help determine the underlying cause.

Two of the tests a doctor is most likely to order at an initial visit are urinalysis and hormonal tests. A urinalysis can indicate the presence of an infection, while hormonal tests provide a measure of testosterone levels and FSH (follicle-stimulating hormone). If initial tests indicate it, serum LH and prolactin tests may be ordered too.

If it’s not possible to make a diagnosis after the initial evaluation, further tests may be required, such as:

  • Seminal fructose test: This test identifies whether the seminal vesicles are properly adding fructose to the semen.
  • Post-ejaculate urinalysis: This test can determine if obstruction or retrograde ejaculation is occurring.
  • Semen leukocyte analysis: This test shows if there are white blood cells in the semen.
  • Kruger and World Health Organization (WHO) morphology: This form of analysis focuses on sperm shape and features.
  • Antisperm antibodies test: This test looks for antibodies that could be targeting sperm.
  • Sperm penetration assay (SPA): This analysis confirms that sperm have the ability to fertilize eggs.
  • Ultrasound: This can detect varicoceles or duct obstructions in the prostate, scrotum, seminal vesicles, and ejaculatory ducts.
  • Testicular biopsy: This can find whether sperm production is impaired or a blockage exists.
  • Vasography: This is the best way to examine the duct system and any potential obstructions.
  • Genetic testing: This can be used to rule out mutations of the Y chromosome as well as to test for cystic fibrosis.

After these evaluations have been completed, the next step is to develop a treatment plan.

How to Treat Male Infertility

The good news is that a variety of options exist for treating infertility in men. The specifics of infertility treatment vary depending on the underlying disease and the extent to which it impairs male fertility.

If the underlying cause can be categorized as pre-testicular, it can most likely be addressed by medical means. It’s also possible to use surgery to address post-testicular infertility caused by obstruction.

Typically, doctors offer three types of treatment based on the patient’s specific issue: surgical treatment, non-surgical treatment, and treatment for unknown causes.

For patients with varicoceles, surgery may be required to correct the problem. A simple outpatient procedure, varicocelectomy involves repairing swollen veins to improve the movement, number, and structure of sperm.

Non-surgical treatments vary based on the specific condition and may include antibiotics to treat infections, medication to control erectile dysfunction or premature ejaculation, hormone replacement therapy, and counseling.

When it comes to testicular-based male infertility, treatment can be more complex. Often, the conception process will require using ART (assisted reproductive technology). These procedures involve obtaining sperm and inserting it into the female genital tract. Some methods of doing so include intrauterine insemination (IUI), in vitro fertilization (IVF), or IVF with intracytoplasmic sperm injection (ICSI). That last technique, IVF-ICSI, can result in pregnancy if even a few healthy sperm exist since it involves using a tiny needle to inject a single sperm directly into an egg.

Tips to Naturally Increase Fertility

In some cases, it can be possible to resolve more mild infertility issues using lifestyle changes and natural treatments. These steps can also complement other infertility treatments and boost overall health.

One of the best ways to protect long-term wellness is to be cognizant of chemical exposure. According to an article in GQ, environmental pollution can affect the shape of the sperm’s head and tail.

Men can boost their fertility by limiting alcohol consumption and avoiding cigarettes. Even reducing the number of cigarettes you’re smoking each day can make a difference in your health and fertility.

While regular exercise is a crucial part of staying fit, engaging in overly intense exercise routines can actually reduce sperm count. For best results, aim to work out 3 times a week and get plenty of rest in between.

Men who are concerned about fertility should also avoid wearing tight clothing, as overheating the testes can cause problems.

Finally, it’s important to sleep for a minimum of 7 hours a night to stay healthy and maximize your chances of conception.

Understanding Perimenopause: The Before, During And After

Doctors refer to perimenopause as the transition to menopause. Women who notice perimenopause signs may expect menopause to set in within a few years, but menopause onset can take as long as 10 years after perimenopause signs start to manifest.

