You might be surprised to learn that your ovarian hormones, including estrogen, have more to offer beyond the menstrual cycle and reproduction. These hormones affect all tissues and systems in the body and are integral to the health of your brain, heart, bones, and more. That’s why there are real health risks that come with low hormone levels in women.
When you lose your ovarian hormones via menopause, early menopause, or surgery, it has body-wide impacts.
In this article, I will dive into ovarian insufficiency, the menopausal transition, and the health consequences of low hormone levels. We’ll also discuss the role of hormone replacement therapy (HRT) and how you can support your body if you choose to replace hormones.
Hormone replacement is a topic wrought with controversy and the leftover consequences of the faulty science behind the Women’s Health Initiative study that made women afraid of hormone replacement. Luckily, the most up-to-date research gives us new understandings of the topic and an appreciation for all the benefits our hormones provide.
Low Hormone Levels and Ovarian Insufficiency
Menopause is the primary reason that most women experience low hormone levels. The postpartum period is another life phase where you experience a drop in estrogen and progesterone.
Menopause occurs when the ovaries stop producing ovarian hormones, including estrogen, progesterone, and testosterone. For most women, this happens gradually and naturally. However, for some women, it may occur prematurely or abruptly. Let’s talk about each case.
The Menopausal Transition
The menopausal transition, also known as perimenopause, is the transition to menopause and the loss of hormones produced by the ovaries. Menopause is the one-year mark after your last period; after that, you are considered post-menopause.
Perimenopause begins at the first menstrual irregularity and ends at menopause. It may last for seven to 10 years before your last period and is associated with symptoms of fluctuating and eventually low hormone levels.
At first, you may notice irregular and anovulatory cycles (cycles where you don’t ovulate). When you don’t ovulate, you won’t produce the progesterone to balance estrogen and may experience symptoms of estrogen dominance, such as heavy bleeding, sore breasts, and PMS symptoms.
Over time, your cycles may become farther and farther apart, and you may experience the symptoms of low estrogen that are commonly thought of as perimenopausal or menopausal symptoms. Your ovaries will eventually stop ovulating, which means you’ll stop producing progesterone, and testosterone levels will also decline.
Low Estrogen
Symptoms of low estrogen include:
- Hot flashes
- Night sweats
- Weight gain
- Vaginal dryness
- Low libido
- Fatigue
- Recurrent UTIs
- Mood swings
- Anxiety
- Depression
- Insomnia
- Brain fog
Early Menopause aka Premature Menopause
When menopause occurs early, sex hormones drop before their time and your body functions that depend on hormones don’t work as efficiently. Early or premature menopause is known as premature ovarian insufficiency, or primary ovarian insufficiency. It occurs when there is a loss of ovarian function prior to the natural age of menopause. Early menopause is a natural, gradual transition that resembles perimenopause—except it starts at an earlier age.
Early menopause may occur because of genetic factors, autoimmunity, infections, certain medications, or other underlying mechanisms. Cancer treatments, including chemotherapy and radiation, may induce menopause prematurely.
Health issues may arise when crucial hormones drop too low, too early for too long. Early menopause risks include early mortality and long-term consequences to the heart, bones, brain, and sexual health.
Doctors often prescribe hormone replacement therapy as a primary ovarian insufficiency treatment, which mitigates some of these risks.
What Age is Considered Early Menopause?
Natural menopause occurs between the ages of 45 and 55, with the average age around 51. When periods stop before age 45, it’s considered premature ovarian insufficiency, or early menopause.
Five percent of women will enter menopause early, before age 45. And around 1% will enter menopause prematurely before the age of 40.
Oophorectomy
Oophorectomy, or the surgical removal of the ovaries, brings on an abrupt loss of ovarian hormones, resulting in much lower estrogen, progesterone, and testosterone. The procedure disrupts the HPO-axis (hypothalamic, pituitary, ovarian axis), the communication between the brain and ovaries.
The specific procedure is salpingo-oophorectomy and typically occurs along with a hysterectomy, or the surgical removal of the uterus.
A total hysterectomy with unilateral salpingo-oophorectomy is the removal of the uterus, one ovary, and the fallopian tube on that side.
