When we don't feel that our estrogen needs are fully being met or when we have symptoms that weren't what we thought we were signing up for, the obvious question to ask is "how can I change this to make it better?" And the answer to that depends upon whether we think that we're failing to meet our needs completely or whether we're overachieving. Estrogen tends to cause some pretty typical effects in its imbalance, and these generally reflect its normal actions taken to extreme. Here are some of the things a lot of women see when their estrogen is out of line with needs.
Low estrogen
Low estrogen starves genitourinary tissues, leading to fragility, dryness and reduced resistance to infection. This would show up as pain or even bleeding with intercourse, excessive vaginal tightness, failure of vaginal incisions to heal, vaginal or labial itching and pain (especially upon washing with soaps), multiple vaginal infections like yeast or repeated urinary tract infections, sensations of urinary tract infection without bacterial growth, and weakening of genitourinary tissues leading to incontinence (involuntary leaking of urine, especially with "urge," laughing or sneezing) or prolapse ("falling").
Low estrogen affects the skin all over the body. You may notice extreme dryness and itching that is poorly relieved by moisturizers and other cosmetic approaches. An especially odd effect, and one that crosses over into neurological realms, is called "formication," described as feeling as though ants are crawling around under your skin. This may not affect the entire body, but it is a troubling feeling and difficult to relieve with anything other than the proper level of estrogen. It is not an allergy, and may not be accompanied by any sort of rash; antihistamines normally taken for an allergic reaction are not usually effective in relieving it.
Dryness can also affect your eyes, leading to difficulty wearing contacts or change in eyeball shape such that your glasses no longer correct your vision adequately. Your nails may become brittle and so can your hair. Hair loss may occur, including male pattern baldness.
Low estrogen has a wide range of effects due to its neurotransmitter and brain receptor actions. You may feel listless, depressed, isolated, indifferent, unenergetic, weak, unable to sleep, or anxious. You may lose emotional stability and contentment, becoming moody, hair-triggered, prone to fits of tears for little obvious reason, irrational, impatient, lacking any self-esteem. You may have trouble breathing, experience irregular heartbeats ("palpitations"), or experiene anxiety attacks.
Because estrogen is so important to brain function and memory, low estrogen is often expressed as foggy thinking or forgetfulness. Nouns are particular victims of this. You may know what you want to say, but the specific word just isn't in your brain even though you know it's one you know very well. You may forget or lose things, or you may get lost yourself, unable to remember how to travel a route with which you are familiar. This can be very scary, not to mention interfering with your job, your ability to take care of your family, your life. This does not necessarily mean that you are developing Alzheimers, even though that long term picture seems also to be linked to estrogen.
Both physical energy and joint inflammation seem to be related to estrogen levels. When they dip, we may become physically fatigued beyond whatever sleep we're losing to insomnia. We may also develop creaky, aching joints, stiffness after being still, and actual symptoms or exacerbation of osteoarthritis, especially in the knees.
These are just the major things that many women have reported. Not every woman has them all—each of our bodies may show up shortfall in a different system first or group certain sets of symptoms together. And some women find that symptoms often attributed to low estrogen are, for them, more indicative of excessive levels. These are just the averages, the typicals, because we all need someplace to start when learning how to interpret what our body is telling us.
Excess estrogen
Excess estrogen leads to exaggerations of its normal effects on the body. It affects your fluid balance, such that swelling due to retained fluid may become noticeable. This may occur all over the body or just in certain susceptible areas—notably, the breasts. Fluid retention and the hormonal imbalances that cause it may lead to elevations of blood pressure. It can also cause headaches or migraines, one of the classic signs of excess. Typically this swelling is not significantly improved by the use of diuretics ("water pills") although some doctors are more comfortable with prescribing them rather than alter HRT doses.
Estrogen has a stimulating effect on breast tissue—one of its feminizing roles in the body when present in normal amounts but more problematic in excess. Fibrocystic breast disease may be attributable to excess estrogen. Breast swelling—sometimes to embarrassing and painful proportions—is another of the classic signs of estrogen excess.
Because estrogen suppresses thyroid hormone activity, an excess can lead to signs of low thyroid—some of which, like fatigue, are confusingly similar to low estrogen. Aches and pains in muscles and joints, however, may be as typical of high estrogen as low.
Estrogen in excess can dampen or altogether suppress orgasm; it may also weaken desire or arousal through its inactivation of testosterone.
Estrogen stimulates the appetite, makes you crave sweets, and can lead to weight gain from fat as well as fluid. While low estrogen may make the fat pad on your belly larger, excess estrogen will help you gain fat all over.
Estrogen causes some PMS symptoms.
Estrogen causes a variety of stimulating, over-energizing responses, probably through its action in conjunction with neurotransmitters. It can make you feel edgy, jumpy, nervous, jittery—all the things that you would expect caffeine from hell to do. To gross excess, it can actually cause seizures. It is notorious for causing insomnia, especially that characterised by difficulty falling asleep.
Just as some women notice that asthma gets worse around their periods, so do women taking HRT notice that their asthma gets worse when estrogen is too high. We haven't seen a great explanation of the physiology behind this, but we suspect that it's another neurostimulation effect.
And finally, the most counterintuitive one of all: dose "hunger." We really didn't believe this until some of us experienced it, but it seems to be that if you are really anxious to have your next dose be on time, are really hungry for it, looking forward to it, afraid to miss it, then that might be a sign that you are taking too much. The only explanation for it that we've seen, that you become a "hormone junkie," seems imaginative at best. Nonetheless, enough of us have had it happen and had it go away when we reduced our dose a smidgeon, that we are willing to acknowledge the reality of the phenomenon. It's not too convenient for reminding you to take your hormones, but when you are really and truly successfully balanced, you feel so little in need of them that you can forget to take them.
Many of us fail to have symptoms that are totally conclusive in terms of clearly indicating one direction as opposed to another. Sometimes our symptoms are directly in conflict. All we can say is to listen to your body and reread these descriptions, going for the sense of the situation behind them rather than treating them like a shopping list full of items to check off in isolation. Truly lost? Sometimes we have to take our best guess and try it out. Remember our "start low and go slow" rule? It has a corollary that says: going down is often clearer than going up.
Why is that? The situation of excess takes longer to clear, especially when we continue taking HRT, than it does to make a deficiency back up. In excess, vague things get worse. In deficit, new things often show up. For some reason, women find it easier to identify when their levels are falling into an unpleasant range than rising into (and past) an excessive one.
So if you've pondered the high estrogen and low estrogen descriptions and are just too baffled to have a sense of direction but feel as though you just have to do something, anything, because where you are right now isn't tolerable, consider that whatever the deviation, cutting your dose slightly (don't lose sight of the "go slow" part) may help you make up your mind. If things look worse, then you may have a clear sense that you need to go the other way. If things look better, giving your body some time to settle in on that change will help you make up your mind whether you need to go further. If you're down to a coin toss, then, it may help you to know that more women have felt that they have more to work with in terms of useful information gained by going down. Listen to your body, first, but if it's speaking a language you don't yet understand, you might as well maximize your chances that a blind stab in the dark will help things out.