Menopause is the time in a woman’s life when she stops menstruating and is no longer able to bear children. Doctors refer to perimenopause as the time in which a woman is transitioning into menopause. Women who notice symptoms of perimenopause may expect menopause to set in within a few years, but menopause onset can take as long as 10 years after perimenopause signs start to manifest.

Understand perimenopause and menopause symptoms before you enter this important stage of a woman’s life. Preparing for this inevitable phase may drastically alleviate the emotional and physical discomfort often associated with menopause transition. And throughout it all, please remember you aren’t alone: approximately 40 million American women are likewise transitioning to menopause.

Premenopause vs. Perimenopause

Perimenopause signals the gradual decrease of the two main female sex hormones estrogen and progesterone. Ovaries, adrenal glands, fatty tissues, and the brain produce these hormones to regulate various functions of the female reproductive system, including menstrual cycles. As a woman ages and levels of estrogen decrease, follicle stimulating hormone (FSH) increases and ovarian egg quality diminishes along with fertility. You can, however, still get pregnant in the perimenopausal stage, so some form of birth control should still be used if a baby is not part of your life plan. Ultimately, the ovaries stop releasing eggs.

Premenopause describes the span of time between when a female begins menstruating, or menarche, until when she enters perimenopause or menopause—or the time between her first and last periods. Premenstrual syndrome (PMS) symptoms, such as irritability, cramps, bloating, breast tenderness, and nausea, are common during premenopause. Although sex hormone levels may fluctuate during premenopause, menstrual periods are usually regular or semi-regular, ovarian eggs are generally healthy, and fertility is most probable.

Menopause occurs when regular vaginal bleeding has ceased for 12 consecutive months. Menopause onset occurs between the ages of 49 and 52 for most women in Western societies, but onset can occur earlier or later.

Cholesterol levels tend to increase during the menopause transition. A 2011 study published in The Korean Journal of Internal Medicine recognized an increase in total and low-density lipoprotein (LDL) cholesterol levels in females transitioning from premenopause to postmenopause. After a woman has gone through menopause, she enters postmenopause, which lasts for the remainder of her life. FSH levels are highest during postmenopause. A doctor can administer urine and blood tests that measure hormone levels to determine your menopausal phase.

Understanding Perimenopause: The Before, During And After

Perimenopause Symptoms

Perimenopausal woman may experience irregular periods that are heavier, lighter, shorter, or longer than is usual. Abnormal premenstrual symptoms may herald these changes.

Other signs of perimenopause often mirror menopausal symptoms and are primarily symptomatic of declining estrogen levels. Vasomotor symptoms (such as night sweats, hot flashes, and flushes) are common manifestations of menopause transition as well as the postmenopausal phase of a woman’s reproductive life.

Sometimes hormonal changes and mood changes can be very disruptive and compromise your daily activities and well-being. Typical perimenopause symptoms include:

  • Irritability and mood swings: Psychological and emotional discomfort are common characteristics of hormone imbalance. Problems concentrating or maintaining consistent moods can worsen during perimenopause. Severe anxiety and depression can set in if these symptoms are not properly addressed. Pre-existing psychological disorders may require mental health intervention.
  • Insomnia: Drops in estrogen levels can lead to feelings akin to chronic distress, and most women suffer sleep disturbances as a result. In addition to psychological disruptions, internal changes during perimenopause may trigger urinary urgency, feverishness, sweating, and chills—all symptoms that can lead to sleep disruption.
  • Hot flashes: An increase of blood flow can trigger hot flashes—sensations of a sharp rise in body temperature—and profuse sweating. Hot flashes can last anywhere from 30 seconds to 10 minutes and often occur around the neck, face, and torso regions. A subsequent drop in body temperature can result in sudden chills.
  • Night sweats: Hot flashes often occur at night during sleep. Sudden perspiration episodes significantly disturb sleep cycles and can induce anxiety or signs that mimic panic, such as heart palpitations. Males who share sleeping quarters with affected women may suffer the effects of insomnia as well as feelings of helplessness.
  • Weight gain: Swelling along with breast tenderness is common, as is weight gain. If you haven’t been much of an exerciser, then perimenopause is a great time to make lifestyle changes and engage in a form of exercise you enjoy.
  • Other symptoms: Vulvovaginal atrophy results from decreased estrogenization of the vaginal tissue that can lead to inflammation and vaginal dryness—which, for some women, may cause soreness and pain during sex. Thinned, damaged vaginal tissue may heighten the occurrence of urinary frequency and pelvic organ prolapse, or bulging in the vagina due to a shifted bladder or uterus that drops down and presses against vaginal walls.

