Estrogens “feminize” the body. They shape the female body, enlarge the breasts and redden the skin. The decrease of estrogen levels at the end of the menstrual cycle makes the female period start. The ovaries, testes and adrenal glands produce estrogens.
There are three forms of estrogen: estrone, estradiol and estriol. Estradiol is the most potent and the most physiologically active. Estrone is considered cancer promoting and is usually not prescribed. Estriol is considered a weak estrogen but has been shown to have anti-cancer properties.
Functions and Actions of Estradiol
- Uterus – Creates normal growth of the endometrium (lining) of the uterus. Excessive estradiol, or estradiol not opposed by progesterone, can increase the risk of developing endometrial cancer.
- Vagina – Promotes vaginal lubrication and thickening of vaginal wall
- Urinary Tract– Promotes bladder tone thereby preventing symptoms of stress incontinence.
- Libido – Can directly increase sexual desire, interest, responsiveness and sexual satisfaction.
- Blood Sugar & Insulin Levels – Improves blood sugar metabolism and decreases risk of developing hyperinsulinemia. Estradiol promotes increases in the uptake of glucose by muscle cells.
- Brain, Mood & Memory – Can significantly improve or alleviate depression in postmenopausal women. It is needed for normal function of neurotransmitters that affect mood and memory.
- Breasts – Helps maintain the size and density of breast tissue, though excess amounts increase risk of some forms of breast cancer or cause breast pain.
- Skin – Has a positive effect on skin thickness, skin collagen, water content, skin softness and blood flow to the skin.
- Bone – Estradiol slows bone loss by decreasing the development and the activity of bone clearing osteoclast cells. It also increases the bone building ability of osteoblast cells directly.
- Heart – Lowers total and LDL (bad) cholesterol levels while increasing HDL (good) cholesterol. Also causes a reduction in lipoprotein (a) which results in a significant reduction in the risk of developing heart disease.
Common Symptoms of Estrogen Deficiency in Women
Physical:
- Hot flushes and night sweats
- Small, “droopy” breasts
- Vaginal dryness and itching
- Low or absent menstrual cycles
- Urinary incontinence, increased bladder infections
- Pale and dry skin
Mental:
- Poor libido (sex drive)
- Depression and fatigue
- Poor memory
Treatment
Requirements for Monitoring Therapy:
- Baseline and periodic blood tests including estradiol, estrone, progesterone, follicle stimulating hormone (FSH) and other hormone testing as appropriate.
- Baseline and periodic women’s exam including mammography and PAP smear as appropriate.
- Other tests that may be needed include: ultrasound imaging of the breast, ovaries and uterus and bone density scans.
Medication:
Estrogen is available in different formulations; the right route and dose depends on the patient needs. Improvements may occur in the first week of treatment, however, full benefits of treatment may take up to three months. Natural replacements such as Biest (80% estriol, 20% estradiol) are preferred.
- Sublingual (under the tongue) tablets
- Trans-dermal (topical cream or patch)
- Vaginal cream
- Oral capsules (not recommended)
- Pellet implants (not recommended)
Signs and Symptoms of Too Much Estrogen Replacement
- Swollen, painful or tender breasts
- Increased anxiety, irritability and nervousness
- Weight gain, especially before periods
- Heavy, painful periods
- Migraine headaches, especially before periods
- Swelling in hands or feet
- “Reddish” face
- Sleep difficulties
Risks, Contraindications and Benefits of Treatment
Risks:
- Nausea, bloating, breast tenderness, headache, change in vaginal discharge, mood swings, blurred vision, dizziness, unusual vaginal bleeding (e.g., spotting, breakthrough bleeding), mental/mood changes (e.g., depression, memory loss), swelling of the hands/feet, frequent/burning/painful urination, breast lumps, dark patches on the skin or face (melasma), yellowing eyes/skin, stomach/abdominal pain, persistent nausea/vomiting, dark urine, unusual tiredness.
- The Women’s Health Initiative used two synthetic hormone “look-alike” drugs called premarin (estrogens) and provera (progestin). Neither of these drugs are exactly the same (bioidentical) as human estrogen or progesterone. The results of this study showed the premarin only group had increased risk of stroke and blood clots. The premarin plus provera group had additional risks of heart attack and breast cancer.
- NOTE: Bioidentical HRT has been extensively studied and does not have the same risk profile as the drugs used in the Women’s Health Initiative.
Contraindications:
- Active or untreated breast or uterine cancer is an absolute contraindication for all estrogen replacement.
- History of treated breast or uterine cancer is a relative contraindication and treatment should occur only with specific education as to the risk and benefits in this particular situation.
Benefits:
- Possible improvements in sleep, mood, energy, skin tone, sex drive
- Reduced risk of heart disease, osteoporosis, dementia, colon cancer, macular degeneration
