Everything you need to know about

estrogen
By Hannah Nichols | Last updated Tue 2 Jan 2018

Reviewed by Natalie Butler, RD, LD

Table of contents

Estrogens are a group of sex hormones that promote the

development and maintenance of female characteristics in the
human body.

They play an essential role in the growth and development of female secondary
sexual characteristics, such as breasts, pubic and armpit hair, and the regulation
of the menstrual cycle and reproductive system.

During the menstrual cycle, estrogen produces an environment suitable for the
fertilization, implantation, and nutrition of an early embryo.

An imbalance of these hormones can lead to a range of health problems and

unwanted physical changes. This MNT Knowledge Center article will explain
what estrogen is, how it works in the body, its range of medical uses, and the
effects of estrogen imbalance.

Fast facts on estrogen

• The ovaries are the main location for estrogen production.

• Estrogen influences the structural differences between the male and

female bodies, such as females having a wider pelvis and more
permanent hair on the head.

• Synthetic estrogen has a range of uses in medicine, including birth

control and managing the effects of menopause.
• Estrogen is involved in the development of a range of health issues.

What is estrogen?
Hormones are chemical messengers
that tell specific tissues to behave in a
certain way.

During puberty, the ovaries begin

releasing estrogen hormones in line
with each monthly menstrual cycle. The
estrogen level rises suddenly halfway
through the cycle, which triggers the
release of an egg. This level then
quickly decreases after ovulation. Estrogen is a vital hormone in female development.

Estrogens usually travel through the

bloodstream in fluids, interact with cells
in a variety of tissues in the body, and deliver a message or instruction.

It is one of the most important hormones for women, alongside progesterone.

Progesterone helps to maintain pregnancies and implant an egg in the uterus.

The related hormones in the estrogen family include:

Estrone (E1): This is a weak form of estrogen and the only type found in
women after the menopause. Small amounts of estrone are present in
most tissues of the body, mainly fat and muscle. The body can convert
estrone to estradiol and estradiol to estrone.

Estradiol (E2): This is the strongest type of estrogen. Estradiol is a

steroid produced by the ovaries. It is thought to contribute to a range of
gynecological problems, such as endometriosis, fibroids, and cancers
that occur in females, particularly endometrial cancer.
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Estriol (E3): This the weakest of the estrogens and is a waste product
 made after the body uses estradiol. Pregnancy is the only time at which
significant amounts of estriol are made. Estriol cannot be converted to
estradiol or estrone.

Far lower levels of estrogen are also present in men.

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Function
Estrogen is crucial to the reproductive function and cycle of a woman.

Benefits

In females, estrogen affects the following areas of the body:

Ovaries: Estrogen helps stimulate the growth of an egg follicle.

Vagina: It also stimulates the growth of the vagina to its adult size, the
thickening of the vaginal wall, and an increase in vaginal acidity that
reduces bacterial infections. It also helps lubricate the vagina.

Fallopian tubes: Estrogen is responsible for the growth of a thick,

muscular wall in the fallopian tubes, and for the contractions that
transport the egg and sperm cells.
 Uterus: Estrogen enhances and maintains the mucous membrane that
lines the uterus. It increases the size of the endometrium as well as
enhancing blood flow, protein content, and enzyme activity. Estrogen
also stimulates the muscles in the uterus to develop and contract.
Contractions help during the delivery of an infant and placenta, and they
also assist the wall of the uterus in getting rid of dead tissue during
menstruation.

Cervix: Estrogen is thought to regulate the flow and thickness of uterine

mucous secretions. This enhances the movement of a sperm cell to an
egg and enables fertilization.

Mammary glands: Estrogen forms unique relationships with other

hormones in the breast. They are responsible for the growth of the
breasts during adolescence, the pigmentation of the nipples, and
eventually stopping the flow of milk when an infant is no longer breast-
feeding.

Estrogen is responsible for the differences between male and female bodies. For
example, in a female body:

Estrogen makes the bones smaller and shorter, the pelvis broader, and
the shoulders narrower.

It increases fat storage around the hips and thighs, meaning that the
body is more curved and contoured.

Estrogen helps to slow down the growth of females during puberty and
increases sensitivity to insulin. Insulin influences the amount of body fat
and lean muscle a person can develop.

