I love estradiol, our strongest and most stimulating estrogen. It builds bone, slows aging, raises libido, regulates appetite, and boosts serotonin (which is why it’s so amazing for mood and sleep). Those are just a few of its benefits. Estradiol regulates the expression of over a thousand genes, so it’s arguably one of our most influential and important hormones.
No wonder it feels so bad to have estrogen deficiency. (It also feels bad to have estrogen excess, but that’s next month’s post!)
Estrogen deficiency causes fatigue, weight gain, hair loss, depression, and terrible insomnia. It also causes dry skin, recurrent bladder infections, and the most characteristic of all estrogen deficiency symptoms: vaginal dryness. (If you were my patient, I would ask you about dryness to try to determine just how estrogen deficient you are.)
How To Boost Estrogen
Readers always ask me: “How can I make more estrogen?”
It all depends on why it’s low. Let’s look at four common scenarios.
You don’t ovulate but you’re not menopausal.
Ovulation is how you make estradiol, so your big question should be: Can you still ovulate? By “still”, I mean: Are you younger than 45? Is your FSH in the premenopausal range (<25 IU/L)? If you’re young and your FSH is low, then you can still ovulate. This is true even if you have had a partial hysterectomy (uterus removed). You have ovaries, so you can ovulate.
Treatment: Figure out why you don’t ovulate. Do you have PCOS ? Do you have low body weight? (For a full discussion of ovulation problems, please see Chapter 7 of my book Period Repair Manual.) Correct the underlying reason you don’t ovulate. Once you do ovulate, your estradiol will rise dramatically. There’s nothing else you need to do.
The Pill is simply not good enough. Hormonal birth control stops ovulation and completely shuts down estradiol. It replaces it with a synthetic estrogen called ethinylestradiol, which is similar to estradiol, but not identical. Ethinylestradiol is not as beneficial as estradiol, and it always comes along with a progestin that causes blood clots, depression, or hair loss.
You do ovulate.
If you are confident that you do ovulate, then you know you have sufficient estradiol on at least some days of your cycle. Why? Because if you did not have sufficient estradiol, you would not have been able to reach ovulation. You have sufficient estradiol. You may still have lower than average estradiol. That’s why you have light periods and estrogen deficiency symptoms. I call this relative estrogen deficiency.
It’s not easy to test for relative estrogen deficiency. Your blood test may show a very low estradiol on day 2 or 3 of your cycle (even within “menopausal” reference range), but that’s normal for that day. You could try testing at peak-estrogen (about three days before ovulation), but it will probably fall within the normal range.
Treatment: Relative estrogen deficiency can occur at any age, and can be the result of smoking, low body weight, excessive exercise, stress, vegetarian diet, gluten sensitivity, or eating too much soy. If you’re younger than 45, the best treatment is to correct the underlying problem, and maybe take an estrogen-boosting herb such as Tribulus or shatavari. (Be careful with Tribulus, however, as it is strongly estrogenic. Do not take during pregnancy or if you have a history of an estrogen-sensitive cancer.)
If you’re older than 45, then your estrogen may become more and more deficient as you move towards menopause. A gradual decrease can be good because it gives your body a chance to adapt to less and less estradiol. In contrast, most women in their 40s experience estrogen excess, or even worse: deficiency interspersed with excess. I call this the perimenopausal “estrogen rollercoaster”, and discuss it in some detail in my book. See next month’s post: Estrogen Excess.
You’re having an easy menopausal transition.
Estradiol decreases after menopause, but it doesn’t stop completely. You continue to make some estrogen (both estrone and estradiol) from your androgens (androstenedione and DHEA). The conversion happens in peripheral tissue, such as brain, fat, and skin, and it should be enough to keep you healthy. You’ll make more estrogen if you have a good supply of DHEA coming from your adrenal glands. That’s why it’s so important to support your hypothalamic-pituitary-adrenal (HPA) axis function during and after menopause.
Treatment: Support your HPA axis by getting enough rest and sleep, and by taking magnesium and adaptogen herbs such as rhodiola or ashwaganda. If you suffer hot flashes, try black cohosh combined with St John’s wort. Those herbs don’t raise estrogen levels, but they do relieve menopausal symptoms. If you suffer vaginal dryness and low libido, then consider using a low dose estradiol vaginal cream.
You’re having a difficult menopausal transition.
If you’re reading this section, then you know what misery comes with a sharp withdrawal of estradiol. Sharp withdrawal occurs after surgical menopause (removal of the ovaries), sudden cessation of hormonal birth control or HRT, or after a particularly rough “estrogen roller coaster” kind of perimenopause.
The worst symptoms are hot flashes, depression, and severe insomnia. I have witnessed these symptoms with many patients, and I really don’t think any woman should have to put up with them. I support the use of bioidentical estradiol replacement.
Treatment: Bioidentical estradiol is very, very different from the horrid horse estrogens and medroxyprogesterone used in the HRT of the 70s and 80s, and in the Women’s Health Initiative study. When used appropriately, bioidentical estradiol is fairly safe. It’s available as a patch or a gel, and must be combined with a progestin, preferably a bioidentical progesterone capsule. Speak to your doctor.
In summary, estradiol is a luscious, life-giving, essential hormone. Before menopause, you make estradiol with your ovaries. You can only do that if you ovulate regularly. After menopause, you make estradiol (and other estrogens) with your adrenal hormones.
Yours in health,