Hormonal Changes During Menopause and the Impact on Fluid Regulation
Open accessAbstract
Reproductive surgeries leave women more susceptible to postoperative hypervolemic hyponatremia because during this period women can retain water at an accelerated pace and much faster than they do sodium. This review proposes that estrogen and progestogen exposure play an important role in the increased risk of hyponatremia in menopausal women. Estrogen and progesterone exposure have important effects on both body fluid regulation and cardiovascular function and both of these reproductive hormones impact blood pressure responses to sodium loads. This article provides information on the effects of female reproductive hormones and hormone therapy (HT) on fluid regulation and cardiovascular function during menopause. Thirst- and fluid-regulating hormones respond to both osmotic and volume stimuli. Aging women maintain thirst sensitivity to osmotic stimuli but lose some thirst sensitivity to changes in central body fluid volume. Thus, older adults are more at risk of dehydration because they may replenish fluids at a slower rate. Estrogen therapy increases osmotic sensitivity for mechanisms to retain body water so may help menopausal women control body fluids and avoid dehydration. Some progestogens can mitigate estradiol effects on water and sodium retention through competition with aldosterone for the mineralocorticoid receptor and attenuating aldosterone-mediated sodium retention in the distal tubule. However, some progestogens can increase cardiovascular risks. Appropriate balance of these hormones within HT is important to avoid the negative consequences of body fluid and sodium retention, including edema and hypertension.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Older women are slower to excrete water (as compared to younger, premenopausal women) increasing the risk of hyponatremia.
“Older women are slower to excrete water (as compared to younger, premenopausal women) increasing the risk of hyponatremia [279,280].”
From International society of sports nutrition position stand: nutritional concerns of the female athlete (2023) · cites this paper as [279]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Croonian Lecture - The antidiuretic hormone and the factors which determine its release
Verney, E. B. (1947) · Proceedings of the Royal Society B Biological Sciences · doi:10.1098/rspb.1947.0037 · Cited by 1,106 · see citing works
Arieff, A. I. (1986) · New England Journal of Medicine · doi:10.1056/nejm198606123142401 · Cited by 587 · see citing works
Neuroendocrine Control of Body Fluid Metabolism
Antunes‐Rodrigues, J., de Castro, M., Elias, L. L. K., Valênça, M. M., & McCann, S. M. (2004) · Physiological Reviews · doi:10.1152/physrev.00017.2003 · Cited by 468 · see citing works
Postoperative Hyponatremic Encephalopathy in Menstruant Women
Ayus, J. C., Wheeler, J. M., & Arieff, A. I. (1992) · Annals of Internal Medicine · doi:10.7326/0003-4819-117-11-891 · Cited by 451 · see citing works
Effects of estrogens and progestogens on the renin-aldosterone system and blood pressure
Oelkers, W. K. H. (1996) · Steroids · doi:10.1016/0039-128x(96)00007-4 · Cited by 333 · see citing works
The Interaction of Blood Osmolality and Blood Volume in Regulating Plasma Vasopressin in Man
ROBERTSON, G. L., & ATHAR, S. (1976) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-42-4-613 · Cited by 298 · see citing works
Epidemiology, pathophysiology, and management of hyponatremic encephalopathy.
Fraser, C. L., & Arieff, A. I. (1997) · The American Journal of Medicine · doi:10.1016/s0002-9343(96)00274-4 · Cited by 288 · see citing works
Plasma volume during stress in man: osmolality and red cell volume
Greenleaf, J. E., Convertino, V. A., & Mangseth, G. R. (1979) · Journal of Applied Physiology · doi:10.1152/jappl.1979.47.5.1031 · Cited by 268 · see citing works
Brainstem catecholamine neurons are target sites for sex steroid hormones.
