When we talk about Perimenopause or menopause, the hormone, Estrogen is a big buzzword and a major player. It is also the source of much confusion, is my Estrogen level high? Is it low? Which is worse, high or low? Should I use hormone replacement therapy (HRT)? The first step I always advise my clients when they have questions regarding any subject is get yourself INFORMED.
Research is a time-consuming task ( this I can assure you) but an informed person is primed to make the best decisions for themselves. You are a unique individual and no one knows you better than you. Don’t forget that and don't stop advocating for yourself. It is my hope that my blogs can provide you with concise, research-based information that can help you get started on your knowledge quest, enable you to ask the right questions and feel more confident in your approach to your health care needs..
So here we go on Estrogen!
Most of us know estrogen is associated with female reproduction and the menstrual cycle, but it has far more reach and implications than that. Estrogen is often labeled the “super hormone”, it is actually a group of hormones made primarily by the ovaries but are also produced in small amounts through the adrenal glands and fat cells (1).
The three types of Estrogen include:
Estrio (E1): produced during childbearing years and pregnancy
Estrone (E2): the only estrogen produced after menopause
Estradiol (E3): most prolific, produced during childbearing years.
Estradiol is responsible for the maturation and eventual release of the eggs from the ovaries, while also preparing the uterine lining to receive a fertilized egg. Excess Estradiol can cause depression, acne, decreased libido, weight gain and in severe cases, high levels are associated with increased breast and uterine cancer risk. Low levels of Estradiol, often found during Perimenopause, are one of the reasons behind hot flashes, mood swings, and increased risk for osteoporosis (2).
The most common and well-known functions of estrogen include:
Regulation of menstruation
Development of female sex characteristics such as breast development and pubic hair
However, estrogen is also involved in:
Regulation of Cholesterol levels
Brain function including mood by boosting serotonin production (now THAT makes sense doesn't
Protection of bone health and bone mass in women and men
Functions of the Musculoskeletal system (there's an interesting NYT read here)
Heart health by keeping blood vessels pliant and by reducing inflammation that can cause plaques
Distribution of adipose tissue
Estrogen levels fluctuate throughout the month. During the menstrual cycle, estrogen typically starts to rise and peak in the middle of the cycle in order to prepare the uterus for possible pregnancy. It works in conjunction with Progesterone, as one rises the other drops. The lowest levels of estrogen are produced during menstrual flow, when the uterine lining is shedding (3).
Estrogen levels can also be affected by outside factors including:
Adipose tissue is a major site for storage and metabolism of the sex hormones. When adipose tissue becomes dysfunctional, as in obesity, the ability of the tissue to metabolize and excrete / eliminate estrogen and other excess products decreases and these byproducts stay in the tissues. This in turn creates a cascade of pro-inflammatory signals in the body (pro-inflammatory is not a good direction to head in, by the way.) (4)
Women with Type 2 Diabetes often have low levels of estrogen. Recent research is suggesting estrogen supplementation to assist in regulation of insulin levels. (5)
High Blood Pressure
Pushing our bodies beyond its limits for prolonged periods of time can result in converting a normally “good stress” or eustress activity to a “bad stress activity” increasing cortisol levels and decreasing sensitivity to estrogen.
What the actual heck, right?! Exercise, they say...but not too much...or too little … Jeesh..can it get any more confusing??
Medications such as certain antibiotics, steroids and estrogen containing drugs
Stress and elevated levels of cortisol. Cortisol is released from the adrenal glands (along with epinephrine) to respond to any perceived stress. It is responsible for our “flight or fight response” and kickstarts a vast number of body processes targeted to provide the body with a quick flood of energy needed to mobilize the body into quick action.
Because the release of cortisol in response to stress is considered necessary for survival, it is preferably selected by the brain. Circulating estrogen is essentially ignored and unable to exert its intended effect. In this scenario, a woman's...or a man’s (they have estrogen too!) estrogen levels may be normal but the brain is not recognizing and using the hormone making it appear that the person has low estrogen, when in fact levels are normal.
That is why hormone testing is so important to determine if estrogen levels are high or low in order to properly direct treatment. Supplementing estrogen when levels are normal will just result in weight gain and mood swings and who wants that?!?
Exposure to Xenoestrogens which are man-made, non biodegradable compounds that mimic estrogen and are found in many everyday products. Xenoestrogens often lead to an increase in available estrogen or “estrogen dominance”
You can get my list of Xenoestrogen products to avoid here
It is important to fully understand if you have high or low estrogen in order to properly direct treatment or symptom management. For that you will need to get tested by a qualified practitioner. Estrogen can be tested in a few ways: saliva, urine or blood. Because your levels fluctuate naturally throughout the month you may need to be tested multiple times to get a tru picture.
In the meantime, the following are typical signs and symptoms of abnormal estrogen levels.
Symptoms of Low Estrogen:
Menstrual periods that are irregular in timing or cease altogether
Hot flashes (sudden onset of heat and/or sweating) and/or night sweats
Dryness and thinning of the vagina mucosa, often causing pain with intercourse
Low sexual drive
Symptoms of High Estrogen:
Weight gain, mainly in the waist, hips, and thighs
Menstrual irregularities, such as light or heavy bleeding
Worsening of premenstrual syndrome
Fibrocystic breasts (non cancerous breast lumps)
Loss of sex drive
Feeling depressed or anxious
Well, that was a lot to digest!
Hormone balance is a very complex process and requires patience, time and seeing the right practitioners (yes, usually more than one)
What I would like to give you as a takeaway are a few tips that can help you maintain healthy hormone levels.
Manage. Your. Stress Levels.
Easier said than done right? I know!! But starting anywhere is better than nowhere. In the words of Arthur Ashe “Start where you are, use what you have, do what you can”. Start paying attention to what you need and follow through with it. Take 5 deep breaths a few times a day, take a 20 minute walk at lunch, listen to some favorite music.
Strive to maintain a healthy weight
A notably sensitive topic. I am a strong supporter of body positivity. I fully stand in support of accepting ALL of who you are regardless of shape, size and the myriad of other factors that make us unique individuals. However, health research is pretty strong in listing the increased health risks related to obesity. All I say is do your due diligence and stay informed so you can make the best decisions for yourself and for your health..
Avoid the Xenoestrogens
I mentioned this earlier, but being mindful about product choices can have far reaching effects. Being able to do this in a way that is also economical is a huge challenge. Feel free to post in comments the economical ways you have reduced the intake of toxins, I would love to hear them!
If you are overwhelmed about where or how to start or would just like some more individualized and in depth guidance on healthy lifestyle management strategies, check out My Peri Plans here, we are here to help you get the most out of your Midlife life.