Estrogen or oestrogen, is the primary female sex hormone that plays a key role in the regulation and development of the female reproductive system as well as secondary sex characteristics. In men, estrogen is also present but in smaller amounts. During puberty, the ovaries start to release estrogen hormones and its levels rise significantly halfway through the menstrual cycle, which triggers the release of an egg. After ovulation, estrogen levels fall back to normal. Aside from the ovaries, estrogen is also produced in the adrenal glands and fat tissues. As a hormone, estrogen usually travels through the bloodstream and interacts with various body tissues to deliver a message.
The estrogen family includes any of a group of chemically similar hormones such as:
E1 is considered as a weak form of estrogen and the only type found in postmenopausal women. It is present in lesser amounts in most body tissues, primarily in fats and muscles.
E2 is responsible for the development of female secondary sexual characteristics such as breast enlargement, erection of nipples, growth of body hair, widening of the hips, changes in genital structure, and feminine pattern of fat distribution. It also maintains female reproductive tissues such as uterus, vagina, and mammary glands.
E3 is considered as the weakest of estrogens. The levels of E3 are almost undetectable in women who are not pregnant. However, significant amounts of E3 are produced by the placenta during pregnancy.
Estrogen is crucial to a woman’s reproductive function and cycle. This powerful hormone affects the following body areas:
Aside from its key role in maintaining the growth and development of the female reproductive system, estrogen also has the following important functions:
Men also produce estrogen in smaller amounts. In order for this process to happen, an enzyme called aromatase converts testosterone into estradiol. Research indicates that certain cells in the testis known as Leydig cells, contain the aromatase enzyme and produce some estrogen. The aromatase enzyme is also abundant in the brain and penis. However, as men age, their aromatase levels can sometimes spike, which causes their testosterone to be converted into excess estradiol.  This in turn results in low testosterone while spiking estradiol levels. In some men, their aromatase levels are insufficient and suffer from estrogen deficiency. Other men produce abnormally low levels of testosterone that there isn’t enough to convert into estrogen, thus, causing a deficiency in both testosterone and estradiol.
Just like women, men also need estrogen to perform at optimal levels. Estradiol, the predominant form of estrogen, is thought to play a major role in male sexual function.  Estradiol in men modulates libido, erectile function, and production of sperm cells. In the brain, estradiol production is increased in areas that regulate sexual arousal. Moreover, several estrogen receptors are distributed throughout the erectile tissues of the penis (corpus cavernosum) with high concentrations found in the nerves, arteries, veins, and other blood vessels.
In women over age 40, estrogen levels will significantly decline due to approaching menopause, which is medically known as perimenopause. During this time of transition, a woman’s ovaries will still produce estrogen, however, in smaller amounts. By the time that estrogen production completely stopped, a woman has already reached menopause. This age-related decline in estrogen levels can lead to debilitating signs and symptoms such as:
In men, low estrogen levels can also lead to the following signs and symptoms:
Aside from the natural process of aging, certain medical conditions, lifestyle choices, and processes can lead to estrogen deficiency. These include:
Over time, the gradual decline in women’s estrogen levels can lead to debilitating signs and symptoms which can ultimately impair one’s quality of life. Women who had their uterus surgically removed (hysterectomy) can also experience these detrimental effects. Fortunately, for those suffering from estrogen deficiency, ERT can be used to increase estrogen levels, alleviate unpleasant symptoms, and improve overall quality of life.
There are different ways ERT is administered. These include:
Potential candidates for ERT usually undergo measurement of estrogen levels first through comprehensive saliva, blood, urine and serum test. By determining the baseline estrogen levels, the ERT physician will be able to customize a treatment plan that is tailored to the individual needs of the patient.
