Ageing affects the reproductive system adversely, as with all other systems. It results in a decrease in the production of estrogen by the ovaries and testosterone by the testes. The former is a relatively sudden drop that halts the production of eggs and heralds menopause. The latter is a gradual drop over time that begins from a relatively younger age.
The menopause has an onset around age 50 and marks the end of unassisted fertility. The reproductive system shuts down with no eggs being released, estrogen levels dropping, and a series of symptoms and short-term and long-term side effects that impact individuals to varying degrees. In severe cases, hormone replacement therapy (HRT) is used to treat the symptoms.
Since sperm production in the testes handles millions of cells, a decrease in testosterone and hence testes activity does not result in a sudden, definitive end to unassisted reproduction. Fertility remains possible, although sperm count is lower and sperm may be of lower quality. Symptoms of a lower testosterone level present to varying degrees in individuals. HRT is possible in this case as well (although it would require strong symptoms alongside a low blood level of testosterone, and the side effects of HRT may outweigh the benefits).
The menopause plays out over a few years, with a period of time before its onset (perimenopause) and after its onset (postmenopause) for adjustment. Uncomfortable symptoms associated with it can last months or years, and include irregular periods (leading up to menopause), hot flushes and night sweats, insomnia, mood instability, decreased libido, urinary problems and vaginal atrophy. Atrophy of the reproductive system takes place, thinning the tissue of the vagina, uterus, ovaries, etc.
Low testosterone with ageing, on the other hand, may not necessarily present issues as acute as menopause, but is associated with symptoms such as decreased erection frequency and intensity, low libido and decreased muscle mass.
Both cases of low estrogen or testosterone are associated with an increased risk of getting brittle bones i.e. osteoporosis. This is one of the long-term implications.
With ageing, the prostate enlarges in many individuals. This is called benign prostate hyperplasia. It may cause symptoms of varying severity, due to the pressure it places on the urethra. This can cause difficulty initiating urination, and over time result in an incomplete emptying of the bladder. This causes frequent urination including at night, and an increased urgency to urinate.
Rarely, complications of benign prostate hyperplasia can occur. Urine in the bladder can increase the pressure on kidney function, resulting in temporary kidney function impairment. Overstretching of the bladder can stretch the veins and cause ruptures, resulting in urinating blood. Inability to empty the bladder can cause severe abdominal pain, and is brought on by periods of being immobile, cold temperature, delaying urination, rectal examination or taking drugs like alcohol, amphetamines and cocaine.
Back to the menopause! Due to the severity and duration of the symptoms of menopause, treatments such as HRT are sought. HRT, or hormone replacement therapy, aims to alleviate these symptoms by restoring estrogen (and sometimes also progestogen) levels to what they were before.
HRT has been shown to be successful at alleviating the main symptoms of menopause including hot flashes, vaginal dryness and mood instability. Unfortunately, HRT is not indicated for those who have a history of conditions that are susceptible to the action of sex hormones, e.g. breast, ovarian or uterine cancer, blood clots, untreated high blood pressure and liver disease.
Therefore, HRT is used as a treatment at the lowest effective dose and for the minimum period of time required. Alternatives to HRT include improving lifestyle such as increasing exercise, improving diet and cutting out caffeine, alcohol and smoking; tibolone which is a drug that acts similarly to the combine estrogen-progestogen HRT, but may be less efficient; antidepressants may reduce hot flashes but cause their own side effects such as agitation; and clonidine which may reduce hot flashes but to a small extent.