Oestrogen is a hormone primarily known for its role in female reproduction, influencing menstrual cycles and pregnancy. Beyond these functions, it also impacts various bodily systems, contributing to bone health, cardiovascular well-being, and cognitive function. When the body produces insufficient levels of this hormone, oestrogen deficiency can arise, affecting overall health.
Understanding Oestrogen Deficiency
A common reason for decreased oestrogen is menopause, occurring around age 51, when the ovaries gradually reduce hormone production and egg release. Some women experience premature ovarian insufficiency (POI), where ovaries stop functioning before age 40, leading to an early decline in oestrogen. This can occur spontaneously or due to medical interventions.
Surgical removal of the ovaries (oophorectomy) causes an abrupt drop in oestrogen levels, leading to sudden menopause. Certain medical conditions can also suppress oestrogen production, including autoimmune disorders like Addison disease or thyroid disease, and genetic conditions such as Turner syndrome. Cancer treatments like chemotherapy and radiation can damage the ovaries, affecting hormone production. Some medications may also influence oestrogen levels, contributing to deficiency.
Recognizing the Signs
Oestrogen deficiency can cause a range of physical and mental changes, with varying severity. Vasomotor symptoms like hot flashes, sudden warmth, sweating, and chills, and night sweats are common. These are caused by fluctuating oestrogen levels affecting the body’s temperature regulation.
Genitourinary Syndrome of Menopause (GSM) manifests as vaginal dryness, itching, irritation, and discomfort during sexual intercourse. Lower oestrogen levels thin and dry vaginal and urinary tract tissues, increasing the risk of recurrent urinary tract infections. Mood and cognitive changes are also common, including mood swings, irritability, anxiety, difficulty concentrating, and memory lapses.
Sleep disturbances, such as insomnia, are often linked to night sweats, contributing to daytime fatigue. Oestrogen deficiency can also affect bone health, leading to joint pain and accelerated bone density loss, which increases the risk of osteoporosis. Dry skin and thinning hair may also occur due to reduced collagen production and hydration. Menstrual irregularities, such as changes in period length, flow, frequency, or cessation, are often among the first noticeable signs, especially in perimenopause.
Diagnosis and Management Approaches
Diagnosis of oestrogen deficiency begins with a thorough review of symptoms and a physical examination. Symptom pattern and severity guide the diagnostic process. Blood tests often measure hormone levels, particularly estradiol, the main form of oestrogen produced by the ovaries before menopause.
Healthcare providers may also check levels of follicle-stimulating hormone (FSH), produced by the pituitary gland to stimulate the ovaries. High FSH levels indicate inadequate ovarian response, suggesting declining function. While oestradiol levels can fluctuate significantly during perimenopause, making a single measurement less conclusive, consistently low oestradiol or high FSH levels, especially in women under 40 with suspected premature ovarian insufficiency, support a diagnosis of oestrogen deficiency.
Management varies depending on symptoms, age, and overall health. Hormone replacement therapy (HRT), also known as menopausal hormone therapy (MHT), involves replacing oestrogen, often with progesterone if a woman has a uterus. HRT is available in various forms, including pills, patches, gels, creams, and vaginal rings, and is highly effective for relieving symptoms like hot flashes and vaginal dryness. Discussing benefits and potential risks, such as those related to cardiovascular health or certain cancers, with a doctor is important.
Non-hormonal therapies offer symptom management alternatives. Selective serotonin reuptake inhibitors (SSRIs) or gabapentin can reduce hot flashes. For vaginal dryness, local vaginal oestrogen preparations like creams, tablets, or rings can provide targeted relief. Lifestyle adjustments also manage symptoms and support overall health. A balanced diet rich in calcium and vitamin D supports bone health, and regular weight-bearing exercise helps maintain bone density and muscle mass. Stress management techniques and avoiding hot flash triggers like caffeine or spicy foods can also provide relief.
Potential Long-Term Health Risks
Unaddressed oestrogen deficiency can lead to several long-term health consequences. One risk is osteoporosis, where accelerated bone loss makes bones brittle and more susceptible to fractures. Oestrogen preserves bone mass by signaling cells to reduce bone breakdown; its decline can lead to rapid bone density loss, especially in the initial years after menopause.
Cardiovascular health can also be impacted, as low oestrogen levels link to an increased risk of heart disease and stroke. Oestrogen protects the cardiovascular system by influencing cholesterol levels, blood pressure, and fat distribution. Its absence can contribute to adverse changes that heighten cardiovascular risk.
Cognitive decline is another concern, with fluctuating or declining oestrogen levels associated with changes in brain connectivity and reduced activation in memory and attention areas. While not everyone experiences progressive cognitive impairment, a link exists to increased dementia risk, including Alzheimer’s disease, particularly with earlier menopause and prolonged oestrogen deficiency. Other issues include muscle mass decline, joint deterioration, and a reduction in overall quality of life. Timely diagnosis and management are important to mitigate these risks.