Compelling evidence indicates that restoring estrogen to youthful levels through ERT can help treat and prevent a wide range of medical conditions that can improve one’s quality of life. The following are among the diverse health benefits of ERT:
The body constantly builds and remodels bone. However, after menopause, this process slows down causing women to lose as much as 20% of their bone mass.  As a result, postmenopausal women begin to experience osteoporosis, fractures, and other bone disorders. [5-7] In aging men, low estrogen levels can also increase their risk of developing bone problems. [8-10] An overwhelming body of clinical evidence suggests that this age-related bone loss can be prevented and treated with ERT:
Menopause can bring in a number of physiological changes that can permanently affect a woman’s life. These significant changes include unpleasant symptoms that appear before, during and after the onset of menopause. In order to treat menopause symptoms and replace the declining estrogen levels, most doctors prescribe ERT. There is mounting clinical evidence that ERT is safe and effective in alleviating menopause symptoms:
When estrogen levels decline, both men and women may experience reduced libido which can ultimately affect their self-confidence as well as quality of life. In women, estrogen deficiency can cause changes to the structures and pH of the vagina, which in turn leads to vaginal health issues such as vaginal dryness, inflammation of vaginal tissues, irritation, and painful sexual intercourse (dyspareunia). In men, low estrogen levels can cause erectile dysfunction and reduced sexual desire. Studies show that undergoing ERT can help treat a wide array of sexual health issues associated with age-related decline in estrogen levels:
In addition to diet, lifestyle, and genetic factors, the aging process can also contribute to weight gain. In fact, the older we get, the more difficult it is to lose weight. Not only does our metabolism slows down, but also the production of estrogen. In women, the age-related decline in estrogen levels causes their bodies to look for other sources of estrogen, which can be found in fat cells.  As a result, their bodies learn to convert more calories into fat, leading to weight gain. In men, the age-related decline in estrogen causes fat accumulation, which in turn results in weight gain.  While diet and lifestyle modifications are critical elements to weight loss, there is increasing evidence that restoring estrogen to youthful levels through ERT may help you achieve healthier weight:
One of the most undesirable consequences of aging is the loss of muscle mass and strength. Current research suggests that low sex hormone concentration, specifically estrogen, may be among the key mechanisms for muscle wasting (sarcopenia) and weakness.  Interestingly, a large body of scientific evidence suggests that restoring estrogen levels through ERT may help diminish age-associated muscle loss and improve overall muscle function:
Women’s emotional symptoms as they approach menopause vary. Some may experience no symptoms at all while others may have mood swings, depression, anxiety, panic attacks, anger, short temper, snappiness, crying episodes, and irritation. These symptoms can be debilitating and may significantly impair one’s quality of life. In addition, menopausal women suffering from low mood and decreased energy levels may increase their risk of developing mood disorders. Thus, ERT has been proposed as a potentially effective therapeutic strategy for mood disorders experienced during menopause. A number of high quality studies support the mood-enhancing effects of ERT:
During the menopausal years, the age-related decline in skin thickness accelerates by as much as 1.13% per year.  The decline in estrogen during this stage results in gradual decrease in collagen, water, and glycosaminoglycans (GAGs) content, which ultimately leads to thinning and sagging of the skin. Fortunately, these age-related skin imperfections can be diminished with ERT. Studies show that estrogen exerts potent anti-aging effect on the skin by reducing wrinkles and improving skin elasticity, which helps maintain a younger, tighter skin:
Evidence, accumulated over the past several decades, shows that estrogen plays a critical role in the modulation of cognitive function in animals and humans. Modulation begins in the womb when estrogens exert their effect on various brain regions involved in cognitive function. Estrogen influences the nervous system, and this continues through adulthood when its production reaches the highest levels. With aging, estrogen levels gradually decline and contribute to impairment in memory, learning, and thinking skills. Research in basic neuroscience and other clinical research shows that ERT protects against the age-related decline in cognitive function:
As women transition into menopause, sleep disorders become more common. They may have trouble falling asleep and staying asleep. In fact, studies show that menopausal women spend less time in one of the deepest cycles of sleep known as the rapid eye movement (REM) sleep.  This in turn results in fatigue or tiredness upon waking up. Interestingly, several lines of evidence show that ERT improves sleep quality, reduces time to fall asleep and number of times a patient awakens, and increases amount of REM sleep:
