Low estrogen levels in women or estrogen deficiency is linked to many undesirable side effects. These include weight gain, mood problems and even infertility. The major causes are said to be chemical overload and diseases in today’s lifestyles. Here are the causes, signs and symptoms, diet and treatment for estrogen hormone deficiency in women.
Causes of low estrogen in women
Estrogen deficiency occurs when estrogen level is low in the body. This is usually observed during menopause, but sometimes it can occur even before the menopause stage as well. This disturbs the menstrual cycle, which leads to more disorders. Some women may also have early menopause that is before the 40s. This also results in low estrogen levels in the body.
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Estrogen is a sex hormone that is responsible for female sexual characteristics. These characteristics in women include larger breasts, wider hips and more body fat than is typically seen in men. Estrogen is also the hormone that results in less hair and smoother skin in women. Although men also have some estrogen, this hormone is much higher in women. When a woman’s estrogen drops, a condition called low estrogen or deficiency develops.
The low estrogen level is termed as hypoestrogenism. The lower levels of estrogen may cause differences in the breasts, genitals, urinary tract, and skin. Other associated symptoms include:
- Presentations of hot flashes
- lowered libido
- Breast atrophy (reduced breast size).
- Reduced bone density leading to secondary osteoporosis
- Atrophic changes such as pH change in the vagina is also linked to estrogen deficiency.
In older women who are approaching menopause, decreasing estrogen levels are common and ultimately result in the cessation of menses (menstrual cycle). In younger women, low estrogen can result from several physical or behavioral problems, genetic problems or even nutritional problems.
Just the same way pregnancy causes a shift in a woman’s hormones, so does breastfeeding. This change in your hormone status is part of the normal physiology (normal body functioning) that makes nursing possible. Since these hormonal changes have an effect on other areas of your life, it can be helpful to know what is normal and what to expect.
Right after giving birth, your estrogen and progesterone levels drop to a great extent. This allows prolactin (the hormone that maintains milk production) to be released. When a baby latches on to the breast, oxytocin is released to help with the milk let (down reflex). Prolactin remains high in women who continue to breastfeed regularly, and this suppresses ovulation (production of ova). Because of this, the normal estrogen levels are decreased
Estrogen deficiency in women is associated with other effects in women. It is god to be aware of this though it is not always the case because other conditions are likely to precipitate the symptoms. The most common and prevalent symptoms are:
- Absence of periods
This should not always be assumed to be cause by low estrogen levels. It is often liked by most women but visit your health professional for more advice and certainty. This is so because disease conditions are also likely to cause lack of periods.
- Vaginal dryness and atrophy
Normal estrogen levels are what help maintain the tissues of the vagina. The low levels seen in breastfeeding can imitate the decreased hormone levels seen in menopause and can result in the same kind of thinning of the skin and increased vaginal dryness postmenopausal women sometimes experience. This may make sex uncomfortable and during intercourse.
- Decreased libido:
In as much as this is hard to link it to low libido, its presence during breastfeeding can act as an inference from which investigations can begin.
During menopause, the levels of estrogen goes down to a greater extent. This is because the ovaries ability to release the ova goes down greatly.
During menopause a woman’s body slowly produces less of the hormones estrogen and progesterone. This often happens between ages 45 and 55. A woman has reached menopause when she has not had a period for 12 months in a row. (Mayo Clinic)
A hysterectomy is one form of surgery that can result in low estrogen levels. A hysterectomy is the removal of the uterus and this can be partial, where the uterus is taken away but the ovaries remain, or a total hysterectomy. A total hysterectomy, which is also known as “surgical menopause”, is when the uterus, fallopian tubes, and ovaries are removed and this disrupts ovarian hormone production.
In the event of a hysterectomy, a woman enters into surgically-induced menopause and experiences hormone imbalance, regardless of whether or not her ovaries remain. Typically, the ovaries stop working within 1-3 years after a hysterectomy procedure as blood flow to them ceases.
