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How Estrogen Affects Women's Health: Signs, Symptoms, and Solutions

Many women come to us with generalized symptoms of perimenopause or menopause and have questions regarding their blood work. Often, we hear questions like “What are my estrogen levels?” and “What should my estrogen levels be at for my age?” It’s important to address what estrogen is and what role it plays in women’s health.  Estrogen is a group of steroid hormones that play a crucial role in the female reproductive system and their overall health. It’s one of the major hormones that’s responsible for the development of female sexual characteristics, regulation of the menstrual cycle, and helps influence various other bodily functions. Estrogen levels naturally fluctuate throughout a woman's life, and understanding these changes is important when it comes to maintaining well-being.  

What is Estrogen?

There are three main types of estrogen in women which are primarily produced in females by the ovaries, with smaller amounts coming from the adrenal glands and fat tissue.

·         Estradiol (E2): The most potent and abundant form of estrogen, primarily produced by the ovaries playing a key role in reproductive health and is measured in blood tests to assess estrogen levels.   Normal estradiol (E2) levels in women vary depending on their age and menopausal status:   Premenopausal women: 30 to 400 pg/mL and Postmenopausal women: 0 to 30 pg/mL

Estrone (E1): A weaker form of estrogen present in lower levels than estradiol. It becomes the dominant estrogen after menopause.  Individual levels will vary from one womean to the next but here is are general ranges. Premenopausal women: 27 to 231 pg/mL  Postmenopausal women: 0 to 125 pg/mL

Estriol (E3): The weakest form of estrogen, mainly produced during pregnancy. Its role in non-pregnant women is not fully understood.   Estriol levels are typically not measured in non-pregnant women.  

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What Does Estrogen Do?

The million-dollar question is “What does estrogen do?”  Estrogen exerts its effects in women by binding itself to specific receptors in various tissues throughout the woman’s body. These receptors are found in tissue and organs such as:  

• Reproductive organs: Uterus, vagina, breasts  
• Brain: Affects mood, cognition, and sleep  
• Bones: Maintains bone density and strength  
• Heart: Influences cholesterol levels and blood vessel function  
• Skin: Contributes to skin elasticity and hydration  

Estrogen Levels Throughout Life

What do normal estrogen levels look like throughout a woman’s life? As it turns out, Estrogen levels will naturally fluctuate throughout a woman's life, influenced by puberty, menstrual cycles, pregnancy, and menopause.  This can be confusing at times and even cause unwanted symptoms such as mood change, hot flashes and night sweats, menstrual cycle irregularity to name a few but don’t worry. This is completely normal and can be addressed by your healthcare provider if needed.

• Puberty: Estrogen levels rise, triggering the development of female sexual characteristics, including breasts, menstruation, and changes in body shape.  
• Menstrual cycle: Estrogen levels fluctuate throughout the menstrual cycle, peaking just before ovulation and then declining.  
• Pregnancy: Estrogen levels steadily increase during pregnancy, supporting the growth and development of the fetus and see a boost of E3.  
• Menopause: Estrogen levels significantly decline as the ovaries stop producing eggs, leading to various physical and emotional changes and E1 becomes the dominant form of estrogen.  

Normal Estrogen Levels

Normal estrogen levels vary depending on age and menopausal status. Here's a general guideline for estradiol (E2) levels:

Premenopausal women: 30 to 400 pg/mL  

Postmenopausal women: 0 to 30 pg/mL  

It's important to note that these are just general ranges, and individual levels may vary.  Also keep in mind that these number will fluctuate and every patient is unique so if you suspect there may be an issue with your hormones, speak to your doctor about your concerns.  A healthcare provider can interpret estrogen levels in the context of a woman's overall health and medical history.

Effects of Low Estrogen

Low estrogen levels can lead to various symptoms, including:

• Menstrual irregularities: Changes in cycle length, flow, or missed periods  
• Hot flashes: Sudden feelings of warmth, sweating, and flushing  
• Vaginal dryness: Discomfort during intercourse  
• Sleep disturbances: Difficulty falling asleep or staying asleep  
• Mood changes: Irritability, anxiety, or depression  
• Decreased libido: Reduced sexual desire  in women
• Bone loss: Increased risk of osteoporosis
• Cognitive changes: Difficulty concentrating or remembering things

Estrogen Replacement Therapy (ERT)

Hormone Replacement Therapy for women is a very common treatment option for women experiencing the unwanted signs and symptoms of perimenopause of menopause. It often includes estrogen, testosterone and progesterone. Estrogen replacement therapy (ERT) in particular involves taking medication to increase estrogen levels back to an optimal level for the patient. It is primarily used to manage menopausal symptoms and prevent bone loss. ERT can be delivered in various forms, including:  

• Oral tablets: The most common form of ERT. These are generally best taken after a meal to reduce the risk of stomach upset and improve absorption. Some women find it helpful to take them in the morning to maintain consistent hormone levels throughout the day.
• Transdermal patches: Applied to the skin, delivering estrogen directly into the bloodstream. These are typically replaced every few days. The time of day for application is less critical, but it's important to choose a consistent time and location for each application.  
• Topical gels or creams: Applied to the vagina or vulva. The time of day for application may depend on the specific product and individual needs.
• Vaginal rings: Inserted into the vagina, releasing estrogen over time. They provide a continuous release of hormones.

