Estrogen Levels in Women: A Key to Understanding Female Health

How Estrogen Affects Women's Health: Signs, Symptoms, and Solutions

Many women come to us with generalized symptoms of perimenopause or menopause and have questions regarding their blood work. Often, we hear questions like “What are my estrogen levels?” and “What should my estrogen levels be at for my age?” It’s important to address what estrogen is and what role it plays in women’s health. Estrogen is a group of steroid hormones that play a crucial role in the female reproductive system and their overall health. It’s one of the major hormones that’s responsible for the development of female sexual characteristics, regulation of the menstrual cycle, and helps influence various other bodily functions. Estrogen levels naturally fluctuate throughout a woman's life, and understanding these changes is important when it comes to maintaining well-being.

What is Estrogen?

There are three main types of estrogen in women which are primarily produced in females by the ovaries, with smaller amounts coming from the adrenal glands and fat tissue.

Estradiol (E2): The predominant circulating estrogen during the reproductive years. Values vary with cycle timing, pregnancy, medicines and the laboratory method; a single universal range is not a treatment target.

Estrone (E1): A less potent estrogen that becomes relatively more prominent after menopause. Interpret a result using the reporting laboratory and clinical context.

Estriol (E3): The weakest form of estrogen, mainly produced during pregnancy. Its role in non-pregnant women is not fully understood. Estriol levels are typically not measured in non-pregnant women.

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What Does Estrogen Do?

The million-dollar question is “What does estrogen do?” Estrogen exerts its effects in women by binding itself to specific receptors in various tissues throughout the woman’s body. These receptors are found in tissue and organs such as:

• Reproductive organs: Uterus, vagina, breasts
• Brain: Affects mood, cognition, and sleep
• Bones: Maintains bone density and strength
• Heart: Influences cholesterol levels and blood vessel function
• Skin: Contributes to skin elasticity and hydration

Estrogen Levels Throughout Life

Estrogen changes during puberty, menstrual cycles, pregnancy and menopause. Perimenopause can involve substantial fluctuations. New or persistent symptoms deserve assessment; heavy bleeding, bleeding between periods or any bleeding after menopause should not simply be dismissed as normal hormone changes.

• Puberty: Estrogen levels rise, triggering the development of female sexual characteristics, including breasts, menstruation, and changes in body shape.
• Menstrual cycle: Estrogen levels fluctuate throughout the menstrual cycle, peaking just before ovulation and then declining.
• Pregnancy: Estrogen levels steadily increase during pregnancy, supporting the growth and development of the fetus and see a boost of E3.
• Menopause: Estrogen levels significantly decline as the ovaries stop producing eggs, leading to various physical and emotional changes and E1 becomes the dominant form of estrogen.

How to interpret estrogen levels

The result must be considered alongside age, menstrual timing, pregnancy status, symptoms, medicines and the laboratory reference interval. A blood level alone cannot establish a need for treatment.

NICE menopause guidance recommends identifying typical perimenopause or menopause clinically in otherwise healthy people aged 45 or older. Testing has a role when the presentation is unusually early, unclear or suggests another condition.

Effects of Low Estrogen

Low estrogen levels can lead to various symptoms, including:

• Menstrual irregularities: Changes in cycle length, flow, or missed periods
• Hot flashes: Sudden feelings of warmth, sweating, and flushing
• Vaginal dryness: Discomfort during intercourse
• Sleep disturbances: Difficulty falling asleep or staying asleep
• Mood changes: Irritability, anxiety, or depression
• Decreased libido: Reduced sexual desire in women
• Bone loss: Increased risk of osteoporosis
• Cognitive changes: Difficulty concentrating or remembering things

Estrogen Replacement Therapy (ERT)

Menopausal hormone therapy is chosen for a clinical indication, not to reach one “optimal” estrogen number. Systemic estrogen is effective for bothersome hot flashes and night sweats and helps prevent bone loss while used.

For someone with a uterus, systemic estrogen generally needs an appropriate progestogen to protect the endometrium. ACOG explains the treatment options. Testosterone is a separate, selected treatment decision, not a routine ingredient of every menopause regimen.

• Oral tablets: Follow the specific prescription and food instructions.
• Skin patches, gels or sprays: These systemic products have different application sites and schedules. A skin gel must not be assumed suitable for vaginal use.
• Low-dose vaginal products: Treat local vaginal and urinary symptoms; they are not interchangeable with systemic treatment for hot flashes.
• Vaginal rings: Some provide local low-dose treatment and others systemic treatment. The exact product matters.

The Menopause Society describes systemic and local therapy. Use only the prescribed formulation and instructions.

Benefits of ERT for Women

ERT can provide several benefits, including:

• Relief from menopausal symptoms: Reduces hot flashes, vaginal dryness, sleep disturbances, and mood changes
• Prevention of bone loss: Helps maintain bone density and reduce the risk of osteoporosis
• Improved quality of life: Enhances overall well-being and reduces the impact of menopausal symptoms

Risks of ERT

Like all medications and medical treatments ERT also carries potential risks, including:

• Endometrial risk: Unopposed systemic estrogen can increase endometrial hyperplasia and cancer risk when the uterus is present. Screening does not replace an appropriate protective regimen.
• Breast cancer: Risk differs between estrogen alone and combined therapy and depends on duration and individual factors. Discuss personal and family history and an appropriate screening plan.
• Blood clots and stroke: Risks depend on the route, dose and individual history. Oral and transdermal preparations should not be assumed to have identical risks.

Age, time since menopause and existing conditions affect the decision. Hormone therapy should not be prescribed solely to prevent heart disease. Unexplained bleeding, prior hormone-sensitive cancer, blood clots, stroke or liver disease require careful evaluation before systemic therapy.

Who Should Consider ERT?

ERT is not suitable for all women. It is important to discuss the benefits and risks with a licensed and experienced healthcare provider to determine if it is appropriate for you. There are several factors to consider including:

• Severity of menopausal symptoms: ERT may be more beneficial for women with severe symptoms that significantly impact their quality of life. Symptoms may last for years, and their duration cannot be predicted for an individual.
• Risk factors for certain cancers: Women with a personal or family history of breast cancer or endometrial cancer may have an increased risk with ERT and should weigh the risk/reward of HRT.
• Risk factors for cardiovascular disease: Women with existing heart disease or risk factors for cardiovascular disease may have an increased risk with ERT and should look for other ways to alleviate symptoms first.

Alternatives to estrogen therapy

For hot flashes, evidence-based nonhormonal options include selected SSRIs/SNRIs, gabapentin and other prescription treatments. The 2023 Menopause Society position statement does not recommend clonidine, pregabalin or herbal supplements for vasomotor symptoms. This is not a list of interchangeable medicines; selection depends on the patient and product.

Fezolinetant (Veozah) has an FDA boxed warning for rare but serious liver injury. Liver tests are needed before treatment, monthly for the first three months, and at months six and nine. Stop it and seek medical advice promptly for possible liver-injury symptoms such as jaundice, dark urine, abdominal pain or unusual fatigue.

Vaginal moisturizers and lubricants can help local discomfort. Exercise, resistance training and good nutrition support overall health, but should not be promised to “balance” estrogen or eliminate hot flashes. Discuss supplements before use because ingredients and interactions vary.

For an evaluation of symptoms, medical history and treatment options, contact NovaGenix or call 561-277-8260. Medical Director Timothy Mackey, D.O., sees patients at 609 N Hepburn Ave, Suite 106, Jupiter, FL 33458.

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