Estrogen deficiency: Description
In estrogen deficiency, the concentration of estrogens (such as estradiol) in the body is too low. This is a group of steroid hormones that are primarily responsible for the development and regulation of the female reproductive system, as well as the development of secondary sexual characteristics (such as breasts).
Men also have small amounts of estrogen. Here, the hormones are important for bone health and fat metabolism, among other things.
You can read more about the formation and tasks of these sex hormones in the article Estrogen.
Estrogen deficiency: symptoms
Estrogen deficiency manifests itself in various symptoms that affect general health and well-being. The following list contains the most common symptoms that typically show up in estrogen deficiency:
Irregular or absent menstrual periods.
Estrogen plays a critical role in regulating the menstrual cycle in women. Therefore, low estrogen levels often cause irregular or weakened periods. Sometimes the period even stops altogether (amenorrhea).
These changes can be very stressful for affected women. They also affect women’s fertility.
Hot flashes and night sweats
In addition, the sudden feelings of heat and sweating (sometimes combined with palpitations) disturb sleep. During the day, women are often tired and irritable as a result.
However, hot flashes do not always accompany the hormonal change – some women also report feeling cold, probably due to circulatory problems.
Dry, thinner mucous membranes in the urinary and sexual tract
Estrogen deficiency changes the mucous membranes, especially in the urinary and sexual tract (urogenital tract). They become thinner, drier and less elastic.
Consequences for the urinary tract
In the urinary tract, the changes can cause problems with urination: Drying of the mucosa can cause itching and burning in the urethra. More often, those affected also have an increased urge to urinate, but only excrete small amounts of urine when urinating (pollakiuria).
The thinning of the mucous membrane as a result of estrogen deficiency can also promote inflammation, for example of the bladder (cystitis).
Consequences for the genital tract
Estrogen deficiency also causes the tissue of the vagina to dry out and shrink (atrophy). This can make sexual intercourse uncomfortable to painful for affected women.
Another contributing factor is that the lack of estrogen changes the discharge from the vagina. It often becomes thinner and less slippery.
More brittle bones
Estrogen is essential for high bone density and thus for strong bones. It regulates the activity of bone-forming cells (osteoblasts) and bone-degrading cells (osteoclasts).
Bone density therefore decreases when estrogen levels are low. The bones thus become more fragile, and the risk of osteoporosis (with consequences such as back pain, bone fractures even without great force, etc.) increases.
Psychological symptoms
Estrogen plays a role in regulating mood and emotional well-being.
Accordingly, estrogen deficiency contributes to mood swings, depressed mood and anxiety. As a result, sufferers’ social relationships and work performance often suffer.
Cognitive impairment
If blood levels of estrogen are too low, this has a negative effect on cognitive functions and memory. Estrogen deficiency is associated with an increased risk of Alzheimer’s disease and other forms of dementia.
Cardiovascular risks
Estrogen has a protective effect on the cardiovascular system, for example by contributing to elastic blood vessels (important for blood pressure regulation) and positively affecting lipid metabolism.
Estrogen deficiency can therefore increase the risk of heart disease, stroke and other cardiovascular problems.
Weight gain
In menopausal women, however, weight gain can be triggered not only by estrogen deficiency but also by a reduced basal metabolic rate and increased hunger. Water retention in the tissues (edema), which occurs more frequently in the period before the last menstrual period (menopause), also often drives up the weight reading on the scale.
Pain
Estrogen deficiency may weaken the pelvic floor muscles and ligaments, which can cause abdominal pain and discomfort. However, the study evidence on this is unclear.
Estrogen deficiency is also associated with accelerated aging of the intervertebral discs, which often triggers back pain.
In addition, estrogen deficiency contributes to joint pain and inflammation because estrogen has anti-inflammatory properties.
Hair loss
Estrogens play a role in hair growth and maintaining healthy skin. Therefore, when estrogen is deficient, hair thins out and becomes more brittle. In some cases, this results in visible hair loss.
