For many women, until the sex hormones veer off course, and the effects are unmistakably felt, hormones aren’t something that’s top of mind. Often, it’s at the start of menopause when my patients become more aware of their down-shifting estrogen levels. For others, entering their 30s and 40s, it may be struggles with issues like fertility, PMS, mood swings, sexual dysfunction that bring hormonal imbalances more prominently into the conversation.

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While some may choose to ignore these ‘annoyances’ or write them off as inevitable harbingers of aging, I strongly advise you not to. Your health depends on all of your body’s systems, very much including your sex hormones, functioning well together so they can keep you healthy throughout your entire life.

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So, how to know when it’s time to take a closer look at your estrogen levels, to determine if yours may be interfering with your optimal health? Here are a few thoughts on what to know and where to start -- and how to navigate those shifting estrogen levels as gracefully as possible. 

Estrogen for all.

For starters, it’s helpful to understand what this hormone actually does, and the multiple roles it plays throughout the body. Most people are aware that estrogen is the primary female sex hormone, but it’s not just about the female reproductive system, and it’s not just about women either. Men’s bodies make estrogen as well, just considerably less than their female counterparts.

Estrogen wears a lot of hats.

Produced primarily in the ovaries (with smaller amounts being synthesized in the adrenals), estrogen is involved in a number of physiological processes that are essential to good health. But when levels are sub-par, trouble can follow – which is why it’s important to know where you stand (more on that in a minute). Among the key areas of the body that rely on a healthy supply:

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1) Bones – Estrogen helps to maintain bone density by slowing the activities of the cells that stimulate bone breakdown, promoting better calcium absorption and by stimulating the activity of bone-building cells (known as osteoblasts).

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So, when estrogen levels start to slide, particularly as menopause progresses, the wheels can start to come off, with an acceleration of bone loss, and increased risk of fractures and osteoporosis.

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2) The heart – Estrogen helps protect the heart by helping to maintain healthy blood vessels, while also helping regulate cholesterol levels and reduce plaque buildup in the arteries.

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So, when estrogen levels are low, the risks for heart disease, stroke, and hypertension tend to go up. That’s why postmenopausal women face an increased likelihood of developing these conditions because of declining estrogen levels.

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3) The brain – Early studies are finding links between estrogen levels and how well the brain functions. That makes sense given that areas in the brain associated with memory and cognition are home to a large number of estrogen receptors.

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The thinking is that dips in estrogen levels may contribute to cognitive decline and an increased risk of neurological conditions such as Alzheimer’s. On the flip side, adequate levels are thought to play a role in maintaining healthy cognitive function and may be one of the physiological differences that tends to give females an edge when it comes to verbal recall, special abilities and fine motor skills. 

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4) Mood management – estrogen influences neurotransmitter activity, including serotonin and dopamine, which play key roles in keeping mood on an even keel.

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Fluctuations in estrogen levels, which are quite common during the menstrual cycle and during perimenopause and menopause, can contribute to mood disturbances like irritability, anxiety, and depression. Postmenopausal women are vulnerable as well.

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5) Reproductive health – no surprises here but estrogen is essential to the health of your reproductive system.

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In addition to disrupting the menstrual cycle and potentially causing fertility issues, less than optimal estrogen levels can lead to vaginal dryness, decreased libido, and discomfort during intercourse, all of which can negatively impact sexual relationships and dampen one’s overall quality of life. 

Falling short ramps up aging speed.

Though research is in early stages, findings point to the not-so-great news about low estrogen levels being a key contributor to rapid aging in women – up to twice as fast (!) as their male counterparts – in a number of ways. Beyond the bone, heart, brain and reproduction connection mentioned above, when it comes to optimizing health and longevity, healthy levels of estrogen help you maintain a more youthful edge, inside and out. Adequate levels of estrogen help the body:

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• maintain skin thickness, elasticity, and hydration by promoting collagen production and inhibiting collagen breakdown – which means less wrinkles and sagging.
• keep weight in check, influencing your metabolism by regulating energy expenditure, fat distribution, and insulin sensitivity – all important to keeping ‘middle age spread,’ obesity and type 2 diabetes at bay.
• manage muscle strength and optimal function by enhancing muscle gains and reducing loss – which helps cut fall and fracture risk.

Estrogen has a number of common enemies.

When it comes to the most common causes of low estrogen, unfortunately, the natural aging process of menopause tops the list. Other common causes include health issues like early menopause, genetic conditions, autoimmune diseases, certain medical therapies, eating disorders, pituitary gland problems and over-exercising.

Are you unknowingly dealing with low estrogen?

