We are continuing our article on everything you need to know about oestrogen. In part two we are looking at some of the medical uses of oestrogen. Synthetic oestrogen are used for a range of medical purposes. The most common uses of oestrogen are in birth control pills and hormone replacement therapy (HRT).
Synthetic oestrogen, bio-identical oestrogen, and oestrogens derived from pregnant mares (Premarin) are used for a range of medical purposes.
The most common uses of oestrogen 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. Oestrogen 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 oestrogen.
The oestrogen 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
- blood clots
- pulmonary embolism
- nausea and vomiting
- 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 oestrogen-only or as a combination of oestrogen and progestin.
For women who still have a uterus, the hormone progestin is used alongside oestrogen 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
- 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:
- breast soreness
- mood swings
- 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 oestrogen 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.
Oestrogen replacement therapy (ERT)
Oestrogen replacement therapy (ERT) is used to increase oestrogen 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 oestrogen 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 oestrogen therapy.
Normal oestrogen levels can vary a great deal. Differences can typically be seen between the oestrogen 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 oestrogen 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
Other factors can lead to a spike in oestrogen, such as:
- overweight and obesity
- high blood pressure
- healthy pregnancy
- tumors of the ovaries or adrenal glands
- a range of medications, including steroids, ampicillin, oestrogen-containing drugs, phenothiazines, and tetracyclines
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 oestrogen-containing supplements, The American Congress of Obstetricians and Gynecologists (ACOG) advises caution. Oestrogen 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 oestrogen is linked to a number of cancers and health risks, it is vital to consult with a doctor before taking any supplements.
The effects of imbalanced oestrogen 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
- mood swings
- feelings of depression and anxiety
- dry skin
It is important when taking medications that contain oestrogen to keep track of symptoms and ensure that you are maintaining balanced oestrogen levels.
If you experience any of the above symptoms, speak to your doctor.
Article by by Hannah Nichols