(This great article reprinted from M. Stewart Good Living Health & Wellness, November 2021)
If estrogen had a motto, it would be "Buckle your seat belt-it's going to be quite a ride." As a woman's levels rise and dip over the decades, they affect everything from her mood to her muscle mass. But new research indicates there are surprising ways it impacts us - may of them overwhelmingly positive-and offers ways to stay in the driver's seat.
Even if it's been a while since health class, you likely know how estrogen impacts reproductive health. Its levels rise as we reach puberty; then each month it surges, causing the uterine lining to prep for a potential fertilized egg, and drops, kick-starting menstruation. As the years go on, levels ricochet up and down in perimenopause and drop at menopause. And along the way, estrogen gets blamed for breakouts and breakups, mood dips, and weight gains.
But what else does the hormone do? The better question may be "What doesn't it do?" "Estrogen touches basically every cell," says Jen Gunter, MD, a gynecologist and author of the The Menopause Manifesto (Citadel, 2021). "Until recently, we didn't recognize its importance beyond reproduction," adds Elizabeth Poynor, MD, a gynecologic surgeon and founder of the Poynor Health clinic, In New York City. "We're learning that estrogen receptors are throughout the body. Fluctuating levels affect almost every organ system." Here are five big benefits the hormone delivers, plus how to make the most of every life stage as its levels change.
A PROTECTED HEART
Estrogen helps keep cardiovascular tissues soft and flexible, maintains healthy blood-pressure and cholesterol levels, may help promote healthy blood clotting, and neutralizes damaging free radicals - all of which would imply that the dropping levels at menopause are a serious health hazard. Not so, says Gunter: "If loss of estrogen with aging were fatal, we wouldn't be here." To fortify your thumper when the hormone skedaddles, eat a heart-healthy, plant-forward diet; get seven to nine hours of sleep a night; and work plenty of movement into your day. Limit alcohol to a serving (12 ounces of beer, 5 of wine, 1.5 of distilled spirits) or fewer daily. If you smoke, STOP. And keep up with your yearly physical; if you're at risk of cardiac disease and a good candidate for hormone-replacement therapy, your doc may suggest estrogen-only HRT, which is shown to lower cardiac risk.
2. A SHARP MIND
The hormone is a neuroprotectant that may help maintain proper blood flow in the brain, protecting against inflammation and disease and aiding everything from verbal memory to fine motor skills to puzzle-solving. This is why many women report "brain fog" just before their period and during per-menopause (for more on this phase, see Onward! below.) The signs? It's harder to focus, you lose words midsentence, and....wait, what were we talking about? Fortunately, for many the fog lifts after menopause, according to long-term research such as 2009 Study of Women's Health Across the Nation. But the relief comes with some sobering science: Lisa Mosconi, PhD, director of the Women's Brain Initiative and associate director of the Alzheimer's Prevention Clinic at Weill Cornell Medicine, says her research indicates a marked decline in women's brain-energy levels at ages 40 to 60 that is tied directly to fluctuating estrogen levels. If you have a genetic predisposition for Alzheimer's disease, brain changes may start at this time, although symptoms usually don't become evident until later in life, typically around age 70.
Whatever your genetic makeup, lifestyle habits are a vital tool for protecting your brain. This means good nutrition-plenty of vegetables, fruit, and whole grains, plus one serving of fish a week-regular exercise, and learning new things to keep it active. If you're worried about Alzheimer's, know that these steps have been shown to slow its roll, and talk with your doctor; early detection is key.
3. A STRONG BODY
This mighty multitasker improves muscle mass and bone density, and keeps tendons agile. But, here's a surprise: Studies show that females make greater strength gains, produce more force, and move faster during the low-estrogen phase at the start of their period, writes exercise physiologist and nutrition scientist Stacy T. Sims, PhD, in her book Roar (Rodale, 2016). This may be because testosterone and estrogen levels are more balanced at this time-so swing those kettle bells on day one!
According to fitness coach Amanda Thebe, author of Menopocalypse: How I Learned to Thrive during Menopause and How You Can Too! (Greystone, 2020), "strength training can be the linchpin to improving menopause." In addition to building stronger bones, lifting weights and sinking into squats can improve metabolism and joint health and function, manage blood sugar, and boost endorphins.
Poynor advocates any type of exercise to turn on anti-inflammatory pathways, regulate the immune system, and manage stress: "I tell patients to take 30 minutes each day to do something that gets their heart rate up and their mind in a different space."
4. BALANCED MOODS
An emotional buffer, estrogen helps with serotonin regulation and may assist in the effectiveness of endorphins, bolstering resilience to stress. This partially explains why many women suffer PMS before their period, as levels drop. It's a chicken-or-egg situation, though: Chronic stress can lead to abnormally high cortisol levels and lower estrogen. Exercise, meditation, and cognitive behavioral therapy (CBT) can all help take the edge off.
In perimenopause, drops in estrogen can make us feel like we have nonstop PMS, and the closer we get to menopause, the higher our nighttime cortisol levels are, leaving us fatigued and fragile. "Maximize your ability to achieve good sleep," suggests Poynor. "Pull your shades, put away screens, try aromatherapy, and if you still suffer poor sleep, tell your doctor." If the usual self-care isn't cutting it, progestin-only or low-dose combination birth control can mitigate menstrual mood swings and perimenopausal angst.
After menopause, hormonally exacerbated emotional ups and downs usually start to level off. But this is a time when hot flashes may still wreak emotional havoc. Hormone therapy, like the estrogen patch or gel, can help, as can CBT and microdoses of some antidepressants, such as paroxetine (Brisdelle). But lifestyle changes are your friend, too. An Australian study from 2013 shows that eating healthy fats, complex carbs, and produce with A, B, and C vitamins, and cutting back on sugar, dairy, and meat, lower the likelihood of feeling the heat.
5. BETTER SEX
Estrogen, progesterone, and testosterone all affect libido. But it's estrogen that helps keep the vagina lubricated so sex is enjoyable. When it drops, vaginal walls thin and produce less lubricant. Still, this is not-we repeat NOT- the end of your sex life! If you're pre-menopausal and experience dryness, try an unscented water - or silicone-based lube. Post menopause, when skin thins, opt for an unscented hyaluronic-acid-based vaginal moisturizer, like Bonafide's Revaree or Kindra's Daily Vaginal Lotion. If you need something stronger, prescription estrogen vaginal cream or gel is very effective.
WHAT IS IT?
PERIMENOPAUSE: For most American women, this starts in our mid-to-late 40s and lasts about four years. It's when follicle-stimulating hormone (FSH) levels rise, causing changes in other reproductive hormones. Estrogen levels fluctuate as they slowly decline, and periods can become irregular. There's no definitive test to predict when you'll hit menopause, but hot flashes and night sweats are signs it's on its way. The symptoms can start anywhere from a few months to a decade before you stop menstruating, and usually continue-and intensify-for a few years post-menopause.
MENOPAUSE: This is a single moment-12 months from your last period-marking that you've officially stopped ovulating. The average is 51 but varies widely. Before 45, a year without periods is considered early menopause. Pre-40, it's premature menopause, which can be due to genetics, very low BMI (body fat stores estrogen), ovarian insufficiency, chemotherapy, radiation, or surgical removal of one or both ovaries. Post-menopause, estrogen levels tend to fall close to where they were at about 10 years of age, which means you can go forth in life with the confidence of a fifth-grader and the wisdom of a grown woman-a pretty sweet deal.
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