Difficulty swallowing and snoring
So far, however, it is unclear by which mechanisms exactly the hormonal changes during menopause (such as estrogen deficiency) can cause swallowing difficulties.
Some menopausal women also report snoring more frequently or suffering from sleep apnea syndrome. Whether estrogen deficiency triggers these complaints has not yet been proven.
Estrogen deficiency: treatment
Whether and how estrogen deficiency is treated depends on the individual case. The decisive factors are, for example, what causes the low estrogen level and how severe the resulting symptoms are.
In principle, there are various ways to compensate for an estrogen deficiency:
Hormone replacement therapy (HRT).
HRT is the most common treatment method to correct an estrogen deficiency, especially in women with menopausal symptoms. However, the aim is not to restore hormone levels to pre-menopausal levels.
Rather, the aim is to increase the blood level of estrogen to such an extent that the distressing symptoms of estrogen deficiency subside.
To achieve this, patients are given estrogen (often combined with progesterone) in the form of pills, patches, gels, creams or vaginal rings. This can alleviate the unpleasant signs of estrogen deficiency such as hot flashes, night sweats and vaginal dryness, thus significantly improving the quality of life of those affected.
Hormone replacement therapy has proven to be a safe and effective treatment for many women suffering from distressing menopausal symptoms. Nevertheless, it also carries risks:
For example, HRT increases the risk of blood clots and resulting vascular occlusion, such as stroke or pulmonary embolism. The risk of some cancers (such as breast cancer) also increases.
However, these risks can be reduced by doctors adapting the hormone treatment individually to a woman’s medical history and existing risk factors – for example, with regard to the type and dosage of the hormone preparation.
Read more about the benefits and risks of HRT in the article Hormone Replacement Therapy.
Local estrogen therapy
For women who suffer from localized symptoms such as dryness and tissue atrophy in the vaginal area, a pure vaginal estrogen preparation may be an effective treatment.
Via a vaginal cream, vaginal tablets or a vaginal ring, the vaginal tissue receives a low dose of estrogen directly. This allows the local amount of hormone to be increased, which can relieve the local symptoms of estrogen deficiency – with minimal systemic side effects.
Exception: High-dose estradiol creams
As a result – as with other forms of hormone replacement therapy – systemic side effects may occur, for example an increased risk of breast and ovarian cancer and blood clots.
Apart from this, some women react to local estrogen application, for example, with temporary itching, skin burning and/or skin rash.
You should only use high-dose estradiol vaginal creams for a single treatment cycle over a maximum of four weeks. You should also refrain from using them if you are already using another hormone replacement therapy medication (e.g., hormone tablets).
Selective estrogen receptor modulators (SERMs).
SERMs are a class of drugs that act selectively on the docking sites (receptors) of estrogen in various tissues. They can thus help alleviate certain symptoms of estrogen deficiency, such as bone loss, without the risks associated with conventional HRT.
One representative of this group of agents is raloxifene. It is approved for the prevention and treatment of osteoporosis in post-menopausal women.
Bioidentical hormone replacement therapy (BHRT)
However, it is important to remember that the safety and efficacy of BHRT have not yet been clearly proven.
Estrogen deficiency: What you can do yourself
If you suffer from symptoms such as hot flashes, sleep disturbances and weight gain as a result of an estrogen deficiency, you can also do something about it yourself.
Healthy lifestyle
A healthy lifestyle can help alleviate some symptoms of estrogen deficiency and increase overall well-being. Meaningful actions include:
- regular exercise
- balanced diet
- stress management / stress reduction
- Maintaining a healthy weight
These strategies have a positive effect on hormone balance.
Medicinal plants
Some plants such as soy and red clover contain so-called phytoestrogens. These are plant compounds with estrogen-like effects. This is why dietary supplements containing soy or red clover extracts, for example, are often used to treat menopausal symptoms.
According to the current guideline on peri- and postmenopause, phytoestrogens may indeed be beneficial. However, the data are unclear, and the safety of many preparations is uncertain.