Heritage, A. S., Stumpf, W. E., Sar, M., & Grant, L. D. (1980) · Science · doi:10.1126/science.7355296 · Cited by 240 · see citing works
Altered osmotic thresholds for vasopressin secretion and thirst in human pregnancy
Davison, J. M., Gilmore, E. A., Durr, J., Robertson, G. L., & Lindheimer, M. D. (1984) · American Journal of Physiology-Renal Physiology · doi:10.1152/ajprenal.1984.246.1.f105 · Cited by 225 · see citing works
Sex Hormone Effects on Body Fluid Regulation
Stachenfeld, N. S. (2008) · Exercise and Sport Sciences Reviews · doi:10.1097/jes.0b013e31817be928 · Cited by 211 · see citing works
Self-citationSelected Contribution: Sex differences in osmotic regulation of AVP and renal sodium handling
Stachenfeld, N. S., Splenser, A. E., Calzone, W. L., Taylor, M. P., & Keefe, D. L. (2001) · Journal of Applied Physiology · doi:10.1152/jappl.2001.91.4.1893 · Cited by 189 · see citing works
Self-citationEndometrial Ablation Complicated by Fatal Hyponatremic Encephalopathy
Arieff, A. I. (1993) · JAMA · doi:10.1001/jama.1993.03510100080037 · Cited by 162 · see citing works
Estrogen, vascular estrogen receptor and hormone therapy in postmenopausal vascular disease
Khalil, R. A. (2013) · Biochemical Pharmacology · doi:10.1016/j.bcp.2013.09.024 · Cited by 151 · see citing works
Body fluid balance in dehydrated healthy older men: thirst and renal osmoregulation
Mack, G. W., Weseman, C. A., Langhans, G. W., Scherzer, H. H., Gillen, C. M., & NADEL, E. R. (1994) · Journal of Applied Physiology · doi:10.1152/jappl.1994.76.4.1615 · Cited by 149 · see citing works
Effects of oral contraceptives on body fluid regulation
Stachenfeld, N. S., Silva, C., Keefe, D. L., Kokoszka, C. A., & Nadel, E. R. (1999) · Journal of Applied Physiology · doi:10.1152/jappl.1999.87.3.1016 · Cited by 143 · see citing works
Self-citationEstrogen influences osmotic secretion of AVP and body water balance in postmenopausal women
Stachenfeld, N. S., Dipietro, L., Palter, S. F., & Nadel, E. R. (1998) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.1998.274.1.r187 · Cited by 132 · see citing works
Self-citationIshunina, T. A., & Swaab, D. F. (1999) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.84.12.6187 · Cited by 132 · see citing works
Estrogen effects on osmotic regulation of AVP and fluid balance.
Stachenfeld, N. S., & Keefe, D. L. (2002) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.00192.2002 · Cited by 126 · see citing works
Self-citationMagnitude-matching: the measurement of taste and smell
Marks, L. E., Stevens, J. C., Bartoshuk, L. M., Gent, J. F., Rifkin, B., & Stone, V. K. (1988) · Chemical Senses · doi:10.1093/chemse/13.1.63 · Cited by 124 · see citing works
Takamata, A., Mack, G. W., Gillen, C. M., & NADEL, E. R. (1994) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.1994.266.5.r1493 · Cited by 115 · see citing works
Mechanism of attenuated thirst in aging: role of central volume receptors
Stachenfeld, N. S., DiPietro, L., NADEL, E. R., & Mack, G. W. (1997) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.1997.272.1.r148 · Cited by 111 · see citing works
Self-citationPhysiological and pathophysiological influences on thirst
McKinley, M. J., Cairns, M. J., Denton, D. A., Egan, G. F., Mathai, M. L., Uschakov, A., Wade, J. D., Weisinger, R. S., & Oldfield, B. J. (2004) · Physiology & Behavior · doi:10.1016/j.physbeh.2004.04.055 · Cited by 107 · see citing works
OELKERS, W., SCHÖNESHÖFER, M., & BLÜMEL, A. (1974) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-39-5-882 · Cited by 106 · see citing works
Denton, D. A., Shade, R. E., Zamarripa, F., Egan, G. F., Blair-West, J. R., McKinley, M. J., & Fox, P. T. (1999) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.96.5.2532 · Cited by 104 · see citing works
Brain damage and postoperative hyponatremia
