Symptoms of hypoestrogenism can manifest in a variety of mild signs and symptoms in the body including:
Vasomotor symptoms
Presentations of low estrogen levels include hot flashes. Hot flashes are sudden, intense feeling of heat predominantly in the upper body, causing your skin to redden as if you're blushing. They are believed to occur due to the narrowing of the thermonuclear zone in the hypothalamus, making the body more sensitive to body temperature changes. Night disturbances are also common symptoms associated with hypoestrogenism. Patients experience having trouble falling asleep, waking up several times a night, and early awakening with different variability between races and ethnic groups.
Genitourinary symptoms
Other classic symptoms include both physical and chemical changes of the vulva, vagina, and lower urinary tract. Genitals go through Atrophic changes such as losing elasticity, losing vaginal rugae, and increase in vaginal pH, which can lead to changes in the vaginal flora and increase the risk of tissue fragility and fissure. Other genital signs include dryness or lack of lubrication, burning, irritation, discomfort or pain, as well as impaired function. Low levels of estrogen can lead to dyspareunia and limited genital arousal because of changes in the four layers of the vaginal wall. People with low estrogen will also experience higher urgency to urinate alongside with dysuria, or painful urination. Hypoestrogenism is also considered one of the major risk factors for developing uncomplicated urinary tract infections in postmenopausal women who do not take hormone replacement therapy.
Decrease of the secretory activity of the Bartholin glands, which leads to traumatization of the vaginal mucosa and painful sensations.
The thinning of the vaginal epithelium layers caused by decreased estrogen levels can increase risk of developing inflammation and infection, such as urinary tract infection. The pH of the vagina also increases during hypoestrogenic conditions, as estrogen levels are closely linked to maintaining intracellular glycogen production. Subsequently, lower levels of glycogen relate to lower levels of lactobacilli, which usually help to maintain the vaginal acidity. With lower levels of lactobacilli, the vaginal epithelium is more prone to bacterial infections.
Diagnosis
Hypoestrogenism is typically used to diagnose other disease states such as menopause, prematureovarian failure, and functional amenorrhea. Estrogen levels can be tested through several laboratory tests: vaginal maturation index, progestin challenge test, and vaginal swabs for small parabasal cells.
Menopause
Menopause is usually diagnosed through symptoms of vaginal atrophy, pelvic exams, and taking a comprehensive medical history consisting of last menstruation cycle. There is no definitive testing available for determining menopause as the symptom complex is the primary indicator and because the lower levels of estradiol are harder accurately detect after menopause. But there can be laboratory tests done to differentiate between menopause and other diagnoses.
Functional Hypothalmic Amenorrhea
Functional hypothalmic amenorrhea is diagnosed based on findings of amenorrhea, low serum gonadotropins and estradiol <50 pg/ml, FSH<10 mIU/ml, and LH<10 mIU/ml. Diagnosis of FHA is also usually based on history of a precipitating factor such as exercise, low weight, and stress. FHA is further diagnosed based on history of menstrual problems, and after other conditions such as thyroid dysfunction, hyperprolactinemia, premature ovarian insufficiency, and polycystic ovary syndrome are ruled out. The evaluation of amenorrhea includes a view of patient's history and physical examination, biochemical testing, assessment of estrogen status, and also imaging, such as ultrasound.
Treatment
is an effective therapy for the treatment of hypoestrogenism and menopause related symptoms. HRT has been used with estrogen can be used to treat hypoestrogenism both in premenopausal and postmenopausal women. Low dose estrogen, approved by the FDA for treatment of menopause-related symptoms, can be used with or without a pro-gestational agent to improve symptoms such as hot flashes, sweating, insomnia, and vaginal dryness and discomfort.
Treatments for hypoestrogenism vasomotor symptoms include:
Common pro-gestational agents to protect the inner layer of the uterus, the endometrium, include:
Medroxyprogesterone acetate
Micronized progesterone
Norethindrone acetate
Drospirenone
Levonorgestrel
The FDA recommend HRT to be avoided in patients with a history or potential of breast cancer, undiagnosed genital bleeding, untreated high blood pressure, history of unexplained blood clots, and history of liver disease, etc.
