In Defense of Estrogen. No Hormone More Powerful for Sleep and Mood and Libido

in defense of estrogenWe must not fear estrogen—our own queen of hormones. With all the current talk of estrogen dominance, plus the 2002 HRT scare, estrogen has acquired a bad reputation it does not deserve.

Estrogen is good for sleep, mood, and libido

Our main estrogen—estradiol—sensitizes the brain to oxytocin and dopamine, and also triggers the release of serotonin. It supports healthy mood and sleep and is also important for skin, bone health, insulin sensitivity, metabolic rate, and libido.

Too little can cause depression and severe insomnia, which is why taking estrogen can relieve those symptoms.

Too much estrogen can cause symptoms because it stimulates the mast cells and histamine. Read The Curious Link Between Estrogen and Mast Cells and Histamine. Estrogen is a hormone to keep in check.

How to keep estrogen in check

  1. Reduce histamine and mast cell activation. Inflammation interferes with estrogen detoxification and increases the sensitivity of the estrogen receptor. A particular part of the inflammatory response (associated with mast cells and histamine) plays a big part in the symptoms typically attributed to “estrogen dominance.”
  2. Ensure adequate progesterone. Progesterone down-regulates and calms tissue. The only way to make progesterone is with regular, healthy ovulation.  After menopause, the only way to have progesterone is to take micronized progesterone, not a progestin. Read The Crucial Difference Between Progesterone and Progestins.
  3. Promote healthy estrogen detoxification or clearance. There are many steps to healthy estrogen clearance including the magnesium-dependent COMT enzyme, as well as phase 2 liver detoxification pathways. Gut bacteria help to escort estrogen from the body. If they are disrupted by, say, antibiotics, then estrogen is not cleared. Even worse, active estrogen intermediates are reabsorbed.
  4. Stabilize receptors with iodineIodine deficiency causes tissue to over-react to estrogen. Consider supplementing iodine to calm the body’s response to estrogen.
  5. Don’t be insulin resistant. Insulin is a growth-hormone and promotes cell division in hormone-sensitive tissue like uterus, breast, and prostate. Furthermore, the pattern of weight gain associated with insulin resistance increases the activity of aromatase which converts testosterone to estrogen.

A modern approach to HRT

Modern hormone replacement is body-identical topical estradiol plus oral micronized progesterone.

Read Rescue Prescription for Perimenopause and Menopause.

Hormonal birth control is not a good type of HRT

Hormonal birth control is a particularly soul-crushing type of HRT because it suppresses the body’s own estradiol and progesterone, and replaces them with contraceptive drugs.

Estrogen may not be a breast cancer risk

Breast cancer risk is determined by insulin, thyroid, inflammation, vitamin D, iodine deficiency, toxic chemical exposure, and so much more. It may not cause breast cancer and at least one study has found that supplemental estradiol slows the growth of advanced breast cancer.

Read:

Lara Briden, women's health doctor and period revolutionary

51 thoughts on “In Defense of Estrogen. No Hormone More Powerful for Sleep and Mood and Libido”

  1. Hi. Love your site. I’m considering a combined oestrogen/progesterone patch. I currently use transdermal estradiol and progesterone pill, but the pill upsets my stomach. Just wondering if the patch will be body identical hormones and no-one seems to know! I’m in the UK. Could you advise? Many thanks, Julie

  2. I’d love to get your opinion: I’m 47 and started 0.025mg patch of Estradiol in May 2018, followed by adding 100mg Prometrium 6 weeks later. I started to feel better very soon after starting the Estradiol and the Progesterone further helped with my insomnia. For months, my symptoms were so much better! I had fairly regular periods after that (short cycles). I started feeling my usual PMS symptoms this last cycle and expected a period. I did not have one this cycle AND my previous constant symptoms that I had prior to starting HRT are significantly back (irritability, insomnia, anxiety, cramps, tender breasts). I asked my OB if she thought increasing the dosage of the Estradiol would potentially help. She is a little perplexed and says that it is unlikely that I need to increase the dosage since it hasn’t even been a year since I’ve been on the current dose. I have traditionally been VERY sensitive to hormones (BCPs were awful for me – increased anxiety) and so she was cautious to begin with in terms of starting with a very low dose. She said that she will increase the patch dose for me as a trial, but that I may experience bloating, more irritability, insomnia, before I feel better. Do you have any thoughts to share on this? How would I know if the newer dose is helping or hurting since I’d potentially feel worse before feeling better? For reference, I would absolutely love to see a naturopath for specialized HRT, but financially, this just isn’t an option at the moment.