It influences body hair to become finer and less pronounced while

making the hair on a woman's head more permanent.

Estrogen makes the voice box smaller and the vocal cords shorter, giving
females a higher-pitched voice than males.

Estrogens suppress the activity of the glands in the skin that produce oily
substances. This reduces the likelihood of acne in females.

Other areas on which estrogen has an impact include:

 The brain: It can help maintain body temperature, regulate the part of the
brain linked to sexual development, and enhance the effects of the
brain's "feel-good" chemicals.

The skin: Estrogens improve the thickness and quality of the skin as well
as the collagen content which prevents aging.

The bones: Estrogen helps to preserve bone strength and prevent bone
loss.

The liver and heart: The hormone regulates cholesterol production in the
liver, helping to protect the heart and arteries.

Foods
Some foods contain phytoestrogens, which may affect levels of estrogen in the
body.

These include:

cruciferous vegetables

soy and some foods containing soy protein, the most concentrated
source

berries

seeds and grains

nuts

fruit

wine

Some scientists consider phytoestrogens to be endocrine disruptors. They

appear to have dual functions at times, able to increase and decrease estrogen
activity.

It is a common misconception that phytoestrogens can negatively impact health,

but some research confirms that the foods containing phytoestrogens listed
above can lower cancer risk, reduce hot flashes, improve other menopausal
symptoms, and provide other health benefits.

The effects of soy's phytoestrogens depend on the type of soy being studied at
the time, and this has led to inconsistent findings. Soy protein isolate will have a
different impact from whole soy foods.

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Uses
Synthetic estrogen, bio-identical estrogen, and estrogens derived from pregnant
mares (Premarin) are used for a range of medical purposes.

The most common uses of estrogen are in birth control pills and hormone
replacement therapy (HRT) and bio-identical hormone replacement therapy
(BHRT) for menopause.

Birth control pill

The birth control pill is the most commonly used method of birth control in the
United States. Estrogen is included in combination oral birth control pills
alongside the hormone progestin.

Many women take low-dose birth control pills, which contain 20 to 50

micrograms (mcg) of estrogen.

The estrogen in the combined pill sends feedback to the brain. This feedback
causes a range of effects in the body, including:

stopping the pituitary gland from secreting follicle-stimulating hormone

(FSH)

stopping the production of luteinizing hormone (LH)

preventing ovulation
 supporting the lining of the womb to prevent the breakthrough bleeding
that can sometimes cause spotting between periods

Some doctors may prescribe birth control for alternative uses, including:

regulating the menstrual cycle

easing severe cramping and heavy bleeding

reducing the risk of ovarian cancer and the development of ovarian cysts

protecting against ectopic pregnancy

decreasing perimenopausal symptoms

helping reduce the severity of hormone-related acne

Taking a birth control pill carries a range of risks, such as:

heart attack

stroke

blood clots

pulmonary embolism

nausea and vomiting

headaches

irregular bleeding

weight changes

breast tenderness and swelling

Long-term use may also lead to a higher risk of breast cancer.

Hormone replacement therapy

Hormone replacement therapy (HRT) aims to relieve some symptoms of

menopause by bringing the levels of female hormones back to normal. The
treatment can be provided as estrogen-only or as a combination of estrogen and
progestin.

For women who still have a uterus, the hormone progestin is used alongside
estrogen to prevent the overgrowth of the uterine lining, which can lead to
endometrial cancer. HRT is available as a pill, nasal spray, patch, skin gel,
injection, vaginal cream, or ring.

HRT may help relieve symptoms of menopause, such as:

hot flashes

vaginal dryness

painful intercourse

mood swings

sleep disorders

anxiety

decreased sexual desire

The US Food and Drug Administration (FDA) recommends that HRT is used at the
lowest doses for the shortest duration needed to achieve treatment goals.

This can help to avoid some of the uncomfortable side effects, such as:

bloating

breast soreness

headaches

mood swings

nausea

water retention

Women who use or are considering using hormone therapy after menopause
should discuss the possible benefits and health risks with their physicians.
Hormone therapy is also used to help transgender people who wish to transition
between genders, with estrogen often being prescribed to help transgender
women who are looking to develop female secondary sexual characteristics.

