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Health-wise, the last year and a half of college did a bit of a number on me. And no, it had nothing to do with too many shots of Fireball or sleepless nights spent cramming at the library. Between a minor heartbreak (is that an oxymoron?), an over-booked class schedule, the emotional come-down after a blissful semester abroad in Ireland, and a few other emotional stressors, by the time I packed my car up that spring, it would be an understatement to say I was feeling worse for the wear.
Physically, I didn't feel like myself, and although I had seen multiple doctors, no one seemed all that concerned—except me. I know my body. I know when something is wrong, and I began to feel frustrated when I wasn't making any headway—instead, I felt like I was doing a perpetual doggy paddle. Finally, roughly one year later, I finally got some answers. The cause, you ask? Estrogen levels that were far from normal.
Despite the fact that I was exercising regularly, eating a healthy diet (for the most part), excelling in my classes, keeping alcohol to a minimum, and abiding by a no-coffee policy, I felt exhausted (like, I-can't-drag-myself-out-of-bed exhausted) and was uncharacteristically moody. I was also having horrible night sweats (to the point where 2 a.m. showers had become routine), and my period had gone AWOL.
Exasperated and tired of treading water, a few months after graduating, I finally made an appointment with a doctor who specialized in functional medicine. Interestingly, five minutes into the consultation, she had a very strong inkling what the problem was. "Your estrogen levels are low," she told me. "I'll run some tests, but I can already tell you exactly what they're going to say." And, not surprisingly, she was completely correct. Slightly taken aback and knowing nothing about normal levels of estrogen, I internalized her parting advice, bought a few supplements she recommended and went on my merry way. In hindsight, however, I wish I had asked so many more questions.
Because as it turns out, low estrogen levels are much more common in young women than one might think, and the symptoms can be easily misunderstood, ignored, or even misdiagnosed. To try to get a more comprehensive understanding of estrogen, what's normal and what's not, I reached out to two different experts: Denise Pate, MD, Internal Medicine Doctor at Medical Offices of Manhattan and Lara Briden, ND, author of Period Repair Manual Second Edition: Natural Treatment for Better Hormones and Better Periods ($10). Keep reading to learn more about low estrogen levels.
Meet the Expert
• Denise Pate is a board-certified internal medicine physician based in Manhattan. She earned her Medical Degree at New York University School of Medicine and completed her residency training in Internal Medicine at NYU Medical Center.
• Lara Briden is a naturopathic doctor and women’s health activist based in New Zealand. She specializes in helping women achieve healthy menstrual cycles without the use of hormonal birth control.
What Is Estrogen and Why Is It Important?
According to Pate, estrogen is a female hormone that's naturally produced by the body (the version in hormonal birth control is synthetic and thus won't serve as a legitimate substitute for deficient estrogen levels—more on this later). Produced by the ovaries, the hormone acts as a chemical messenger and is essential for "normal sexual development and regulation of the menstrual cycle."
"The strongest and most stimulating hormone, estrogen builds bone, slows aging, raises libido, regulates appetite, and boosts serotonin," says Briden, which, she says, is why it's so vital for quality sleep and maintaining a positive mood: "Estradiol regulates the expression of over a thousand genes, so it’s arguably one of our most influential and important hormones. Our hormones and estrogen levels are very dynamic and, essentially, they act like our body's report cards. If something is wrong, your hormones will let you know. In short, hormones are an expression of health," Briden says.
What Are the Symptoms of Low Estrogen?
According to Pate and Briden, the following are the most common symptoms of low estrogen:
- Hot flashes
- Night sweats
- Sleep disturbances
- Mood swings
- Weight gain
- Irregular or absent periods
- Pain with sexual intercourse due to vaginal dryness
- Thinning of the vaginal lining
- Hair loss
- Dry skin
Briden makes a special note on vaginal dryness, pointing out that it is perhaps the most characteristic of symptoms when it comes to deficient estrogen levels. In fact, in her blog post on the topic, she explains that dryness is one of the first questions she has for her patients, as it can help her quickly determine how low they are in the hormone.
What Are the Causes?
This is where the topic gets tricky. While both doctors point out that stressors like over-exercising, smoking, eating disorders, stress, or a low-functioning pituitary gland can lead to a dip in estrogen, Briden explains to me that low levels of estrogen are still a part of a healthy menstrual cycle.
As mentioned above, our hormones are dynamic and ever-changing due to changes in our ovulation. Specifically, she tells me that estrogen will naturally be at its very lowest during menstruation. (When you're ovulating, you're making estrogen). The takeaway: If you were to get estrogen levels tested that week, your results would be null as the test would (and should!) indicate low levels of estrogen.
Therefore, in order to get an accurate sense of how high or low your levels are, it's important to test hormones after ovulation has peaked. Another note: If you're taking hormonal birth control (which suppresses ovulation) versus non-hormonal, a test will always indicate low hormone levels since birth control essentially "switches off your hormones."
"It is controversial whether to formally check estrogen levels in the blood as there are factors that can alter the levels over time. For example, estrogen levels vary over the course of a woman's menstrual cycle, and small amounts of estrogen can even be secreted by fat cells so even a woman's weight can alter estrogen levels," Pate explains.
Are There Ways to Improve Estrogen Levels?
Though in severe cases medication and hormone therapy are options, neither Pate nor Briden find the option particularly favorable: "There are medications and hormone replacement therapies that can replace a woman's low estrogen, however, this remains controversial and should be evaluated on a case-by-case basis with a health care provider as these medications come with some serious health risks," Pate explains.
She adds that some women will try a more natural approach to hormone therapy by incorporating "phytoestrogens" (which naturally occur in plants, fruits, and vegetables) into their diets. However, effective results and the precise dosing in comparison to traditional therapies is still unclear. Alternatively, Briden suggests reducing stress and getting enough healthy carbohydrates, zinc, and iodine to maintain normal estrogen levels.
Does Low Estrogen Have Long-Term Repercussions?
Going into my interview with Briden, I had a deep-seated fear that my low estrogen levels might have some serious long-term consequences—especially in terms of fertility. However, she quickly assured me that this is not the case.
While it's definitely in someone's best interest to try to improve and get to the root problem of low estrogen levels, it shouldn't have serious consequences where fertility is concerned. But again, she says that recovery is important, as ongoing estrogen deficiency will cause menopausal-like symptoms (not fun) and could even lead to bone loss, known as osteoporosis.
If you think you might be low in estrogen, it's a good idea to contact your health care provider or make an appointment with an expert who specializes in female health and hormones.