4. Anorexia nervosa
Conditions, including anorexia nervosa, can disturb the activity of hormones such as estrogen within the body. Although this condition is rare in women entering menopause, it is important to remember that a balanced diet and active lifestyle are key to maintaining hormonal balance.
5. Testosterone insufficiency
Although predominant in men, testosterone insufficiency can contribute to low estrogen. Testosterone in women aids in estrogen synthesis to prevent and relieve menopausal symptoms such as hot flashes, vaginal dryness, urinary urgency and incontinence, low sexual drive. Testosterone also plays a role in preventing breast cancer and heart disease in menopausal women.
6. Excessive exercise
Extremely active female athletes often experience a drastic drop in estrogen levels as a result of their intense physical activity and loss of body fat, especially those participating in sports that value thinness, such as ballet, figure skating, gymnastics and running.
7. Other causes of estrogen deficiency
Other causes of low estrogen in women are related to the pituitary gland. In addition to eating disorders, extreme exercise and pituitary diseases can also result in insufficient estrogen levels. This is because such ailments lead to a miscommunication between the pituitary gland and the ovaries, with the pituitary gland failing to stimulate estrogen production in the ovaries, resulting in inadequate amounts being created.
For young women, in particular, the following conditions can each prompt low estrogen levels:
- Genetic diseases, such as Turner syndrome.
- Thyroid disorders
- Insufficient body fat
Low estrogen symptoms
What are the symptoms of low estrogen levels in women? There are several ranges of symptom categories that mean low levels of estrogen in women. They can broadly be classified as physical or behavioral. Physical symptoms include the following:
1. Hot flashes
Hot flashes usually begin when periods are still regular or are just starting to fluctuate. They are most uncomfortable in the first stages of perimenopause, gradually decreasing in frequency and intensity as the body adapts to the hormonal changes.
How does low estrogen cause hot flashes? Diminished estrogen levels are somehow responsible but exactly in what way remains a bit unclear. Withdrawal of estrogen causes an increase in the levels of the hormones FSH and LH.
The brain center that secretes these hormones, the hypothalamus, directs many body functions, including body temperature, sleep patterns, metabolic rate, mood, and reaction to stress. The higher the levels of FSH and LH, the more the blood vessels dilate, or enlarge, this increases blood flow to the skin, which in turn raises its temperature.
Fatigue is a tell-tale sign of hormonal imbalance in women, especially prevalent during perimenopause and menopause. It is a medical term used to describe a state of lethargy; feeling tiresome and worn out for an extended period of time.
Having steady estrogen levels may improve headaches, while experiencing estrogen levels that dip or change can make headaches worse. The drop in estrogen just before your period may contribute to headaches. Many women with migraines report headaches before or during menstruation. [Mayo Clinic]
3. Vaginal and bladder infections
From research, it has been found out that estrogen encourages production of natural antimicrobial substances in the bladder.
- The hormone also makes the urinary tract tissue stronger by closing the gaps between cells that line the bladder.
- By gluing these gaps together, estrogen makes it harder for bacteria to penetrate the deeper layers of the bladder wall, the study authors said.
Estrogen also helps prevent too many cells from shedding from the top layers of the bladder wall. Deficiency of the hormone therefore increases the likelihood of having infections in the urinary tract and bladder.
4. Painful intercourse
The vagina, clitoris, urethra (the tube leading from the outside of your body to the bladder), bladder and other urogenital components all contain significant numbers of estrogen receptors. This hence means they rely on estrogen for healthy functioning.
As estrogen levels decline and less reaches these tissues, they literally atrophy or shrink, not just dry up but sometimes resulting in a significant negative effect on your sex life.
Estrogen produced by the ovaries helps prevent bone loss and works together with calcium, vitamin D and other hormones and minerals to build bones. Osteoporosis occurs when bones become too weak and brittle to support normal activities.
Your body constantly builds and remodels bone through a process called resorption and deposition. Up until around age 30, your body makes more new bone than it breaks down. But once estrogen levels start to decline, this process slows.
Thus, after menopause your body breaks down more bone than it rebuilds. In the years immediately after menopause, women may lose as much as 20 percent of their bone mass. Although the rate of bone loss eventually levels off after menopause, keeping bone structures strong and healthy to prevent osteoporosis becomes more of a challenge.
