Genitourinary
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 increasing of 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 limited genital arousal and cause dyspareunia, or painful sexual intercourse because of changes in the four layers of the vaginal wall. People with low estrogen will also experience higher urgency to urinate and dysuria, or painful urination. Hypoestrogenism is also considered one of the major risk factors for developing uncomplicated urinary tract infection in postmenopausal women who do not take hormone replacement therapy. Bone health
Estrogen contributes to bone health in several ways; low estrogen levels increase bone resorption via osteoclasts and osteocytes, cells that help with bone remodeling, making bones more likely to deteriorate and increase risk of fracture. The decline in estrogen levels can ultimately lead to more serious illnesses, such as scoliosis or type I osteoporosis, a disease that thins and weakens bones, resulting in low bone density and fractures. Estrogen deficiency plays an important role in osteoporosis development for both genders, and it is more pronounced for women and at younger (menopausal) ages by five to ten years compared with men. Females are also at higher risk for osteopenia and osteoporosis.
HRT can be used with or without a progestogen to improve symptoms such as hot flashes, sweating, trouble sleeping, vaginal dryness and discomfort. The FDA recommends HRT to be avoided in women with a history or risk of breast cancer, undiagnosed genital bleeding, untreated high blood pressure, unexplained blood clots, or liver disease.HRT for the vasomotor symptoms of hypoestrogenism include different forms of estrogen, such as conjugated equine estrogens, 17β-estradiol, transdermal estradiol, ethinyl estradiol, and the estradiol ring. In addition to HRT, there are common progestogens that are used to protect the inner layer of the uterus, the endometrium. These medications include medroxyprogesterone acetate, progesterone, norethisterone acetate, and drospirenone.Non-pharmacological treatment of hot flashes includes using portable fans to lower the room temperature, wearing layered clothing, and avoiding tobacco, spicy food, alcohol and caffeine. There is a lack of evidence to support other treatments such as acupuncture, yoga, and exercise to reduce symptoms. In men
Estrogens are also important in male physiology. Hypoestrogenism can occur in men due to hypogonadism. Very rare causes include aromatase deficiency and estrogen insensitivity syndrome. Medications can also be a cause of hypoestrogenism in men. Hypoestrogenism in men can lead to osteoporosis, among other symptoms. Estrogens may also be positively involved in sexual desire in men. See also
Estrogen insensitivity syndrome
Aromatase excess syndrome

References


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