Due to the risks posed by this type of therapy, it is vital that a course of hormone
therapy is followed under supervision by a medical professional.

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Estrogen replacement therapy (ERT)

Estrogen replacement therapy (ERT) is used to increase estrogen levels in

women who have undergone menopause and have had their uterus removed.
This is because ERT is linked to uterine cancer but would not have this effect in
women after removal of the uterus.

ERT can also treat a range of other conditions, such as delayed puberty,
symptomatic vaginal atrophy, and breast atrophy.

This treatment may have additional benefits, including:

preventing symptoms during the menopause

preventing osteoporosis

preventing colon cancer

reducing early bone loss and osteoporosis in women who had their
ovaries removed between the ages of 20 and 40 years

ERT can reverse the effects of low estrogen levels and may also:

control the occurrence and severity of hot flashes

 improve mood and sleep problems that occur due to hormonal changes

maintain the lining and lubrication of the vagina

maintain skin collagen levels

prevent osteoporosis following the menopause

reduce the risk of dental problems, including tooth loss and gum disease

ERT should be avoided if the person taking them:

is pregnant

has unexplained vaginal bleeding

has liver disease or chronically impaired liver function

has a strong family history of cancer in the breast, ovaries cancer, or

endometrium

is a smoker

has a history of blood clots

has had a stroke

Topical estriol application for vaginal atrophy has been shown to be effective
with the least side effects compared to combination estrogen therapy.

Levels
Normal estrogen levels can vary a great
deal. Differences can typically be seen Strenuous exercise can impact estrogen levels.

between the estrogen levels of two

women on the same day of their cycles,
for example, or in the same woman on
different days.

However, when levels fall or rise too far, bodily functions can become irregular.
Certain conditions, lifestyle choices, and processes can reduce the amount of
estrogen in the body. These include:

ovarian failure

an underactive pituitary gland

pregnancy failure

the menopause and perimenopause

polycystic ovarian syndrome (PCOS)

anorexia nervosa

strenuous exercise or training

certain medications, such as clomiphene

childbirth

breast-feeding

Other factors can lead to a spike in estrogen, such as:

puberty

overweight and obesity

high blood pressure

diabetes

healthy pregnancy

tumors of the ovaries or adrenal glands

a range of medications, including steroids, ampicillin, estrogen-

containing drugs, phenothiazines, and tetracyclines

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Supplements
Natural alternatives and supplements, such as black cohosh, are often touted as
a treatment for the symptoms of menopause. Research findings have been
inconsistent, but side effects from taking black cohosh are reported to be minor
and infrequent.

For estrogen-containing supplements, The American Congress of Obstetricians

and Gynecologists (ACOG) advises caution. Estrogen is linked to a number of
cancers and health risks, and so it is vital to consult with a doctor before taking
any supplements. In addition, the FDA cannot regulate or ensure the safety and
effectiveness of herbal and non-medicinal supplements.

As estrogen is linked to a number of cancers and health risks, it is vital to consult

with a doctor before taking any supplements.

Side effects
The effects of imbalanced estrogen levels can include the following:
 menstruation becoming less frequent or stopping

light or heavy bleeding during menstruation

hot flashes, night sweats, or both

non-cancerous lumps in the breast and uterus

mood swings and sleeping problems

weight gain, mainly in the hips, thighs, and waist

low sexual desire

fatigue

mood swings

feelings of depression and anxiety

dry skin

High levels of estrogen in men can lead to infertility, erectile dysfunction,

prostate cancer, and the development of larger breasts, also known as
gynecomastia.

It is important when taking medications that contain estrogen to keep track of

symptoms and ensure that you are maintaining balanced estrogen levels.

If you experience any of the above symptoms, speak to your doctor.

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ENDOCRINOLOGY MENOPAUSE PREGNANCY / OBSTETRICS

WOMEN'S HEALTH / GYNECOLOGY

Additional information

Article last updated by Yvette Brazier on Tue 2 January 2018.

 Visit our Endocrinology category page for the latest news on this subject, or sign up to
our newsletter to receive the latest updates on Endocrinology.

All references are available in the References tab.

References

Citations

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