6. Episodes of rapid heartbeat
Irregular heartbeat is a common symptom many women experience during menopause. This cardiovascular phenomenon is often prompted by changing estrogen levels, which naturally occur as a woman approaches menopause.
Some of the emotional problems during episodes of low estrogen include:
- Minor anxiety
- Feelings of despair
- Crying easily
Which birth control pills have low estrogen? How do birth control pills work? Birth control pills contain either a combination of synthetic estrogen and progestin or progestin alone. Progestin is a man-made hormone that functions like progesterone. These hormones work in different ways to prevent pregnancy.
Estrogen and progestin both prevent the pituitary gland from producing hormones that trigger ovulation. Progestin also thickens your cervical mucus. This makes it harder for sperm to reach any released eggs. Progestin also thins the uterine lining. This makes it harder for an egg to implant there if the sperm fertilizes one.
There are several brands that have come on market and they contain very little estrogen and therefore minimal. There are some disadvantages of taking a low-dose combination pill, though. These may include:
- An increased risk of heart attack
- An increased risk of stroke
- An increased risk of blood clots
- Reduced milk production, which is why doctors don’t recommend this pill if you’re breast-feeding
- Spotting between periods
The various brands available are grouped into ultra-estrogen birth control pills and low estrogen birth control pills. The ultra-low estrogen birth control pills have low have 0.02 mg of estrogen. Low estrogen birth control pills have between 0.02mg and 0.035 mg of estrogen. The birth control pills may include:
There are two ultra-low dose varieties:
- Alesse (Aviane, Lessina, Lutera, Sronyx): It contains 0.02 mg ethinyl estradiol and 0.1 mg levonorgestrel (a kind of progestin – read more about progestin types in my blog here and here)
- Mircette: It contains 0.02 mg ethinyl estradiol and 0.15 mg desogestrel (a kind of progestin).
The favorite and widely used are the low estrogen birth control pills that may include:
- LoOvral: It contains 0.03 mg ethinyl estradiol and 0.3 mg norgestrel (progestin)
- Nordette: It contains 0.03 mg ethinyl estradiol and 0.15 mg levonorgestrel
- Ortho-Cept (Reclipsen, Solia): It contains 0.03 mg ethinyl estradiol and 0.15 mg desogestrel
- Desogen: It contains 0.03 mg ethinyl estradiol and 0.15 mg desogestrel
- Levlen 21: It contains 0.03 mg of ethinyl estradiol and 0.15 mg of levonorgestrel
Low estrogen levels side effects
Women with estrogen deficiency may experience a number of side effects. These range from difficulty in losing weight, hair loss, constant headaches to anxiety and fatigue. Below is a list of the most common signs and symptoms that you are suffering from a deficient amount of female hormones.
1. Weight gain
According to Mayo Clinic, “Scientists have long known that lower estrogen levels after menopause can cause fat storage to shift from the hips and thighs to the abdomen. Proteins, revved up by the estrogen drop, cause fat cells to store more fat, then it gets worse. These cellular changes also slow down fat burning by the body.”
2. Hair loss
Estrogen functions in the body to nourish the hair follicles and this in the end result leads to growth of hair to full length and strength. There is need to balance between estrogen and male hormones especially testosterone.
Male hormones encourage hair loss. In the body, the level of androgens should be kept at bay since any overproduction leads to hair loss.
Acne results when the skin’s sebaceous glands produce too much of the oil known as sebum, clogging pores and causing an overgrowth of the bacteria that normally lives in those glands. This leads to inflammation, whiteheads and blackheads. Low levels of estrogen, coupled with high levels of androgen hormones, can cause the sebaceous glands to overproduce sebum.
4. Headaches or migraines
A drop in estrogen levels can trigger migraines. That’s why some women get headaches just before their period, which is when estrogen levels dip. If you have these menstrual migraines, birth control pills might help prevent your headaches by keeping your estrogen levels stable throughout the menstrual cycle
Low levels of estrogen in the body is likely to bring about depression. The reason is that estrogen plays an important role in regulating the hormones that control depression.