  3. Hello, thank you for this. Some time ago I ordered some estradiol valerate (sp?) and never really took it bc I’m 52 yrs old—I opted for smoky mountain naturals progesterone and estrogen cream off amazon. Ok, so I’m using it…but feel tired a lot still. I then found my old pack of estradiol and for the heck of it—took a pill for 4-5 days—and low and behold I feel like I have enough energy to go about my day. I can’t tell you how stressful it’s been feeling for years now—that I don’t have enough energy to take care of myself and my children and survive my marriage😊. I’m thinking it’s the extra estrogen?? Now the thing is do I supplement with prescription progesterone or same cream to balance out?

  4. Hi Dr. Brides,
    I have Pan Hypopituitarism, so I have been on Premarin/Provera for replacement since I was a teen! Since then struggled since with my weight, and at times, insomnia and worry.

    Flash forward: I’m now 39 years old with 4 year-old twins from IVF. My usual symptoms seem to have steadily increased over the last few years. A new doc is putting me on Progesterone and I am super excited! I am now considering the E Patch as well.

    My question to you is this: I am on these hormones primarily to protect myself from osteoporosis, as I have been on hydrocortisone and Synthroid for most of my life. Would the E patch and 200mg of Progesterone offer me the same protection? If so, are there specific dosages I should be looking at?

    Thanks in Advance,
    Andi

    • Hi Andi,
      Yes bioidentical estradiol and progesterone will offer you the same protection for your bones. Even better than Provera!

        • I think either is fine. The key is to stay low with the dose. And also take micronised (natural) progesterone (even if no uterus).

          • Hi Dr. Briden,

            I have since gone on Progesterone (200mg last month did not provide a bleed like Provera did, so I am being switched to 300mg).

            I switched from Premarin 0.625mg to an Estradiol 0.0375mg patch a couple of weeks ago. Since then, I have been having hot flashes every night.

            Is my body still adjusting, or is the patch dose too low?

            Thanks!
            Andi

          • That’s a pretty low dose of estradiol, so you might need more. Also, using hormone replacement the way you do, there shouldn’t really be a reason to bleed. You just need to be sure you’re taking enough progesterone to prevent build-up of the uterine lining. But of course, please speak to your doctor.

  5. I am trying to find a better source of estrogen. I’ve found out about the maca root but have read that it would cause my estrogen receptors to no longer be sensitive to my rx estrogen. I want to try it but don’t want to make it impossible to use my estradiol if I decided to go back to it. Is this true?

  6. I’m about to have a total hysterectomy and both ovaries and cervix removed. My gynae here in the U.K. says I’ll need oestrogen patches to protect against osteoporosis and that the risks of breast cancer and stroke though doubled will stillonly be 2 in 1000 women. At this stage I have no idea if these patches will be bioidentical or synthetic. There was no mention of progesterone. Reason for surgery is complex endometrial hyperplasia that didn’t regress with Provera. In addition to ovarian cysts. Before this diagnosis I had planned to go through menopause using bioidentical hormones after reading up on them but now I have no idea what I need and my gynae on the NHS dismissed bio identicals as not fully researched (I understand why, the impossibility of patenting of a natural plant based product). Please could I have some advice on a suitable course of action post-surgery for hormone treatment so I can go back to my gynae feeling more confident? Thank you

    • I should have added, I’ve suffered from insomnia, depression and anxiety for 3 years. I’m 47 and before I started Provera for the hyperplasia I still had a regular menstrual cycle.

