Estrogen deficiency – causes, symptoms, treatment of low estrogen levels

Causes of Low Estrogen Levels

Estrogens are involved in many processes occurring in a woman’s body. Without these hormones, secondary sexual characteristics do not develop - the presence of a uterus, vagina, vulva, tertiary - bust, body proportions, characteristics of a typical female psyche and specific sexual desire.

The production of estrogen in the ovaries depends on the functioning of the hypothalamus and pituitary gland. The FSH (follicle-stimulating) hormone is responsible for controlling the formation of these hormones, protecting the body from excessive or insufficient production of estrogen.

Estrogens are responsible for the correct menstrual cycle, influencing the growth of the endometrium. Their action serves to prepare the endometrium to receive the embryo during the implantation process. In addition, estrogens affect metabolic changes in the body.

They also affect a woman's lipid profile, calcium and protein management.

Estrogen deficiency can occur in women with pathologies of ovarian development, for example, atrophy, when they do not produce estrogens. Another pathology associated with estrogen deficiency is premature loss of ovarian function.

Typically, this condition occurs in the case of physiological changes in the female body during menopause, during which the ovaries cease to be hormonally active.

Loss of ovarian function does not occur in women without symptoms.

Hypoestrogenic conditions in women of reproductive, pre- and menopausal ages

Hypoestrogenic conditions include changes in the body of women against the background of a decrease or cessation of estrogen production by the ovaries.

First of all, a complex of vegetative-vascular, neuroendocrine and neuropsychic symptoms arises (early temporary disorders). Then urogenital and sexual disorders and changes in appearance appear (medium-term disorders). Late metabolic disorders occur last: osteoporosis, coronary heart disease, Alzheimer's disease [1].

These numerous symptoms of hypoestrogenism are associated with the presence of a huge number of estrogen receptors in various organs and systems of a woman: genitals, hypothalamus and pituitary gland, cardiovascular system, urethra and bladder, skin and hair, large intestine, liver [2].

The above changes can occur not only naturally during menopause, but also when a woman’s body is exposed to other factors: after surgical operations (removal or resection of the ovaries due to cysts and apoplexy, amputation of the uterus); with depletion of the follicular apparatus (ovarian depletion syndrome) [3, 4]; with a perverted reaction of estrogen receptors (resistant ovarian syndrome); against the background of the use of certain medications, in particular hormone-releasing hormone agonists (AH-RG); in the treatment of estrogen-dependent diseases of the female reproductive system, as well as in long protocols for stimulating superovulation in the in vitro fertilization (IVF) program for the treatment of infertility (requires add-back therapy to relieve neurovegetative symptoms) [5, 6].

Hypoestrogenic conditions associated with a slight decrease in estrogen production (with sparing resection of the ovaries, cauterization of not polycystic, but multifollicular ovaries, etc.) have their own special clinical manifestations, most often leading to impaired reproductive function (anovulation, luteal phase deficiency; reduced ovarian reserve , leading to a poor ovarian response in IVF programs) [7]. According to our data, such patients occur in IVF programs in 22.3% of cases.

Hypoestrogenism in the menopausal period can serve as a model for studying the classical clinical manifestations of this condition, since menopause is a natural rather long biological process of transition from the reproductive period to old age, which is based on the gradual decline of ovarian function and a decrease in estrogen production. Early-time disorders manifest themselves most clearly [1]. The complex of symptoms of early-term disorders with a certain degree of severity is usually called climacteric syndrome (CS). According to our data obtained together with I.V. Besman [8], CS in perimenopause occurs in 57.6% of cases, while in 65% it occurs in a complicated form (i.e., against the background of extragenital pathology). The complicated form of CS causes the maximum severity of CS symptoms. Currently, early symptoms of hypoestrogenism are associated with disorganization of the function of the limbicoreticular complex. Impaired hypothalamic function is associated with manifestations of early-onset disorders such as hot flashes, hyperhidrosis, palpitations, and hypertension. Depression, sleep disturbances, headaches, and memory loss are associated with dysfunction of the limbic system. All early-term disorders reduce a woman’s quality of life, but this is especially true for hot flashes and sleep disorders. Hot flashes can bother a woman 5–10–20 or more times a day. Sleep disorders: prolongation of the period of falling asleep, frequent awakenings at night, shallow sleep - do not give the feeling of proper rest. Undoubtedly, all these disorders require a differentiated approach to treatment depending on the cause of hypoestrogenism and the age at which they occur.