A total hysterectomy with bilateral salpingo-oophorectomy is the removal of the uterus, both ovaries, and both fallopian tubes, which is the most common type of hysterectomy—even with benign disease.
The removal of the ovaries, especially prior to natural menopause, is associated with mortality and long-term health consequences, including:
- Coronary heart disease
- Dementia
- Parkinson’s disease
- Osteoporosis
- Mood disorders
- Sexual dysfunction
- And more
- All-cause mortality
The risks of bilateral oophorectomy depend upon age and the use of HRT after surgery, which offers some protection against long-term consequences. There is a current movement towards preserving ovaries in women who undergo hysterectomies, especially in younger women, because of the profound health consequences of early hormone loss.
Negative Health Outcomes Associated with Low Hormones
No matter when or how you go through menopause, the loss of estrogen and other ovarian hormones is associated with the acceleration of the aging process. Chronic disease risk increases with aging—referring to not only chronological age but also the wear and tear on your tissues and organs. Let’s look at some health outcomes of low ovarian hormones.
Dementia
We’ve discussed the connection between brain health and hormone balance before, and the connection becomes clear when we think about menopause. Many of the perimenopausal symptoms are brain-related symptoms (hot flashes, brain fog, mood changes) and result from a drop in estrogen in the brain.
Removing the ovaries before menopause is associated with a two-fold increase in dementia risk and Alzheimer’s disease. In addition, those who’ve undergone a unilateral or bilateral oophorectomy prior to natural menopause also have an increased risk of Parkinson’s disease. The earlier the age of the oophorectomy, the greater the risk.
Estrogen hormone replacement therapy helps mitigate the risk by offering neuroprotective effects, but timing matters. Administration needs to begin early in the menopausal transition. Beginning HRT in older women who are past their transition may increase dementia risk.
Osteoporosis
Estrogen is also crucial for bone health. Bone cells have estrogen receptors, and estrogen offers protective effects. Bone loss correlates with a decline in estrogen, and menopause is a risk factor for osteoporosis.
In natural menopause, most bone loss occurs over a five-to-seven-year period, with loss peaking around three years after the final period. Then, there is a smaller annual decline. Bone loss rates are higher in those who experience early menopause and oophorectomy.
Resistance training along with adequate calcium and vitamin D intake can help keep your bones as strong as they can be in the face of hormone effects.
Cancer
The connection between ovarian hormones and cancer is more nuanced. Menopause isn’t the cause of cancer, but cancer risk does increase with age.
Those who go through menopause late, after age 55, may have an increased risk for cancer. However, these women also have a lower risk of mortality and a greater lifespan, suggesting the protective effects of ovarian hormones.
While removing the ovaries reduces the risk of ovarian and breast cancer quite significantly, it may also increase the risk of lung cancer, heart disease, dementia, psychiatric symptoms, osteoporosis, and all-cause mortality. (Read more about the connection between estrogen and breast cancer here).
In addition, some cancer treatments send women into early menopause and bring the associated risks of chronic disease and mortality.
Heart Disease
Heart disease remains the number one cause of death for American women, and declining hormones could be a factor.
Estrogen supports all aspects of the cardiovascular system. Estrogen protects the endothelium (cells that line blood vessels), promotes nitric oxide production (allowing blood vessels to dilate), and has anti-inflammatory and antioxidant actions.
The loss of ovarian estrogen disrupts cardiometabolic health, increasing oxidative stress, inflammation, and strains the cardiovascular system.
Premature menopause may put additional strain on the heart and is associated with an increased risk of coronary heart disease, heart attacks, and stroke.
All-Cause Mortality
Premature menopause increases the risk of early mortality and overall mortality. Interestingly, later age with natural menopause is associated with longevity, suggesting the protective effects of prolonged exposure to ovarian hormones.
Primary Ovarian Insufficiency Treatment and HRT
Hormone replacement therapy, HRT, is a supportive treatment for many women in perimenopause, and especially for those with primary ovarian insufficiency (early menopause).
For those who go through early menopause or have an oophorectomy, HRT may lessen some of the risks associated with low ovarian hormones, including:
- Dementia
- Depression
- Anxiety
- Osteoporosis
- Heart disease
- Early death
There are benefits to replacing hormones to premenopausal levels for those experiencing early menopause until they reach the age of natural menopause.