Early Menopause

Doctors commonly use the term premature menopause to describe menopause onset that occurs before the age of 40. There are known and unknown reasons why a woman may experience early menopause.

The age for menopause transition is dwindling in India—a country that has seen tremendous social and economic gains over the last few decades—but India’s fertility rates have plummeted. Some health experts believe that unprecedented stressors of a newly burgeoning economy, a fast-paced lifestyle, and changes in traditional dietary practices are several reasons why women in India are exhibiting untimely menopausal signs during normal reproductive years—sometimes as early as 29 years of age.

You will likely experience more acute perimenopausal symptoms if you undergo treatments that induce early menopause. Certain chemotherapy, radiation treatments, or other medications can lower estrogen levels. Synthetic phytoestrogens are known endocrine disruptors that compromise reproductive health, and cigarette smoking or long-term opioid use have been linked to early menopause. Primary ovarian insufficiency caused by poor genetics and autoimmune illnesses, like celiac disease, can also lead to advanced menopause transition; although premature, perimenopausal symptoms are usually normal in these instances. In rare cases, however, women bypass the perimenopause stage altogether, no longer have menstrual periods, and experience menopause symptoms indefinitely through postmenopause.

Menopause that is surgically induced by way of hysterectomies without the removal of ovaries preserves gradual perimenopause responses. Under these circumstances, even though you do not experience menstrual periods, your ovaries continue to produce sex hormones. However, the removal of both the uterus and the ovaries triggers an abrupt estrogenic drop, and menopause is either immediate at the time of removal or soon-to-occur after surgery.

Perimenopause Treatment

Don’t let perimenopause symptoms dishearten you, as there are many treatment options available. For some of these remedies time is of the essence, so understand your options early on and be mindful of any harmful side effects.

Every woman’s experience is different. A doctor will cater your treatment plan based on your specific needs. Your detailed observations of bodily changes, frequency of symptoms, or any abnormalities can help your medical team in this process and can subsequently enhance the effectiveness of your perimenopause treatment plan.

In addition to consulting your doctor for treatment, you may lessen the severity of perimenopause symptoms by heeding the following tips.


Do not smoke. Smoking cigarettes increases the risk of heart disease and osteoporosis—known complications linked to menopause.

Hormone Replacement Therapy

Take hormone replacement therapy (HRT) medication to compensate for drops in estrogen. HRT is most effective in patch form, although estrogen therapy also comes in gels, creams, and pills. Women who experience debilitating vasomotor symptoms often find relief with hormone therapy. HRT is also known to impair the effects of low bone density, which can cause osteoporosis.

HRT’s health benefits notwithstanding, it is important not to take dosages above what is deemed effective for your specific health needs. Hormone therapy has been linked to uterine cancer and breast cancer. Other side effects may include blood clots, stroke, and heart attack.

Perimenopausal woman should remain particularly vigilant about HRT and possible implications for short-term or long-term use. The Women’s Health Initiative’s 2017 guidelines regarding hormone therapy assess the benefit-risk ratios for taking HRT in relation to age and menopausal phase. Women younger than 60 years old or who are within 10 years of menopause onset appear to have a more favorable treatment response than women 60 years or older who initiate HRT more than 10 or 20 years from menopause onset.


