Surgical menopause is a whole different experience from natural menopause. Instead of a gradual decline in hormones, it’s an abrupt hormonal shift that can feel like a free fall. Many women are given estrogen replacement to manage the most obvious symptoms, but that’s often where the conversation ends. What gets left out? The role of luteinizing hormone (LH), estrogen, and androgens (LEA) in overall health and well-being.
The Estrogen-Centric Approach
When ovaries are removed, estrogen levels plummet overnight. This leads to hot flashes, night sweats, mood swings, and bone loss. Because these symptoms are so disruptive, the primary focus in hormone replacement therapy (HRT) is on replacing estrogen. It makes sense—estrogen is essential. But treating estrogen alone often leaves women struggling with lingering fatigue, loss of muscle mass, low libido, and a general feeling of “not feeling like themselves.” That’s where LH and androgens come in.
Why LH and Androgens Matter
LH is a hormone that plays a role in regulating androgens, which include testosterone and DHEA. These hormones contribute to energy, motivation, strength, and sexual health. Before menopause—natural or surgical—ovaries produce a portion of a woman’s androgens, alongside the adrenal glands. When the ovaries are removed, this source of androgens is gone, leading to a more profound hormonal imbalance than just low estrogen.
Low androgens can lead to:
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Decreased muscle mass and strength
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Fatigue and low energy
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Reduced motivation and drive
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Decreased libido and sexual response
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Mood changes, including increased anxiety and depression
Yet, most HRT protocols don’t include androgen replacement. This isn’t because it isn’t needed. It’s because the research on women and androgens is lacking, and there’s still a reluctance to prescribe testosterone to women—even though it plays a crucial role in overall well-being.
The Research Gap and Medical Hesitation
The lack of research on androgen therapy in women means many doctors don’t have clear guidelines on how to prescribe it. There’s also lingering stigma around testosterone, as it’s often associated with men’s health. Some women who ask about it are met with hesitation or told it’s unnecessary. But for women in surgical menopause, replacing androgens can be the missing piece in restoring energy, muscle mass, and overall quality of life.
A More Comprehensive Approach
If you’re in surgical menopause and feel like something is still off despite taking estrogen, it may be worth having a conversation with your doctor about LEA—luteinizing hormone, estrogen, and androgens. A comprehensive approach to hormone therapy should consider all three, not just estrogen alone.
This isn’t about chasing numbers or trying to “fix” menopause. It’s about feeling strong, energized, and balanced in your body. And that starts with advocating for a treatment plan that looks at the full picture of your hormones, not just the parts that are easiest to prescribe.