During menopause many women notice it first in their sleep and mood, even before the hot flushes begin. The common thread behind that broad range of complaints is often one hormone slowly declining: oestrogen. And because this hormone steers so many different systems, a deficiency can show up in the most varied ways.
My conviction: oestrogen is too often dismissed as "the hot-flush hormone", while it just as much affects your bones, your heart and your head.
What does oestrogen do in your body?
Oestrogen is more than a sex hormone. It plays a role in your menstrual cycle and fertility, the health of your bones, your cardiovascular system, your mood and cognitive function, the elasticity of your skin and mucous membranes, and your cholesterol balance. The main oestrogen in the fertile years is estradiol (E2). During menopause production declines gradually.
Causes of oestrogen deficiency
The table below lines up the main causes, with the typical life stage and a fitting first step.
| Cause | Typical stage | Fitting first step |
|---|---|---|
| Menopause or perimenopause | From ~45 years | Measure FSH and estradiol |
| Early menopause (POI) | Before age 40 | Have it investigated quickly |
| Intensive exercise + low intake | Any age | Review nutrition and training |
| Underweight or eating disorder | Any age | Seek support |
| Chronic stress | Any age | Measure cortisol, address stress |
| Medical treatment (e.g. ovary surgery) | Variable | Discuss with treating doctor |
Symptoms of oestrogen deficiency
The complaints are varied and not always recognised straight away. Common ones are hot flushes and night sweats, an irregular or absent period, vaginal dryness, mood complaints (oestrogen affects serotonin), sleep problems, fatigue, joint complaints and morning stiffness, a reduced libido and drier skin with thinning hair. According to the NVOG, the symptom pattern varies strongly per woman: one mainly has hot flushes, another mainly mood or sleep complaints.
What can you do?
Lifestyle changes
Phyto-oestrogens in soy, flaxseed and legumes can offer mild support. Regular, moderate exercise supports your hormone balance and bone health, a healthy weight helps (both under- and overweight can affect your oestrogen level), and stress reduction gives your body more room. The Gezondheidsraad stresses the importance of enough exercise and, for your bones, a good intake of calcium and vitamin D, especially around menopause.
Medical options
With severe complaints your doctor may consider hormone therapy (HRT), which replenishes the oestrogen your body makes less of. Always discuss the pros and cons, as hormone therapy is not suitable for everyone. Never start hormones on your own.
Why a deficiency in young women deserves extra attention
Menopause is the best-known cause, but in women under 40 especially, low oestrogen is a signal you do not want to ignore. Sometimes there is an identifiable reason behind it, such as intensive exercise combined with eating too little, significant underweight or a lot of stress. In that case the body has temporarily shifted into a saving mode. If your period stays away for more than a couple of months, that is a reason to see your GP, even if you otherwise feel fine. Long-term low oestrogen at a young age can affect your bone building, and that foundation is laid precisely in these years.
What oestrogen means for your bones and heart
Oestrogen has a protective role that reaches beyond your cycle. It helps maintain your bone density and has a favourable effect on your cholesterol profile. After menopause, when oestrogen is permanently low, the risk of osteoporosis and cardiovascular disease therefore rises gradually. That need not frighten you, but it does explain why a doctor sometimes looks beyond your hot flushes. If you want to know more about this, our pillar osteoporosis after menopause: risk and testing helps further.
When to get your hormones tested?
If you suspect a deficiency, a blood test on estradiol (E2) and FSH can help: low estradiol with an elevated FSH fits oestrogen deficiency. It is advisable to include your thyroid function (TSH) for a complete picture. A broad test such as our menopause test measures these values together.
Further reading
Also read the signal list oestrogen deficiency symptoms: 12 signs you should not ignore and, if you want to know what lifestyle can do, increase oestrogen: natural ways and when to test.
Frequently asked questions
Can oestrogen deficiency be dangerous?
Long-term low oestrogen can raise the risk of osteoporosis and cardiovascular disease over time. That does not mean you are in immediate danger, but it is a reason to take it seriously and discuss it with your doctor.
Can I raise my oestrogen naturally?
Food rich in phyto-oestrogens, regular exercise and stress reduction can be supportive. With a substantial deficiency these measures alone are not always enough.
Is oestrogen deficiency the same as menopause?
Not necessarily. Menopause is the most common cause, but younger women can also have a deficiency for other reasons. A blood test can help distinguish this.
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