Ayus, J. C., & Arieff, A. I. (1996) · Neurology · doi:10.1212/wnl.46.2.323 · Cited by 101 · see citing works
Female sex hormones inhibit volume regulation in rat brain astrocyte culture
Fraser, C. L., & Swanson, R. A. (1994) · American Journal of Physiology-Cell Physiology · doi:10.1152/ajpcell.1994.267.4.c909 · Cited by 98 · see citing works
Sar, M., & Stumpf, W. E. (1980) · Neuroscience Letters · doi:10.1016/0304-3940(80)90081-6 · Cited by 93 · see citing works
Blood pressure around the menopause: a population study
Cífková, R., Pitha, J. V., Lejsková, M., Lánská, V., & Zecova, S. (2008) · Journal of Hypertension · doi:10.1097/hjh.0b013e32830b895c · Cited by 92 · see citing works
Effect of ovarian sex steroids on osmoregulation and vasopressin secretion in the rat
Barron, W. M., Schreiber, J., & Lindheimer, M. D. (1986) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.1986.250.4.e352 · Cited by 89 · see citing works
Crowley, W. R., O'Donohue, T. L., George, J. M., & Jacobowitz, D. M. (1978) · Life Sciences · doi:10.1016/0024-3205(78)90373-9 · Cited by 88 · see citing works
VARIATION IN OSMOREGULATION OF ARGININE VASOPRESSIN DURING THE HUMAN MENSTRUAL CYCLE
SPRUCE, B. A., BAYLIS, P. H., BURD, J., & WATSON, M. J. (1985) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1985.tb01062.x · Cited by 82 · see citing works
Osmoregulation of thirst and vasopressin during normal menstrual cycle
Vokes, T. J., Weiss, N. M., Schreiber, J., Gaskill, M. B., & Robertson, G. L. (1988) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.1988.254.4.r641 · Cited by 81 · see citing works
Crowley, R. S., & Amico, J. A. (1993) · Endocrinology · doi:10.1210/endo.133.6.8243294 · Cited by 79 · see citing works
Acute Effects of Sodium Ingestion on Thirst and Cardiovascular Function
Stachenfeld, N. S. (2008) · Current Sports Medicine Reports · doi:10.1249/jsr.0b013e31817f23fc · Cited by 78 · see citing works
Self-citationThirst and fluid regulatory responses to hypertonicity in older adults
Stachenfeld, N. S., Mack, G. W., Takamata, A., DiPietro, L., & NADEL, E. R. (1996) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.1996.271.3.r757 · Cited by 77 · see citing works
Self-citationBody temperature modification of osmotically induced vasopressin secretion and thirst in humans
Takamata, A., Mack, G. W., Stachenfeld, N. S., & NADEL, E. R. (1995) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.1995.269.4.r874 · Cited by 67 · see citing works
Self-citationPotency of progestogens used in hormonal therapy: Toward understanding differential actions
Hapgood, J. P., Africander, D., Toit, R. L.-D., Ray, R. M., & Rohwer, J. M. (2013) · The Journal of Steroid Biochemistry and Molecular Biology · doi:10.1016/j.jsbmb.2013.08.001 · Cited by 66 · see citing works
Plasma volume during heat stress and exercise in women
Stephenson, L. A., & Kolka, M. A. (1988) · European Journal of Applied Physiology · doi:10.1007/bf00417979 · Cited by 62 · see citing works
Drospirenone in combination with estrogens: for contraception and hormone replacement therapy
Oelkers, W. (2005) · Climacteric · doi:10.1080/13697130500330341 · Cited by 60 · see citing works
Osmotic Regulation of Estrogen Receptor-β in Rat Vasopressin and Oxytocin Neurons
Somponpun, S. J., & Sladek, C. D. (2003) · Journal of Neuroscience · doi:10.1523/jneurosci.23-10-04261.2003 · Cited by 58 · see citing works
Na+-K+-ATPase pump function in rat brain synaptosomes is different in males and females
Fraser, C. L., & Sarnacki, P. (1989) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.1989.257.2.e284 · Cited by 51 · see citing works
Hypertension in women: the role of progesterone and aldosterone
Boschitsch, E., Mayerhofer, S., & Magometschnigg, D. (2010) · Climacteric · doi:10.3109/13697131003624649 · Cited by 46 · see citing works
Stephenson, L. A., Kolka, M. A., Francesconi, R., & Gonzalez, R. R. (1989) · European Journal of Applied Physiology · doi:10.1007/bf00637388 · Cited by 41 · see citing works
