Hypoestrogenism in women

Hypoestrogenism: causes, symptoms, treatment

In the section on endocrine diseases and disorders of the endocrine glands ICD-10,  hypoestrogenism , a condition associated with a decrease in the production of female sex hormones (estrogens) by the ovaries, has the code E28.39.

As the main female sex hormones, estrogens play an important role not only in the reproductive function of women, but also in the normal functioning of other body systems, including the cardiovascular, musculoskeletal and central nervous system.

Causes

The most likely  causes of  hypoestrogenism or  estrogen deficiency  are associated with a decrease in estrogen synthesis in primary ovarian failure, as well as their secondary (premature) failure in women under 40, caused by extensive inflammation of the ovaries, their cystic changes - with  polycystic ovary syndrome , as well as surgical interventions and the use of certain medicines.

Also, estrogen production decreases when:

• isolated hypogonadotropic ovarian hypofunction ;
• functional insufficiency of the hypothalamic-pituitary system (controlling the work of the gonads) - due to damage or pathology of the hypothalamus and impaired gonadotropic function of the pituitary gland, which are manifested in women with  hypopituitarism  and functional insufficiency of the gonads - hypogonadism, in particular, with  postpubertal hypothalamic hypogonadism ;
• hypocorticism - chronic insufficiency of the adrenal cortex.

In addition,  hypoestrogenism in women of reproductive age  can occur as a consequence of hyperprolactinemia (increased production of prolactin) - with the development of  hyperprolactinemic hypogonadism  or  Chiari-Frommel syndrome .

If hypoestrogenism in young women is the result of pathology, then the physiological decrease in the level of estrogens (estrone, 17β-estradiol and estriol) in women during perimenopause, which precedes the onset of menopause, does not belong to painful conditions, but is a natural stage of the extinction of the functions of the glands of the female reproductive system...

Risk factors

Endocrinologists have noted such  risk factors for  low estrogen levels as:

• age (the older the woman, the less estrogen is produced by the ovaries);
• delayed sexual development;
• a family history of ovarian cysts and hormonal problems;
• tumors of the ovaries or adrenal glands;
• pathology of the pituitary gland (including adenoma) and neoplasms in the hypothalamus;
• severe renal failure;
• functional disorders of the endocrine system;
• critically low body weight;
• passion for extreme diets for weight loss and eating disorders (anorexia);
• excessive physical activity and stress;
• iatrogenic effects of radiation and chemotherapy;
• the use of pharmaceuticals, in particular, steroids, opioids, psychotropic drugs, as well as drugs that inhibit the synthesis of estrogens - inhibitors of the aromatase enzyme (which are used in the treatment of neoplasms of the breast and uterus).

There is a high risk of hypogonadism and ovarian dysfunction in autoimmune disorders (for example, hypoparathyroidism, Addison's disease), genetic syndromes (Turner, Kallman, Prader-Willi), hemochromatosis.

Pathogenesis

With cystic changes in the ovaries, the  pathogenesis of a  violation of their estrogen-producing function, as a rule, is due to alteration of granular and theca cells of the follicles that provide steroidogenesis: the synthesis of pregnenolone from cholesterol, the conversion of pregnenolone into progesterone, and progesterone into androgens (which are androstenedione, testosterone) using aromatase (P450Arom) are transformed into estradiol.

A decrease in estrogen production occurs due to degenerative changes in their granular cells and increased proliferation and / or insufficient activity of the androgen-producing follicular theca cells (which leads to increased synthesis of follicular androgens).

In some cases of primary ovarian failure, the violation of estrogen synthesis is of autoimmune origin and is associated with the presence of autoantibodies that damage the ovarian follicular apparatus.

Estrogen deficiency in hypogonadism can be a consequence of impaired secretion and a decrease in the level of pituitary gonadotropic hormones - follicle-stimulating hormone (FSH) and luteinizing hormone (LH), as well as gonadotropin-releasing hormone (GnRH) produced by the hypothalamus.

And with an increased synthesis of prolactin in the anterior lobe of the pituitary gland, the mechanism lies in the ability of this hormone to suppress the production of estrogen by the ovaries.

Statistics

The prevalence of premature ovarian failure among the female population is estimated by clinical statistics in the range of 0.3-1.4%.

Functional insufficiency of the female reproductive glands (hypogonadism) is the cause of hypoestrogenism in about one case in 2.5-3 thousand; in almost 35% of cases, it is genetically determined; it is associated with the absence of menstruation (amenorrhea) in 10-35% of women.

About 50% of cases of hyperprolactinemia (diagnosed in less than 1% of women) occur with a prolactin-secreting pituitary tumor -  prolactinoma .

According to foreign specialists in reproductive medicine, menstrual irregularities against the background of increased physical exertion are observed in almost half of female athletes, and amenorrhea is noted in a third.

Symptoms

Let it not seem strange to you that the  first signs of  hypoestrogenism are similar to the  first signs of menopause , because any decrease in estrogen levels, including those caused by age (provided by nature), has a similar clinical picture.

With a low level of estrogen, symptoms are noted   in the form of irregular periods or their absence, hot flashes, nocturnal hyperhidrosis, sleep disturbances (insomnia), frequent headaches, vaginal dryness (vulvo-vaginal atrophy), decreased libido.

In addition, memory deteriorates, mood often changes, and irritability, fatigue and depression are observed.

Consequences and complications

Hypoestrogenism can have long-term  consequences and complications, the most significant of which are:

• absence of menstruation - secondary  amenorrhea ;
• violation of ovulation with partial or complete infertility;
• atrophy of breast tissue;
• early menopause in women ;
• sexual dysfunction and decreased physical performance;
• atrophy of the urethral mucosa, urinary incontinence, increased risk of urinary tract infections;
• violation of lipid metabolism and a decrease in bone mineral density - with the development of osteopenia and osteoporosis in women and an increased risk of scoliosis in girls of puberty;
• predisposition to cardiovascular and neurodegenerative diseases.

Diagnostics

In endocrinology and gynecology, the  diagnosis of  hypoestrogenism is based not only on the assessment of symptoms and anamnesis (including family history).

To objectively confirm estrogen deficiency and identify its causes, laboratory tests are carried out and  blood tests are taken  for the level of estrogen, prolactin, follicle-stimulating and luteinizing hormones, anti-Müllerian hormone, thyroid hormones (total triiodothyronine) and insulin levels.

Instrumental diagnostics  includes ultrasound of the uterus and ovaries, X-ray of the pelvic organs, MRI of the pituitary gland, etc.

See also:  Diagnosis of polycystic ovaries

Differential diagnosis  is designed to distinguish a decrease in estrogen levels with damage and dysfunction of the ovaries, from hypoestrogenism of pituitary-hypothalamic or autoimmune origin.

Treatment

The main  treatment for  hypoestrogenism in women of any age is  hormone replacement therapy  (HRT) with conjugated estrogens.

What drugs are used in this case , in more detail in the materials:

• How to increase estrogen levels?
• Hormones in pills

And read all the details about phytoestrogen-based products in the publication -  Preparations and products containing phytoestrogens

You can also  treat with herbs : decoctions and water infusions of fenugreek seeds and creeping tribulus, hop cones, red clover flowers, sage, wild yam (dioscorea).

Prevention

Hypoestrogenism associated with functional insufficiency of the hypothalamic-pituitary system, genetic and autoimmune disorders cannot be prevented. And the use of the same hormonal drugs for prevention cannot be recommended to everyone, especially given their possible side effects.

Forecast

With a low level of estrogen, the  prognosis of the  general state of health and the prospects for the normalization of the hormonal background depend on the reasons leading to the hypoestrogenism.