Estrogen deficiency - symptoms & remedies

What Is Estrogen, And What Is Its Function?

Estrogen is a significant sex hormone that is mainly produced in the ovaries of women but is also found in small amounts in the testicles of men and the adrenal glands of both sexes. Estrogen affects many bodily functions in both sexes, including bone metabolism, the cardiovascular system, the brain, immune function, skin elasticity and moisture, and the genitourinary system. [1]

Chemically, estrogen is a member of the steroid hormone group and exists in several forms, including estradiol (E2), estrone (E1), and estriol (E3). Estradiol is the most effective and most influential form in women of childbearing age.

However, estrogen has partially different functions in the male and female bodies.

In women, it regulates the menstrual cycle, promotes the development of secondary sexual organs and characteristics, regulates the female reproductive system and supports pregnancy. With age, the female body naturally produces less estrogen, leading to perimenopause and postmenopause. [2]

In the male body, estrogen is found mainly in the form of estradiol, produced by converting testosterone using the enzyme aromatase. In men, estrogen contributes to the regulation of libido (sex drive) and cholesterol levels and plays a role in spermatogenesis. [3]

An imbalance, estrogen deficiency, can significantly impact your health.

What Are the Causes of Estrogen Deficiency?

Menopause

During the menopause and with the ageing process, hormone production in the ovaries in the female body decreases, resulting in lower estrogen levels. This leads to the typical menopausal symptoms, which can be the cause of low estrogen levels.

Primary Ovarian Insufficiency

Primary ovarian insufficiency is a premature dysfunction of the ovaries that prevents the normal production of the estrogen hormone. [4]

Polycystic Ovary Syndrome (PCOS)

PCOS impairs the normal estrogen production in the female body.

Anorexia or Severe Underweight

Reduced nutrient intake in anorexia or severe underweight reduces hormone production because the body does not receive enough energy and essential nutrients to maintain normal endocrine gland function.

Extreme Stress

Hormones released during extreme stress (like cortisol) have a negative effect on the regulation of estrogen production.

Intense Physical Activity

Intense exercise can lead to hormonal imbalance and, thus, lower estrogen levels. Therefore, excessive physical activity can cause estrogen deficiency, especially if your body is unused to exercise or intensive workouts.

Pituitary Problems

Disorders of the pituitary gland impair the release of hormones responsible for controlling estrogen production. [4]

The Contraceptive Pill

Taking the contraceptive pill can, in some cases, lead to estrogen deficiency, mainly if the pill contains a low-dose form of estrogen or if only progestogens (synthetic progesterone) are used.

Such a deficiency can occur because the contraceptive pill alters the natural hormone balance and suppresses the body's production of estrogen, which can lead to symptoms such as decreased libido and vaginal dryness. [5]

You should discuss with your gynecologist whether the birth control pill is the right contraceptive for you if you experience any symptoms of estrogen deficiency.

Removal of the Ovaries

After an ovariectomy, estrogen levels drop sharply. Removal of the ovaries (ovariectomy) can lead to estrogen deficiency, as the ovaries are the main source of estrogen production in a woman's body. [6]

What is estrogen dominance?

When we talk about estrogen deficiency, we also need to briefly discuss estrogen dominance. This is because the phase of estrogen deficiency in the menopause is preceded by the phase of estrogen dominance. During the perimenopause, progesterone decreases and estrogen struggles with unpredictable fluctuations.

Estrogen dominance therefore occurs when the estrogen level is too high in relation to progesterone.

Symptoms of estrogen dominance are:

• Weight gain (especially in the abdominal area)
• Water retention
• Premenstrual symptoms (PMS)
• Breast tenderness
• Mood swings
• headaches
• tiredness
• sleep disorders
• Irritability
• Decreased libido

What Are the Symptoms of Estrogen Deficiency?

Below, we have listed the most common estrogen deficiency symptoms for you: [4]

Hot Flushes and Night Sweats

Low estrogen levels affect the body's temperature regulation, leading to sudden sweats and hot flushes, especially at night.

Sleep Issues

Estrogen deficiency can disrupt your sleep-wake cycle (circadian rhythm) and lead to insomnia or restless sleep, as the hormone also has calming effects on the nervous system.

Dryness of the Vaginal Mucosa

Estrogen plays an important role in maintaining the moisture and elasticity of the vaginal mucosa. A deficiency in estrogen can cause dry mucous membranes and thus lead to vaginal dryness, irritation and pain during sexual intercourse. Affected women struggle with this unpleasant symptom, which can be alleviated in the short term with special creams.

Dry Eyes

The eyes can also be affected by dryness, as there is a reduction in tear fluid. This is particularly noticeable in contact lens wearers. A visit to the ophthalmologist with recommendations for suitable lenses and eye drops is recommended in any case

Dry Oral Mucosa, Nose and Throat

The mouth, nose and throat can also be affected. This manifests itself in increased coughing, a slightly scratchy throat or even difficulty swallowing.

