Is Estrogen Menopause’s Miracle Solution?

Picture your ovaries. I know it’s a bit weird, but bear with me. You probably imagine them as the female sex organs that hold your eggs. Once a month, one or the other of your ovaries “plops” out an egg, and your fallopian tubes carry it down to your uterus. If you sat through those uncomfortable junior high sex-ed classes, you probably know the rest of the story. During menopause, though, picture your ovaries less as egg baskets and more like a kind of very small manufacturing facility which, due to inconsistencies in the supply chain, sometimes has to put everything on hold. What’s not being made during those pauses is estrogen, progesterone, and testosterone. So if you’ve gone through menopause, the rest of the story is . . . history.

In fact, as you get more and more into menopause, your ovaries/manufacturing facilities are like America’s infatuation with the sport of golf . . . shrinking. Since estrogen is the hormone that primarily regulates the menstrual cycle during your reproductive years, its unpredictability means you sometimes get a period, and sometimes you don’t. It also means you will likely become acquainted with hot flashes and vaginal dryness. It’s like the rest of your body is saying, “What the heck, estrogen? We’re mad that you keep coming and going, so we’re going to express our frustration through symptoms ranging from joint pain and dry eyes to tender breasts, chin hair (yes, you read that right), and much, much more. Pooh, pooh on you.”

Because of estrogen’s importance, doctors often recommend estrogen replacement as a part of hormone replacement therapy. Indeed, when you truly understand how much estrogen has done for your body, you may think that estrogen is menopause’s miracle solution.Take it, and your problems are done, el fin, finito. Every perimenopausal person just needs to take estrogen and they’ll be fine, right? Right??

Weeeellll . . . Not quite. Estrogen is pretty amazing, but, like everything else in the menopause treatment “pie,” it has its good and its not-so-good qualities. That is to say, as much as modern medicine has created something that works just like the estrogen our body used to make consistently on its own, it still hasn’t made something that totally takes its place and does so without any risks. 

So, let’s dive into what estrogen’s erratic departure actually looks like in your body (picture your body becoming its own “sweatshop”), what estrogen therapy can do for you, and ways to decide if it is, in fact, what you need. Because what you need is very important right now. 

estrogen

What Is Estrogen? 

Estrogen is a class of many different compounds, because, of course, it wants to be complicated like that. The main three blends that estrogen is composed of are:

  • Estradiol
  • Estrone
  • Estriol

What Does Estrogen Do?

Johns Hopkins Medicine points out that estrogen actually does much more than just regulate your menstrual cycle. It also affects your: 

  • Reproductive tract
  • Urinary tract
  • Heart and blood vessels
  • Bones
  • Breasts
  • Skin
  • Hair
  • Mucous membranes
  • Pelvic muscles
  • Brain

Why Does Estrogen Get All the Hype?

Why does estrogen get all the attention during menopause? You know those amazing performers that are unbelievably talented at acting, singing, AND dancing? Or those film artists who are masterful at writing, acting, AND directing? In the arts community, those folks are dubbed a “triple threat.” Where Daveed Diggs and Elizabeth Banks are triple threats among humans, Estrogen is the triple-threat hormone. Estrogen affects so many body systems, especially when compared to progesterone and testosterone. When it fluctuates or decreases, your body feels it all over, so it’s no wonder many women tend to think estrogen is the most important of the three sex hormones. Really, though, progesterone and testosterone, though they’re “quieter” in some ways, are still important. This is not only because they impact a lot of important and noticeable things (sleep as just one example), but also because they balance estrogen. In a way, the three hormones are like Phoebe, Monica, and Rachel from Friends . While you may focus mostly on Rachel’s dating dramas, the show wouldn’t work without the professional storylines of Monica, or the quirky comic-relief storylines of Phoebe. 

What Are the Symptoms of Low Estrogen in Women?

