HormonesWomen's Health

Estrogen – Estrogen Deficiency and Estrogen Dominance

Written by

Anna Roell
18 September, 2023

Medically checked article All HOMED-IQ content is reviewed by medical specialists

In the world of hormones, estrogen plays a crucial role, especially in relation to women’s health. However, estrogen is not only important for women, but also influences a number of processes in the bodies of men. Want to learn more about estrogen and specific conditions like estrogen deficiency and estrogen dominance? Learn all about it in this blog.


Table of Contents

What is estrogen?

Estrogens are a group of hormones produced mainly in the ovaries in women, but also in the testes in men in smaller amounts. Fatty tissue also secretes estrogen, but in lower quantities than the ovaries and testes. These hormones are best known for their role in the development and regulation of the female reproductive system and secondary sexual characteristics, such as growth of breasts, body hair, and widening of the hips. There are three main types of estrogen. Estrone (E1) is the weakest form of estrogen and is the only form of estrogen produced in women after menopause, or when menstrual periods stop. Estradiol (E2) is the most abundant and potent form of estrogen and is found in the bodies of men and women during their reproductive years. Estriol (E3) is the primary form of estrogen that is produced during pregnancy. Additionally, there is a fourth form of estrogen called estetrol (E4), which is found only in pregnant women (Endocrine Society, 2022).

What is the function of estrogen?

Estrogens play a role in many body functions, particularly reproductive function in women. These functions include:

  1. Development of secondary sexual characteristics
  2. Regulation of the menstrual cycle
  3. Function of the placenta and development of the fetus during pregnancy
  4. Induction of menopause

In men, estrogen regulates sex drive, sperm production, and the ability to get an erection. While it is often assumed that these functions are controlled only by the male sex hormone testosterone, estrogen also plays a role.

Estrogen also has several non-reproductive functions in both men and women, including:

  1. Supporting bone health
  2. Protecting the cardiovascular system
  3. Supporting skin quality
  4. Influencing mood and well-being

Source: Cleveland Clinic, 2022

Estrogen during menopause

Menopause is a normal part of aging and is defined as the stage of life when menstruation stops. It can be diagnosed after one year without a menstrual period. Menopause is a time when a woman’s hormone levels change significantly, indicating the end of a woman’s ability to have children. As a woman ages, the ovaries produce less estrogen. With this decrease, the menstrual cycle begins to change so that it becomes irregular and eventually stops (Cleveland Clinic, 2021). The average age of menopause is about 51, although women who smoke experience menopause an average of 2 years earlier (Whitcomb et al., 2018). Physical changes can also occur as the body adjusts to different hormone levels, causing symptoms such as hot flashes, mood swings, dry skin, and vaginal discomfort (Johns Hopkins, 2023).

What is estrogen deficiency?

Estrogen deficiency refers to levels of estrogen in the body that are lower than normal. Unnaturally low estrogen levels over a long period of time can lead to symptoms that affect quality of life and cause long-term health problems.

What are the causes of estrogen deficiency?

Possible causes of low estrogen levels in women include:

  • Menopause: The most common cause of low estrogen in women is the natural aging process. As menopause begins, the ovaries produce less estrogen. This is a natural process and generally occurs during middle age (Cleveland Clinic, 2022).
  • Autoimmune diseases: Certain autoimmune diseases can attack the ovaries, causing them to stop producing enough estrogen. This may lead to primary ovarian failure, in which estrogen levels drop early and periods stop before middle age. During primary ovarian failure, menopause begins before the age of 40 (Mayo Clinic, 2021).
  • Eating disorders: Anorexia nervosa and other eating disorders can affect the production of sex hormones, including estrogen. The malnutrition associated with eating disorders can inhibit normal ovarian function and result in low estrogen levels (Schorr & Miller, 2016).
  • Hypothalamic amenorrhea: Hypothalamic amenorrhea is a condition where menstruation stops completely occur due to stress on the body, such as from intense exercise or inadequate nutrient intake. During this condition, the brain does not release enough hormones to activate estrogen production in your ovaries. As a result, menstruation stops completely. Women who do intense endurance training are particularly susceptible to this (De Souza et al., 2014).
  • Treatments affecting the ovaries:
    • Hysterectomy or oophorectomy: These are surgical procedures in which the uterus (hysterectomy) or one or both ovaries (oophorectomy) are removed. Because these organs are involved in the production of estrogen, removal of them results in an immediate and significant decrease in estrogen levels (American College of Obstetricians and Gynecologists, 2020).
    • Chemotherapy and radiation: These cancer treatments can damage the ovaries, reducing estrogen production (Cleveland Clinic, 2022).
  • Genetic factors: Turner syndrome is a genetic condition that affects only women and can cause the ovaries not to develop, resulting in low estrogen (NIH, 2021).
  • Pituitary gland disorders: The pituitary gland secretes hormones that instruct the ovaries to produce estrogen. If the pituitary gland does not secrete enough of these hormones, low estrogen may be a result.

