Menopause Symptom Groups or Types Part 2: Estrogen Deficiency

In Part 1, Estrogen Dominance, we talked about the idea that it was not simply that there was too much estrogen around in this type of menopause, we said that the ratio of estrogen to progesterone was the critical issue.

In estrogen deficiency, there is similar thinking—it’s not simply that there is too little estrogen, it’s that there is too little estrogen relative to the amounts of progesterone. In this case, the estrogen can’t counterbalance the effects of progesterone.

This is a common type of menopause and perimenopause—and according to most mainstream medical doctors, it IS menopause and perimenopause.

The most common symptoms include (the most common of the common symptoms are in bold):

  • Hot flushes
  • Vaginal dryness and discomfort. There may be discomfort during sexual intercourse
  • Sleeplessness (either the ability to fall asleep or stay asleep)
  • Fatigue
  • Lethargy
  • Depressed mood (or changing moods)
  • Decrease libido
  • Irregular periods —ranging from heavy one month and light the next. Frequency will vary as well
  • Increased number of urinary tract or vaginal infections
  • Vaginal dryness and discomfort. There may be discomfort during sexual intercourse
  • Poor memory or concentration

There are a number of things to keep in mind if you are thinking about HRT.

First—estrogen should NEVER be taken alone—it should always be taken along with progesterone. In 2004, the Women’s Health Initiative (WHI) that was running a very large study on synthetic estrogens and progestins (the synthetic version of progesterone) stopped the arm of the study which was looking at the effects of estrogen alone because of an increased risk of stroke and an increased risk of blood clots.

It should also be mentioned that the studies which used the synthetic estrogens plus the synthetic progestins were stopped in 2002 because of an increased risk of breast cancer, heart attack, stroke and blood clots (which can cause heart attacks and strokes).

So, why are we talking about the possibility of HRT at all if these risks are increased with HRT? That brings us to the second thing to keep in mind: there is a difference between the forms of estrogen and progesterone that were used in the WHI study.

In those studies, they used conjugated estrogens derived from pregnant horse urine and progestin (a synthetic type of progesterone). Yes, you read that correctly…one of the more well-known drugs used was Premarin™…and abbreviated version of pregnant mare urine. For years, Premarin™ was used alone (without any progesterone)—and this increased the risk of uterine cancer. The combination of Premarin™ with a progestin is now marketed as Permpro™.

The conjugated estrogens and the progestins used in these studies—are very different from natural hormones. The conjugated estrogens were a complex mixture—the progestins used were purer. Recent studies indicate that the bioidentical hormones are “are associated with lower risks, including the risk of breast cancer and cardiovascular disease, and are more efficacious than their synthetic and animal-derived counterparts. Until evidence is found to the contrary, bioidentical hormones remain the preferred method of HRT. Further randomized controlled trials are needed to delineate these differences more clearly.” 1 Many conventional physicians are still hesitant, however, to use the bioidentical hormones because there are a larger number of studies using these synthetic hormones than there are using the bioidentical hormones—that’s a situation that is changing. 2 It should also be mentioned that bioidentical hormones have been used in Europe for decades. 3

Why all this controversy?

Part of the controversy lies in the fact that bioidentical hormones cannot be patented—and therefore the pharmaceutical companies cannot make a large profit on them. Another aspect is that many of the pharmacies that provide bioidentical hormones compound them—in other words, a relatively small pharmacy can make an individualized product for an individual woman. Again, the profit margin for the larger drug companies isn’t there. Another argument has been made that there haven’t been enough clinical studies to prove the safety and effectiveness of the bioidentical hormones. This has some truth—but it does stand to reason that a substance which is chemically identical to the natural substance stands a smaller chance of causing problems than a chemically synthesized product or one derived from a non-human animal….doesn’t it?

Whatever you and your healthcare provider determine is best for you—keep in mind these principles:

  • Choose the lowest dose possible for relief of symptoms
  • Use any kind of HRT for the shortest time possible. Consider tapering off the dose slowly after 6 months of treatment
  • Remember that HRT is NOT the only possible approach to dealing with your symptoms—read the articles on diet, lifestyle, herbs and stress reduction to help you through the menopause transition phase. For example:
    • Phytoestrogens such as soy (from the soybean), resveratrol (found in grape skins), various flavenoids (found in fresh fruit and vegetables) and catechins (found in tea and chocolate) have been successfully used to minimize a number of the symptoms of menopause.
    • There are a number of herbs that have been traditionally used to lessen some of the more problematic effects of menopause. Make sure to read the article on herbs and menopause to learn more!


  1. Holtorf K. The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy? Postgraduate Medicine 2009;121:73-85.
  2. Moskowitz D. A Comprehensive Review of the Safety and Efficacy of Bioidentical Hormones for the Management of Menopause and Related Health Risks. Alternative Medicine Review 2006;11:208-23.
  3. Conaway E. Bioidentical hormones: an evidence-based review for primary care providers. The Journal Of The American Osteopathic Association 2011;111:153-64.

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