If you’re experiencing hot flashes, night sweats, vaginal dryness, memory difficulties – if you find intercourse painful, are getting bladder infections, and feel lethargic or depressed, then you are suffering from the most common symptoms of estrogen deficiency. You don’t have to experience all or many of these symptoms to have your life significantly impacted from a deficieny in estrogen. And it is possible to be estrogen deficient and not experience any symptoms, or only minimally so.
Estrogen deficiency contributes to bone loss and osteoporosis, which is not associated with any symptoms until a fracture occurs.
The symptoms of estrogen deficiency can occur with other hormonal imbalances too, or be related to non-hormonal causes. For instance, hot flashes can also be caused by low progesterone and memory loss can be related to too much cortisol, the stress hormone. Lethargy can be caused by a thyroid disorder or from anemia.
So if you are experiencing any of the above estrogen deficiency symptoms you should be evaluated by your physician, undergo a physical examination, and obtain diagnostic studies, primarily laboratory studies to assess hormone levels and to rule out other medical conditions. Some physicians prefer to use saliva testing to measure hormone levels rather than blood. There are pros and cons to each.
Symptoms of estrogen deficiency can significantly impact the quality of your life as well as those around you. Sleep can be affected by hot flashes and night sweats, and a lack of quality sleep has its own adverse effects on health. And, even if your libido is good, experiencing pain during intercourse can lead to avoidance and strain a relationship.
Hormone Replacement Therapy
Fortunately, the many symptoms related to estrogen deficiency can be managed successfully with estrogen replacement therapy. There are actually three main estrogens in women, estrone (E1), estradiol (E2), and estriol (E3). Estradiol is the most potent and important.
The most prescribed estrogen therapy is Premarin, which comes from the urine of pregnant mares. Though the estrogens in Premarin are natural to horses, it contains little estrogen naturally found in humans.
The trend these days is to prescribe bioidentical hormones, but many of the early studies on hormone replacement therapy were done using Premarin. It’s important to recognize this when interpreting results of earlier studies and extrapolating from them.
Bioidentical hormones are molecularly identical (exact match) to those the human body naturally makes. Logically, this only makes sense – to replace exactly what the body naturally makes.
Bioidentical hormones can be compounded by a pharmacy tailoring the dose to your particular needs. More and more of the pharmaceutical companies are producing commercially available bioidentical hormones as well.
Estrogen replacement can be administered in a pill form or applied to the skin either as a cream or a patch. A vast majority of women obtain significant relief of their symptoms from estrogen replacement therapy (as well as other hormones), and gain improvement in the quality of their lives.
Risks Associated with Estrogen Replacement Therapy
As with most anything there are some risks related to estrogen replacement therapy. These risks were highlighted in the Women’s Health Initiative Study (WHI). This study used to two non-bioidentical hormones, Premarin and Prempro. Prempro is a combination of Premarin and Provera. Provera is a progestin. Progestins are not the same as progesterone, though both will protect women against endometrial cancer.
There were two arms to the WHI Study. In one arm women received either Premarin or a placebo, and in the second arm they received either Prempro or a placebo. Adverse effects were reported as cases per 10,000 women. The World Health Organization defines 10 cases or less per 10,000 as a RARE event. 10 cases per 10,000 equates to 0.1% additional risk.
In the Premarin arm there were 7 fewer cases of breast cancer, no additional heart attacks, 12 more cases of stroke, 6 more cases of blood clot, and no additional colon cancer. In the Prempro arm there were 8 more cases of breast cancer (therefore must be related to the progestin), 7 more cases of heart attacks (therefore must be related to the progestin), 8 more cases of stroke, 18 more cases of blood clots, and 6 fewer cases of colon cancer.
Again, these are additional cases per 10,000 women. The additional risk of blood clots (which showed the largest additional risk) in the Prempro arm equates to 0.18%. Whether these same risks occur to the same magnitude with bioidentical hormones is not fully known at this time, but it would seem bioidentical hormones would carry lower risks as those seen in the WHI.
The WHI did not evaluate the symptomatic improvement received from Premarin or Prempro which becomes an important consideration when weighing risks and benefits.
What to Do Ab0ut Estrogen Deficiency?
Ultimately, each woman needs to weigh the above additional risks found in a study using non-bioidentical hormones, and in a study in which the same dose was given to each woman without measuring hormone levels versus the possible improvement in symptoms and quality of life by taking hormone replacement for estrogen deficiency.
For a more detailed critical review on the WHI Study read “The Women’s Health Initiative Reports: Critical Review of the Findings” by R. Don Gambrell, MD.
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