Many women who begin menopause transition also begin a new and exhilarating fitness lifestyle. Some women who’d never go near a gym in their premenopausal days have entered and won bodybuilding competitions in their perimenopausal and menopausal, or even postmenopausal, days.

Harboring excess weight can aggravate perimenopause symptoms. Engaging in guided vigorous activity on a continual basis helps keep your zest for life high and your body fat low. If weightlifting is not your shtick, other weight-bearing exercises, like running, yoga, tai chi, and dancing, can be just as effective for tackling weight gain.


Hormonal changes can subdue your sex drive, but menopausal transition can be a liberating time for a woman. Remedy the physiological perimenopausal impairments in order to enjoy a fulfilling sex life. Enjoyable sex can lower stress levels and fortify relational bonds with your mate. Done regularly, Kegel exercises can help strengthen vaginal muscle tissue. Water-based vaginal lubricants or local vaginal estrogen treatment can ease dryness symptoms.


Avoid spicy foods and hot beverages to ease or lessen the frequency of hot flashes. Low estrogen levels can lead to low bone density, so it is important to consume bone-nourishing nutrients like calcium, iron, phosphorus, and vitamin K. Spinach and other dark leafy green vegetables contain all of these nutrients in considerable dosages. Low estrogen is also attributable to accelerated cardiovascular illness. Consuming omega-3 fatty acids can help bolster blood circulation and heart muscle strength. Avoid foods high in saturated fats to help keep your LDL cholesterol low.


Excess stress often turns a good situation bad and a bad situation worse, so avoid or limit stressors whenever possible. Be prepared to embrace the fact that your body may be limited in what it can take on physically, as well as emotionally. This may mean that you need to set up social mechanisms, for example, to help mitigate your exertion levels as you age. The support networks—family, friends, church groups, volunteer organizations, etc.—you have cultivated through the years can be great sources of physical and emotional assistance, so communicate your needs and concerns with your growing inner circle of helpmates. Knowing that you have a trove of unconditional support at your disposal can help alleviate the psychological discomfort that can trigger vasomotor responses during menopause transition.

It’s Time to Re-Think Menopause!

Menopause—also known as “climacteric” or “the change of life”—is the time when the ovaries stop producing sex hormones estrogen and progesterone that regulate menstruation. Discover what to expect, as well as tips to making the transition as easy as possible.

Menopause—also known as “climacteric” or “the change of life”—is the time when the ovaries stop producing reproductive hormones estrogen and progesterone that regulate menstruation, while other parts of the body (e.g., fatty tissues and adrenal glands) decrease the production of sex hormones. Menopause persists over a successive timespan of 12 months during which a woman has not experienced cyclical vaginal bleeding. Thereafter, these menstrual cycles stop permanently and the ability to bear children ceases.

Rethink menopause!

Menopause Symptoms

Irregular periods—longer, shorter, heavier, or lighter vaginal bleeding—are signs for perimenopause, which is the transitional phase before the onset of menopause that occurs several years before a woman’s last period. During menopausal transition, a woman may experience a few or more of the following vasomotor symptoms in varying degrees and based on her menopausal status.

Hot flashes Weight gain due to a slower metabolism
Vaginal dryness Thinning, dry skin
Thinning hair Insomnia caused by mood changes and hot flashes
Flaccid breasts Mood swings and irritability
Lethargy Joint soreness
Back pain Anxiety or depression
Night sweats Low sex drive

Menopause Complications

A number of factors can disrupt the typical transition from menstruation to menopause. The following risk factors and medical conditions may also worsen menopausal symptoms.

Smoking Tobacco

Women who smoke cigarettes tend to experience menopause 1 to 3 years earlier than women who do not smoke. In 2015, HHS Public Access published data that indicated escalated ovarian aging for women exposed to smoke “both prenatally and around the time of menopause.”

Obesity, Pollutants, and Poor Diet

Women with excess fat cells are at higher risk for developing menopause earlier than normal, as are women who regularly adhere to a poor diet.

