Is Estrogen Deficiency Really A Thing?
"Estrogen deficiency " is a common phrase. The term "Estrogen deficiency" is commonly used to identify people with a one-year or longer wait between their last period. A 13-year-old or 14-year-old who has just had their first period can be diagnosed with estrogen deficiency. It could also be found in stressed, thin university students whose periods suddenly stop. You might also find it in teenagers who have persistent adolescent skin problems, unwanted hair growth and irregular periods. A 35-year-old perimenopausal woman might have skipped or irregular periods.
It's odd, isn’t it? So many people are deficient in estrogen.
Estrogen deficiency can be a serious condition in cisgendered women. You can get serious illnesses like heart attack and osteoporosis. Low estrogen levels in teenagers who have stopped having their periods can lead to lower bone density, which could result in later life fractures. Women living with PCOS are also at increased risk for diabetes, heart attacks, and endometrial and ovarian cancers as well as infertility. The typical perimenopausal woman develops high cholesterol and may be at increased risk for heart attacks. Menopause itself is linked to an increased risk of osteoporosis and heart attacks, as well as vaginal dryness and decreased interest in sex .
The big problem with estrogen deficiency as a symptom or diagnosis is that it is a catchall term that plays into a cultural notion that estrogen is what makes a woman a woman. I am now at 77, and have entered my 20th year of menopause. However, my strong argument is that I don't "estrogen-deficient." I am normal in my estrogen and progesterone levels. Menopause is an normal phase of life.
Does "estrogen deficiency" even exist?
But it's not the only reason. Why? Why? Because of low levels of progesterone (sometimes called "progesterone deficit"), they always happen first. The brain's protective and fine-tuned responses to stressors are always first. Ovulatory disturbances with low progesterone levels (also called "progesterone deficiencies") can occur without us knowing. To make any progesterone, your body first needs to have estrogen. Before ovaries can produce an egg, and high levels of progesterone, estrogen's peak in the mid-menstrual period must have occurred. This is why estrogen cannot be isolated.
Progesterone and estrogen are both essential components of human female reproduction. The hormones estrogen and progesterone (a type of estrogen), work together during menstruation and help to produce healthy basic cellular functions. Estrogen plays a vital role in stimulating growth. Cell growth (also known as proliferation) can lead to genetic errors and cancer. The "job" of progesterone is to lower estrogen's effects on proliferation and increase cell maturity and specialization.
When a teenager is without a period or experiences a prolonged cycle , the only possible explanation for "estrogen deficit" is that they believe estrogen is their only cycle hormone. Important new information says that, to be healthy as well as fertile, women need balanced actions of both estrogen and progesterone during menstruating years. That means women usually have regular, normally month-apart, ovulatory (with at least 10 days of high progesterone) menstrual cycles. Without these balanced levels of estrogen and progesterone levels for most of our menstruating years, we are at risk for osteoporosis, heart attacks and breast and endometrial cancers when older.
Therefore, the term "estrogen deficiencies" is not scientifically accurate and scientifically described amenorrheas, oligomenorrheas, PCOS, menopause or perimenopause . Further, it doesn't tell us what therapy is best for each of these potential issues across a woman's life cycle. The goal of these therapies in younger women should be to restore a healthy estrogen-progesterone balance with regular, ovulatory cycles.
Why do we continue to hear about estrogen deficiency? Because this marketing term is very powerful. The term was invented by and for companies that sell estrogen. The term implies that estrogen and only estrogen are necessary treatments. It is important to note that this term was used in the same period as "hormone substitute therapy", or HRT.
If a woman is younger than 35, she skips her periods unless it's pregnancy. This is because she's missing estrogen and progesterone. A woman with PCOS without flow for months, paradoxically has normal or high estrogen and testosterone levels, but likely low progesterone. When a perimenopausal woman starts getting night sweats and premenstrual symptoms , she already has higher-than-usual-menstrual cycle estrogen levels, and lower progesterone levels. And when a menopausal woman has been without periods for a year, her progesterone levels are reliably low, but she may still have intermittently normal (or even high) estrogen levels.
We know that because one or two of every 10 women over 40 years of age, who has not menstruated for a year, will have another, natural period. A woman can tell it is a normal but "rogue flow" and not cancer if she had breast tenderness, bloating or felt PMS-like symptoms before it started.