Plasma renin activity and plasma aldosterone during the normal menstrual cycle
Michelakis, A. M., Yoshida, H., & Dormois, J. C. (1975) · American Journal of Obstetrics and Gynecology · doi:10.1016/0002-9378(75)90495-0 · Cited by 39 · see citing works
Blyth, B. J., Hauger, R. L., Purdy, R. H., & Amico, J. A. (2000) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.2000.278.3.r684 · Cited by 39 · see citing works
The Effect of Vasopressin on Solute and Water Excretion
Fieldman, N. R., Forsling, M. L., & Quesne, L. P. L. (1985) · Annals of Surgery · doi:10.1097/00000658-198503000-00022 · Cited by 33 · see citing works
Atrial natriuretic peptide suppresses osmostimulated vasopressin release in young and elderly humans
Clark, B. A., Elahi, D., Fish, L. C., McAloon-Dyke, M., Davis, K., Minaker, K. L., & Epstein, F. H. (1991) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.1991.261.2.e252 · Cited by 32 · see citing works
Sex differences in central adrenergic control of vasopressin release
Stone, J. D., Crofton, J. T., & Share, L. (1989) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.1989.257.5.r1040 · Cited by 32 · see citing works
Somponpun, S. J., & Sladek, C. D. (2004) · Journal of Neuroendocrinology · doi:10.1111/j.1365-2826.2004.01200.x · Cited by 25 · see citing works
Pathogenesis of Hyponatremic Encephalopathy Current Concepts
Arieff, A. I., & Ayus, J. C. (1993) · CHEST Journal · doi:10.1378/chest.103.2.607 · Cited by 25 · see citing works
The Impact of Anesthesia on Glycine Absorption in Operative Hysteroscopy
Bergeron, M.-È., Ouellet, P., Bujold, E., et al. (2011) · Anesthesia & Analgesia · doi:10.1213/ane.0b013e31822649d4 · Cited by 25 · see citing works
Trigoso, W. F., Wesly, J. M., Meranda, D. L., & Shenker, Y. (1996) · Human Reproduction · doi:10.1093/oxfordjournals.humrep.a019121 · Cited by 24 · see citing works
Davidson, B. J., Rea, C. D., & Valenzuela, G. J. (1988) · Fertility and Sterility · doi:10.1016/s0015-0282(16)60308-4 · Cited by 24 · see citing works
Sex differences in central cholinergic and angiotensinergic control of vasopressin release
Stone, J. D., Crofton, J. T., & Share, L. (1992) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.1992.263.5.r1030 · Cited by 22 · see citing works
(1997) · PubMed · Cited by 20 · see citing works
Estrogen-induced modulation of hypothalamic osmoregulation in female rats
Akaishi, T., & Sakuma, Y. (1990) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.1990.258.4.r924 · Cited by 18 · see citing works
Hormone Pellet Implantation for the Menopause and Premenstrual Syndrome
Studd, J. W. W., & Magos, A. L. (1987) · Obstetrics and Gynecology Clinics of North America · doi:10.1016/s0889-8545(21)00581-7 · Cited by 18 · see citing works
Posthysteroscopic hyponatremia: Evidence for a multifactorial cause
Agraharkar, M. L., & Agraharkar, A. (1997) · American Journal of Kidney Diseases · doi:10.1016/s0272-6386(97)90499-6 · Cited by 17 · see citing works
Oestrogen Receptor β: Role in Neurohypophyseal Neurones
Sladek, C. D., & Somponpun, S. J. (2004) · Journal of Neuroendocrinology · doi:10.1111/j.0953-8194.2004.01187.x · Cited by 16 · see citing works
Effect of 5α-pregnan-3α-ol-20-one on nitric oxide biosynthesis and plasma volume in rats
Lo, F., & Kaufman, S. (2001) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.2001.280.6.r1902 · Cited by 15 · see citing works
Amede, F. J., James, K. A., Michelis, M. F., et al. (2002) · International Urology and Nephrology · doi:10.1023/a:1025601304345 · Cited by 10 · see citing works
Kühl, H. (2004) · Maturitas · doi:10.1016/j.maturitas.2003.11.010 · Cited by 9 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- Arieff AI, Ayus JC. Pathogenesis of hyponatremic encephalopa- thy. Curr Concepts. Chest. 1993;103(2):607-610.
