Estrogen is an incredibly powerful hormone, with a number of important roles to play in both female and male endocrine systems. For women, estrogen production from the ovarian follicles is highest in the first half of her menstrual cycle. It leads to the growth of a thick endometrium that is receptive to embryo implantation and the stimulation of crypts in the cervix to produce fertile cervical mucus. It raises female libido, strengthens bones, and improves moods by regulating serotonin.
However, estrogen often gets a bad wrap. In conditions like endometriosis or uterine fibroids, elevated estrogen gets blamed for the excessive growth of endometrial tissue. With dysmenorrhea, excessive estrogen is implicated in heavy periods, breast pain, and mood swings. Elevated levels of estrogen have also been associated with breast and uterine cancer risk. Estogen dominance is a hot topic in natural medicine, and we’ve got lots of natural interventions to help the body clear excessive estrogen from the system that have phenomenal impacts when indicated.
But what if you’ve got low levels of estrogen?
When I did my first hormonal test after naturopathic college, I was surprised to find that my estrogen levels were somewhere between perimenopausal and undetectable. But I was 26 years old. I was having slow, but regular-ish cycles, almost a year after coming off of the oral birth control pill. I thought things were pretty normal, but once I started learning about the signs of estrogen deficiency, I started to realize I might need some help. Everywhere I looked online, people were talking about the signs and symptoms of excessive estrogen. But what about those of us with low estradiol?
Estrogen deficiency doesn’t feel great. Some of the symptoms associated with low estradiol production include: fatigue, hair loss, insomnia (mind racing, can’t fall to sleep), weight gain, dry eyes, dry skin, vaginal dryness, scanty periods, anxiety, depression, hot flashes or night sweats, mental fogginess, decreased libido, pain with intercourse, palpitations, migraines and bloating. So why is your estrogen low?
First, if you’re younger than 45, you might not be ovulating.
Regular ovulatory cycles are what promote estradiol production. If you’re younger than 45, and your FSH is lower than 25 IU/L, you can still ovulate as long as you’ve got ovaries. For women with PCOS, irregular ovulation can lead to estrogen deficiency. For others, low body weight (low body fat %) is the culprit. In many cases including my own, taking the oral contraceptive pill for years (which shuts down natural estradiol production) leads to post-pill anovulatory cycles, and that’s the cause of low estradiol. This relative deficiency post-pill usually resolves itself as a woman starts ovulating regularly again (usually 3-6 months), but in some cases it lasts much longer. If you have irregular cycles and think you’re not ovulating, you may need the help of acupuncture or herbal medicine to get your body back on track.
Second, if you’re confident you are ovulating but have many of the signs of estradiol deficiency, there is a secondary cause.
In ovulatory women younger than 45, slightly low estrogen production can be due to low body weight, excessive exercise, stress, smoking or a vegetarian/vegan diet. Correcting these underlying problems is the first place to start. If you’re younger than 45 and none of the above apply to you, the cause of estrogen deficiency could be an earlier-than-expected menopause, in which case it is important to test your FSH and AMH for ovarian reserve if you wish to become pregnant. Estrogen levels gradually fall as we approach menopause, and unfortunately for some women that can come in the early 40s (sometimes as early as late 30s) instead of the early 50s as is typical.
Third, if you’re >45, have an FSH >25 IU/L or a low AMH, you may be in the perimenopausal transition.
For many women, the transition to menopause can be quite the rollercoaster. The quick, sharp decline of both estrogen and progesterone can come with a myriad of uncomfortable symptoms that can last for up to ten years before menses actually cease. Unfortunately, many women suffer with hot flashes, depression, night sweats and insomnia, thinking they are a normal part of the aging process. But they don’t have to be! If you’re in the perimenopausal transition, often your menses will get closer together before spacing out and eventually ceasing. Many herbal and nutritional supplements can greatly improve the estradiol:progesterone ratio and ease this transition; sometimes bioidentical estradiol, estriol or progesterone are indicated. Keeping the adrenals well-regulated is also incredibly helpful, as they pick up the slack of hormonal production after the ovaries start to fail. Working with your ND, menopause can be nothing more than a blip on your radar – it doesn’t have to be a scary and uncomfortable 5 to 10 years.
For more information on how to increase your estradiol production in any of the above scenarios, feel free to schedule a free 15 minute consult with me through Acubalance.