Understanding estrogen: deficiency & dominance

In the world of hormones, estrogens play a crucial role, especially regarding women's health. However, they are not only important for women—they also influence a number of processes in the male body. Would you like to learn more about estrogens and specific conditions such as estrogen deficiency and estrogen dominance? Then feel free to read on.

Table of Contents

• What are estrogens?
• Estrogens during menopause
• What is estrogen deficiency?
• What causes estrogen deficiency?
• Low estrogen levels in men
• What are the symptoms of estrogen deficiency?
• Estrogen deficiency and other health conditions
• How can estrogen deficiency be treated?
• What is estrogen dominance?
• What are the symptoms of estrogen dominance?
• What causes estrogen dominance?
• How is estrogen dominance treated?
• Summary

What are estrogens?

Estrogens are a group of hormones primarily produced in the ovaries in women, but also in smaller amounts in the testes in men. Fat tissue also secretes estrogen. Estrogens are responsible for the development and regulation of the female reproductive system and secondary sexual characteristics but also influence many other processes in the human body. Estrone (E1) is a form produced by the body after menopause. Estradiol (E2) is the most common form and is present during reproductive years, such as puberty. Estriol (E3) occurs during pregnancy. Additionally, estetrol (E4) is found only in the bodies of pregnant women (Endocrine Society, 2022).

What is the function of estrogens?

Estrogens play a role in many parts of the body. The most important reproductive functions of estrogen in women include:

• Development of secondary sexual characteristics
• Regulation of the menstrual cycle
• Support of processes during pregnancy
• Initiation of menopause

In men, estrogen regulates libido, sperm production, and the ability to have an erection. Contrary to common belief, testosterone alone is not responsible for these functions.

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

• Influence on bone health
• Protection of the cardiovascular system
• Support for skin quality
• Influence on mood and well-being

Source: Cleveland Clinic, 2022

Estrogens during menopause

Menopause, also referred to as “the change,” occurs naturally as women age and is defined as one full year without menstruation. Menopause marks a time of significant hormonal changes and the end of a woman's fertility. As women age, the ovaries produce less estrogen. As estrogen levels decline, the menstrual cycle begins to change, becoming irregular and eventually stopping (Cleveland Clinic, 2021). The average age of menopause is about 51 years; in women who smoke, menopause occurs about two years earlier (Whitcomb et al., 2018).  Physical changes may also occur as the body adjusts to changing hormone levels, resulting in symptoms such as hot flashes, night sweats, mood swings, dry skin, and vaginal discomfort (Johns Hopkins, 2023).

What is estrogen deficiency?

Estrogen deficiency means that the body has lower-than-normal levels of estrogen. Abnormally low estrogen levels over a longer period can lead to symptoms that impair quality of life and cause long-term health problems.

What causes estrogen deficiency?

Possible causes of low estrogen levels in women include:

• Menopause: The most common cause of low estrogen levels in women is the natural aging process. As menopause begins, the ovaries produce less estrogen. This is a natural process and affects every woman at a different age (Cleveland Clinic, 2022).

• Autoimmune diseases: Certain autoimmune diseases can attack the ovaries and lead to insufficient estrogen production. One example is primary ovarian insufficiency, in which estrogen levels drop prematurely and menstruation stops. Menopause may then occur before the age of 40 (Mayo Clinic, 2021).

• Eating disorders: Eating disorders such as anorexia nervosa can impair the production of sex hormones, including estrogen. The malnutrition associated with eating disorders can hinder normal ovarian function and lead to low estrogen levels (Schorr & Miller, 2016).

• Hypothalamic amenorrhea: Stress (e.g., from intense exercise) and insufficient nutrient intake can lead to hypothalamic amenorrhea. In this condition, the brain does not release enough hormones to activate estrogen production in the ovaries. As a result, menstruation stops completely. Women who engage in intensive endurance training are particularly at risk (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. Since these organs are involved in estrogen production, such procedures cause an immediate and significant drop in estrogen levels (American College of Obstetricians and Gynecologists, 2020).

  • Chemotherapy and radiation therapy: These cancer treatments can damage the ovaries and reduce estrogen production (Cleveland Clinic, 2022).

• Genetic factors: Turner syndrome is a genetic condition that occurs only in women and leads to insufficient production of sex hormones such as estrogen (NIH, 2021).  

• Pituitary gland disorders: The pituitary gland releases hormones that instruct the ovaries to produce estrogen. If the pituitary gland does not release enough of these hormones, the body may produce low estrogen levels (Cleveland Clinic, 2022).

Low estrogen levels in men

Although men produce much less estrogen than women, this hormone is also important for them. A low estrogen level in men may be due to undernutrition, obesity, excessive physical activity, or chronic stress. Estrogen levels can also change due to a condition known as hypogonadism, in which testosterone production in the testes decreases. Since some testosterone is converted into estrogen, reduced testosterone production can also result in lower estrogen levels (Healthline, 2019). 

What are the symptoms of estrogen deficiency?

Symptoms of estrogen deficiency may vary depending on age and individual circumstances. Common symptoms of low estrogen levels include:

• Irregular or absent periods
• Hot flashes and night sweats
• Sleep disturbances
• Tender breasts
• Mood swings
• Cognitive impairments
• Weight gain, especially around the abdomen
• Vaginal dryness and discomfort during sex
• Dry skin

Source: Cleveland Clinic, 2022

Some women may experience menstrual migraines due to a drop in estrogen—these are severe headaches that occur shortly before menstruation. In men, estrogen deficiency can lead to symptoms such as excessive abdominal fat, low sex drive, erectile dysfunction, and mood swings (Endocrine Society, 2022).

Would you like to get an overview yourself?