With its influence extending across so many functions, it’s easy to see why low and/or declining estrogen levels can make a big dent in women’s overall health and quality of life, in the reproductive years as well as in perimenopause and menopause. What makes the problem of low estrogen levels particularly vexing though is that it’s often overlooked – much of the medical community just doesn’t think to ask or test for it. That’s when the patient has to advocate for themselves and get it on their doctor’s radar! When to raise the question? How to know if low estrogen levels may be taking a bite out of your bone, heart, brain and or reproductive health? Here are a few classic clues to look for, according to the researchers at the Cleveland Clinic:

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• Dry skin
• Tender breasts
• Weak or brittle bones
• Trouble concentrating
• Moodiness and irritability
• Vaginal dryness or atrophy  
• Hot flashes and night sweats
• Irregular periods or no periods 
• Weight gain, especially in your belly
• Headaches before or during your period
• Decreased sex drive and painful intercourse
• Feeling fatigued and having trouble sleeping 

Assess your hormonal situation.

OK so let’s say you’ve got a few of the symptoms mentioned above. The first thing you can do is have your doc test your levels. Basic blood and urine tests can provide a window into where you stand. Your doc can test for the three kinds of estrogen that your body produces, estradiol, estrone and estriol, but estradiol is the strongest and most important one to measure. From there, your next move is to consider giving your body a hormonal helping hand.

Give your estrogen levels a hormonal helping hand.

In menopause, estrogen levels most often wind up in the basement, despite the long-term health of your heart, brain, bones, etc. still relying heavily on the hormone’s continued presence in your system. This natural drop makes feeling and looking good in menopause (and beyond) something of an uphill battle, which is where bioidentical hormone replacement therapy (BHRT) comes in. For those in menopause, HRT is an excellent way for many women to keep the tank topped up. Although choosing to take hormones in menopause is a personal choice, I am a big fan of BHRT – as in the bioidentical kind that are identical in chemical structure to those naturally made by the human body and which have identical effects. These are custom-formulated at a fully licensed, high-quality compounding pharmacy and are different to the synthetic hormones patented by pharmaceutical companies. 

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Over the years I’ve witnessed exceptional improvements in menopausal symptoms, overall health and quality of life, particularly when BHRT, usually in the most important form of estrogen known as estradiol – when combined with progesterone and testosterone, and hormone-balancing lifestyle to-dos like the 10 outlined below.

The benefits of a bioidentical boost.

One of the many reasons why I almost always opt for bioidenticals is not only because of what’s in it but also what’s not: think one-size-fits-all Big Pharma synthetic hormones versus custom-formulated, which are safer, better tolerated and with a lot fewer harmful side effects.

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Another thing to like about the bioidenticals is that they’re metabolized by normal metabolic pathways, delivering similar results without generating the harm that often comes with chemically-different, synthetic hormones, which can produce harmful metabolites and complications. What’s more, medical studies report far fewer negative effects – think blood clots, heart attack, breast cancer concerns, etc. –  and complications with BHRT than with synthetic HRT. Think about it, why would Mother Nature make a hormone that drives cancer? So, it’s easy to see why bioidenticals get my vote.

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But the boosting doesn’t stop with bioidentical estradiol. You can add more support to your hormonal mix as well with these 10 lifestyle tweaks:

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1. Commit to making your diet great: You can support estrogen production with healthy whole foods, ideally organic and non-genetically modified (GM) soy that are rich in phytoestrogens, like tofu, tempeh, edamame, flaxseeds, sesame seeds, and legumes. Colorful vegetables and low sugar berries, nuts, and seeds added to meals to provide essential vitamins and minerals that support hormone synthesis will also add additional support.
2. Dig into healthy and delicious fats: Avocados, olive oil, fatty fish (salmon, mackerel), nuts, and seeds not only put plenty of satiety on your plate but also provide the building blocks necessary for hormone production, including, you guessed it – estrogen.
3. Plenty of movement: besides being handy for weight control and stress reduction, working your body helps with the conversion and regulation of estrogen, and supports better hormone balance.
4. High-quality sleep: At least 7 hours a night to help keep your stress hormones in check and your sex hormones in balance 
5. Bust that stress: chronic stress impacts estrogen levels and not in a good way, so go deep with daily stress reduction practices like meditation, deep breathing, yoga, or spending time in nature. 
6. Make a healthy weight a priority: Obesity and being underweight can both contribute to hormonal imbalances. Strive to maintain a healthy weight through a balanced diet and regular exercise. Losing excess weight, if necessary, can help improve estrogen levels, especially in individuals with excess body fat, as fat cells can produce estrogen.
7. Lighten up a lot on caffeine and alcohol: Excessive alcohol consumption and high caffeine intake can disrupt hormone balance and impair estrogen metabolism. Limit your intake of alcohol – or quit it altogether -- and curb your caffeinated beverage intake, opting for herbal teas or water instead.
8. Avoid endocrine disruptors: As in purge or at least minimize exposure to endocrine-disrupting chemicals found in plastics, pesticides, and certain personal care products, as these chemicals can interfere with estrogen levels.
9. Consider supplements: Supplements such as vitamin D, vitamin E, and omega-3 fatty acids may support estrogen production, as can certain herbal supplements may like black cohosh, red clover, dong quai, and maca root – but here too, its essential to work with a healthcare professional before taking any herbal supplement, especially if you have existing medical conditions or are taking medications.

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Pay attention to what you put in your body: Ditch sugar and processed foods – no excuses – your estrogen levels will be better for it!