- Verney E. The antidiuretic hormone and the factors which deter- mine its release. Proc Soc Lond B Biol. 1947;135(878):25-105.
Cited by
Sorted by citations
Changes in body composition and weight during the menopause transition
Greendale, G. A., Sternfeld, B., Huang, M., Han, W., Karvonen-Gutierrez, C., Ruppert, K., Cauley, J. A., Finkelstein, J. S., Jiang, S.-F., & Karlamangla, A. S. (2019) · JCI Insight · doi:10.1172/jci.insight.124865 · Cited by 491 · see citing works
International society of sports nutrition position stand: nutritional concerns of the female athlete
Sims, S. T., Kerksick, C. M., Smith-Ryan, A. E., Janse de Jonge, X. A. K., Hirsch, K. R., Arent, S. M., Hewlings, S. J., Kleiner, S. M., Bustillo, E., Tartar, J. L., et al. (2023) · Journal of the International Society of Sports Nutrition · doi:10.1080/15502783.2023.2204066 · Cited by 91 · see citing works
“slower to excrete water (as compared to younger, premenopausal women) increasing the risk of hyponatremia [279,280].”
BackgroundGould, L. M., Gordon, A. N., Cabre, H. E., Hoyle, A. T., Ryan, E. D., Hackney, A. C., & Smith-Ryan, A. E. (2022) · Menopause · doi:10.1097/gme.0000000000001932 · Cited by 45 · see citing works
Nutritional Strategies and Sex Hormone Interactions in Women
Rehrer, N. J., McLay-Cooke, R. T., & Sims, S. T. (2017) · Sex Hormones, Exercise and Women · doi:10.1007/978-3-319-44558-8_6 · Cited by 6 · see citing works
- Authors
- Stachenfeld, N. S.
- Affiliations
- John B. Pierce Laboratory (US)
- Corresponding author
- Stachenfeld, Nina S.
- ORCID
- Stachenfeld, Nina S.
- Venue
- Reproductive Sciences
- Published
- 2014-05
- Volume
- 21
- Issue
- 5
- Pages
- 555-561
- ISSN
- 1933-7191 (ISSN-L)
- 1933-7205
- PMC
- PMC3984489
- OpenAlex
- W2073615153
- Cited by
- 111
- References
- 63
- Citations by year
- 2026: 15 · 2025: 14 · 2024: 10 · 2023: 16 · 2022: 11 · 2021: 8 · 2020: 7 · 2019: 11 · 2018: 4 · 2017: 2 · 2016: 4 · 2015: 5 · 2014: 4
- FWCI
- 0.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Reproductive Sciences (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- PepsiCo
- National Heart, Lung, and Blood Institute (R01HL062240, R01HL071159)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Estrogen and related hormone effects
- Keywords
- menopause, estrogen, progestogens, hormone therapy, hyponatremia, water retention, sodium retention, fluid regulation, thirst, dehydration, aldosterone, mineralocorticoid receptor, cardiovascular function, blood pressure, edema, hypertension, reproductive surgery
- MeSH terms
- Body Fluids, Estrogens, Female, Humans, Menopause, Progesterone, Thirst, Water-Electrolyte Balance
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