If you’re experiencing any of the following, it’s most likely estrogen’s fault, says Healthline, who lists these: 

  • Painful sex due to a lack of vaginal lubrication
  • An increase in urinary tract infection (UTIs) due to a thinning of the urethra
  • Irregular or absent periods
  • Shifts in mood
  • Hot flashes
  • Breast tenderness
  • Headaches or accentuation of pre-existing migraines
  • Depression
  • Trouble concentrating
  • Fatigue

In short, estrogen affects so many body systems in one way or another, and low estrogen can cause a number of symptoms. Giving your body back some estrogen seems like a magic solution to keep your  menopausal blues less blue and more purple-ish. But the truth is a little more nuanced than that

Is Estrogen Menopause’s Miracle Solution?

The real question, then, is does estrogen really resolve all of menopause’s many maladies? The short answer is no, although it does help ease many symptoms that menopausal mavens may experience. The slightly-longer-but-still-not-too-tedious answer starts by exploring this hormone’s many perks.

Benefits of Estrogen Replacement Therapy

One of the main benefits of ERT (or “ET,” as some doctors like to call it) is the cooling off of those pesky, or sometimes even downright mean, hot flashes. Since excessive sweating can make it hard to work, rest, or pretty much do anything, for that reason alone many people prefer to do anything they can to increase their estrogen. Dr. Christiane Northrup reports that “estrogen gives better hot flash relief than just about any other treatment, [although] it can take up to four weeks to notice the effect.”

Types of ERT

According to the Mayo Clinic, estrogen therapy usually comes in one of two forms, differentiated by the way you take them, the amount of estrogen they contain, and what symptoms they target:

  • “Systemic estrogen—which comes in pill, skin patch, ring, gel, cream, or spray form—typically contains a higher dose of estrogen that is absorbed throughout the body. It can be used to treat any of the common symptoms of menopause.
  • Low-dose vaginal products—which come in cream, tablet, or ring form—minimize the amount of estrogen absorbed by the body. Because of this, low-dose vaginal preparations are usually only used to treat the vaginal and urinary symptoms of menopause.”

WebMD provides some good information on the pros and cons of each ERT/ET form. 

The Forms of Estrogen Therapy

What types of ERT are available? Estrogen replacement therapy comes in the form of synthetic or bioidentical hormones, and there are also natural ways to support your body in making its own estrogen. 

Synthetic Estrogen Replacement Therapy

“Synthetic” technically means that the hormones are made in a lab from things not found in the human body, such as the urine of pregnant mares. 

Bioidentical Estrogen Therapy

“Bioidentical” is a relatively new term referring to hormones also made in a lab but from plants like soy and yam.

Important Note: There is a lot of debate about the advantages and disadvantages of synthetic and bioidentical estrogen. One could say that synthetic is still technically natural, since horses aren’t man-made … at least last time I checked. And one could also argue that bioidentical hormones—even though they’re molecularly identical to the ones our bodies make—aren’t as natural as their manufacturers and pharmacists claim either because of their sources. What we do know, however, is that there is more science and regulation behind synthetic hormones (e.g., Prempro, Premarin) and more possibilities for customization, and thus less chance of unpredictable side effects than with bioidentical hormones.

Phytoestrogens (Dietary Estrogens)

If that ambiguity scares you, then it is possible to get some of your estrogens from food. Some people and, in fact some experts, swear by foods like flax seeds, soy beans, dried fruits, sesame seeds, garlic and others to balance estrogen. Those foods contain phytoestrogens, or chemicals that are similar to estrogen and may mimic its hormonal actions. (They also cause a lot of flatulence, but hey, you can’t win ‘em all.)

That said, phytoestrogens are complicated. According to a study shared on the NCBI’s website, “Phytoestrogens are plant derived compounds found in a wide variety of foods, most notably soy. A litany of health benefits including a lowered risk of osteoporosis, heart disease, breast cancer, and menopausal symptoms, are frequently attributed to phytoestrogens but many are also considered endocrine disruptors, indicating that they have the potential to cause adverse health effects as well. Consequently, the question of whether or not phytoestrogens are beneficial or harmful to human health remains unresolved. The answer is likely complex and may depend on age, health status, and even the presence or absence of specific gut microflora.”