Homed-IQ offers a range of hormone tests for women that can be conveniently performed at home. These tests can be a useful tool for monitoring hormonal balance, especially when it comes to hormones like estrogen. With regular testing through Homed-IQ, women can monitor their estrogen levels and detect possible irregularities early. This allows you to respond proactively to changes in your body.

Estrogen deficiency and other health conditions

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

• Osteoporosis: Estrogen plays a key role in bone formation. When estrogen levels decline, it can lead to an imbalance in bone formation and resorption, which in turn can cause osteoporosis. Osteoporosis is characterized by brittle and weak bones that break easily.
• Heart disease: Estrogen has a protective effect on the heart. It helps maintain the flexibility of the inner walls of the arteries and supports healthy blood vessels. When estrogen levels drop, these protective effects may diminish, increasing the risk of heart disease.
• Cognition: There is also scientific evidence suggesting 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 its deficiency can accelerate brain aging and increase susceptibility to such diseases (Sherwin, 2003).

It is important to note that low estrogen levels do not always lead to these conditions. Often, multiple factors contribute to the development of these diseases. If you notice symptoms that suggest estrogen deficiency, you should consult a doctor.

Source: Cleveland Clinic, 2022

How can estrogen deficiency be treated?

Treatment of low estrogen levels depends on the underlying cause and the individual needs of the person affected. Here are some common approaches to treating estrogen deficiency:

1– Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) is a treatment used to relieve menopause symptoms caused by a drop in estrogen production. It involves taking medications that contain estrogen to increase hormone levels in the body and alleviate symptoms such as hot flashes, mood swings, and vaginal dryness. HRT can also help reduce the risk of osteoporosis. However, it is not suitable for every woman and should always be administered under the supervision of a doctor who can weigh the risks and benefits (NHS, 2022).

What are the risks of HRT?
Hormone replacement therapy may increase the risk of certain conditions such as heart disease, stroke, blood clots, and breast cancer. 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 whether HRT is right for you (Mayo Clinic, 2022).

2– Estrogen cream or gel

For women experiencing only local menopause symptoms such as vaginal dryness and discomfort during intercourse, estrogen can also be administered in the form of a pill, patch, gel, vaginal cream, or a slow-releasing suppository or ring inserted into the vagina. Talk to your doctor to find the treatment that best suits you (Mayo Clinic, 2022).

3– Lifestyle

Finally, lifestyle changes such as a healthy, balanced diet, regular exercise, and sufficient sleep can help support hormone health and improve hormonal balance. Pay attention to your stress levels and aim for low cortisol levels. Stress hormones such as cortisol can throw off the hormones that regulate your reproductive system (Cleveland Clinic, 2022). 

What is estrogen dominance?

Estrogen dominance occurs when the balance between estrogen and progesterone in the body is disrupted, resulting in a relative excess of estrogen. This imbalance can arise due to various factors. 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 associated with a hormonal imbalance.

What are the symptoms of estrogen dominance?

Symptoms of estrogen dominance include:

• Irregular menstrual cycles
• Bloating and water retention
• Breast swelling or tenderness
• Mood swings, including depression or anxiety
• Weight gain, especially around the hips and thighs
• Headaches or migraines
• Fatigue, sleep disturbances
• Changes in libido

Source: Holland, 2023

What causes estrogen dominance?

Estrogen dominance occurs when estrogen levels are high in relation to progesterone. This can happen if your body produces too much estrogen, if medications excessively increase estrogen levels, or if the body is unable to process estrogen efficiently. Possible causes include:

• Health conditions: Certain conditions can cause hormonal imbalances and lead to estrogen dominance, such as polycystic ovary syndrome (PCOS), uterine fibroids, genetic disorders, or endometriosis.
• Chronic stress: Stress increases cortisol levels. A consistently high cortisol level can deplete progesterone, leading to estrogen dominance.
• Exposure to xenoestrogens: These chemical compounds mimic estrogen in the body and are found in many everyday products such as plastics, cosmetics, and certain foods.
• Obesity: Since fat tissue secretes estrogen, obesity can contribute to excessively high estrogen levels.
• Medications: Hormone therapy or taking estrogen-containing contraceptives in high doses can also lead to elevated estrogen levels.

Source: Cleveland Clinic, 2022

How is estrogen dominance treated?

The treatment of estrogen dominance aims to restore hormonal balance and relieve symptoms. This can be achieved in several ways:

• Lifestyle changes: Adjustments in diet, regular exercise, and stress management can not only help balance hormone levels but also reduce body fat. Reducing your body fat percentage can lower the risk of estrogen dominance. Since estrogen is largely broken down in the liver, excessive alcohol consumption should be avoided to prevent overloading the liver.

• Avoiding xenoestrogens: Reducing exposure to xenoestrogens can help restore hormonal balance in the body. Whenever possible, choose products packaged in glass or steel containers instead of plastic.

• Medications: Before starting any medication, the underlying cause of elevated estrogen levels should be identified and addressed. Your doctor can advise you, especially if you are already taking medications that may be linked to increased hormone levels.
  

Medications that influence estrogen levels in the body include:

• Aromatase inhibitors: These medications are used to treat breast cancer. They prevent fat cells from producing estrogen.

• Gonadotropin-releasing hormone (GnRH) agonists: GnRH agonists stop the ovaries from releasing estrogen.

The specific treatment may vary from person to person, depending on the individual symptoms and medical history (Cleveland Clinic, 2022).

Summary

Estrogens play a crucial role in many aspects of health, for both women and men. An imbalance of these hormones—whether due to deficiency or dominance—can lead to a wide range of symptoms and health issues. Maintaining a healthy lifestyle, including a balanced diet and regular exercise, is essential to support hormonal balance. Persistent or severe symptoms should always be evaluated by a doctor.