Estrogen deficiency: what is it?

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Estrogen deficiency occurs when women have low levels of the important ‘female’ hormone, estrogen. Sometimes this condition occurs before menopause and is considered abnormal because it interrupts menstrual cycles and creates many unpleasant symptoms. An estrogen deficiency is expected during menopause, but when the body stops producing estrogen in premenopause, doctors may choose to treat with estrogen substitutes.

The causes of estrogen deficiency are varied in women who have not gone through menopause. Some benign causes include extreme exercise, and champion athletes or women with very little body fat may have unusually low levels of estrogen and progesterone, which is most noted because periods stop or are irregular. Some women go through menopause very early, usually before the age of 40. The average age of menopause is around 51, so low estrogen before age 40 is considered unusual. Thyroid disorders, genetic disorders such as Turner syndrome, or some tumors of the adrenal glands or ovaries can also reduce estrogen.

With normal menopause or surgical removal of the ovaries, an estrogen deficiency is expected. In younger women, treatment may include estrogen supplementation, and this was a common treatment for women with normal or induced menopause. Today, if estrogen replacement therapy is used in menopausal women, it is usually short-term because estrogen increases the risk of certain cancers and heart disease. Many of the symptoms of menopausal estrogen deficiency lessen as women enter post-menopause, and doctors and their patients determine whether adding estrogen to the body is worth the risks.

There are many common symptoms associated with estrogen deficiency, and women may experience all or some of these to a greater or lesser extent. The first symptom is usually the irregularity or complete cessation of the menstrual cycle. Headaches and migraines become more common, women may experience hot flashes and night sweats, vaginal dryness, and vaginal or urinary tract infections occur more regularly. Sleep can be disrupted, fatigue can result, and these two symptoms can be related to impaired concentration and forgetfulness.

The libido may be decreased and this symptom is often related to the discomfort that sex can cause due to vaginal dryness. Some women also have problems with urinary incontinence. More serious symptoms include changes in heart rhythm. Emotionally, low estrogen is linked to dramatic mood swings, from depression to anxiety to anger or hopelessness. Many women describe temper as a short fuse and report episodes of extreme emotional reactions such as lots of crying.

These initial symptoms may be associated with long-term causes of estrogen deficiency. Lack of estrogen may be linked to obesity. It also affects bone stability and can lead to osteoporosis over time.

In younger women, it is usually important to treat the decrease in estrogen with supplemental estrogen. In older women who are thought to be estrogen deficient, this course of treatment is not always approved, although short-term treatment for exaggerated symptoms may be advised. Should these symptoms arise, women are suggested to consult a doctor on the best course of treatment.

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