The Endless Confusion About Estrogen, Explained

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(Article first published on The Candidly.)

Let’s discuss one of the most universal facts of womanhood; we all feel, at the very least, mildly shitty on a near-daily basis. Some of us feel very shitty all the time, and the lucky ones feel “meh” some of the time. Our doctors usually just chalk it up to “aging,” but is that really an adequate explanation for half the population feeling tired, bloated, and lethargic?

Another popular explanation for women feeling like total crap is simply “women are hormonal!” As much as this statement can be incredibly frustrating, dismissive, and…let’s be honest…sexist, it, unfortunately, holds a nugget of truth.

And the truth is that women have a delicate balance of hormones—specifically, estrogen–that can get out of whack, causing a whole host of health issues.

Most of us think of estrogen as one simple, defined chemical that comes in 3 quantities: too little, too much, or just enough. But shockingly, “estrogen” is actually group of sex hormones that promotes our sexual development, and includes estradiol, estriol, estetrol, and estrone. Estradiol, the strongest and most common form of estrogen, guides the functioning of everything from our skin, bones, and muscles to our liver and brain.

It’s normal for hormones to fluctuate throughout our lives (or even in the course of a menstrual cycle), but when the various forms of estrogen become imbalanced, we can experience irritability, depression, weight gain, painful periods and a slew of other conditions.

Let’s break down the most common health conditions associated with estrogen imbalances, what causes them, and what you can do to get your system back on track.

But first, we need to address an elephant in the room: hormone testing.

What Is Up With Hormone Testing?

In our research for this article, we were hoping to develop a clear picture of hormone tests; which ones to get, what they do, and what can they tell us. Instead, we learned that hormone testing for women in the U.S. still has a long way to go, scientifically, before the medical community can fully understand how to better test and treat women with hormonal imbalances.

To start, we all know that the medical community has been traditionally skeptical and dismissive of women’s pain and illnesses. According to Dr. Sara Gottfried, author of “The Hormone Reset Diet,” “millions of women around the world suffer from hormone imbalance. Many doctors say, ‘You’re just getting older. This is normal!’ and offer prescriptions for anxiety, sleep, and depression…Ignoring the root cause is not the path to total health.”

While the medical community might be finally acknowledging this tendency to overlook women’s hormonal imbalances, it’s still struggling to understand how to actually test for them. So even when we can convince our doctors to willingly prescribe a blood test with a full hormone panel, the results can be inaccurate.

According to the CDC, everyone from researchers to laboratory clinicians to endocrinologists have expressed concerns about the unreliability of hormone tests and measurement, prompting many organizations to reject certain hormone tests. Essentially, many of these tests are widely considered inaccurate by the professionals who use them, which is a problem, as variabilities in tests can lead to “different clinical interpretations of test results on the same patient, misdiagnoses, delayed diagnoses, or suboptimal patient care.”

According to Dr. Sarah Oreck, a reproductive psychiatrist, hormone testing is still a relatively unstudied science. And even test results that come back “normal” don’t tell the whole story. As Dr. Oreck told The Candidly, “we aren’t where we wish we were in terms of hormone testing, regarding the technology and research. With the limited evidence we have, we might think that someone’s test results are in a ‘normal’ range, but it certainly might not be the case for that person.”

She believes that it’s not always the raw numbers on a test that are important, but instead, it’s the changing balance of hormones over time that can indicate an imbalance. She explains, “I can’t just test your estrogen and say ‘at this level, it’s causing these issues.’ Because we actually think the problem might be the changes of these levels over a period of time, not sort of any kind of number that we get on a lab test.”

However, even in calling for standardized hormonal testing, it seems like the medical community still focuses more on testosterone than estrogen. According to Dr. Oreck, this tendency to study male hormones has created a huge gap in medical knowledge when it comes to women’s hormones. In fact, she said, “I’ve found that most [hormone] studies are done on healthy males.”

