When women come to see me for hormone concerns, the first place we start is evaluating their menstrual cycle, PMS symptoms and period to begin to gain insight into how their female hormones are functioning. Estrogen and progesterone are the two primary hormones that influence the female cycle, but they are by no means the only ones!

When it comes to these two particular hormones, there are 3 common patterns of hormone imbalance that I see in women: low progesterone, “estrogen dominance”, and lastly, low estrogen AND progesterone.

This article will cover hormone pattern # 3: low estrogen and low progesterone.

Firstly, why is estrogen important for women’s health?

Estrogen is the hormone that is responsible for giving females the characteristic rounded hips and breasts. It’s best known for its functions in reproduction, where it promotes the development of an egg and the lining of the uterus. However, there are many other reasons why estrogen should be one of your favourite hormones. Estrogen also has the following benefits for your health:

• Helps you feel happy and energized
• Promotes a healthy libido
• Protects your bones
• Benefits your brain function, cognition, and mental sharpness
• Supports healthy, supple skin and hair
• Protects your heart and cardiovascular system
• Supports your metabolism
• I describe estrogen as the “yang” hormone of the first half of your cycle. When present in healthy levels, estrogen helps you feel energized, confident, sexy, mentally sharp and productive, particularly in your follicular phase.

What about progesterone?

As we know from Traditional Chinese Medicine, “yang” energy must always be balanced with “yin.” In this case, the counterbalancing hormone to estrogen is progesterone. Progesterone is the calming, cooling, grounding, balancing hormone.

In order to produce progesterone, ovulation must occur. What is needed for ovulation? Adequate estrogen levels. Therefore, low estrogen = no ovulation = low progesterone. Low progesterone always comes along with low estrogen.

More specifically, progesterone helps to:

• Grow and maintain the lining of the uterus
• Support and regulate your mood, especially in the second half of your menstrual cycle
• Maintain a regular menstrual cycle length (no less than 21 days, and no longer than 35 days)
• Maintain a predictable period schedule
• Normalize period bleeding (not too heavy or too light)
• Calm the mind and minimize anxiety
• Calm the nervous system and enhance your capacity to manage stress
• Support quality sleep
• Promote fertility, implantation and early stages of pregnancy
• Progesterone also appears to have some neuroprotective brain benefits, especially after concussions.

How can I tell if my estrogen and progesterone are low?

The following is a list of signs that may indicate low estrogen and progesterone. If you suspect this might be the case, further blood testing with your family doctor or your Naturopathic Doctor is warranted.

1. Your period has disappeared (and you know you’re not pregnant).

When estrogen is deficient, the uterus can’t build up a healthy thick lining, and therefore won’t shed in a period. Low estrogen may also mean you aren’t ovulating, which means your fertility is being negatively impacted.

There are several other reasons why your period can disappear, so it’s important to get testing done to understand whether it’s a result of low estrogen, or something else.

2. Your period is irregular (once every 35+ days) and your period bleed is scanty/minimal.

Normal period flow is typically a minimum of 25ml of menstrual blood per period. This is the equivalent of 1 (soaked) regular tampon per day for 5 days, or about 2 menstrual cups’ worth. If you have a very light period that only lasts a few days and barely requires a pad, this indicates that estrogen may be low. If estrogen is too low to support ovulation, then progesterone will be low as well.

3. Difficulty sleeping or insomnia.

Estrogen and progesterone support your sleep quality. Low levels of these hormones, especially progesterone, can contribute to problems falling asleep, staying asleep, or achieving deep restorative sleep.

4. Brain fog, fatigue, moodiness or memory problems.

As mentioned earlier, estrogen supports your brain function, mood and cognition. Low estrogen contributes to low serotonin and dopamine (neurotransmitters that regulate the mood and emotional regulation). Low estrogen can make you feel forgetful, less mentally sharp, depressed, and overall impairs your brain performance.

5. Hot flashes and/or night sweats.

These “vasomotor” symptoms are associated with the perimenopause or menopause time of life, however they can occur earlier in life if estrogen is abnormally low. Speak to your ND or your health care provider if you are consistently getting hot flashes or night sweats and you are younger than age 40.

P.S. If you’re age 40 or above and getting bothersome hot flashes or night sweats, you should also speak to an ND. Don’t suffer with these symptoms just because you’re in your late 40’s or 50's and this is considered "common"! There are LOTS of ways we can soothe hormones during the perimenopause years.

6. Hair loss, or dry brittle hair and skin.

Estrogen is a beauty hormone! Estrogen has a plumping, healing effect on the skin. It promotes collagen synthesis, wound healing and blood flow and helps to protect the skin from oxidative stress. All of these lovely effects create beautiful, glowing, collagen-rich skin. As estrogen declines after menopause, skin loses its elasticity and becomes more dry. And I’m not just talking about the skin on your face and décolleté (see the ‘vaginal dryness’ section, next).

7. Vaginal dryness.

Did you know that estrogen is protective for your vagina? Chronically low estrogen levels contribute to vaginal dryness and atrophy over time. This is why I always discuss vaginal health with women in perimenopause and menopause; we need to address this early and take a preventative approach to maintaining vaginal health over the rest of your life. 

8. Low libido.

Without a doubt, many factors impact a woman’s libido. When it comes to the hormone influences on sexual desire, estrogen is a primary player (along with testosterone). Studies show that female sexual desire tends to decrease during certain times in the menstrual cycle when estrogen is lowest. Other studies demonstrate that low estrogen states (such as post-menopause, and after surgeries to remove ovaries) often result in lower scores for sexual desire. If low libido is a concern, we need to address this holistically, including examining your hormones.

If these symptoms sound familiar, it’s important to speak to your Naturopathic Physician or health care provider to investigate your hormones.

Why does this hormone pattern occur?

When I am working with patients on balancing their hormones, we first need to identify their hormone pattern. This can be accomplished in a detailed initial consultation, using my hormone assessment questionnaire, and in some cases, hormone testing.

After identifying your hormone pattern, the next most important question is to ask is WHY?

Now, if you are a post-menopausal woman reading this article, know that menopause is a naturally time of low estrogen and progesterone, and that is normal and expected. However, if you are bothered by the physical effects of low estrogen and progesterone, then come in and see me for support. There are many different treatment options available to help with hot flashes, night sweats, insomnia, and vaginal dryness (and all the other physical changes of menopause). Do NOT settle for “well, that’s just menopause.”

If you a younger woman and are experiencing the symptoms listed above, then we need to do more investigation to understand why your hormones are abnormally low.

Low estrogen and progesterone can be associated with:

• High levels of prolonged physical or mental stress
• Over-exercising or overtraining
• Female athletes with intense training schedules and not enough fuel/food (this is called Relative-Energy Deficiency of Sport, or RED-S, formerly known as the Female Athlete Triad)
• Dieting, caloric restriction, or rapid weight loss
• Thyroid problems (hypothyroidism, or hyperthyroidism)
• Other hormone concerns, such as elevated prolactin
• Among other causes.

If you identify with the list of hormone above and want to investigate further, come in for a consultation. In my practice, my hormone balancing programs involve a combination of foods, herbs, nutrients, acupuncture, and sometimes bioidentical hormone therapy. Each woman receives a treatment plan that is based on her unique pattern and needs.

References

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