Estrogen builds bone, strengthens muscle, slows aging, strengthens libido, enhances insulin sensitivity, and boosts serotonin. And those are just a few of its many benefits. Estrogen regulates over a thousand genes, so it’s 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. Read Part 2: Estrogen Excess.)
Estrogen deficiency causes fatigue, weight gain, hair loss, depression, and 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 figure out how estrogen-deficient you are.
How to boost estrogen
There’s no one way to boost estrogen. It all depends on why it’s low. Let’s look at four common scenarios.
Scenario 1. You don’t ovulate but you’re not menopausal.
Ovulation is how you make estradiol, your strongest and best estrogen. So your big question is: “Can you still ovulate?”
You can ovulate if your FSH is less than 40 IU/L. That’s true even if you’ve had a partial hysterectomy (uterus removed). If you have ovaries, you can ovulate.
Treatment: Figure out why you don’t ovulate. Are you on the pill? Do you have one of 4 types of PCOS? Are you eating enough? (For a full discussion of obstacles to ovulation, read Chapter 7 of my book Period Repair Manual.)
Once you identify your obstacle to ovulation, then simply correct that obstacle and your estradiol will rise dramatically. That’s all you need to do. You don’t need to “boost” estrogen because it will do its own boosting. In the case of PCOS or hypothalamic amenorrhea, eating phytoestrogens like soy or flaxseed will do nothing to raise your estrogen because phytoestrogens are not estrogen.
👉 Hormonal birth control is not the solution. The pill stops ovulation and completely shuts down estradiol. It replaces it with a synthetic estrogen called ethinylestradiol, which is similar to estradiol, but not identical. That’s why being on the pill can cause vaginal dryness.
Scenario 2. You do ovulate.
If you ovulate, then you have enough estrogen. Why? Because if you did not have enough estrogen, you would not be able to ovulate.
👉 Tip: It’s normal to have very low estradiol early in your cycle, even “menopausal” levels.
If you have light scanty periods (but you ovulate), then you may have slightly lower than average estradiol. I call this relative estrogen deficiency.
Treatment: Relative estrogen deficiency can occur at any age, and can be the result of smoking, undereating, stress, gluten sensitivity, a vegan diet, or eating too many phytoestrogens. Your best treatment is to correct that underlying problem.
Scenario 3. You’re having an easy menopause transition.
Your ovaries make less estrogen after menopause but your body can adjust. You can also make some estrogen by converting the adrenal hormone DHEA to estrogen. To be able to do that, you need a good supply of DHEA, which is why it’s important to support your HPA (adrenal) axis during the menopause transition.
You could benefit from taking progesterone. Read Rescue Prescription for Menopause and Perimenopause.
Scenario 4. You’re having a difficult menopause transition.
If you’re reading this section, you know the hell that can come from a sudden and severe drop in estrogen. A difficult menopause transition can happen after a total hysterectomy (ovaries removed), or suddenly stopping hormonal birth control or hormone therapy.
Severe estrogen deficiency can cause hot flashes, depression, and terrible insomnia. I’ve witnessed these symptoms with many patients, and I really don’t think any woman should have to put up with them. That’s why I support the use of a body-identical estrogen such as an estradiol patch like Estradot. Estrogen works best when used together with a micronized or natural progesterone capsule such as Prometrium (even if you don’t have a uterus). Read 4 Things to Know about Body-Identical Menopausal Hormone Therapy.
In summary, estradiol is a luscious, life-giving hormone. Before menopause, you make estrogen by ovulating. After menopause, you can still make a small amount locally in tissues, but overall, your body has to get used to a much lower level of estrogen.
Ask me in the comments.