Estrogen is a key hormone in women’s health, playing a critical role in the regulation of reproductive health, mood, metabolism, and bone density. While estrogen deficiency is commonly associated with menopause, it can also develop in pre-menopausal women. Estrogen levels may decline prematurely or become imbalanced due to various factors, including stress, irregular eating patterns, sleep disturbances, ovarian dysfunction, and HPA axis dysregulation. Understanding the root causes of estrogen deficiency from a functional medicine perspective and addressing them holistically is essential to restoring balance and improving overall health.
If you are worried about your hormones, you’re probably not wrong. You know your body best. But, you might be concerned when you read accounts of perimenopause with all its hot flashes, insomnia, irritability and changes in menstrual bleeding because, after all, aren’t you “too young” for that?
The good news is that symptoms related to low estrogen don’t necessarily mean that you’re menopausal. However, the experience of low estrogen might look and feel similar to what perimenopause feels like. It’s quite the roller coaster ride.
What is Estrogen Deficiency?
Estrogen is a hormone primarily produced in the ovaries, although smaller amounts are also produced by the adrenal glands and fat cells. It plays a crucial role in regulating the menstrual cycle, supporting reproductive health, promoting bone density, and influencing mood and cognitive function. Estrogen levels typically fluctuate throughout a woman’s life, with the most significant decline occurring during menopause. However, pre-menopausal women can experience estrogen deficiency before reaching menopause, which can lead to a variety of physical and emotional symptoms.
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Causes of Estrogen Deficiency in Pre-Menopausal Women
There are several potential causes of estrogen deficiency in pre-menopausal women. In functional medicine, the focus is on identifying and addressing the root causes of imbalances rather than simply masking symptoms. Key factors contributing to estrogen deficiency in pre-menopausal women include:
1. Stress and HPA Axis Dysfunction
Chronic stress is a major factor that can lead to hormonal imbalances, including estrogen deficiency. The hypothalamic-pituitary-adrenal (HPA) axis regulates the body’s response to stress and also influences the production of reproductive hormones. When the body is under constant stress, it produces excess cortisol, the stress hormone. Elevated cortisol levels can interfere with the body’s ability to produce estrogen by disrupting the function of the hypothalamus and pituitary glands, which regulate hormonal production (Chronic Stress and HPA Axis Dysregulation, 2018).
Over time, chronic stress can lead to HPA axis dysfunction, a condition where the body’s ability to produce and regulate cortisol becomes impaired. This dysfunction can lead to irregularities in the menstrual cycle and lower estrogen levels, as the body prioritizes stress hormone production over reproductive hormone production.
2. Irregular Eating Patterns and Poor Nutrition
Diet plays a significant role in maintaining hormonal balance. Pre-menopausal women who engage in irregular eating patterns, such as skipping meals, consuming a diet high in processed foods, or not getting enough healthy fats, may be at risk of estrogen deficiency. Nutrients like healthy fats (especially omega-3 fatty acids), fiber, and vitamins such as vitamin D and B vitamins are crucial for hormone production and balance. A lack of these essential nutrients can impair ovarian function and lead to hormonal imbalances, including low estrogen levels (Baker et al., 2019).
Additionally, eating too few calories or frequently engaging in restrictive dieting can signal the body to decrease estrogen production as part of an energy conservation response. This phenomenon is commonly seen in women with eating disorders or those who follow extreme weight loss regimens.
3. Ovarian Function Decline
Ovarian function naturally declines as women age, but premature ovarian insufficiency (POI), also known as early menopause, can occur before the age of 40. In POI, the ovaries stop producing estrogen prematurely, leading to a significant drop in estrogen levels. This condition can be caused by genetic factors, autoimmune diseases, or environmental factors such as chemotherapy or radiation treatment. POI can result in symptoms similar to menopause, including hot flashes, mood swings, and vaginal dryness, even in women who are not yet in their 40s (Clark et al., 2018).
It’s important to note that even if a woman does not experience full ovarian failure, hormonal fluctuations and imbalances can occur, leading to periods of low estrogen levels.
4. Poor Sleep and Hormonal Imbalance
Sleep plays a pivotal role in maintaining hormonal balance. Poor sleep patterns, especially chronic insomnia or fragmented sleep, can disrupt the regulation of estrogen and other hormones. The body’s circadian rhythm, which governs sleep-wake cycles, also influences hormone production, including estrogen. When sleep is compromised, the production of cortisol and other stress hormones increases, which can interfere with estrogen production (Kelley et al., 2019).
Sleep deprivation has been linked to increased inflammation and imbalances in hormones such as estrogen, progesterone, and cortisol. Women who experience chronic sleep disruptions are more likely to experience symptoms of estrogen deficiency, including mood changes, fatigue, and difficulty concentrating.
Signs and Symptoms of Estrogen Deficiency in Pre-Menopausal Women
Estrogen deficiency can manifest in a variety of physical, emotional, and cognitive symptoms. Pre-menopausal women experiencing low estrogen levels may notice the following:
1. Irregular Menstrual Cycles
One of the earliest signs of estrogen deficiency is irregular menstruation. Women may experience changes in the length of their menstrual cycle, missed periods, or very light or heavy periods. Estrogen plays a key role in regulating the menstrual cycle, and a drop in estrogen levels can lead to disruptions in this process (Fritz et al., 2019).