  7. Hi! Cameacross your site last night while wide awake at 1am. This is typical for me, severe insomnia. I am 39 and my life is filled with going through the motions and doing the best I can for my 4 children while I feel so ill. Hysterectomy stole my life 2 years ago. Kept ovaries and uterus was wrongly removed. Pathology came back benign.
    I have been to so many doctors and they say my hormones are fine based on blood serum and blood spot. They offer to put me on the pill again to smooth things out and that I will love it. Don’t buy that for a second.
    Finally this last endo said my estrogen was low at 20, probably lower as the lab does not measure lower than that. She starts me on 1 mg estradiol tabs and says I do not need progesterone due to not having a uterus. This sounds weird to me. My symptoms are: 60 lb weight gain, hair loss, severe insomnia, worry, edginess, forgetfulness, heart palpitations, body pain, bladder issues.
    I feel worse now on the estradiol and my ovaries are aching sooooo bad. I am considering going to the er.
    I don’t know what to do or who to see that can help me get this figured out. I had another naturopath tell me my estrogen was too high based on a saliva test. I am so confused. One says high, one says low. My body is a science project and I am paying the price for it. Please help!

      • Thank you for all of the feedback. I contacted the doctor and discontinued the 1mg estrogen she had me on. I had only been on it 5 days and was in the worst pain ever. I am still hurting, but can feel it slightly letting up. Having an ultrasound on Tuesday. I agree that progesterone is till needed which is why I was taken aback to have her tell me different. I know what they will say Tuesday, that I need to have another surgery and that scares me to pieces as my first surgery made things worse.

        Having been told I was high and then low estrogen within a weeks time is very confusing along with all of my other symptoms. It is a little scary too as I have read the consequences of low estrogen. Without concrete info I don’t know who to listen too and it makes me wonder why these ovaries ache so bad all the time. I will look into the progesterone you both recommended. I wonder if PCOS is in play here. Thank you again for caring.

  8. Hi Dr. Briden,

    1.What do you recommend testing to BEST determine my baseline estrogen levels to start to decipher what treatment I may need. Do I need to test all of these: estradiol, estriol, estrone lc/ms/ms and estrogen total? I want to get the most accurate picture of what is happening. Do I test 7 days before period or cycle day 3? My periods are usually every 28-30days, but I have dc/spotting most of the month- clear only the week or so before my period. I am concerned about getting more labs than necessary with low ferritin (9) and heavy periods, so which of these ‘estrogen labs’ do you recommend as the best measurement for estrogen and when to test?

    2. Is there anything you recommend to help ‘replenish’ the iron after labs with my low ferritin. I have been taking Thorne vegetarian iron, but still feel dizzy, weak and breathless most days. It seemed the dizziness even got worse on the iron.

    Sincere thanks for your help!

  9. After a few years of estrogen dominance I also had vistibular migraines due to hormone fluctuating. This lasted for 3 years whilst I was In Peri menapause. Now I’m in menapause I was given biodentical hormones which was also causing me to have dizziness. So I had to stop and now I have low estrogen 20 and high insulin which has caused huge weight gain. I’ve always eaten well and excercised so now I’m on low carb diet but eat good fats. Natropath has me on rda solution for insulin resistance and has tried me on o-lift for menapause symptoms but it brings on slight dizziness. I’m lost and so stressed as my weight has gone from 55 kilos to 67 and rising
    Chris

  10. I am 58 and had my hyst at 26. I still have both my overies (most probably all dried up) but nonetheless I have NEVER been on any hormone pills or anything like that. But lately I have been going through very, very terrible time. I cry almost every day,..I am so negative,.fearfull,..anxiety feelings and most of all depressed. I do not have any sex drive. my husband has given my altimatum. That makes me even more fearful. I have gone from Dr to Dr. Stress release therapy TRE Therapy etc. etc,…I cannot make a decision about anything. I dont even feel like doing anything. I sometimes wish the sun does not want to shine instead it should be misrable weather and rain so that I have reason to stay in. I have given up on myself and do not see the fun or good in life anymore. I use to be so much fun and funny and nice to be around with. I have suicide thoughts although I know I wont see it through but wonder what it would be like.

    I have grandchildren that I love and adore but have anxiety attacks when I am with them. I cannot sleep and do no switch off. my mind just goes on and on and keep onto negative stuff. I cannot be positive anymore.

    All of that said now. I am on Premarin for the second day,..please tell me this will help. The worst for me is just the smallest thing is so big for me so that I see up to everything.

    I want to move away from where I have stayed for 20 years cause I feel I am not happy here anymore. I think I am running away from myself.

