Estrogen deficiency

Introduction

Estrogens, like gestagens, are the sex hormones (reproduction hormones) of women. They are mainly produced in the ovaries, but to a lesser extent also in the adrenal cortex, connective tissue and fatty tissue. The production of the sex hormones is subject to a control circuit between structures in the brain (pituitary gland and hypothalamus) and the ovaries.

Oestrogens influence the sexual organs (structure of the uterine lining, growth of the uterine muscles, quantity and nature of vaginal discharge) and the formation of secondary sexual characteristics (growth of the mammary gland during puberty, high voice, female body appearance with wide hips, narrow waist and narrow shoulders). During puberty, the estrogens also cause the growth spurt. A lack of estrogens can have many different causes and many different effects.

Causes

An oestrogen deficiency or a lowered oestrogen level is physiological in women during the menopause (climacteric) or after the menopause – that is, it is completely natural. During the menopause, which usually occurs between the ages of 45 and 55, the ovaries stop producing estrogens. This results in a lack of estrogens with a variety of symptoms.

In pre-menopausal women, estrogen deficiency can be caused by impaired function and/or malformation of the ovaries. The malfunction of the ovaries is divided into primary and secondary forms. In the case of primary dysfunction, the problem lies with the ovaries themselves.

They can no longer perform their tasks (egg cell maturation and hormone production) due to malformation or dysfunction. Premature “fatigue” of the ovaries before menopause can occur, for example, after autoimmune processes (in the ovaries themselves), after chemo- or radiotherapy or metabolic diseases such as diabetes mellitus. If the primary functional disorder of the ovaries occurs before the age of 40, this is known as “climacterium praecox” (premature menopause).

The woman becomes prematurely infertile because the eggs no longer mature and ovulation cannot occur. This phenomenon occurs more frequently in families. If the mother has entered the menopause early, it may be important for the daughter not to start her family planning too late.

In the case of secondary ovarian dysfunction, the problem lies at the level of the hypothalamus or pituitary gland in the brain, but the ovaries themselves are actually functional. If, due to a disorder of the brain, the impulses to the ovaries are missing, the ovaries do not produce hormones. Causes of the disorders in the corresponding areas can be inflammatory processes, trauma, tumors, stress, excessive physical activity, severe underweight (anorexia nervosa: in anorexic patients, periods often stop because the menstrual cycle no longer functions properly and therefore a regular cycle does not occur), depression and endocrine disorders such as hypothyroidism.

A so-called gonadal dysgenesis describes the congenital, genetically determined absence of the ovaries. Since no estrogens are produced here, the sexual organs do not mature during puberty. The affected women do not get their period (primary amenorrhea) and remain infertile.

Gonadal dysgenesia occurs in the context of rare genetic syndromes such as Turner syndrome or Klinefelter syndrome. Of course, estrogen production is also reduced after surgical removal of one or both ovaries (ovarectomy). An ovarectomy can be part of the therapy for the following clinical pictures, for example: ovarian tumors, ovarian endometriosis, breast cancer, cancer of the fallopian tubes.

The menopause (climacteric) is the transitional phase from a woman’s reproductive period (the time when she is fertile) to the absence of menstruation. During this period, the ovaries gradually cease to function. The menopause usually begins between the ages of 40 and 50.

The production of estrogens decreases, the cycle becomes irregular and periods become less frequent. Menopause is defined as the time of the last menstruation, on average in the 52nd year of life. The hormonal change can proceed without symptoms, but some women unfortunately suffer from the typical “menopausal symptoms”.The symptoms of sex hormone deficiency can be many and varied: they include outbreaks of sweating, hot flushes, dizziness, headaches, sleep disorders, skin changes, urinary tract problems, cardiac arrhythmia, nervousness, irritability and depressed mood.

In addition, vaginal dryness can occur, which on the one hand leads to pain during sexual intercourse and on the other hand promotes infections with bacteria or fungi. In the long term, the estrogen deficiency can cause osteoporosis (bone loss) and arteriosclerosis (deposition in the vessel walls). These diseases are associated with increased risks of bone fractures and circulatory problems, for example in the legs or heart.

If the unpleasant symptoms during menopause are very pronounced, hormone replacement therapy may be considered. In this therapy, the female sex hormones (estrogens and gestagens) are replaced by drugs in the form of tablets, patches or creams. Creams, vaginal rings or pessaries (hard plastic pieces that hold the uterus in position) are also available for local treatment.

Hormone substitution can improve the above-mentioned complaints and reduce the long-term consequences such as osteoporosis. One disadvantage of hormone replacement therapy with estrogens is that it can increase the risk of breast cancer and uterine cancer. Alternative treatment methods come from the field of naturopathy and include, for example, cupping (using negative pressure through small glasses on the skin to release tension and relieve pain), neural therapy (local anesthetics are said to affect the autonomic nervous system), moorland baths and the use of cimicifuga rootstock (plant extracts that are said to have estrogen-like effects).

The frequently lamented weight gain during menopause is not so much due to hormonal changes as to the body’s age-related decreased basal metabolic rate. The greatest energy turnover takes place in the muscles. Shrinking muscle mass due to lack of exercise while eating habits remain the same therefore leads to weight gain.

The hormonal changes can also lead to a conversion of the fat reserves. The relative predominance of male sex hormones causes increased fat storage in the trunk, especially in the abdomen and around the internal organs. This can influence the metabolism and promote the development of adult-onset diabetes and rising cholesterol levels.