And aside from a lack of reliability in diagnoses, this massive scientific gap can lead women to seek out harmful, unnecessary, or unproven treatments. “A lot of things are being sold to women that don’t have the amount of evidence that we typically use in employing treatments. You’ll find saliva tests, at-home saliva kits, and untested, over the counter estrogen treatments, and I don’t endorse any of those. People think because it’s ‘natural’ or sold over the counter, that it’s safe. But there’s a huge lack of regulation,” said Dr. Oreck.

Great! So what we do?

Dr. Oreck still recommends seeking out a reproductive endocrinologist for estrogen testing and estrogen treatment, instead of turning to at-home tests or physicians who don’t specialize in hormonal issues. A reproductive endocrinologist might still be able to spot any glaring hormonal imbalances, or can test your estrogen levels overtime to get a fuller picture of your changing hormones.

Now, if you’re wondering why the inaccuracy of hormone testing is even a problem for you, then you might want to keep reading. Because estrogen and estrogen imbalance can be at the root of some of your most frustrating health concerns.

Weight Gain and Weight Loss Resistance:

If you’ve ever wondered why you just started gaining weight inexplicably, and no amount of dieting or exercise seemed to make a difference, we have good and bad news; you might have an estrogen imbalance. Estrogen levels that are too high or too low are linked to weight gain.

On one hand, low estrogen may affect insulin levels, leading to insulin resistance, which can cause fatigue, hunger, and—you guessed it—weight gain. But, when estrogen levels are too high, estrogen dominance can make it easier to gain weight and harder to lose it.

Unfortunately, the medical world’s understanding of these hormones is still evolving, meaning that plenty of women are simply directed to try more extreme diets and exercise regimens, never making weight loss progress because they’re solely focused on calories, and not their hormone levels.

As Dr. Gottfried explains, “most diets don’t work for women, because they fail to address the hormonal root causes that are the most common reasons for weight loss resistance, like excess cortisol, insulin and/or leptin blockage, estrogen dominance, a sluggish thyroid, low testosterone, and problems with HPA (hypothalamic-pituitary-adrenal) control system.”

Menstrual, Perimenopausal, and Menopausal Problems:

Even the most basic understanding of hormones includes the notion that estrogen impacts our reproductive health for our entire lives. And we know that our estrogen levels will change with big life events—like the onset of menstruation, pregnancy, perimenopause, and menopause, just to name a few. But generally, reproductive health issues at certain stages of life typically reflect age-related hormonal imbalances.

For example, reproductive health issues faced by women who haven’t gone through perimenopause or menopause often include irregular periods, spotting between periods, heavy bleeding, severe PMS, and intense cramps. These issues can usually be traced to higher levels of estrogen in young women.

And as estrogen levels fall with age, women over 40 or those entering menopause might experience more cramping, vaginal dryness, painful sex (due to low lubrication), and lowered libido.

Additionally, when women enter menopause, their estrogen levels drop significantly, which can potentially lead to an increase in bad cholesterol that can create fat build up in the arteries, contributing to the potential for heart disease.

But not all hormonal changes are bad! One serious benefit of a post-menopausal life is that, in the absence of estrogen fluctuations and frustrating mood swings, women ages 50-70 have actually reported feeling happier.

Mood Swings and Emotional Imbalances:

Let’s revisit those *super* fun mood swings for just a sec. We all experience mood shifts on occasion. Ok, some of us have even possibly experienced an emotional range consisting of happiness, sadness, anxiety, elation, love, disgust, and rage over the course of a few minutes. It’s called being married.

But when our estrogen production is particularly off-kilter, our daily activities might produce an abnormally heightened emotional state. Have you ever just burst into tears one morning while dropping your kid off at kindergarten? You can thank estrogen.

We hate to play into stereotypes about women as overly emotional, hormonal, or erratic, but estrogen does play a serious part in mood regulation by acting on specific chemicals in the brain. For example, it helps boost serotonin and endorphins, which are associated with positive emotions that make you feel good.

Though it’s still virtually impossible to predict how your changing estrogen hormones will impact your mood, the point is that hormonal imbalances can make you feel great, but they can also impact depression, irritability, anxiety, and emotional reactivity.

