The most common condition associated with low estrogen levels is menopause. Menopause is defined as the cessation of the menstrual cycle for 12 months. In the US, the average age of menopause is 51.4 years of age. In menopause, the brain sends signals to the ovarian follicle to make estrogen through a hormone called follicle stimulating hormone (FSH), and the ovaries are depleted and do not respond to this signal. This results in high laboratory values of FSH when the woman is post-menopausal. The body recognizes it needs estrogen, but the ovary does not respond.

This deprivation of estrogen results in a myriad of symptoms, including:

  • Vasomotor symptoms – Hot flashes, night sweats
  • Vaginal dryness
  • Sleep disturbances
  • New onset depression
  • Joint pain
  • Memory loss
  • Cognitive changes
  • Mood disruption/changes
  • Loss of libido
  • Diminished sexual function
  • Breast pain
  • Menstrual migraines

The long term effects of estrogen deficiency are more “behind the scenes”, and include:

  • Bone loss
  • Cardiovascular disease
  • Dementia
  • Osteoarthritis
  • Changes in body composition
  • Decreased collagen and elasticity of skin
  • Balance problems

Many of these issues can be addressed with hormone replacement therapy. It is important that the estrogen be given in a parenteral route, rather than by mouth. Parental routes of administration include transdermal creams/gels, sublingual troches or fixed oil suspensions, subcutaneous pellet implant or injection. It is also important to give the bioidentical form of estrogen, not other forms such as “conjugated equine estrogen”, synthetic estrogenic substances, selective estrogen receptor modulators (SERMs) or plant based estrogens.