Source: Cleveland Clinic, 2022

Low estrogen levels in men

Although men produce much less estrogen than women, this hormone is also important to their health and wellbeing. Low estrogen levels in men may be caused by malnutrition, obesity, excessive physical activity, and chronic stress. Estrogen levels in men can also be affected by a condition called hypogonadism. This is a condition in which testosterone production in the testes decreases. Because some testosterone is converted to estrogen, lowered production of testosterone can also lead to lower estrogen levels (Healthline, 2019).

What are the symptoms of estrogen deficiency?

Symptoms of low estrogen can vary depending on age and the cause of the deficiency. In women, the following symptoms may occur:

  1. Irregular or missed periods
  2. Hot flashes and night sweats
  3. Sleep disturbances
  4. Sore breasts
  5. Mood swings
  6. Cognitive impairment
  7. Weight gain, especially around the abdomen
  8. Vaginal dryness and discomfort during sex
  9. Dry skin

Source: Cleveland Clinic, 2022

Due to the drop in estrogen before menstruation, some women also experience menstrual migraines. These are severe headaches that occur just before menstruation. Estrogen deficiency in men can lead to symptoms such as excess abdominal fat, low sexual desire, erectile dysfunction, and mood swings (Endocrine Society, 2022).

Would you like to get insight into your hormone health from home?

Homed-IQ offers a range of hormone tests for women that can be done in the comfort of your own home. These tests can be a useful tool for monitoring hormone balance, especially when it comes to hormones like estrogen. By testing regularly with Homed-IQ-, women can monitor their estrogen levels and detect potential irregularities early. This allows you to proactively respond to changes in your body and get to the root of potential symptoms.

Estrogen deficiency and other diseases

The profound effects of estrogen on the body not only highlight its important role in regulating multiple bodily functions, but also shed light on the potential risks associated with an imbalance of this hormone. Decreased estrogen production can have far-reaching effects and increase the risk for other health problems and diseases.

  • Osteoporosis: Estrogen plays a key role in bone formation. Low estrogen levels can cause an imbalance between bone formation and breakdown, which in turn can lead to osteoporosis. Osteoporosis is characterized by brittle and weak bones that can break easily.
  • Heart disease: Estrogen has a protective effect on the heart. It helps keep the inner walls of the arteries flexible and promotes healthy blood vessels. When estrogen levels drop, these protective effects can diminish, increasing the risk of heart disease.
  • Cognition: There is scientific evidence to suggest that low estrogen levels are associated with an increased risk of neurodegenerative diseases such as Alzheimer’s. Estrogen appears to have a neuroprotective effect, and a deficiency may accelerate brain aging and increase susceptibility to neurological diseases (Sherwin, 2003).

It is important to note that low estrogen levels do not always lead to these health problems. Often, multiple factors are involved in the development of these diseases. If you notice symptoms that could indicate low estrogen, speak to your doctor about follow-up testing and treatment.

Source: Cleveland Clinic, 2022

What is the treatment for low estrogen?

The treatment for low estrogen depends on the underlying cause and the individual needs of the person affected. Common treatments for low estrogen include:

1- Hormone replacement therapy (HRT).

Hormone replacement therapy (HRT) is a treatment used to relieve the symptoms of menopause caused by a drop in estrogen production. It involves taking medications that contain estrogen to increase hormone levels in the body and relieve symptoms such as hot flashes, mood swings, and vaginal dryness. HRT may also help reduce the risk of osteoporosis. (NHS, 2022).

What are the risks associated with HRT?

