Estrogen Deficiency: Before, During, and After Pregnancy

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Estrogen is the main “female” hormone. (Men do make it in small amounts, but it is the hormone that leads to most female-specific traits.) Estrogen is important in many body functions, so a lack of estrogen is associated with many health issues, especially during pregnancy and lactation.

Facts about estrogen

The ovaries produce most of the estrogen in your body. Primarily, estrogen is responsible for sexual development; as such, one of its most significant functions is regulating your menstrual cycle and promoting ovulation. It also causes breast changes during puberty and pregnancy. Additionally, estrogen helps keep bones strong, participates in cholesterol metabolism, increases serotonin levels, maintains a healthy lining of the urethra, enhances vaginal lubrication, and controls metabolism and bodyweight.

What does “low estrogen” mean?

 Estrogen levels vary during a woman’s life, but having lower-than-normal levels can cause significant health problems, including:

  • Irregular or missed menstrual cycles
  • Weak bones
  • Dry skin and/or eyes
  • Painful intercourse due to lack of lubrication
  • Hot flashes
  • Depression
  • Anxiety
  • Mood swings
  • Breast tenderness
  • Fatigue
  • Trouble concentrating
  • Increased urinary tract infections due to a thinning of the lining of the urethra

If prolonged or left untreated, estrogen deficiency can lead to infertility.

What are the causes of low estrogen?

 Since the ovaries are the main producers of estrogen, any damage to or change in the ovaries can cause low estrogen production. Age is the most common cause of decreasing estrogen: as women age, estrogen levels naturally drop as the ovaries cease normal functioning and the body prepares for menopause. In women over the age of 40, low estrogen may simply be an indication of approaching menopause.

Estrogen levels can also be low due to premature ovarian failure, congenital conditions such as Turner syndrome, thyroid disorders, excessive exercise, being severely underweight or malnourished, eating disorders, exposure to certain toxins or chemotherapy, autoimmune conditions, and a low-functioning pituitary gland.

If anyone in your family has a history of hormone problems, including ovarian cysts, you may be at higher risk for estrogen deficiency.

How do I get diagnosed?

If you have any symptoms consistent with low estrogen, see your doctor. Many of the symptoms of estrogen deficiency are similar to those associated with other conditions, so a blood test is needed to confirm a diagnosis. Your doctor will also complete a comprehensive physical exam to identify what is causing the low estrogen levels.

To treat or not to treat?

Some women with estrogen deficiency will not require treatment. Depending on age, symptoms, and other factors, some women will require hormone therapy in which a synthetic hormone is used to replace the naturally occurring one. The hormones can be delivered in varying dosages, depending on the severity of the deficiency; they can be administered via an oral tablet, a topical cream, a vaginal insert, a patch, or an injection.

There is some evidence that maintaining a healthy weight and not over-exercising can help promote healthy levels of estrogen. A few small studies have suggested that soy is beneficial in treating low estrogen levels, but this may not be appropriate for all women. Ask your doctor what treatments and lifestyle modifications are appropriate for you.

Sometimes, the estrogen level itself does not need to be corrected, but the symptoms of low estrogen can be treated. For example, creams or lubricants can be used to treat vaginal dryness or eye drops can alleviate dry eyes, and mind-body practices such as yoga can improve mood, sleep, and concentration. Additionally, antidepressants or anti-anxiety medications may be helpful in maintaining your mental health, and vitamin D and/or calcium supplements can improve bone health.

Low estrogen in pregnancy and lactation

 Estrogen plays many important roles during pregnancy:

  • Carrying the baby to full term
  • Ensuring normal fertility levels in your baby
  • Maintaining adequate fetal nutrition

Low levels of estrogen can be devastating to a pregnancy and can lead to miscarriages, fewer eggs in a newborn female, and future fertility issues in female babies.

After delivery, estrogen levels decrease, and they will stay low as long as you are breastfeeding. (This is why your periods are often absent as long as you are breastfeeding.)

Your doctor will routinely ask about symptoms related to hormone levels and do blood tests as necessary during pregnancy to make sure you and your baby are staying healthy. If you have any concerns or are experiencing symptoms consistent with estrogen deficiency during pregnancy, do not hesitate to talk to your doctor.

Estrogen and your overall health

 Estrogen plays a large role in a woman’s overall health. When genetics, other diseases, or normal aging processes cause estrogen levels to drop, your risks for health problems increase: sexual development and sexual function may be impaired; risks for obesity, osteoporosis, and cardiovascular disease increase; and mental and cognitive health may decline.

Estrogen levels fluctuate monthly and over the course of a lifetime. And, the ranges of hormone levels that are considered “normal” vary from person to person. There is no definitive marker of low estrogen and no specific number that should make you panic about your levels. Pay attention to your body and alert your doctor to any changes that may relate to estrogen levels.

Jennifer Gibson
Dr. Jennifer Gibson earned a Bachelor of Science degree in Biochemistry from Clemson University and a Doctor of Pharmacy degree from the Medical College of Virginia School of Pharmacy at Virginia Commonwealth University. She trained as a hospital pharmacist and is the author of clinical textbooks, peer-reviewed journal articles, and continuing education programs for the medical community, as well as a contributor to award-winning healthcare blogs and websites. In her free time, she enjoys running, reading, traveling, and spending time with her family.

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