Be sure to check out the pros and cons of taking these dietary estrogens. Some foods, or quantities of food, increase estrogen levels in your body and others decrease them. Also, it is possible to take in too many, which could cause hormone imbalance, the very thing you’re trying to avoid. Most evidence, however, links them to health benefits and relief of some menopausal symptoms.

Top 6 Ways Estrogen Makes Your Menopausal Life Easier

There are six specific ways that estrogen therapy, in whatever form you choose to take it, can help:

1. Eases Vaginal Symptoms

Our poor menopausal vaginas! They tend to dry out, turning sex into something way less fun than it used to be. The Change likes to rain on our parades in as many ways as possible, right? (In this case, by “rain” we actually mean “cause a massive drought.”) This drying out can not only make for painful sex but also increase urinary tract infections (UTIs). If taken in the low-dose vaginal form, however, estrogen can help decrease your  number of UTIs.

2. Increases Skin Thickness, Which Can Reduce Wrinkling

Can you say “fountain of youth … maybe?” When estrogen is applied to the skin of your face topically, it enhances the collagen layer in people whose estrogen levels are low. 

3. Moderately Protects Against Cognitive Decline 

Since estrogen has well-documented effects on nerve cells, studies suggest that the estradiol patch may give moderate protection against general “cognitive decline” if it’s begun soon after menopause [source]. A 2009 study did show that estrogen—or estradiol, specifically—could be “neuroprotective” if used along with good nutrition, exercise, and stress reduction.

4. Improves Depression

According to Drs. Kimberly M. Albert and Paul A. Newhouse, because estrogen “modulates brain networks and processes related to changes in stress response, cognition, and emotional [regulation],” the disruption of estrogen can very easily be associated with depression, even Major Depressive Disorder. Thus, estrogen hormone therapy can help alleviate symptoms of depression, although it shouldn’t be used as a primary antidepressant, and menopause itself is not necessarily associated with an increased risk of depression.

5. Improves Bone Density

Because estrogen’s departure also tends to make our bones question how strong they really are, estrogen therapy can “remind” them of their strength. ERT/ET can do this as much as bisphosphonates do! This reduces the risk of fracture as you get older. Remember the old saying, “What doesn’t kill us makes us stronger?” Yeah, that doesn’t apply to bone fractures. Better to keep your skeleton strong in the first place.

6. Lowers Your Chance of Developing Diabetes

A study published in 2019 showed that estrogen may have the potential to lower insulin resistance, thus also lowering the chance of developing diabetes. How sweet is that?

What Are the Risks of Estrogen HRT?

Remember those “not-so-good” things about ERT/ET that I mentioned? It’s important to note them before running off to your doctor’s office and demanding, “Give me estrogen, at once!” First, we wouldn’t want to, ya know, increase your risk of death. Second, we wouldn’t want you suffering unnecessarily if just estrogen treatment (as opposed to a combined approach, including estrogen and progesterone treatment) isn’t quite right for you. The risks of estrogen-only therapy can be significant and it’s good to know the stats and get a doctor’s opinion before starting down the road of hormone replacement therapy.

As you read through the five risks of estrogen listed below, remember to factor in that genetics and lifestyle, and not just hormone therapy alone, impacts the risk of any cancer or health issue. Family history, eating an unhealthy diet, not exercising, and/or smoking contribute to your odds. Just like searching for Waldo, be sure to look at the whole picture when you check out these risks and the stats from their studies.