Other Health Issues:

If you have an estrogen imbalance, you may have experienced any of the following conditions:

  • Low libido

  • Sleep difficulties

  • Fatigue

  • Hair loss/thinning

  • Noncancerous breast lumps and uterine fibroids

  • Heavy or irregular periods

  • Acne

  • Vaginal dryness or pain during sex

Basically, an estrogen imbalance could be at the root of anything and everything making you feel shitty.

Causes of Estrogen Imbalances:

Great. Estrogen is wreaking havoc on your body. But why have your own hormones turned against you?

Unfortunately, the list of potential causes for hormonal imbalances is almost as long as the symptoms. Hormonal contraceptives, antibiotics, genetics, and stress are just a few. Recently though, the medical community has started to explore environmental and dietary factors as well.

Some endocrinologists have begun pointing to exposure to certain chemicals found in everything from the environment to food to personal care products as potential hormone disruptors. Meanwhile, phytoestrogens, pesticides, and growth hormones found in our food could also be contributing to estrogen imbalances.

Some more traditional causes for estrogen imbalances include:

  • Turner syndrome (a chromosomal condition that affects development in girls)

  • Heredity

  • Medication

  • Obesity

  • Tumors affecting endocrine or pituitary glands

  • Diabetes

  • An overactive OR underactive thyroid

How To Get Your Estrogen Levels in Balance:

Since every single person reading this is currently nodding their head, thinking (or maybe even screaming) “this is me!” let’s discuss how to get your estrogen levels in balance.

The process of balancing your hormones can seem costly, time-consuming, and opaque. Treatments can range from switching up your diet to hormone replacement therapy, which includes consistently taking medication to replace the hormones that our bodies are struggling to produce.

But let’s start with the “easy” method: diet. According to Dr. Gottfried, one of the simplest ways to counteract the effects of hormonal imbalance is through the foods you eat, and so she suggests that you “eat in a way that optimizes your hormones.”

If you tend towards estrogen dominance, then a hormone-balancing diet might entail plenty of leafy green vegetables such as kale, collard, and mustard greens, along with broccoli, cabbage, and cauliflower, which all lower estrogen levels and can “improve your…estrogen ratio by 30 percent.” Side note: wouldn’t it be amazing if, just this once, science proved that the best food to balance hormones included coffee, chocolate, and pasta? Anyways, mushrooms, red grapes, flax seeds, and whole grains are also great for lowering estrogen.

Dr. Gottfried also recommends eliminating processed foods, refined flours, sugars, and sugar substitutes, because of course. Dr. Gottfried encourages the elimination of alcohol a few weeks out of the year because alcohol might change the way a woman’s body metabolizes estrogen.

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Some practitioners may recommend a course of supplements to even out your hormones, such as those that aid estrogen metabolism, but it’s important to dive into the research of these supplements, as some have yet to be proven safe and effective. Similarly, if you are on medication that can affect estrogen levels–like hormonal contraceptives– talk to your doctor about the dosage, and if it could be affecting your estrogen balance.

When it comes to glaringly obvious hormone imbalances, like those in perimenopausal and menopausal women, some practitioners will recommend hormone replacement therapy. Dr. Oreck believes hormone replacement can be great for some women, but recommends approaching these methods with caution, as hormone replacement therapy been associated with an increased risk of endometrial cancer, blood clots, stroke, and dementia. She explains, “sometimes estrogen replacement and hormone replacement for perimenopause can be helpful for some women, sometimes it can be harmful. Women with a history of breast cancer or endometrial cancer in their family should not be doing hormone replacement therapy—they should really talk to a physician about the chance of potentially increasing the risks of those cancers.”

We know it sounds like estrogen, whether it’s too high or low, is at the root cause of every one of your health frustrations. Maybe it is. But don’t let the challenging, opaque nightmare of trying to navigate hormonal changes deter you from finding a great doctor who will listen, believe you, and thoroughly and accurately test and treat your hormones for an imbalance. Because you should not have to feel crappy all the time. That shouldn’t be your life or a burden you constantly shoulder. And hopefully, more doctors and researchers will continue to realize the importance of understanding and properly managing estrogen, so hormonal imbalances become as minor and treatable as a small headache.

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