Today, hormone replacement therapy (HRT) is considered a non-alternative pathogenetic therapy for early symptoms of hypoestrogenism [1, 6]. In women of reproductive age after surgical removal or resection of the ovaries, with resistant and exhausted ovarian syndromes, treatment can begin with combined estrogen-progestogen drugs [1]. These can be modern three-phase drugs, for example Qlaira. In women after hysterectomy, therapy is carried out using natural estrogens followed by the addition of gestagens [6]. If oral drugs are poorly tolerated, they can be recommended in the form of a gel or patch for percutaneous administration (Estrogel, Divigel, Klimara) with periodic administration of gestagens vaginally (for example, Utrozhestan). The duration of HRT is determined by the condition and well-being of the patient.

During menopause, when treating early-onset disorders, it is important to adhere to the position of the International Menopause Society (2007):

• HRT is prescribed for clear indications, primarily for the relief of menopausal symptoms;
• the need for continued treatment and the presence of indications for HRT should be reviewed regularly, especially with long-term use.

In addition, modern principles for prescribing HRT should be taken into account:

• only natural estrogens are used (17β-estadiol, estradiol valerate);
• minimally effective doses of hormones are used;
• the drug is selected individually;
• before therapy, a special examination is carried out, during therapy - daily monitoring;
• the start of HRT should not be later than 5 years from the onset of menopause;
• HRT should not be prescribed if there are contraindications.

Contraindications to HRT:

• skin lesions;
• estrogen-dependent tumors of the genital organs;
• suspected presence or presence of breast cancer;
• venous thromboembolism;
• severe liver and kidney diseases;
• bleeding from the genital tract of unknown origin.

HRT modes:

• In perimenopause - cyclic drugs that imitate the normal menstrual cycle (Klimonorm, Cyclo-Proginova, Estrogel, Divigel + Utrozhestan, Duphaston, Klimen, Femoston 1/10, 2/10, etc.).
• In postmenopause - continuous therapy that does not cause bleeding: Angelique (1 mg 17β-estadiol + 2 mg drosperinone), Mirena + Klimara, Klimadien (estradiol valerate + dienogest), Estrogel + Utrozhestan, Livial (tibolone), Femoston 1/5.
• In the absence of a uterus, monotherapy with estrogens (Klimara, Proginova, Estrogel, Divigel).
• For obesity, metabolic syndrome, increased risk of vascular episodes, phase therapy with transdermal and vaginal forms (Estrogel, Divigel, Utrozhestan).
• If the patient refuses HRT or there are contraindications, decide on the use of herbal medicine in the form of homeopathic medicines and dietary supplements, which include estrogen-like substances. These drugs have virtually no contraindications and contain cohosh extract, soy, vitamins, minerals, etc. Among them are Remens, Klimaxan, Klimaktoplan, Klimadinon, QI-CLIM, Menopace Plus, Estrovel, Menoril, Soifem, etc.

The drug Menopace Plus is interesting in its composition, which includes capsules with vitamins and minerals (21 components), as well as herbal tablets containing soy isoflavones, flax seed lignans, sage and green tea. The components of the herbal tablet are converted into phytoestrogens in the intestines, have a beneficial effect on the nervous system, reduce hot flashes, and are sources of antioxidants. The cycle of taking this drug, one capsule and one herbal tablet per day, is 28 days.

We, together with I.V. Besman [9], have experience in the use of alternative herbal remedies to HRT in the treatment of a complicated form of CS in cases where HRT was contraindicated. Our studies have shown that the quality of life of these patients, determined by a special scale, is somewhat worse than that of those who took HRT; but significantly better than those who did not take any drugs at all. In addition, these drugs give a good effect in relieving vasomotor symptoms in long protocols with AG-RG IVF programs.

All of the above once again confirms the opinion of experts that a differentiated approach to the treatment of early-term disorders in hypoestrogenic conditions using HRT of various regimens or alternative herbal remedies gives a good effect and significantly improves the quality of life of women.