Synthetic phytoestrogens, such as the industrial pesticides sprayed in the air and on foods, are known endocrine disruptors that can trigger antiestrogenic effects and damage to reproductive organs. Long-term exposure to synthetic phytoestrogens in plastics and canned food containers may be unavoidable for certain low-income individuals. A 2015 study identified 15 endocrine-disrupting chemicals (EDCs) and highlighted potentially detrimental effects of EDCs on ovarian health, in particular.

Surgically Induced Menopause

Some medical problems may require the surgical removal of the ovaries and uterus. Removal of only the uterus does not typically cause menopause. Without a uterus, you will no longer menstruate, but you may not experience menopausal symptoms immediately with your ovaries intact. Once the ovaries are removed, sex hormones decrease rapidly. The normal gradual transition leading to the last menstrual period does not take place, and menopause happens instantaneously after surgery.

Medication-Induced Menopause

Certain types of chemotherapy, radiation, or pharmaceuticals may damage ovaries and cause a more rapid decrease in sex hormone production, eventually causing menopause in a shorter span of time than usual. Symptoms of menopause may occur during or immediately after chemotherapy and radiation treatments, but this is not always the case and may not be permanent. Medication- or surgically-induced menopause symptoms are generally more acute than normal.

Ovarian Failure

It is rare, but a small percentage of women experience premature menopause (before the age of 40) due to abnormal ovarian function—that is, ovaries that fail to produce sufficient levels of sex hormones. As with induced menopause, conditions such as fragile genetics, thyroid disease, diabetes, endometriosis, certain cancers of the female reproductive organs, or autoimmune disease may predispose women to experience poor ovarian function.

There are also unknown causes for ovarian failure. Premature menopausal patients tend to experience aggressive menopausal symptoms, and they are at high risk for developing peculiarly degenerative forms of cardiovascular disease, bone disease, and neurological illness.

Celiac Disease

If left untreated, complications stemming from celiac disease can adversely affect fertility and increase the risk for menopause. Celiac disease is an autoimmune disorder of the gastrointestinal system when it is unable to properly process gluten, which is a protein found in wheat.

Vulvovaginal Atrophy

Vulvovaginal atrophy (VVA) can affect any woman, though it is most prevalent in postmenopausal women. It is a complication that stems from a decrease in estrogen of the vaginal tissue that can induce vaginal deformities. Symptoms for VVA include dryness, pain during sex, incontinence, and accelerated urinary frequency.

Chronic Disease

The Iranian Red Crescent Medical Journal documented in 2011 that cardiovascular disease and osteoporosis (a disease characterized by abnormally low bone mass density and higher-than-normal incidences of bone fractures) are more prevalent in early menopause, while breast cancer and uterine cancer are more common with delayed menopause. Heavy-to-moderate vaginal bleeding or spotting during postmenopause is a sign of uterine cancer. Menopause has been linked to a decline in lung function as well.

Menopause Positives

It is good practice to take preemptive, as well as remedial, measures during all phases of womanhood to help stave off complications and ease menopause symptoms. Make every effort to enjoy this special time in your life as much as possible. The following points can help dim menopause stigma and redefine common preconceptions regarding this estimable phase in a woman’s life.


If you experience severe menopause symptoms, you should consult your health care provider for treatment options. Hormone replacement therapy (HRT) delivered as a skin patch is most effective for treating vasomotor symptoms and preventing bone loss, which are conditions linked to low estrogen levels.

The Women’s Health Initiative (WHI) issued a 2017 report positing benefit-to-risk ratios for HRT users. Women younger than 60 years old who receive hormone therapy within 10 years of menopause onset have a more favorable benefit-risk ratio for treatment of vasomotor symptoms than women age 60 years or older who receive treatment 10 to 20 years from menopause onset.