Benefits of ERT for Women

ERT can provide several benefits, including:

• Relief from menopausal symptoms: Reduces hot flashes, vaginal dryness, sleep disturbances, and mood changes  
• Prevention of bone loss: Helps maintain bone density and reduce the risk of osteoporosis  
• Improved quality of life: Enhances overall well-being and reduces the impact of menopausal symptoms  

Risks of ERT

Like all medications and medical treatments ERT also carries potential risks, including:

• Increased risk of certain cancers: ERT may increase the risk of breast cancer and endometrial cancer so it’s important to get screened. The U.S. Preventive Services Task Force (USPSTF) recommends that women aged 40 to 74 years with average risk get screened every 2 years, however, the American Cancer Society (ACS), recommend annual mammograms starting at age 45, or even 40, depending on individual risk factors and preferences.   Higher risk patients with a family history of breast cancer should get tested more frequently.
• Increased risk of blood clots: May increase the risk of deep vein thrombosis and pulmonary embolism  
• Possible Increased risk of stroke and heart attack: ERT May increase the risk of cardiovascular events, especially in women with existing risk factors. Studies on the relationship between ERT and CVD have yielded mixed results. Some studies have shown an increased risk of heart attack, stroke, and blood clots in women taking ERT, while others have not found a significant association. Its important to discuss whether you’re in a high risk category for your age, overall health, family history and time since the onset of menopause to determine if there is an increased risk.

Who Should Consider ERT?

ERT is not suitable for all women. It is important to discuss the benefits and risks with a licensed and experienced healthcare provider to determine if it is appropriate for you. There are several factors to consider including:

• Severity of menopausal symptoms: ERT may be more beneficial for women with severe symptoms that significantly impact their quality of life. Oten mild symptoms subside fairly quickly for many women.
• Risk factors for certain cancers: Women with a personal or family history of breast cancer or endometrial cancer may have an increased risk with ERT and should weigh the risk/reward of HRT.
• Risk factors for cardiovascular disease: Women with existing heart disease or risk factors for cardiovascular disease may have an increased risk with ERT and should look for other ways to alleviate symptoms first.

Alternatives to ERT

There are alternative treatments for managing menopausal symptoms and preventing bone loss for women, including:

• Lifestyle changes: Regular exercise, a healthy diet, and stress management can help alleviate menopausal symptoms. Strength training in particular is beneficial. Strength training can stimulate the production and balance of various hormones, including growth hormone, testosterone, and estrogen. This can help alleviate symptoms associated with hormone imbalances, such as mood swings, fatigue, and weight gain.  
• Non-hormonal medications: Certain medications can help reduce hot flashes and improve sleep.   These medications work through different mechanisms than hormone replacement therapy (HRT) and may be suitable for women who cannot or choose not to take HRT.  

Here are some common non-hormonal medications used for hot flashes and sleep problems during menopause:

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs): These antidepressants can also help reduce hot flashes. Examples include paroxetine (Brisdelle), venlafaxine (Effexor XR), and desvenlafaxine (Pristiq).  

Gabapentinoids: Gabapentin (Neurontin, Gralise) and pregabalin (Lyrica) are anti-seizure medications that can also reduce hot flashes. Gabapentin can also improve sleep quality.  

Clonidine: This medication, typically used to treat high blood pressure, can also help reduce hot flashes.  

Fezolinetant (Veozah): This is a newer non-hormonal medication specifically for hot flashes. It works by blocking a pathway in the brain that helps regulate body temperature.  

It's important to note that these medications may have side effects, and their effectiveness can vary among individuals. It's crucial to discuss the benefits and risks of each medication with a healthcare provider to determine the most appropriate treatment plan.

• Herbal remedies: Several herbal remedies have been traditionally used to manage hot flashes and sleep problems during menopause. However, it's important to note that the effectiveness and safety of these remedies can vary, and scientific evidence supporting their use may be limited. It's crucial to consult with a doctor before trying any herbal remedy, as they may interact with other medications or have potential side effects. This list is not intended as an endorsement of any herbal remedy or to treat any symptoms but instead is for informational purposes as to how menopause symptoms have been treated without using hormone therapy. Here are some commonly used herbal remedies for hot flashes and sleep problems during menopause:

Black cohosh: This herb has been traditionally used to relieve hot flashes, night sweats, and other menopausal symptoms. However, studies on its effectiveness have yielded mixed results.  

Red clover: Red clover contains isoflavones, which are plant-based compounds that can mimic estrogen's effects. Some studies suggest that red clover may help reduce hot flashes.  

Soy: Soybeans are rich in isoflavones and may help alleviate hot flashes and improve sleep quality.  

Evening primrose oil: This oil contains gamma-linolenic acid, which may help regulate hormone levels and reduce hot flashes. However, scientific evidence supporting its use is limited.  

Valerian root: Valerian root has been traditionally used to promote relaxation and improve sleep quality. It may be helpful for women experiencing sleep problems during menopause.  

Sage: Sage has been used to reduce hot flashes and night sweats. Some studies suggest that it may be effective in alleviating these symptoms.  

It's important to choose high-quality herbal supplements from reputable brands and follow recommended dosages. Be aware of any potential side effects or interactions with other medications. If you experience any adverse reactions, discontinue use and consult with a healthcare provider.

As women age, they start to experience changes and often these changes can be directly attributed to hormonal health. Estrogen in particular plays a vital role in women's health throughout their lives. Understanding estrogen levels and their fluctuations is essential for maintaining well-being and improving quality of life. ERT can be an effective treatment for managing menopausal symptoms and preventing bone loss, but it is important to discuss the benefits and risks with a healthcare provider to determine if it is appropriate.   For more information visit us online or call to schedule an appointment to speak with our physician Dr. Timothy W. Mackey.

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