With aging, a person’s activity level can significantly decrease because of various changes in body composition. Older persons start to gain weight, lose muscle and bone mass, and become susceptible to a wide array of debilitating diseases that affect their daily routine as well as overall quality of life. Fortunately, aside from diet and lifestyle modifications, restoring estrogen to youthful levels can be beneficial for older people who want to engage in any form of exercise to keep them in shape. By restoring muscle mass and bone quality, studies show that ERT can help enhance one’s exercise performance so that they can become physically active again:
Postmenopausal women are often vulnerable to bacterial infections such as UTI. During this stage, falling estrogen levels result in deterioration of the urinary tract and vagina, as well as alteration in vaginal flora (bacteria that live inside the vagina). These changes predispose postmenopausal women to recurrent rate of UTIs. A growing body of scientific evidence indicates that ERT can restore vaginal flora and acidic pH to its premenopausal state, thus reducing the prevalence of UTIs in postmenopausal women:
The age-related decline in estrogen increases one’s risk of heart disease. This is because estrogen is believed to play a crucial role in the maintenance of a healthy heart by keeping blood vessels flexible, thereby improving the heart’s pumping power and overall blood circulation. In addition, falling estrogen levels increase blood pressure, blood sugar and cholesterol levels – all of which are major risk factors for heart disease! Recent research adds to the evidence that estrogen protects against heart attack and other adverse cardiovascular events:
Cholesterol levels spike in men and women with advancing age. For women, however, this age-related change is striking at the menopausal transition stage. With falling estrogen levels, high-density lipoprotein (HDL) cholesterol, also known as the “good cholesterol”, starts to decline. On the other hand, the age-related decline in estrogen levels increases low-density lipoprotein (LDL) cholesterol, also known as the “bad cholesterol”. These changes in cholesterol levels are very detrimental to health because it drastically increases one’s risk of developing fatal medical conditions such as heart disease, stroke, cancer, diabetes, and hypertension. While diet and lifestyle modifications can be beneficial in improving cholesterol profile, there is strong evidence that ERT may also help normalize cholesterol levels:
Estrogen helps optimize the action of insulin, the hormone that stabilizes blood sugar levels. Consequently, the age-related decline in estrogen may lead to insulin resistance, a condition in which the body doesn’t respond to the effects of insulin. Falling estrogen levels can also impair the function of insulin, resulting in sudden spikes in blood sugar levels. Studies show that by restoring estrogen to youthful levels, blood sugar levels can be normalized, thus, preventing chronic medical conditions such as diabetes:
During menopause, women lose hormone protection against a wide array of fatal medical conditions. Among them is high blood pressure or hypertension, which is highly prevalent in menopausal women. In addition to this, the age-related decline in estrogen levels puts them more at risk since estrogen engages several mechanisms that protect against hypertension. An overwhelming body of clinical trials supports the antihypertensive effect of estrogen:
Although middle-aged women have a lower incidence of stroke than men, their risk significantly increase by as much as 50% in the decade after menopause.  This may be due to the fact that estrogen deficiency during the postmenopausal period leads to obesity and increases in blood pressure, cholesterol and blood sugar levels – all of which are major risk factors of stroke. Interestingly, there is robust clinical evidence that ERT may actually protect against different types of stroke:
With aging, estrogen levels along with immune function start to decline predisposing a person to wide array of diseases. This is because sex hormones such as estrogen are known as the “master regulators” of the immune system. Therefore, restoring estrogen to youthful levels through ERT can significantly boost immune function and prevent fatal illnesses related with advancing age. An increasing number of scientific evidence supports the “immune-boosting” effect of estrogen:
By the mid-1990s, ERT had become one of the most widely prescribed medications for women in their menopausal period. Several observational studies have shown that women who were given ERT had lower risk of heart disease. However, in 2002, the results of the large Women’s Health Initiative (WHI) study have been both influential and controversial. This study involved 27,347 U.S. women ages 50-79 – 16,608 of them had a uterus and were given estrogen-plus-progestin while 10,739 had no uterus and were given estrogen alone. Unfortunately, the study concluded that ERT can increase one’s risk of developing breast cancer, heart disease, stroke, blood clots, and overall harm, which led to early stoppage of the clinical trial.  While the WHI study is considered as one of the largest clinical trials assessing the safety and efficacy of estrogen on women, several high quality studies do not agree with its results because of the following reasons:
The reasons for this are the following: [511-515]
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