Literature

1. Medicine of menopause / Ed. V. P. Smetnik. Yaroslavl: Litera Publishing House LLC, 2006. 848 p.
2. Kulakov V.I., Prilepskaya V.N. Practical gynecology. Clinical lectures. 3rd ed., add. M.: MEDPress-inform, 2006. 720 p.
3. Dobrokhotova Yu. E. Hysterectomy in reproductive age (systemic changes in a woman’s body and methods of their correction). Author's abstract. dis. Dr. med. Sci. M., 2000. 36 p.
4. Zaidieva Ya. Z. Hormone replacement therapy. Pharmacology and clinical application. M.: 2001. 50 p.
5. Infertile marriage. Modern approaches to diagnosis and treatment: a guide / Ed. G. T. Sukhikh, T. A. Nazarenko. 2nd ed., rev. and additional M.: GEOTAR-Media, 2010. 784.: ill.
6. Guide to outpatient care in obstetrics and gynecology / Ed. V. I. Kulakov, V. N. Prilepskoy, V. E. Radzinsky. M.: GEOTAR-Media, 2006. 1056 p.
7. Nazarenko T. A. Stimulation of ovarian function. 3rd ed., add. M.: MEDPress-inform, 2011. 272 ​​p.: ill.
8. Besman I.V., Rudakova E.B. Medical tactics for complicated forms of menopausal syndrome in perimenopausal women // Omsk Scientific Bulletin. 2010. No. 1 (94). pp. 10–13.
9. Rudakova E. B., Besman I. V. Quality of life as a criterion for the effectiveness of treatment of menopausal syndrome // Omsk Scientific Bulletin. 2008. No. 1 (65). pp. 81–84.

E. B. Rudakova1, Doctor of Medical Sciences, Professor T. V. Strizhova, Candidate of Medical Sciences L. Yu. Zamakhovskaya

GBUZ MO MOPC, Balashikha

1 Contact information

Abstract. Pathogenetic therapy treatment of early symptoms of hypoestrogenism consists of hormone replacement therapy (HRT). In the case of contraindications to the HRT medication or refusal of a woman, alternative herbal medication is effective less than HRT, but however improves the quality of life.

Estrogen deficiency - symptoms

Menopause is associated with menopause. During this period of life, a woman may develop somatic or vasomotor disorders. The latter - hot flashes and excessive sweating - occur in certain situations - at high air temperatures, under conditions of mental stress.

Vaginal dryness is also a common problem, leading to vaginal itching and more frequent intimate infections. In addition, a woman stops enjoying sex life, because irritation and burning often lead to dyspareunia - pain during sexual intercourse. There may even be slight bleeding after sexual intercourse.

Low estrogen levels may also be associated with psychological symptoms. Depression is a common companion to menopause (perimenopausal depression). Patients complain of increased anxiety, sleep problems, and decreased psychomotor skills.

General signs of hormonal disorders

In addition to specific symptoms of hormonal imbalance, there are also less typical ones, which may, however, indicate incorrect functioning of the thyroid gland, or be part of the picture of an imbalance of sex hormones:

• decreased or sharp increase in libido;
• excess weight without diet errors;
• fatigue, loss of strength, tearfulness;
• changes in facial features (bulging eyes with hypothyroidism);
• drowsiness, tachycardia, sweating;
• muscle weakness.

Hormonal imbalance in women is characterized by a pattern in which several alarming signs appear simultaneously. The sexual sphere, appearance, and activity suffer.

Treatment of hormonal imbalance is necessary to restore the normal functioning of a woman’s reproductive system, make conception and pregnancy possible, achieve regular ovulation and simply give a woman a high quality of life. The Dr.AkNer clinic will definitely help you understand the causes of the failure and eliminate them.

What happens when there is too little estrogen in a woman's body?

Somatic ailments are associated with the influence of estrogens on estrogen-dependent tissues. The lack of hormones dramatically changes their functioning.

• Low estrogen levels affect the circulatory system. When its concentration decreases, unfavorable changes in the lipid profile occur. The simultaneous occurrence of changes in the vascular walls and the promotion of the formation of atherosclerotic plaques increases the risk of developing coronary heart disease in postmenopausal women.
• A decrease in estradiol concentration also negatively affects bone health. Estrogen deficiency is associated with decreased bone density and bone loss.
• A decrease in the content of collagen and hyaluronic acid in the skin leads to its aging and decreased elasticity. Estrogen deficiency is also responsible for this process.
• Estrogen-dependent tissues include tissues of the genitourinary system. The condition of the connective tissue of the genital area and the supporting apparatus of the reproductive organ depends on the concentration of estrogen. When they are absent, the connective tissue and support system of the uterus weakens. This leads to a tendency to static disorders of the reproductive organ, hernias and urinary incontinence.
• The effect of estrogen deficiency on the condition of the mucous membrane of the genital tract is undeniable. In postmenopausal women, there is a predisposition to atrophic changes (atrophic vaginitis, vaginal atrophy) and dryness of the vaginal mucosa. A decrease in estrogen concentration causes a decrease in the amount of glycogen in the cells of the vaginal mucosa.

This affects the pH of the genital tract and the emergence of a tendency to bacterial infections. The effect of estrogens during atrophic changes in the skin of the vulva cannot be denied. Lack of estrogen can affect the occurrence of retrograde skin lesions.

