The Juicy Hormone: All About Estrogen and Its Role in Perimenopause and Menopause
Navigating the natural changes in your body as a woman can feel as complicated as navigating the plot twists of a primetime soap. Estrogen, our "female hormone," lies at the heart of this drama. As we gracefully (or not so gracefully) age, the levels of estrogen in our bodies rise and fall, significantly impacting our health and wellbeing.
Estrogen: The Juicy Hormone
Estrogen is more than just a hormone. It's a complex chemical messenger that plays a starring role in the bodies of both women and men (yes, men too) that’s involved in a whole host of physiological processes that go beyond just fertility and reproduction. Bone strength, heart health, mood, and skin elasticity are all regulated by estrogen. But during perimenopause, our estrogen levels fall and the varied dynamics the lack of this essential hormone creates are plentiful. Let’s dive into them.
Estrogen's Role in the Female Body
Estrogen is responsible for the development of secondary sexual characteristics, like breast tissue and the distribution of body fat. It regulates our menstrual cycle, thickens the lining of our uterus to prepare for a possible pregnancy, influences mood and behavior, protects bone health by helping bones absorb calcium, and supports healthy cholesterol levels.
Starting in our mid to late forties, perimenopause begins and is the transition period leading into menopause. During perimenopause, estrogen levels can fluctuate wildly before eventually declining, leading to irregular periods and a variety of other symptoms. Estrogen dominance, a common imbalance during perimenopause, occurs when there are greater levels of estrogen in relation to progesterone. It can lead to symptoms such as:
Irregular periods
Bloating
Breast swelling and tenderness
Decreased sex drive
Headaches
Weight gain
Conversely, low estrogen levels in relation to progesterone can cause:
Hot flashes and night sweats
Mood swings
Sleep disturbances
Physical changes, like vaginal dryness and decreased bone density
It's the balance of estrogen with other hormones, particularly progesterone, that's crucial. Estrogen can become unbalanced for a variety of reasons. Lifestyle factors such as stress, obesity, and poor diet can contribute to hormonal imbalances. Moreover, external substances like xenoestrogens found in plastics and personal care products can mimic estrogen in the body, disrupting the natural balance. Certain medical conditions and medications can also affect how estrogen is processed in the body.
There are both natural and synthetic ways to boost estrogen levels in our bodies:
Natural Ways to Boost Estrogen
Adopt a diet rich in phytoestrogens found in foods like soy products, flaxseeds, and whole grains.
Ensure you have an adequate intake of vitamins and minerals that support estrogen production, including B-vitamins, magnesium, and zinc.
Get regular exercise, which supports hormone regulation.
Chemical Ways to Boost Estrogen
For some women, particularly those with significantly low estrogen levels, chemical intervention may be necessary. This could come in the form of hormone replacement therapy (HRT) and there are several forms to choose from:
Systemic HRT involves delivering estrogen through pills, skin patches, gels, or sprays. This method broadly circulates estrogen throughout the bloodstream and is generally used to treat common menopausal symptoms.
Localized HRT includes creams, tablets, or rings that are applied directly to the vaginal area. These are intended to alleviate local symptoms like vaginal dryness and discomfort without significantly increasing estrogen levels in the rest of the body.
Bioidentical Hormones are chemically identical to those the human body produces and can be custom-compounded to fit an individual's needs, although their use is less regulated.
Combination Therapies that include both estrogen and progesterone (or a synthetic version known as progestin) are often prescribed for women who still have their uterus, to mitigate the risk of endometrial cancer associated with estrogen-only therapy.
Each type of HRT carries potential risks and benefits, and the decision to use hormone therapy must be made on an individual basis, in consultation with healthcare providers.
Dispelling the Myth: Estrogen's Relationship with Breast Cancer
There is a prevalent belief that estrogen directly causes breast cancer, but the truth is more nuanced. While estrogen can stimulate the growth of certain types of breast cancer cells, it doesn't necessarily cause cancer to occur. In fact, most breast cancers are the result of complex interactions between hormones, genetic factors, and environmental influences. Hormone Replacement Therapy (HRT), which may include estrogen, has been wrongly associated with an increased risk of developing breast cancer as this risk actually depends on individual patient factors. This emphasizes the importance of personalized medical advice where a healthcare provider can assess the benefits of HRT against potential risks on a case-by-case basis.
Do We Ever Get It Back After Menopause?
At some point, on average in our fifties, we finally achieve menopause. This is marked by significantly lower estrogen levels and the cessation of our menstrual cycle. While the ovaries produce a small amount of estrogen even after menopause, it’s not enough to fully support a woman's health. At this stage, the adrenal glands and fat cells become the primary sources of our estrogen production.
It’s a common misconception that the adrenals and fat cells merely act as storage for estrogen, but they actually play a role in estrogen synthesis. After menopause, the ovaries significantly reduce their production of hormones, and the adrenal glands along with fat tissues take on a more pronounced role. The adrenal glands secrete androstenedione, which peripheral tissues convert to estrone, the type of estrogen produced in menopause. Fat cells contribute to estrogen levels by converting adrenal androgens into estrogens through a process known as aromatization. So, after menopause, while estrogen levels are lower, fat tissues are indeed active in manufacturing and not just storing estrogen.
Do We Need Estrogen Indefinitely (and Can We Continue Taking It)
The decision to continue HRT is a personal one, made together with your healthcare provider. For some women, it's a short-term solution to manage symptoms, while others may require it for a longer period. Current research is leaning towards this being an indefinite option for women as it may provide protective health benefits long term. As with any medical treatment, when discontinuing HRT make sure to have a discussion with your healthcare provider to ensure a gradual and safe transition.
Every woman's experience with estrogen is unique; the best approach is one that considers personal health history, lifestyle, and the delicate balance of risks and benefits. While navigating perimenopause and menopause, remember that knowledge is your best asset. The ebb and flow of estrogen levels are as integral a part of being a woman as embracing the changes with grace and understanding that this is part of an extraordinary cycle of life. As the science of hormones continues to evolve, so does the potential for personalized medical strategies that honour the nuances of each individual's journey. Embrace this transition armed with knowledge, support, and the courage to seek out what works best for you and your body.