Natural remedies like isoflavone supplements, black cohosh, and vitamin E, remain popular alternatives, especially in light of menopausal hormone therapy side effects that include higher risks for heart disease, blood clots, dementia in patients 65 years or older, as well as breast and endometrial cancers. Melatonin supplementation has shown favorable for addressing menopause-related depression and menstrual disturbances in perimenopausal women.


Frank discussions about sexuality—female reproductive health and sexuality, in particular—are often taboo in many societies. Lack of honest communication often hinders societies from properly supporting those going through the aging process, starting at menopause and beyond. In the absence of necessary education, myths and assumptions run rampant and become embedded in the culture, which can be psychologically damaging. It is no coincidence that couples in Western societies often complain of irritability, anxiety, and depression in menopausal woman.

Japan currently boasts a large aging population that the country has mobilized great efforts to accommodate through progressive social programs. Logically, such conscientious support of the aging has produced great results. This is reflected in the quality of life afforded their elderly population. Japan’s elderly tend to live longer, healthier lives and do not experience as many chronic illnesses that plague Western societies. Japanese menopausal women do not suffer psychological stress as severely as American women do. Vasomotor symptoms, like hot flashes and insomnia, are common in America; whereas, they are rare for most Japanese females who tend to report back and joint pain—symptoms largely attributable to aging.


Rites of passage ceremonies, like bat mitzvahs, cotillions, sweet sixteen celebrations, and quinceaneras, celebrate the transition from girlhood to womanhood, but similar transitional rituals for middle-aged females are lacking. For the most part, rites of passage ceremonies assist participants in psychologically transitioning to new phases in life. Retirement celebrations are significant but value materialism and what someone has produced, rather than a woman’s intrinsic value. Create your own rituals for menopausal transition and be sure to involve devoted family and friends to mark the special occasion.


Menopause does not mean the end of sex. The risk of pregnancy diminishes greatly during this time, so there is a potential for a liberating sex life.

Consider Kegel exercises to strengthen vaginal muscles that may thin and weaken as a result of low estrogen levels.

Pain and discomfort during intercourse due to vaginal dryness are common complaints with menopause. Water-based lubricants and local vaginal estrogen treatments (rings, creams, or tablets) help remedy vaginal dryness.

After menopause, lower estrogen levels can cause recurrent urinary tract infections. Vaginal estrogen creams and rings can help rebalance vaginal bacterial flora so that UTIs don’t get in the way of your sex life.

Low sex drive among menopausal women may be due to psychological and/or hormonal reasons. If you suffer an impaired libido, talk with your doctor about somatic and mental health remedies. Have honest discussions with your partner about changing or steadying expectations to help nurture your confidence during your physical and psychological transition.


It is never too late to try new foods that promote good health, especially those that include isoflavones that are chemically linked to the amino acid phenylalanine. Isoflavones were used to treat hot flashes and other vasomotor symptoms in a 2014 study, and these nutrients exhibited very promising results.

Natural phytoestrogens are plant-derived and not produced by the endocrine system. Although more research is required to better substantiate the ameliorative effects of phytoestrogens, they may help remedy the side effects of low estrogen levels in menopausal females. Soybeans, sesame seeds, oats, lentils, ginseng, and carrots are some dietary sources of phytoestrogens.

Because menopause can increase your risk for osteoporosis and get in the way of quality sleep, supplements such as calcium, magnesium, and vitamin D can help.


Weight gain is a common symptom of menopause, but one that can easily be outwitted with high-intensity exercise and amino acid supplementation.

One study showed that exercising at high intensity kept the weight and fat off of postmenopausal women. High-intensity workouts come in many forms, from HIIT and Tabata training, to speed walking, jumping rope, and cycling.

Here’s a high-intensity workout from SELF that you can do at home using just your body.

If you want extra support keeping the fat off your frame, or if high intensity is a total turn off, then adding an essential amino acid supplement can help you increase lean body mass without all the extra sweat.

A study of postmenopausal women showed that supplementing with essential amino acids daily increased lean muscle mass and muscle protein synthesis without any change in activity! So, don’t sweat it.