Estrogen Replacement Therapy
New research suggests using estrogen replacement therapy, combined with progesterone, for the primary prevention of heart disease. Clinical researchers suggest initiating hormone replacement therapy early, along with the cessation of ovarian hormone production.
There are many options available for HRT for women, including bioidentical or human-identical preparations. Please consult with your healthcare provider for discussions around hormone replacement therapy, if it’s a good fit for you, and what options are available.
Nutritional Support for Women in Hormone Replacement Therapy
Whether your body is making your hormones or you are taking them through HRT, liver and gut health are essential for proper hormone levels. Your liver and digestive system help detox and clear excess hormones from the body so that you don’t end up with imbalanced hormones. In fact, supporting these pathways prior to hormone therapy is advised to increase tolerance.
Work with your naturopathic doctor for personalized testing and guidance around diet, lifestyle, and supplemental support.
Cruciferous Vegetables
Cruciferous vegetables, including kale, brussels sprouts, broccoli, cabbage, cauliflower, and others, provide sulfur-rich compounds, like I3C, DIM, and sulforaphane, that support estrogen detoxification in the liver.
In addition to cruciferous veggies, an overall plant-rich diet offers fiber, essential nutrients, and phytonutrients to promote hormonal health and overall wellness.
Supplementation
The ovaries aren’t the only site of sex hormone production. The adrenal glands also produce some estrogen, progesterone, and testosterone. With the ovaries offline in menopause, adrenal hormone production becomes more important. Stress, toxins, trauma, and modern life impact adrenal function. Most of us could use a little support in this area.
Adrenal Support is a comprehensive formula that helps the body adjust to stress. It combines essential stress-busting vitamins and a blend of adaptogenic herbs to support energy and vitality. It may be a helpful addition to your supplement plan in menopause.
Other supplements to consider while using hormone replacement therapy include Magnesium Plus, Women’s Twice Daily multivitamin, Balance – Women’s Hormone Support and Women’s Probiotic.
To help your body adjust to HRT and find the balance your body needs, check out my Period Problems Kit. I’ve included Balance to support healthy levels of estrogen, progesterone and testosterone, Adrenal Support to support your adrenal glands and the body’s stress response, and my Women’s Probiotic for overall gut and vaginal health.
Takeaway
Menopause and low hormones don’t mean the same thing for you as they did for your mom. Hormone replacement therapy for women is a powerful tool to help smooth the menopausal transition and reduce the health risks associated with early menopause. If HRT is right for you, use it in the context of a healthy diet, active lifestyle, and smart supplementation to feel strong and vibrant for decades to come.
References
- Santoro N.. Perimenopause: From Research to Practice.. J Womens Health (Larchmt).. 2016. 25. 332-339.
- de Kruif M, Spijker AT, Molendijk ML. Depression during the perimenopause: A meta-analysis.. J Affect Disord.. 2016. 206. 174-180..
- Shadyab AH, Macera CA, Shaffer RA, et al.. Ages at menarche and menopause and reproductive lifespan as predictors of exceptional longevity in women: the Women's Health Initiative.. Menopause.. 2017. 24. 35-44.
- Faubion SS, Kuhle CL, Shuster LT, Rocca WA.. Long-term health consequences of premature or early menopause and considerations for management.. Climacteric.. 2015. 18. 483-491.
- Gersh FL, Lavie CJ. Menopause and hormone replacement therapy in the 21st century. Heart. 2020. 106. 479-481.
- Australasian Menopause Society.. Adverse long-term health outcomes associated with premature or early menopause. Australasian Menopause Society..
- Muka T, Oliver-Williams C, Kunutsor S, et al.. Association of Age at Onset of Menopause and Time Since Onset of Menopause With Cardiovascular Outcomes, Intermediate Vascular Traits, and All-Cause Mortality: A Systematic Review and Meta-analysis.. JAMA Cardiol. 2016. 1. 767-776.
- Gersh FL, O'Keefe JH, Lavie CJ.. Postmenopausal hormone therapy for cardiovascular health: the evolving data.. Heart. 2021. 107. 1115-1122.
About The Author
