Estrogen is a group of hormones influencing reproductive health, bone density, skin health, and mood regulation in the female body. Estradiol (E2) is the most active form during a woman’s reproductive years, while estrone (E1) becomes more prevalent after menopause. Estrogen contributes to female secondary sex characteristics, the menstrual cycle, and preparing the uterine lining for pregnancy. Estrogen deficiency occurs when the body does not produce adequate amounts of these hormones, leading to various health concerns.
Understanding the Causes
A decline in estrogen levels can stem from several factors, with natural menopause being the most common cause. Surgical removal of the ovaries, known as oophorectomy, also results in an abrupt drop in estrogen. Primary ovarian insufficiency (POI) causes ovaries to stop functioning before age 40, leading to reduced estrogen production. POI can result from autoimmune diseases, genetic conditions like Turner syndrome, infections, or cancer treatments such as chemotherapy and radiation.
Certain medical conditions can also contribute to low estrogen. Thyroid disorders or issues with the pituitary gland, which regulates ovarian function, can disrupt hormone balance. Lifestyle factors such as excessive exercise or eating disorders like anorexia nervosa can also suppress ovarian function and lead to lower estrogen levels.
Recognizing the Signs
Estrogen deficiency manifests through a variety of signs. Vasomotor symptoms are common, including hot flashes, which are sudden feelings of warmth often accompanied by sweating and flushed skin, and night sweats, which are hot flashes occurring during sleep that can disrupt rest.
Genitourinary symptoms arise from reduced estrogen, which affects the thickness and elasticity of vaginal tissues. This can lead to vaginal dryness, irritation, burning, and discomfort or pain during intercourse (dyspareunia). This can also increase the risk of inflammation and infection, including urinary tract infections.
Psychological and cognitive changes are also associated with low estrogen. Many individuals report mood swings, irritability, anxiety, and feelings of depression. Difficulty concentrating, memory lapses, and general “brain fog” are also common. Sleep disturbances, such as difficulty falling or staying asleep, and fatigue often accompany these symptoms. Physical changes may include thinning hair and dry skin, reflecting estrogen’s role in skin health.
Diagnosis and Management
Diagnosing estrogen deficiency involves a comprehensive assessment of symptoms and medical history. Healthcare providers will order blood tests to measure hormone levels, including estradiol (E2), follicle-stimulating hormone (FSH), and luteinizing hormone (LH). Estradiol levels, primarily produced by the ovaries, are low in cases of deficiency, while elevated FSH and LH levels can indicate that the pituitary gland is working harder to stimulate the ovaries, which are not responding adequately.
Management approaches vary and are individualized based on the specific cause and severity of symptoms. Hormone Replacement Therapy (HRT) is a common medical treatment that replenishes declining hormone levels. HRT can be administered systemically through pills, patches, gels, sprays, or vaginal rings, or locally with creams or supposions for vaginal symptoms. For individuals with a uterus, HRT includes both estrogen and a progestogen to prevent endometrial hyperplasia and a small increased risk of endometrial cancer that can occur with estrogen alone.
Non-hormonal prescription medications can also alleviate specific symptoms. For instance, certain antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs), can help manage hot flashes and mood swings. Gabapentin or fezolinetant are also options for hot flashes. Vaginal moisturizers and lubricants can address vaginal dryness and painful intercourse.
Lifestyle modifications play a supportive role in managing symptoms and improving overall well-being. Regular exercise, a balanced diet rich in calcium and vitamin D, and stress management techniques can be beneficial. Avoiding smoking and reducing alcohol and caffeine intake may also help alleviate hot flashes.
Potential Long-Term Health Impacts
If left unaddressed, estrogen deficiency can lead to several long-term health consequences. One impact is an increased risk of osteoporosis and bone fractures. Estrogen plays a protective role in bone health by promoting bone formation and inhibiting bone breakdown. The most rapid bone loss occurs in the years immediately following the final menstrual period.
Estrogen deficiency is also linked to an increased risk of cardiovascular disease, including heart disease and stroke. Low estrogen levels can negatively affect cholesterol profiles, promote central fat accumulation, and influence blood pressure, thereby accelerating cardiovascular disease development. A potential link between low estrogen and cognitive changes, such as memory issues, is also suggested. Early diagnosis and appropriate management can help mitigate these potential long-term health risks.