    Thank you I hope you can give me advise on this medication I am on now.

    Marietha

  11. After the birth of my third baby in Jan of 2014, I’ve been dealing with hot flashes, anxiety, low energy/libido, dry scalp, vaginal dryness, and hair loss. I’ve been tested out the wazoo, and after the latest round of tests, my Naturopath wants me to try Emerita, a phytoestrogen cream (estrogen totals of 79 pg/mL on day 3 of my cycle and an FSH of 5.6 mIU/mL). She said I’m probably low in Progesterone as well, but she’s hoping the cream alone will make a difference. Should also mention that I went back on Ortho-tri-cyclen Lo shortly after birth to “regulate” things, but went off of birth control for good in July 2015. Since then, I’ve had regular cycles, except for spotting before and after the main bleed, bringing my total # of days to 8-14. Also, I’m 35.

    My question is: what are your thoughts on phytoestrogen creams? I’ve read your Estrogen related blog posts and the Period Repair Manual and I don’t recall your opinion of that type of treatment option. Thank you!

  12. I went into menopause while on chemo over 17 years ago. I’ve suffered from hot flashes and sweats ever since. I’ve had breast cancer twice. No doctor wants to prescribe any kind of hormones for me. I recently quit taking citalopram, trazodone, letrozole, and clonidine. Hot flashes worse than ever. I have some progesterone cream but it seemed to me that when I used it hot flashes got worse. I’m sick of waking up so many times a night hot and sweaty. I also feel generally dysthymic now. I just want to feel “normal”, whatever that is now. I took the letrozole for four years and the clonidine was for helping with the hot flashes. I’m 63. Got any ideas for me?

  13. I am 47 and have suffered for almost 6 years with chronic insomnia, went to so many doctors and tried different bio Identical hormones the biest cream which is 2 different estrogens, I have taken TONS of over the counter sleep aids nothing worked! Finally I am on only the estridial patch!!!! and I am sleeping and feel better then I have felt in years!!!!!! I love your website!!!

  14. Hi Lara,
    I am a 50 y/o and peri-menopausal. I have done the 23 and me test and have found I have the COMT met/met mutation. This means I have difficulty clearing dopamine, epinephrine, nor-epinephrine and estrogen and that because of this I have a tendency to anxiety. Several years ago I started to have severe problems with insomnia. I have tried oral progesterone and DHEA but have found the both seem to convert to cortisol in my case, making the insomnia worse. Progesterone cream does not seem to do this however and I do use this though I cannot tell it helped with sleep. I was started on a low dose of estrogen a year or so ago. It immediately gave me hot flashes which I had never had before. I decreased to just a tiny dose and it initially seemed to help with sleep. However, I seemed to now feel underlying anxiousness and the insomnia and the hot flashes have returned. I am assuming it is the excitatory effects of excess estrogen. Any idea how I can increase my COMT activity so that I can have the benefits of low dose estrogen (bones, eyes, brain) but yet be able to better clear any excess? Thanks

  15. I am 50 yrs old and had a full hysterectomy when I was 34. I have been on bioidentical hormones for the last 10 yrs. But it hasnt been a smooth ride. Nobody ever seems to get it right. So, anyways presently I am on BiEstro-care with 1mg natural estriol and .25 of natural estradiol with each dose which is one pump. I am also on 20 mg of bioidentical progesterone from women’s international pharmacy. I was using it everyday until iit was suggested to me to me to use it for 25 days and then go off it all for 5 days. Today is day 1 after being off for 5 days. I am so irritable, which I usually am. I then realized that the last 5 days that I wasnt. I found your site and read that if estrogens and progesterone are not balanced right irritability can occur. So my question is what should the ratio be for progesterone and the estrogens.

    • One of the biggest issues with excess progesterone supplementation is that it converts to testosterone, and that can cause irritability and other side effects.
      I wish there was a simple blood or saliva test (or ratio) to monitor progesterone supplementation, but there is not. That’s one of the reasons I recommend 5 days off every month. So you can check in with your symptoms, and see how you feel. If you feel better OFF the hormone supplement, then there’s a problem. That said 20 mg progesterone is not a high dose. It might be that you’re not metabolising it very well, which can happen if there is underlying issue with thyroid, for example.

