I love estrogen. It builds bone, strengthens muscle, slows aging, raises libido, enhances insulin sensitivity, and boosts serotonin (which is why estrogen is so important for mood and sleep).
And those are just a few of the hormone’s many benefits. Estrogen regulates 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. Please see Part 2: Estrogen Excess.)
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 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 you are younger than 50 and your FSH is in the premenopausal range (<25 IU/L). That’s 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? Are you undereating? (For a full discussion of obstacles to ovulation, please see Chapter 7 of my book Period Repair Manual.) Then correct that obstacle and start to ovulate. Your estradiol will rise dramatically. There’s nothing else you need to do.
Hormonal birth control is not a 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. Ethinylestradiol is not as beneficial as estradiol and always comes along with a progestin that can cause depression and hair loss.
Scenario 2. You do ovulate.
If you do ovulate, then you have sufficient estradiol. Why? Because if you did not, then you would not be able to reach ovulation. You may still have lower than average estradiol, and 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, undereating, stress, vegetarian diet, gluten sensitivity, or eating too much soy. Your best treatment is to correct that underlying problem.
Scenario 3. You’re having an easy menopausal transition.
Your ovaries make less estrogen after menopause but the rest of your body can pick up the slack by converting an adrenal hormone called DHEA into estrogen. To be able to do that, you need a good supply of DHEA, which is why it’s so important to support your HPA or adrenal axis function during and after menopause. And over time, your body will adjust to your new normal lower level of estrogen.
Treatment: Support your adrenal axis by getting enough rest and sleep, and by taking magnesium and adaptogen herbs such as Rhodiola or ashwagandha. If you suffer hot flashes, you can also 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 such as Vagifem.
Scenario 4. You’re having a difficult menopausal transition.
If you’re reading this section, then you know what misery can come from a sudden and severe drop in estrogen. That can happen after a total hysterectomy (ovaries removed), or suddenly stopping hormonal birth control or hormone replacement.
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 bioidentical estrogen such as an estradiol or Estradot patch.
Treatment: Bioidentical estradiol is very, very different from the horrid horse estrogens and medroxyprogesterone used as hormone replacement in the ’70s and ’80s. At a low dose, bioidentical estradiol is relatively safe. It works best when used together with a micronized or natural progesterone capsule such as Prometrium. Please speak to your doctor.
In summary, estradiol is a luscious, life-giving, essential hormone. Before menopause, you make estrogen with your ovaries. You can only do that if you ovulate regularly. After menopause, you make estrogen from your adrenal hormones.
Yours in health,