Hormone replacement therapy may increase the risk of heart disease, stroke, blood clots, and breast cancer. However, the risks depend on factors such as age, type of hormone therapy, and medical history. All of these risks should be considered by you and your doctor when deciding if HRT is right for you (Mayo Clinic, 2022).

2- Estrogen cream or gel

For women who have symptoms such as vaginal dryness or discomfort during intercourse, estrogen-containing gels, creams, suppositories, or insertable vaginal rings can be used directly on the affected area. Talk to your doctor to find the treatment option that is right for you (Mayo Clinic, 2022).

3- Lifestyle

Lifestyle changes such as following a balanced diet, getting regular exercise, and prioritizing adequate sleep can also help support hormone health. In addition to good nutrition and regular movement, try to limit stress, as stress hormones such as cortisol can contribute to imbalances in reproductive hormones (Cleveland Clinic, 2022).

What is estrogen dominance?

Progesterone is another sex hormone that plays an important role in pregnancy. Estrogen dominance occurs when the balance between estrogen and progesterone is disturbed, with estrogen levels being higher relative to progesterone. It is important to note that estrogen dominance is not a medically recognized diagnosis, but some professionals use the term to describe a specific group of symptoms that may be related to an imbalance of these hormones.

What are the symptoms of estrogen dominance?

Symptoms of estrogen dominance can vary from person to person. While these symptoms may signal higher than normal estrogen levels, it is important to note they could be due to other health conditions and should be investigated by a doctor:

  1. Irregular menstrual cycles
  2. Bloating and water retention
  3. Breast swelling or tenderness
  4. Mood swings, including depression or anxiety
  5. Weight gain, especially around the hips and thighs
  6. Headaches or migraines
  7. Fatigue or trouble sleeping
  8. Changes in libido

Source: Holland, 2023

What causes estrogen dominance?

Estrogen dominance occurs when estrogen levels are too high in relation to progesterone. This may occur if your body is making too much estrogen, if medications are increasing estrogen levels too much, or if the body is unable to efficiently process estrogen. Potential causes include:

  • Health conditions: Certain medical conditions can lead to hormonal imbalances and estrogen dominance, such as polycystic ovary syndrome, uterine fibroids, genetic conditions, or endometriosis.
  • Chronic stress: Stress increases cortisol levels. Cortisol levels that are high for a long period of time can deplete progesterone, leading to estrogen dominance.
  • Exposure to xenoestrogens: These chemical compounds estrogen in the body and are found in many everyday products such as plastics, cosmetics, and certain foods.
  • Obesity: As fat tissue secretes estrogen, obesity can contribute to excessively high estrogen levels.
  • Medications: Hormone therapy or taking excessive doses of estrogen-containing contraceptives can also lead to an increase in estrogen levels.

Source: Cleveland Clinic, 2022

How is estrogen dominance treated?

Treatment of estrogen dominance aims to restore hormonal balance and relieve symptoms. Potential treatments include:

  • Lifestyle changes: For estrogen dominance that is not caused by a specific medical condition, dietary changes, regular exercise, and stress management can help regulate hormone levels and reduce body fat. Reducing your body fat can reduce the risk of estrogen dominance. Since estrogen is largely broken down by the liver, limiting alcohol is also recommended to avoid stressing the liver.
  • Avoidance of xenoestrogens: Reducing exposure to xenoestrogens can help restore hormone balance in the body. When possible, buy products in glass and steel containers instead of plastic containers.
  • Medications: If there is a risk of disease or long-term health problems from high estrogen, a doctor may prescribe medication to help lower it. Before taking any estrogen-lowering medications, the underlying cause of the high estrogen deficiency should first be identified.

Medications that can lower estrogen levels include:

  • Aromatase inhibitors: These drugs are used to treat breast cancer. They stop an enzyme in fat cells from producing estrogen.
  • Gonadotropin-releasing hormone (GnRH) agonists: These medications stop your ovaries from releasing estrogen.

Source: Cleveland Clinic, 2022

Summary

Estrogens play a crucial role in many aspects of health in both women and men. An imbalance of these hormones can lead to a variety of unpleasant symptoms and health problems. It is important to practice healthy habits that include a balanced diet and regular exercise to support hormone balance. If you are experiencing symptoms of a potential hormonal imbalance, contact your doctor.