  16. I have just begun Enjuvia(estrogen) as I have low to no libido, dry skin, sleeplessness, hot flashes and sagging skin. I had a hysterectomy 10 years ago leaving one ovary. My ovary has since stopped working and I am experiencing, major vaginal dryness and low libido. I am very healthy and a bit uncomfortable taking estrogen low dose .3mg 1x/day. Do you have an opinion?

  17. I recently started taking Estrosense to detox from the birth control pill I’ve been taking for more than 10 years. I’m planning on quitting my BC pills after finishing the next 2 packs. My problem is, ever since I started detoxing, I’ve been getting HORRIBLE mood swings. I cry so easily and everything feels like it is end of the world to me. While I cognitively know that I am okay, I am emotionally gripped by these powerful feelings of sadness. I don’t want to stop detoxing, because the pills have done more harm than good… but I just don’t know if I can stand these mood swings any longer. Any suggestions on how we can alleviate mood changes due to detoxing from estrogen?

    • Hi Rachel. I had similar symptoms and then switched to pregnenolone 50 mg 2x a day and now feel so much better n sleep well. It’s not talked about as the drug companies can’t license it as it is a natural hormone found in yams. It Is the base hormone your body uses to make estrogen, testosterone and progesterone. Your body can use it to Mar what it needs. I can’t believe the difference. Please try it. It’s sold on Amazon. X

  18. Thank you, Lara! I do appreciate your advice and this website SOOO much! If you lived here in the U.S. and near where I live, I would most definitely have you as our family doctor!

  19. Hello! I’m 56 years old and had my last period two years ago. I’ve never had a hysterectomy. About a year to a year and a half ago I started struggling with UTIs. The first two UTIs were treated with antibiotics. Then I made an appointment with a urogynecologist for a check up this past April, 2014. She diagnosed me with vaginal atrophy and said that that was the cause of the urethral discomfort I was having. Actually, it was a lot more than discomfort. She prescribed Estrace vaginal cream, 1 g three times a week. It helped within the first week of use. I stayed on the Estrace cream for about 2 1/2 months. Then I went to my family doctor for bronchitis and while I was there I inquired about Vagifem tabs 10 mcg. She said I could try them and prescribed them for me and I switched to those three times a week, but after one week of use, the discomfort came back, although not quite as bad. I switched back to the Estrace about a week to two weeks ago but I am not completely comfortable yet. Sort of feel like I have a mild UTI which I am taking d-mannose for. I’m guessing my atrophy must be on the severe side. Ugh, all of this is no fun! I have always been one who hated the idea of using hormones, however, there is no way I can live with that pain. From what I have read on the web, it seems as though I should also be using a progesterone cream, though my doctor said they don’t usually prescribe it with the Estrace. Since I’m through menopause, do you think that is why they didn’t prescribe progesterone cream? Do you think it’s necessary? Also, to your knowledge, can Estrace vaginal cream cause anxiety? I know some doctors think it’s not absorbed systemically, but I don’t believe that. I would so appreciate your advice. Thank you!

    • I am generally in favour of vaginal estradiol for menopausal women. It helps with bladder, and also with lubrication and libido. I will probably use it myself when I get to that age. Bioidentical estradiol is not AT ALL the same thing as the horrid premarin-provera HRT combo of the 1980’s.

      Yes, a small amount of estradiol is absorbed systemically from vaginal applications, but it is a very small amount and most women find that its effects are mild. It generally does not require the addition of progesterone. They symptom to watch for is breast tenderness (to indicate excess estrogen).

  20. Hi I had a total hysterectomy and Oopherectomy almost 2 years ago. I have tried to be HRT free but I have low libido, vaginal dryness and my hair and skin is suffering. I am surprised to read that I should also take Progesterone with estrogen as I was told no ovaries meant no need for progesterone. I have been given Everol patches but as yet have not used them. What should I be taking please?

  21. Hi I’m hoping you can help. I thought for sure I had low progesterone. Spotting before periods and my hair has been shedding for 2 years. I am 39 years old and don’t take any prescription medicine. Thyroid normal. I just took a saliva test on day 20 of my cycle through ZRT labs. Here are my results:
    Estradiol E2 is .7 (normal range is 1.3-3.3)
    Progesterone is 127 (normal range is 75-270)
    Ratio: PG/E2 is 181 (optimal range 100-500 when E2 1.3-3.3)

    Would you recommend natural estrogen and progesterone to bump my levels up? I am very upset about my hair loss mainly.