Increased Risk of Breast Cancer

New research reports that people who had ever taken hormone therapy—including ERT/ET—had a 26 percent greater risk of developing breast cancer, although women on just ERT/ET (either estradiol or conjugated estrogen) had a lower risk than those taking estrogen and progesterone together. According to Susan G. Komen, “a pooled analysis of data from 7 studies found women with higher blood estrogen levels may have a modestly increased risk of breast cancer before menopause” and “a pooled analysis of data from 9 studies found the risk of breast cancer was twice as high among women with higher levels of estradiol compared to women with lower levels.” In other words, your risk of developing breast cancer while on estrogen therapy increases with the amount of estradiol (remember that’s only one of the compounds that makes up estrogen) you have in you. Or, put more simply, “it’s all relative, baby.”

Increased Risk of Ovarian Cancer

Those on estrogen-only therapy have a greater risk of developing uterine cancer than nonusers, but that risk gets cancelled out when estrogen is combined with progesterone.

Increased Risk of Pancreatitis and Gallstones

Those who take oral estrogen with or without progesterone have an increased risk of high triglyceride levels, which increases their risk for pancreatitis.

Increased Risk of Blood Clots and Stroke

Dr. Christiane Northrup says that “estrogen appears to double the risk of blood clots … [and] pulmonary embolism.”

Risk of Too Much Estrogen

We all know you can have too much of a good thing. Just like chocolate or after-work margaritas, it is possible to have too much estrogen in your system. If you’re asking how to know if a menopausal person has high estrogen levels, this is what that might look like:

  • Bilateral, pounding headache
  • Recurrent vaginal yeast infections
  • Breast swelling and tenderness
  • Depression
  • Nausea and vomiting
  • Bloating
  • Leg cramps
  • Yellow-tinged skin
  • Excessive vaginal bleeding

Is It Safe to Take Estrogen Replacement Therapy for Menopausal Symptoms?

So, back to the question: “Should you take ERT for menopause?” The short answer is, “Yes.” The long answer is, “It depends.” You need to factor in your individual needs (whether your menopausal symptoms are interfering with your daily life), your lifestyle, your health history, your age (“Advancing age is the most important risk factor for cancer overall,” the NCI website says), and where you are in your menopausal journey. You have to consider all of those factors when determining if the benefits of taking ET outweigh the risks. 

All that being said, it’s important to remember that risk does not mean guarantee, and there are different kinds of risk. BreastCancer.org reminds us that it’s important to understand the difference between relative risk (i.e., the number that tells you how much something you do, such as maintaining a healthy weight, can change your risk compared to your risk if you’re very overweight) and absolute risk, which is the size of your own risk compared to others’). This applies not just to breast cancer risk, but the risk of developing any of the above health problems. 

In short, “…most experts agree that if HRT is used on a short-term basis (no more than five years), the benefits [of using hormone replacement therapy] outweigh the risks. If HRT is taken for longer, particularly for more than 10 years, you should discuss your individual risks with your GP and review them on an annual basis.”

Who Should Not Take Estrogen Therapy?

Not to beat a dead horse, but remember how I said I don’t want to increase your risk of death?  As a rule of thumb, do not to take ERT/ET if you:

  • Are older than 60. 
  • Have cardiovascular disease.
  • Are prone to develop blood clots. 
  • Have a history of breast cancer.
  • Are sensitive to hormone replacement therapy’s ingredients.
  • Currently have breast cancer or any kind of cancer that is estrogen dependent.
  • Have any symptoms, such as irregular periods, that you haven’t shared with a doctor.
  • Have liver disease. 

As always, consult first with your doctor to get the A-OK to go on hormone replacement therapy for menopause. And, keep in close contact with them about getting the right combination, dose, and frequency.

It’s a Wrap!

In short, it’s very important to tune into your body, know all the ways menopause is affecting you specifically (did you know there can be as many as 34 symptoms of menopause?), track your symptoms, with the help of your doctor, pinpoint as much as possible which ones are being caused by estrogen depletion, and which ones aren’t (because unlike politicians, maybe estrogen can’t be blamed for everything?). Knowing that, along with the benefits and risks of estrogen therapy, can help you make a more informed decision about what’s right for you. Because you not only deserve relief, you deserve the right relief!

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