It boosts serotonin, which helps fight depression and promotes sleep. It also increases GABA, the calming neurotransmitter and raises endorphins, which help you feel good. Low estrogen levels often found in menopause can cause feelings of sadness and hopelessness.
Hormonal changes have from time to time been associated with heightened anxiety. There is an increase in anxiety and frequency of panic attacks during Premenstrual syndrome, post-childbirth, perimenopause and menopause.
- Women with low progesterone levels are prone to anxiety, whereas women with decreased estrogen levels are susceptible to panic attacks.
Estrogen helps to stimulate the production and transportation of serotonin around the body, and prevents its break down. Therefore, when estrogen levels are low serotonin is low and an unstable mood and anxiety can develop.
7. Joint pain
The hormone estrogen plays an important role in maintaining joint and bone health. As you reach the menopause, levels of estrogen in your body begin to drop. This gives rise to common menopause symptoms including hot flushes and night sweats, and may also result in swollen and painful joints.
8. Fatigue, dizziness and lack of sleep
Estrogen deficiency can cause insomnia. This is because of its effect on the production of serotonin to help maintain good quality sleep. As a result, you will not have adequate time to get refreshed and in the end result lead to fatigue, dizziness, mood swings, depression, and an inability to concentrate.
If your estrogen levels are low, an imbalance in your natural menstruation cycle may occur because of the normal feedback mechanisms of the hypothalamus and pituitary malfunctioning. In such a case, you will find that the lining of her uterus is inadequate and unhospitable for pregnancy to occur. Most of the time, in such a situation, ovulation may not even occur.
In menopause, the level of estrogens goes down. At the end of it all end-result progesterone dominates over estrogens. This slows down your food transit in the gut, leading to menopause and constipation issues.
In this regard, the link between low estrogen and constipation can be explained as:
- The slowing down of intestinal and colonic motility
- The drying up of the digestive process, less digestive juices available to the digestive process means drier feces (bile in particular is our natural laxative)
11. Dry skin
When estrogen levels drop during menopause, the skin gets more wrinkled and dry, and in some women, it can even be itchy.” This is because oil glands in the skin shrink after menopause, and less is secrete.
12. No period or missed period
In the event that the level of estrogen goes below the normal, then it therefore follows that the will be no signal sent to the ovaries to begin the process of ovulation. In the end result, there arises a situation of absence of periods.
Our main estrogen—estradiol—sensitizes the brain to oxytocin and dopamine, and also triggers the release of serotonin. Too much can cause irritability (especially without the balancing effect of progesterone). Too little can cause depression and severe insomnia
14. Polycystic ovarian syndrome (PCOS)
When monthly bleeding ends (estrogen is low), the hypothalamus secretes gonadotropin-releasing hormone (GnRH), which stimulates the pituitary gland in the brain to release follicle stimulating hormone (FSH) and luteinizing hormone (LH). These hormones direct an ovary to start making estrogen to curb the insufficiency.
Low estrogen treatment
In order to arrest the condition, it is good to know that low estrogen level treatment is based on the underlying cause. Younger women going through menopause are not treated the same as older women with low estrogen levels. In all cases, the underlying cause determines the specific treatment.
There are both natural and chemical remedies available to help treat low levels of estrogen. The key chemical therapy involves hormone replacement therapy. This therapy is broken down into two broad categories:
- Estrogen alone therapy (ET)
- Estrogen combined with progestogen therapy (E/PT).
Hormone therapy is the most effective treatment for hot flushes and also decreases sleep disturbances, directly or indirectly, thereby improving quality of life. Hormone replacement therapy medications containing female hormones to replace the ones the body no longer makes after menopause, used to be a standard treatment for women with hot flashes and other menopause symptoms. Hormone therapy was also thought to have the long-term benefits of preventing heart disease and possibly dementia. [Mayo Clinic]
This approach is also associated with some side effects which include:
- Heart disease
- Blood clots
- Breast cancer