Another medicinal plant that is often mentioned as an effective aid against hot flashes & co. is black cohosh (Cimicifuga). Standardized extracts of the medicinal plant are officially approved as medicines to alleviate menopausal symptoms.
Alternative medicine
Some alternative methods such as acupuncture or yoga are also said to be able to relieve estrogen deficiency symptoms. The effectiveness of these methods has not yet been clearly proven.
Some women nevertheless rely on them and use them – often in addition to other measures (such as hormone replacement therapy) as part of a holistic treatment plan.
Estrogen deficiency: causes and risk factors
A variety of causes and risk factors favor the development of estrogen deficiency. The most common are:
Menopause
Menopause is a natural biological process that marks the end of a woman’s fertile (reproductive) years: Estrogen production in the ovaries gradually decreases.
At some point, the last menstrual period (menopause) occurs. This usually happens between the ages of 45 and 55.
Premature menopause
Doctors speak of premature menopause when the ovaries stop functioning before the age of 40 and thus also stop producing estrogen. Another term for this is primary ovarian failure (POF).
The associated estrogen deficiency can trigger the same symptoms in young women as occur in older women during the “normal” menopause – for example, vaginal dryness and hot flashes.
Medical treatments
Various medical procedures can also be responsible for too little estrogen.
For example, if one or both ovaries are surgically removed (called an oophorectomy or ovariectomy), this naturally reduces estrogen production. Chemotherapy and radiation therapy can have the same effect.
However, these treatments are often mandatory to treat various conditions such as cancer or endometriosis.
Hypogonadism
The term hypogonadism refers to an underactivity of the gonads (ovaries, testes). Especially in the case of the ovaries, this is associated with limited hormone production, i.e. estrogen deficiency.
Hypogonadism may be due to congenital disorders such as Turner syndrome or to acquired disorders such as polycystic ovary syndrome (PCOS). It causes puberty to be delayed in adolescents. In some cases, infertility and various health problems also develop.
Unfavorable lifestyle factors
Sometimes an unhealthy lifestyle is the reason when estrogen is too low.
For example, extreme weight loss, excessive exercise and eating disorders disturb the hormonal balance of the body. This can result in low estrogen levels, among other things.
Genetic factors and autoimmune diseases
For example, in autoimmune oophoritis, the immune system attacks the ovaries, causing the tissue to become inflamed. As a result, the ovaries fail prematurely (primary ovarian failure, POF) – estrogen levels drop.
Estrogen deficiency: examinations and diagnosis
To detect estrogen deficiency, a thorough evaluation of the medical history, a physical examination, and laboratory tests are necessary – and sometimes other tests as well. The goal is to determine the underlying cause of the hormone deficiency and to rule out other possible conditions that cause similar symptoms.
Medical history
The doctor will first take your medical history (anamnesis). This may include information about your menstrual cycle, the onset of menopause, previous surgeries, and any medical history.
The doctor will also ask you in detail about your symptoms. These may provide more specific information about a hormonal imbalance.
Physical examination
Based on a physical exam, the doctor will assess your general health and look for visible signs of estrogen deficiency (e.g., dry mucous membranes, hair loss).
Laboratory tests
Afterwards, blood tests are often scheduled to measure various hormone levels. Most commonly, blood levels of estrogen, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) are determined.
In addition, tests of thyroid function and other hormones are often necessary to rule out conditions with symptoms similar to estrogen deficiency.
Imaging studies
In some cases, imaging studies are helpful to clarify estrogen deficiency in more detail.
For example, an ultrasound examination or magnetic resonance imaging (MRI) can be used to visualize the ovaries and assess their structure and function. This can help detect conditions such as polycystic ovary syndrome (PCOS) or tumors that may be causing estrogen deficiency.
Additional tests
If an autoimmune or genetic cause of estrogen deficiency is suspected, additional tests are needed to confirm the diagnosis.
For example, a karyotype analysis helps to detect a chromosomal abnormality such as Turner syndrome, which causes hypogonadism of the gonads and thus estrogen deficiency.