To learn more about how amino acids and other nutrients can help ease menopause transition, read this article.

Embrace Change

Stay curious and committed to a healthy lifestyle! There’s much to be celebrated in this new phase of your life. Is it time to start a new exercise program? Retire and shift career gears? Write that book you’re always talking about? What about going back to school or taking a certification course in something that’s sparked your interest? What kind of positive lifestyle changes can you make?

Talk with members of your support system—church, community center, family, friends—about your plans no matter what they may be. You will be surprised at how well your newfound desires are received. And go easy on yourself, always bearing in mind any physical limitations. Remain enthusiastic about your new exercise regimen, but be mindful of low bone density and a higher risk of injury, for example.

And remember: every end makes way for a new beginning. So, what sort of magic will you invite into your life after menopause?

Maneuvering Through Menopause: Outwitting Body Composition Changes with Amino Acids

There are ways to maneuver through menopause that make the transition from your bleeding to non-bleeding years easier. Managing menopause and body composition changes with essential amino acid support is key.

Menopause is a natural biological process that marks the end of a woman’s reproductive cycle. It occurs most commonly between the ages of 48 and 55. The average age for a woman to go through menopause in the United States is 51.

Menopause begins when the ovaries greatly reduce the production of the hormone estrogen, and it is marked by the end of menstrual cycles.

There are a variety of responses that can occur during the menopause transition. Most women recognize…

  • Hot flashes
  • Night sweats
  • Mood changes
  • Thinning of hair
  • Dry skin
  • Loss of breast fullness
  • Vaginal dryness

Then there are the postmenopausal symptoms, which can increase your risk of serious medical conditions:

  • Elevated blood cholesterol level
  • Osteoporosis (brittle bones)
  • Susceptibility to constipation
  • Urinary incontinence
  • Impaired sexual function (discomfort during sex)
  • Weight gain and altered body composition

There are ways to maneuver through menopause that make the transition from your bleeding to non-bleeding years more manageable.

Hormones and Menopause

Hormones are the body’s chemical messengers that direct different bodily functions, from hunger to happiness to reproduction. During menopause, your ovaries stop producing as much of the sex hormones estrogen and progesterone, and menstrual cycles and fertility decrease as a result. As ovarian follicles decrease, the luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are unable to effectively regulate your estrogen, progesterone, and testosterone levels. Lower levels of reproductive hormones can impact your health.

Menopause is a natural biological process that marks the end of a woman’s reproductive cycle. There are ways to maneuver through menopause that make the transition from your bleeding to non-bleeding years easier. Managing menopause and body composition changes with essential amino acid support is key.

Hormone Replacement Therapy (HRT)

Produced by the ovaries, estrogen is the “female” hormone that is important in the development of many female characteristics. Because estrogen levels plunge in menopause, hormone replacement therapy (HRT) is used to decrease the symptoms of estrogen deficiency.

HRT can be taken orally, vaginally, or transdermally (in patches). The most common type of hormone therapy combines estrogen and progesterone. Estrogen is given regularly, while progesterone is added in on a supplementary basis. The two hormones are given in combination to prevent the overgrowth of the uterine lining, which decreases the risk of endometrial cancer that might occur as a result of estrogen therapy alone.

The effects of HRT on body composition in postmenopausal women are inconclusive, with some studies showing a positive effect and others failing to show any difference in body composition between HRT users and control subjects. While cross-sectional studies demonstrate conflicting results as to HRT’s effect on muscle performance, experimental trials indicate that hormone therapy may actually help prevent the deterioration in muscle force that commonly accompanies menopause.

HRT is generally used for lessening menopausal symptoms and is not recommended for more than 3 to 5 years due to evidence of increased health risks.

Risks of HRT

Hormones have a wide variety of effects in the body, and providing hormones therapeutically to increase hormone levels and treat one problem often causes unexpected side effects. HRT increases the risk of a number of conditions and diseases.