Referenzen

Biggers, A. (2019, October 22). Estrogen in Men: How It Works and What High or Low Levels Mean. Healthline. Retrieved June 24, 2023, from https://www.healthline.com/health/estrogen-in-men#high-estrogen

Desmawati, D., & Sulastri, D. (2019). Phytoestrogens and Their Health Effect. Open access Macedonian journal of medical sciences, 7(3), 495-499. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6390141/#:~:text=Phytoestrogens%20are%20estrogen%2Dlike%20compounds,legumes%2C%20including%20in%20red%20clover.

De Souza, M. J., & et al. (2014). 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, Ma. British Journal of Sports Medicine, 48, 289. https://bjsm.bmj.com/content/48/4/289.short

High Estrogen: Causes, Symptoms, Dominance & Treatment. (2022, February 9). Cleveland Clinic. Retrieved June 25, 2023, from https://my.clevelandclinic.org/health/diseases/22363-high-estrogen

Hormone replacement therapy (HRT). (n.d.). NHS. Retrieved June 22, 2023, from https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/

Hormone therapy: Is it right for you? (n.d.). Mayo Clinic. Retrieved June 22, 2023, from https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-therapy/art-20046372

Hot flashes – Symptoms and causes. (2022, May 20). Mayo Clinic. Retrieved June 22, 2023, from https://www.mayoclinic.org/diseases-conditions/hot-flashes/symptoms-causes/syc-20352790

Hysterectomy. (n.d.). ACOG. Retrieved June 22, 2023, from https://www.acog.org/womens-health/faqs/hysterectomy

Introduction to Menopause. (n.d.). Johns Hopkins Medicine. Retrieved June 22, 2023, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/introduction-to-menopause

Kallen, A., Balingit, A., & Kubala, J. (2023, June 9). Signs and Symptoms of High Estrogen: Diagnosis, Treatment, and More. Healthline. Retrieved June 25, 2023, from https://www.healthline.com/health/high-estrogen#symptoms

Low Estrogen: Causes, Symptoms, Diagnosis & Treatment. (2022, February 8). Cleveland Clinic. Retrieved June 22, 2023, from https://my.clevelandclinic.org/health/diseases/22354-low-estrogen

Menopause: What It Is, Age, Stages, Signs & Side Effects. (2021, October 5). Cleveland Clinic. Retrieved June 22, 2023, from https://my.clevelandclinic.org/health/diseases/21841-menopause

Menstrual Cycle (Normal Menstruation): Overview & Phases. (2022, December 9). Cleveland Clinic. Retrieved June 22, 2023, from https://my.clevelandclinic.org/health/articles/10132-menstrual-cycle

Primary ovarian insufficiency – Symptoms and causes. (2021, October 27). Mayo Clinic. Retrieved June 22, 2023, from https://www.mayoclinic.org/diseases-conditions/premature-ovarian-failure/symptoms-causes/syc-20354683

Schorr, M., & Miller, K. K. (2017). The endocrine manifestations of anorexia nervosa: mechanisms and management. Nature reviews. Endocrinology,, 13(3), 174-186. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5998335/

Sherwin, B. B. (2003). Estrogen and Cognitive Functioning in Women. Endocrine reviews, 24(3), 133-151. https://academic.oup.com/edrv/article/24/2/133/2424179

Turner syndrome – Symptoms. (n.d.). NHS. Retrieved June 22, 2023, from https://www.nhs.uk/conditions/turner-syndrome/symptoms/

Whitcomb, B. W., & et al. (n.d.). Cigarette Smoking and Risk of Early Natural Menopause. American journal of epidemiology, 187(4), 696-704. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5888979/

Wilson, D. R., & Nichols, H. (2020, March 12). Estrogen: Functions, uses, and imbalances. Medical News Today. Retrieved June 25, 2023, from https://www.medicalnewstoday.com/articles/277177#function

About the author

Anna Roell

Anna is a trained nurse and health economist specializing in epidemiology, combining her medical and scientific interests. Her goal is to improve others' understanding of medical information and to communicate it in an understandable way. Anna is originally from Germany and now lives in Amsterdam. What she appreciates most about Amsterdam is the open-minded, active attitude of the people, the markets, and the beautiful nature in the areas surrounding Amsterdam.