The estrogen hormone is one that must be very familiar to many due to its association with sexual development and post-menopausal symptoms in women. However, from my discussions with women I see in the clinic, very little is known about the hormone, its functions and relation to menopause. The information provided below seeks to unveil the mystery behind this hormone as we continue our series on understanding our bodies better.
Estrogen in Men
Unlike other hormones we have discussed in this series, estrogen is made by several organs in both women and men! In men, testosterone (male sex hormone) is converted into estrogen by tissues such as the brain and adipose (fat). Many studies have shown that a certain amount of estrogen is required in men to protect the heart, strengthen bones, improve brain function and increase libido (sexual drive). Decreased levels of estrogen may cause weak bones leading to greater incidence of bone fractures, increased LDL (bad cholesterol) and decreased HDL (good cholesterol) which leads to hypertension and high cholesterol blood levels.
If too much estrogen is produced due to a defect in the body’s regulation or from a tumor, men might have decreased amounts of testosterone, loss of muscle tone, decreased libido and sexual function, male breast enlargement (called gynecomastia), male breast cancer, feelings of fatigue most of the time, weight gain (due to increased body fat) and an enlargement of the prostate gland.
Estrogen in Women
If there was one hormone I had to pick as most important to the female body, it would definitely be estrogen. It is the chemical code that instructs the creation of primary and secondary sex characteristics we tend to associate with being ‘female.’ These include breasts, menstrual cycles, the female body shape and appropriate amount of body and pubic hairs.
There are three types of estrogen present in women that are produced mainly by the ovaries and placenta (in pregnant women): estradiol, estriol and estrone. Estradiol is mostly produced during the reproductive years (puberty till menopause) while estrone is higher in post-menopausal women. Several studies have been conducted to uncover other roles of estrogen and also why a lack of it during menopause causes several health problems. Below is a list of some of benefits of estrogen:
Benefits:
- Stimulate endometrial growth (the endometrium is a layer of muscles inside the uterus which serves as a surface for a fertilized egg to grow; estrogen stimulates this layer to grow and promotes good blood supply in preparation for pregnancy during each menstrual cycle. If no fertilization occurs, estrogen levels decrease and the endometrium is shed as a menstrual period)
- Increase bone formation/bone mass; it prevents osteoporosis
- Helps the liver produce proteins that help form clots to prevent excessive bleeding resulting from cuts
- Helps increase fat metabolism
- Increases HDL (good cholesterol) and decreases LDL (bad cholesterol); high blood levels of LDL cholesterol can cause heart attacks or strokes
- Protects the heart (cyclical estrogen has been found to be cardiac protective in pre-menopausal women but not after menopause)
- Improves brain function
- Enhances skin elasticity/ decreases formation of wrinkles as one ages
- Helps improve vaginal lubrication and wall thickness to prevent pain or injury during intercourse
Lack of it:
Decreased levels of estrogen are primarily due to dysfunction of the ovaries as seen in menopause and polycystic ovary syndrome (a disease that causes several cyst-like structures in the ovaries, increases production of male hormones instead of estrogen and leads to irregular periods, infertility, obesity and facial acne). Women who starve themselves frequently (anorexics) tend to have low estrogen levels because the body shuts down the reproductive cycle in order to conserve calories/fuel. Taking a closer look at what goes on in menopause can shed some light into the effects of low estrogen in the female body.
Menopausal women tend to experience:
- Hot flushes and sweating which are usually worse at night and triggered by smoking, hot beverages, alcohol or spicy foods
- Decreased sleep due to frequent waking up from intense hot flushes; this leads to day time fatigue and sleepiness
- Poor concentration, memory loss, depression, anxiety and irritability
- Increased pain during intercourse due to vaginal dryness and wall thinning
- Decreased interest in sex partly due to pain during intercourse
- An increase in bone fractures/ weak bones
- Increased weight gain
- Increasing dryness of skin, eyes and wrinkle
Other significant health problems that might occur in women with low estrogen include:
- Increased cardiac related deaths
- Increased disability from long-term osteoporosis-related fractures
- Development of colon cancer in the large intestine
- Occurrence of pelvic prolapse (weakening of the muscles around the vagina and anus leading to poor support of the internal organs) and urinary incontinence (leaking of urine).
Diagnosis:
Various tests can be carried out to determine if adequate amounts of it are being produced and if not, what the defect is likely to be. Your doctor might order these tests if you are having irregular or no menstrual bleeds, have several of the symptoms of menopause or if you are having difficulties getting pregnant:
FSH and LH levels (these are hormones that work together with estrogen to regulate the menstrual cycle. They tend to be high if estrogen is low) estrogen, progesterone and testosterone levels, thyroid hormones (TSH, T3/T4)
Treatment:
Until 2002, menopausal women were given estrogen hormone replacement therapy (HRT) to help prevent some of the bad side effects of low estrogen including osteoporosis. Unfortunately, research has shown that continuous use of estrogen has more negative effects than good ones. Currently, estrogen replacement therapy has been shown to cause:
- Increased formation of blood clots which can lead to heart attacks, pulmonary embolism (serious lung problem that limits oxygen exchange) and strokes
- An increased heart disease such as angina (occurs when the blood supply and oxygen to the heart muscle is reduced)
- High risk of endometrial cancer
- Increased risk of breast cancer (breast tissue is very sensitive to estrogen levels in general. However, cancer cells tend to respond even more to estrogen, grow faster and re-occur)
Recommendations
As such, the current recommendations is not to use estrogen HRT in menopausal women or those with low levels of it, especially in women with past history of breast cancer, strokes, blood clots or heart disease. Topical estrogen creams can be used in the vagina to decrease dryness; women report significant decrease in pain during intercourse. Hot flushes tend to decrease over time and as such, no drug treatment should be used.
Healthy changes in diet (increased calcium, Vitamin D, low-fat, low-cholesterol), increased exercise, decreased habits such as smoking and alcohol consumption can also improve symptoms greatly. Although no official data has been provided, a cross-section of doctors believe that eating foods high in phytoestrogen, a naturally occurring estrogen, might relieve some of the effects of low estrogen. Foods high in phytoestrogens include soybeans, tofu, millet, lentils, flaxseeds, kidney and lima beans. Herbal supplements like ginseng or black cohosh also contain some phytoestrogens and are good for treating hot flushes and night sweats.
Talk to your health care provider about changes you notice in your body, moods and relationships. They can provide information, insights and natural solutions (if you prefer this to pharmacologic treatment) that might help improve your daily well-being and enjoy fully the blessing of all that it means to be a woman!
Resources:
1) Information on Menopause:
–http://www.webmd.com/menopause/
–http://www.mayoclinic.com/health/menopause/DS00119