Here are the takeaways of HRT risks:

  • When estrogen is given alone the risk of endometrial cancer is increased.
  • Combining estrogen with progesterone diminishes this risk.
  • The combined use of estrogen and progesterone slightly increases the risk of breast cancer.
  • Combined estrogen and progesterone therapy increases the risk of venous thromboembolic disease (blood clots in the veins).
  • HRT increases the risk of gallbladder disease.
  • The risk of both dementia and Alzheimer’s disease is also increased.

We will cover some HRT alternatives in a bit, but first, let’s discuss menopause and its influence on body composition.

Menopause and Body Composition

Menopause is associated with weight gain and a change in body composition. Not only can fat mass increase and lean mass decrease, but the distribution of body fat (otherwise known as adipose tissue) can change as well. In particular, the deposition of trunk fat increases after menopause—the trunk area of your body is your abs, hips, and back.

Many of the adverse responses during and after menopause are related to these changes in body composition and fat distribution. An increase in trunk fat is associated with increased cardiovascular disease risk. Total body and trunk fat accumulation also have indirect effects on other heart disease-risk factors, including plasma lipoprotein-lipid profiles, blood pressure, and insulin resistance. A loss of muscle mass can lead to impaired physical function and other problems as well. Addressing the changes in body composition related to menopause may be the most important way to decrease many of these related detrimental responses.

What Causes Body Composition Changes in Menopause?

Weight gain, especially fat, occurs so commonly after menopause that it is presumed by many to be caused by the drop in estrogen. This perspective was supported by some early studies indicating changes in body weight and composition could be lessened with HRT therapy. However, more recent evidence suggests that an increase in body and trunk fat in midlife women is a natural function of aging, as well as a response to changes in dietary and physical activity patterns.

The effects of regular physical activity on body composition changes was demonstrated in a study comparing three groups of postmenopausal women.

  • One group consisted of endurance athletes who had been training for many years and regularly performed high-intensity athletic endeavors.
  • The second group was composed of sedentary women.
  • The third group was made up of active women who were not athletes.
  • About half the women were receiving HRT.

Total and regional body composition were measured using dual-energy x-ray absorptiometry. The results showed that the active women and endurance athletes spent about the same amount of time per week performing exercise, and had been for the same number of years. The women who performed high-intensity training had the lowest body fat, but there was no difference between the sedentary and active women. HRT had no significant impact on body composition in any of the groups. These results indicate that it is possible to do something about body composition changes in menopause by exercising, but that the intensity of exercise must be high.

The Effect of Essential Amino Acids on Body Composition

If you are in the postmenopausal category, take a moment to check in and be honest with yourself: now that you know that high-intensity training can improve body composition in postmenopausal women, will you engage in high-intensity exercise on a regular basis?

We hope so, as high-intensity training can help tone your heart and lungs, lower you body mass index (BMI), and improve your overall health, while a sedentary life contributes to a higher waist circumference, intra-abdominal (or visceral) fat and significantly less lean mass. But, if you think you might slack on your high-intensity training efforts, then we have some good news.

The good news is that you can improve your body composition without intensive training if you add an essential amino acid supplement to your diet. Essential amino acids are the active components of dietary protein. They cannot be produced in the body but are crucial components of all proteins in the body.

One study of postmenopausal women showed that supplementing with essential amino acids daily increased lean body mass and muscle protein synthesis in the absence of any change in activity level.

In a different study, essential amino acid supplementation for 3 months increased lean muscle mass, strength, and physical function in sedentary postmenopausal women. Other responses associated with changes in body composition in menopause, including plasma and liver fat and impaired insulin sensitivity, were also improved with essential amino acid supplementation.

So, while changes in body composition at the time of menopause are, in part, an unavoidable aspect of aging, supplementing with essential amino acids has a proven beneficial effect on body composition, strength, and physical function, along with improvement in many of the risk factors for serious diseases and conditions. Combining essential amino acid supplementation with high-intensity exercise is an optimal duo for health before, during, and after menopause.