  22. Hi Lara, I am 49 and had a hysterectomy about 3 years ago but retained my ovaries. I am now experiencing extreme hot flushes and sleeplessness, I am in a constant haze. I am nervous about persuing bioidentical hormones but will give anything a try. Do you know of any great naturopaths in Brisbane? I did see you about 10 years ago while living in Sydney.

  23. I believe the pill has had a massive effect on my health and would never go near it again! I was taking it for 5years and came off it to try and start a family with my husband. That was two years ago, my body hasn’t been the same nor have I had a period since. Diagnosis is ‘boarder line PCOS’ – even though I do not match all of the criteria – except for the multiple under developed follicles.. Were now undergoing fertility treatment to help our cause.

    I wish there were more studies and research done on the long term damage the contraceptive pill causes, or that I did some myself before taking it. I am in two minds whether to research into what long term effect particular fertility drugs will have, I am quite afraid of answers I may find.

  24. Hi Lara,

    You put me on bio-identical HRT (estrogens, progesterone and DHEA) about 10 years ago after I had terrible side-effects on conventional treatment. I am 58 years old now and have been on them until I weaned myself off about a year ago. Probably too long I know, but since stopping I have experienced some weight gain – particularly around my middle – hot flushes and night sweats and I don’t seem to have the energy I use to have. My diet and activity levels have not changed. I am thinking of going back on the hormone treatment. What do you think?

    • Hi Kris, I’m happy to hear from a former patient. You could consider going back on a very low dose, or maybe just onto DHEA alone, depending on your hormone levels. I’ll send you a private message to discuss in more detail.

  25. Excellent info Lara. So we should ask our doctor for a scrip of estradiol or estriol with progestrone?
    Do women need the progestrone even if they have had a menopause or a hysterectomy?
    Does that come in a patch? and is Estrodot a form you like?

    • Post-menopausal women can consider temporary use of low-dose estriol or estradiol or estriol/estradiol combination. Yes, should usually be accompanied by micronised progesterone, to protect the breasts. (but the ultra low-dose in an estrogen vaginal pessary is probably ok on its own). Hysterectomy doesn’t change the need for progesterone. That idea harks back to the old days when they were using nasty progestin to protect against uterine cancer. Natural progesterone is a different thing, and has benefits that go way beyond uterus-protection.

      I would almost never recommend an estrogen supplement for a pre-menopausal women. If the ovaries are still cycling, then they are a much better source of estradiol than any supplement.

  26. In treating women in menopause, I balance the estradiol with progesterone and estriol in appropriate amounts. There is good evidence that IF there are any hazards with estradiol (vascular endothelium, for instance) that estriol is beneficial. Also, estriol is a weaker estrogen, so estradiol, which can stimulate endometrial hyperplasia, is reined in with estriol.

  27. I was on birth control pills for almost 11 years (from 19 to around 30) before deciding they were completely undermining my health (even though through the years the doctors assured me they were healthy and did not cause weight gain and other problems). I am 33 and have been off of them for 3 years…recovering from the long stint of taking the pill and a bout of adrenal fatigue. I found real food about a year ago and have been trying to implement changes. I still am exhausted all the time, holding weight, low to no libido. I wouldn’t say I have problems with sleep. My blood work indicated I had low testosterone, and very low vit d levels, and my cholesterol was high. Within 3 months of quitting the pill, I returned and did more blood work and didn’t tell my doctor I had stopped taking it, my cholesterol went down 30 points and my testosterone normalized.

    Now I eat real food and take fermented cod liver oil. What else should I be doing to remedy recovery from the pill? I was once on natural progesterone cream and I was thinking of starting that back up and taking desiccated liver pills.

    • Hi Angie, The most important thing is to have normal, regular periods. Then you will have good levels of estradiol and progesterone to recover your libido. There are many effective natural treatments for regulating periods. The vitamin D in the cod liver oil will help. You may also want to have your thyroid levels checked.

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