the estrogen gap: are clinical standards sidelining a vital lifeline for women?
5 minute read
there are many symptoms, health risks and even long-term chronic diseases that can develop when the body loses its estrogen. these changes are subtle and unexpected—like a decline in your senses.
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everyone has estrogen, but for women, it’s a key component of your overall well-being. it’s the hormone that fluctuates during your monthly cycle and depletes as you age, leading up to menopause.
what many people may not know is that estrogen is a whole lot more than just a reproductive helper.
the hormone essentially plays a role in everything. there are more than 400 areas of the body where estrogen receptors impact function, all of which work on different processes to ensure you remain healthy.
“there are estrogen receptors in our ears. there are estrogen receptors in our nose, in our eyes,” said dr. colleen norris, professor and associate dean of research in the faculty of nursing at the university of alberta. “wherever those 400 receptors are, it’s doing something.”
so, what exactly does estrogen do, and why is it so important? well, as dr. norris noted, a little bit of almost everything.
estrogen and your health
estrogen is often called the sex hormone because it plays a vital role in a woman’s reproductive health. but when it comes to your overall health, estrogen plays a role in more than one area.
as new research surrounding women’s health continues to unfold, more is known about estrogen and its functions.
estrogen plays a role in how much serotonin your body produces, which affects mood. it can affect sight, heart health and even disease risk later in life. other effects of estrogen include:
- blood sugar balance
- cholesterol
- bone mass
- muscle mass
- circulation and blood flow
- collagen production
- skin moisture barrier
- brain function
- mental health
most of what is researched nowadays has to do with perimenopause and menopause—and their relation to estrogen—because that’s when the hormone becomes the most depleted. but it’s still far out of the realm of commonplace when speaking about overall health.
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“fairly novel studies are starting to come out and saying, ‘did you know that there’s estrogen in the ear?’ or people get really itchy eyes when they’re in perimenopause, and estrogen helps with the fluid in your eyes,” said dr. norris. “women will say, ‘i have odd symptoms. i’m not going to a doctor because my eyes are so itchy suddenly, or i’m not hearing well. i must be getting old.’”
women chalk these effects up to their age or previous lifestyle, like going to loud concerts when they were young, causing damage to their eardrums. the truth of the matter might be more hormone-based.
the effects of low estrogen
estrogen keeps various bodily systems running as they should. when those stores become depleted in the natural process of aging, it isn’t just a lack of a menstrual cycle and menopause-related ailments that women have to deal with.
there are many symptoms, health risks and even long-term chronic diseases that can develop when the body loses its estrogen. these changes are subtle and unexpected—like a decline in your senses.
“the estrogen drops off, but it’s the same time that you’re aging, and so we’re telling all these women, you need a hearing test,” said dr. norris, on the example of hearing loss as one of the many impacts of low estrogen.
a ripple effect of hearing loss is the link to cognitive decline and dementia. while not directly caused by low estrogen, dementia is an example of long-term risk that grows when the body has less protection from the hormone.
another big one is heart disease.
“[estrogen] sends messages to our blood vessels and our heart to clear out the fats, and it’s an antioxidant, and it does all sorts of jobs in the vessels and in the heart,” said dr. norris.
since focusing her research on estrogen, dr. norris has found that the hormone acts as an internal shield and protects the heart by:
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- reducing inflammation, oxidative stress damage, and blocking signals that attract harmful immune cells
- maintaining the structural integrity of blood vessels because of its effect on collagen and elastin stores in the body
- increasing good cholesterol while lowering bad cholesterol to reduce heart disease risk
- controlling the growth and movement of cells that make up smooth vascular muscle to prevent plaque buildup
- increasing substances, such as nitric oxide and prostacyclin, to keep blood flowing adequately
unfortunately, no clinical trials have been done on estrogen for the reduction of heart disease. they can’t really be done in a traditional sense because you can’t effectively randomize low estrogen in women and track the outcomes over decades.
“we will never be able to say no estrogen causes heart disease,” said dr. norris “it’s the same as [how] they never really got the solid evidence [from randomized trials] to say smoking causes lung cancer. because you couldn’t randomize [people to smoke]. we had to look at people who’d smoked versus people who didn’t.”
the connection is in the language: there’s an association, but “we can’t say causal.”
another significant issue that’s often chalked up to aging, but could be more in line with estrogen depletion, is bone health. estrogen acts as a balancer of bone breakdown and rebuilding by reducing the activity of cells that break down bone, called osteoclasts, while promoting the activity of bone-forming cells, known as osteoblasts.
so, when there’s enough estrogen in the body, the turnover rate is adequate. but when it depletes, the rate of bone breakdown accelerates, which can lead to thinner and weaker bones or osteoporosis.
opening doors for estrogen as a treatment option
physicians provide hormone therapy for a variety of reasons, including birth control, gender-affirming care, fertility treatment and to treat hormone-dependent cancers.
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but when it comes to women’s health, or discomfort as they age, the suggestion of estrogen is often a non-starter.
dr. norris is currently working on post-reproduction health, trying to make it easier for women to see physicians, get help for their symptoms and spread the word that estrogen deserves a seat at the table of research and potential preventive therapy.
this data will pinpoint who’s affected by what, and allow people to see the correlation between hormones and a host of ailments and chronic diseases.
insomnia, for example, is a diagnosis often given to women in perimenopause who can’t sleep and is treated as such. but if the root cause was addressed with hormone therapy, in this case progesterone over estrogen, sleeping aids or other medication that only treat the symptom wouldn’t be needed.
the same can be said for many issues women face, even painful periods that may be misdiagnosed as endometriosis and treated as such, but could be down to “something going on with their hormonal cycle.”
it’s all being labelled and medicalized because it’s easy. but according to dr. norris, the idea that no one is even willing to entertain the possibility that female hormones such as estrogen play a much more significant role in health is doing women a huge disservice.
“that’s what i honestly don’t get in all my travels. what is the pushback? why do you care so much if women are given access to something that will improve their quality of life?” she said. “let’s try it out. there are small dosages, the exact same thing that you have in your body. so, you’ll know pretty quickly if it’s not right for you.”
she continued, “we should start looking at this as part of your women’s health going forward … if you’re done having children … 35 and on.”
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