How to ease the course of menopause

It is necessary to make some changes in diet and lifestyle. Eat more dietary fiber and eliminate animal fat. Add a small amount of vegetable fats. Include calcium-rich foods in your diet; the recommended daily calcium intake for women over 50 is 1200 mg. per day, and for better absorption, do not forget about vitamin D.

Alcohol, smoking, caffeine, excessive consumption of salt and protein foods lead to the excretion of calcium in the urine. To reduce temperature changes, avoid spicy and strong drinks and try to lose excess weight. Eat foods containing phytoestrogens - plant compounds similar in structure to estrogen. If you suffer from migraines, limit your intake of tyramine and MSG.

Physical activity speeds up metabolism, improves heart and lung function, slows down the process of bone density decline, normalizes blood pressure, reduces the frequency of temperature changes, and improves mood through the production of endorphins in the brain.

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Low estrogen levels - treatment

Therapeutic options for menopausal symptoms are based on hormone replacement therapy (HRT). There are specific indications and contraindications for the use of estrogens.

In each clinical case, the advantages and disadvantages of using HRT should be considered individually. There are different ways to administer estrogen - tablets, patches, gels, implants and creams. They can be administered intravenously, vaginally or orally.

To get rid of vaginal dryness, you can use special lubricants or vaginal moisturizing beads with hyaluronic acid. They reduce burning and discomfort. This is a good way to relieve pain during intercourse.

Any treatment should be prescribed by a gynecologist after receiving test results.

How the body synthesizes estrogen

Most estrogen is produced by the ovaries.
To do this, they use precursor hormones that have an androgenic effect. Small amounts of estrogen are also produced by the adrenal cortex and adipose tissue in women and men. During pregnancy, estrogen is additionally synthesized by the placenta. The body produces three types of estrogen: estradiol, estriol and estrone. In this article we will talk mainly about estradiol, since it is most common in women before menopause.

After entering the blood, part of the estrogen combines with sex hormone binding globulin. The rest remains free. It is she who already reaches the organs and tissues and is responsible for all functions. It turns out that globulin regulates the amount of estrogen available to the body.

Free estrogen enters cells, binds to receptors and thus regulates the production of various proteins and the rate of division of estrogen-sensitive cells.

Diagnostics

An endocrinologist and gynecologist-endocrinologist are involved in finding out the causes of hormonal changes, their prevention, and eliminating the consequences. During the first visit, the doctor will find out the patient’s complaints, examine him, and get acquainted with the medical history and outpatient card.

After this, he will prescribe a comprehensive diagnosis:

• blood and urine tests;
• biochemistry;
• hormonal panel;
• ultrasonography of the ovaries, pelvic organs, thyroid gland, TRUS for men;
• mammography;
• PCR test.

Additionally, an MRI may be prescribed, especially if there is a suspicion of a tumor of the pituitary gland or other endocrine organ. X-ray contrast and other studies are carried out as indicated. The patient can be advised by highly specialized doctors.

Menstrual cycle and hormones

The level of female sex hormones, including estrogen, depends on the phase of the menstrual cycle. There are 4 of them in total.

Menstrual phase

It begins the female cycle in the absence of pregnancy. At the end of the cycle, a thickened mucous layer of the endometrium, necessary for the fetus, is formed in the uterus. When pregnancy does not occur, the layer is rejected and comes out along with the blood. Hormone levels are low during this period. During menstruation, pain may occur in the groin area and lower back.

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Follicular phase

It begins on the first day of the cycle and continues until ovulation. In a woman's ovary, follicles containing eggs begin to form and gradually mature. Estrogen levels gradually rise and reach a peak around ovulation. During this phase, the endometrium in the uterus begins to thicken, which provides nutrition for the embryo if fertilization occurs.

Ovulatory phase

The egg is released from the mature follicle into the fallopian tubes, which are connected to the uterus. This is where the fusion of sperm and egg occurs during conception, and then the embryo moves into the uterus and attaches to a special layer. If fertilization does not occur, the egg dies in the fallopian tube.

Luteal phase

After the follicle ruptures and the egg is released into the fallopian tubes, the corpus luteum remains in the ovary. It produces estrogen and progesterone, a hormone that also regulates the cycle and is necessary during pregnancy. Together they prepare the uterus for fertilization. If this does not happen, the corpus luteum stops functioning, and the level of estrogen and progesterone decreases. Then menstruation begins.

If the cycle is 28 days, then ovulation occurs approximately on the 14th day - the middle of the cycle. Typically the cycle length is 25–30 days, but it can be shorter or longer.