Dry Skin and Hair Loss

Estrogen contributes to skin elasticity and moisture and supports hair growth. A lack of estrogen can lead to dry, thin skin and increased hair loss.

Mood Swings and Depression

Like progesterone and testosterone, two other sex hormones, estrogen also impacts mood. Estrogen influences the production and effect of neurotransmitters such as serotonin, which regulate mood. Low estrogen levels can, therefore, cause mood swings, anxiety and depression.

Reduced Bone Density & Joint Pain

Estrogen helps maintain bone density by inhibiting bone resorption. A deficiency can lead to reduced bone density and an increased risk of osteoporosis — in both sexes.

Estrogen deficiency can also lead to joint pain, as estrogen has anti-inflammatory properties, and a decrease in estrogen can increase susceptibility to inflammation and joint pain. [7]

Memory Problems and Difficulty Concentrating

Estrogen supports cognitive functions, including memory and concentration. An estrogen deficiency can lead to memory problems and difficulty concentrating. [8]

Irregular Menstrual Cycle

Estrogen regulates the menstrual cycle, and a deficiency can lead to menstrual irregularities or missed periods.

Infertility

Estrogen deficiency can be the reason for an unfulfilled desire to have children. It can lead to infertility, as estrogen is crucial for regulating the menstrual cycle and preparing the uterine lining for the implantation of a fertilized egg. Low estrogen levels can lead to irregular or absent ovulation and an inadequate uterine lining, which reduces the likelihood of pregnancy. [1]

Complications During Pregnancy

Estrogen deficiency during pregnancy can increase the risk of fetal maldevelopment, as estrogen plays an important role in the healthy development of fetal organs and tissues. [2]

Decreased Libido

Low estrogen levels can decrease sexual desire and responsiveness, as estrogen supports blood flow, moisture and sensitivity in the genitals. [2]

Dry Skin and Hair Loss

Estrogen contributes to skin elasticity and moisture retention and supports hair growth. A deficiency can lead to dry skin and increased hair loss.

How Is a Low Estrogen Level Diagnosed?

Low estrogen levels are diagnosed by a particular blood test measuring estradiol (E2) concentrations, the most common and potent estrogen. Doctors can also test FSH (Follicle Stimulating Hormone) and LH (Luteinizing Hormone) to get a complete picture of your hormone status.

FSH (Follicle Stimulating Hormone) and LH (Luteinizing Hormone) are gonadotropins that control ovarian function and are often elevated in blood work when estradiol (E2) levels are low. While E2 directly indicates estrogen levels, FSH and LH indicate ovarian activity and potential dysfunction.

What Can I Do About Estrogen Deficiency?

Adjust Your Diet

Estrogen-rich foods such as soy, flaxseed and whole grains contain phytoestrogens, which are plant compounds with estrogen-like properties. These can help to naturally increase estrogen levels in the body and remedy or alleviate estrogen deficiency. [9]

Regular Exercise

Moderate physical activity promotes general health and can regulate hormone levels. Exercise strengthens bones, improves mood and reduces stress, contributing to hormonal balance. Exercise is a beautiful way to naturally address estrogen deficiency. [10]

Reduce Stress

Relaxation techniques such as yoga or meditation help reduce the release of stress hormones, which can negatively affect your hormone balance. Less stress often means more stable hormone production, including estrogen.

Herbal Supplements

Consider herbal supplements such as black cohosh or red clover, which have phytoestrogenic properties, to combat estrogen deficiency. These natural herbs can positively influence estrogen production: [11]

• Black cohosh is a North American medicinal plant thought to stimulate estrogen receptors in the body and help relieve hot flushes and other menopausal symptoms.
• Red clover is also rich in phytoestrogens, which have been shown to help stabilize estrogen hormone levels and relieve symptoms of estrogen deficiency.
• Monk's pepper (Vitex agnus-castus) supports regulating hormone balance by having an estrogen-like effect on the body.
• St. John's wort (Hypericum perforatum) is known for its mood-enhancing effects and can help with depression and mood swings that can be caused by estrogen deficiency. [12]

How Is Estrogen Deficiency Treated Medically?

Hormone Replacement Therapy (HRT)

This hormone therapy involves the prescription of synthetic or bioidentical estrogen, which increases natural hormone levels and relieves symptoms such as hot flushes, sleep disturbances and vaginal dryness. [6]

Estrogen-containing Creams or Vaginal Suppositories

These topical applications specifically help to treat vaginal dryness and associated symptoms by acting directly on the affected areas.

Drug Therapy

In some cases, specific medications may be prescribed to stimulate or support hormone production, depending on the underlying cause of your estrogen deficiency.