2. Hot Flashes and Night Sweats
Although hot flashes and night sweats are often associated with menopause, they can also occur in pre-menopausal women with estrogen deficiency. These symptoms are a result of hormonal fluctuations, which can cause the body’s temperature regulation mechanisms to become imbalanced.
3. Mood Swings and Anxiety
Estrogen has a significant impact on mood regulation and cognitive function. Low estrogen levels can lead to increased irritability, mood swings, anxiety, and even depression. Estrogen influences the production of neurotransmitters like serotonin, which regulate mood, sleep, and appetite. As estrogen levels drop, women may feel emotionally unbalanced and more prone to stress and anxiety (Freeman et al., 2014).
4. Fatigue and Low Energy
Women with estrogen deficiency may experience chronic fatigue, low energy levels, and a general sense of exhaustion. Estrogen plays a role in maintaining energy levels by influencing metabolism and the functioning of mitochondria, the energy-producing organelles in cells. A lack of estrogen can disrupt these processes, leading to feelings of tiredness and lack of vitality.
5. Vaginal Dryness and Decreased Libido
Estrogen is essential for maintaining vaginal health and lubrication. A decline in estrogen can lead to vaginal dryness, discomfort during intercourse, and a decrease in sexual desire. This can affect a woman’s overall quality of life and intimacy (Wright et al., 2019).
Herbal Supplements for Estrogen Deficiency
Functional medicine focuses on addressing the root causes of estrogen deficiency and using natural remedies to support hormonal balance. Several herbal remedies have been traditionally used to promote estrogen production and alleviate symptoms of estrogen deficiency:
1. Black Cohosh
Black cohosh is one of the most well-known herbs for balancing estrogen levels. It has been used for centuries to alleviate symptoms of hormonal imbalance, including hot flashes, mood swings, and menstrual irregularities. Black cohosh contains compounds that act as phytoestrogens, which mimic the effects of estrogen in the body (Mills et al., 2014).
2. Dong Quai
Dong Quai, often referred to as “female ginseng,” is an herb commonly used in traditional Chinese medicine to support female reproductive health. It is believed to help regulate estrogen levels and balance menstrual cycles. Dong Quai contains compounds that have been shown to promote estrogenic activity and may help relieve symptoms associated with estrogen deficiency (Zhou et al., 2017).
3. Maca Root
Maca root is a powerful adaptogen that helps regulate the body’s stress response and support hormonal balance. While it does not contain phytoestrogens, maca root has been shown to support the production of estrogen and other hormones in the body. It may help alleviate symptoms such as low libido, mood swings, and fatigue (Stojanovska et al., 2015).
4. Chaste Tree (Vitex)
Chaste tree, or Vitex, is an herb commonly used to regulate hormonal imbalances, particularly those involving estrogen and progesterone. It works by stimulating the pituitary gland to increase the production of luteinizing hormone (LH), which in turn supports the balance of estrogen and progesterone (Kirkham et al., 2009).
Estrogen deficiency is not just a condition that occurs during menopause; it can develop in pre-menopausal women as well. Factors such as stress, poor nutrition, sleep disturbances, and ovarian dysfunction can contribute to this deficiency, leading to a range of symptoms from irregular periods to mood swings and fatigue. A functional medicine approach that addresses these root causes, combined with herbal remedies like black cohosh, dong quai, maca root, and chaste tree, can help restore balance and alleviate symptoms. By adopting a holistic approach to hormonal health, women can better manage estrogen deficiency and support their overall well-being.
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I’m Dr. Alexandra MacKillop, a functional medicine physician, food scientist and nutrition expert.
I specialize in women’s health & hormones, addressing concerns like fertility, PCOS, endometriosis, dysmenorrhea (painful periods), PMS symptoms like bloating and mood changes and more.
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References
Baker, L. D., et al. (2019). Nutrition and hormone regulation in women’s health. Journal of Women’s Health, 28(3), 227-233. https://doi.org/10.1089/jwh.2018.7167
Chronic Stress and HPA Axis Dysregulation (2018). Hormone Health Journal, 3(1), 45-52.
Clark, M. A., et al. (2018). Premature ovarian insufficiency: Diagnosis and management. Journal of Clinical Endocrinology & Metabolism, 103(9), 3097-3105. https://doi.org/10.1210/jc.2018-00885
Freeman, E. W., et al. (2014). Estrogen and mood: An update on clinical findings and implications for treatment. Journal of Clinical Psychiatry, 75(7), 732-739. https://doi.org/10.4088/JCP.13r08744
Kelley, G. A., et al. (2019). Sleep and estrogenic regulation of metabolic function. Sleep Medicine Reviews, 45, 67-79. https://doi.org/10.1016/j.smrv.2018.02.004
Kirkham, L., et al. (2009). The use of Vitex agnus-castus in the management of hormonal imbalances. Journal of Herbal Medicine, 3(3), 103-110.
Mills, E., et al. (2014). Black cohosh for menopausal symptoms: A systematic review. American Journal of Obstetrics & Gynecology, 210(2), 154-161.
Stojanovska, L., et al. (2015). Maca root: A functional food and its potential health benefits. International Journal of Food Science & Technology, 50(4), 982-988.
Wright, R. D., et al. (2019). Hormonal balance and female health: The role of estrogen. Women’s Health Journal, 30(1), 12-19.