Is Estrogen Deficiency Even a Thing?

When I was 25, I started drinking eight glasses of water a day. 

Ever mindful of the latest health news, although much less experienced and discerning, I'd read several articles quoting doctors saying that was the amount that we needed for optimal hydration.

It was only after years in journalism that I began to question the origins of what has become my most healthy – and annoying – habit. It turns out that if you drink eight glasses of water a day, religiously, for years, eventually you must drink eight glasses of water a day, or you will feel very, very thirsty.

If I had the time and the funds, I’d trace that “8 glasses” messaging backwards from the editorial pages where I read it. I suspect it was connected to the introduction of plastic bottles. Back in the day, if I was promoting a new product, or even an old product in a new container, I'd hire a PR team, which would find a doctor who would say that we needed lots of whatever it was to be healthier. We'd find or fund some studies about it, even. Issue a press release quoting the doctor talking about the new findings about how much we needed about the new thing. And watch as that message appeared, over and over and over, in legitimate editorial pages. (Nowadays you’d do the same thing, but you’d also work extensively with influencers to get word out.)

As a journalist, I see this sort of thing all the time. That’s how the language around menopause hormone therapy, aka hormone replacement therapy (HRT), first spiked my spidey senses several years ago. And it's why I find Dr Jerilynn Prior's discussion about the frequent use of the term "estrogen deficiency" fascinating.

Dr Prior is about as credible as you can get: an American professor of endocrinology at the University of British Columbia, and scientific director at the Centre for Menstrual Cycle and Ovulation Research.

And although we see this term everywhere these days, she's not buying it.

"It is a catchall term that plays into a cultural notion that estrogen is what makes a woman a woman,” writes Dr Prior. “I am now 77 years old and am 20 years into my own menopause. Yet, I robustly argue that I am not 'estrogen deficient'. Why? Because my low estrogen and progesterone levels are normal for my age. And menopause is a normal life phase.”

She continues:

“Does 'estrogen deficiency' even exist? Not alone, it doesn’t... So, why do we keep hearing about 'estrogen deficiency'? Because it is a very effective marketing term. It was made by and for estrogen-selling companies. It implies that estrogen, and estrogen alone, is a necessary and effective treatment."

Modern medicine is a beautiful thing, and even though we may not have been designed to suffer from low hormones at menopause, we certainly have evolved to; these days our environments, toxins, longer lives, individual genetics and lifestyles and risk factors for bigger problems often render them essential.

Adding to the confusion? Medical professionals not on the same page about what to even call what happens to estrogen at this time in our life, let alone how much estrogen and progesterone we do make after menopause in other parts of our body – tissues, adrenal glands, etc. I have three books on my coffee table by three different doctors, and they all say different things, including "undetectable" and a "healthy" amount.

Either way, it's comforting when someone as experienced as Dr Prior calls out 'truthiness' when she sees it.

Dr Prior also points out that the term hormone replacement therapy, or HRT, is incorrect, and that the proper term is menopause hormone therapy, or MHT, even though almost no one uses it. No wonder: one is steeped in lack and loss; the other is not. (I personally think we should call it HTUT, for hormone topping-up therapy. Snappier acronym.)

Please understand that knowing ‘estrogen deficiency’ is a marketing term takes nothing away from how MHT, aka HRT, is being used to help people cope with the perimenopause and menopause transition. Just as the newish label “low T” (also, I suspect, a marketing creation) is helping men get the testosterone treatment they need to cope with the increasing number and severity of symptoms that accompany their andropause.

In the end, we are all being marketed to, right? And I certainly don't regret all the water I've consumed over the years.

However when it comes to something as important as my health, I will always want to know when language is being twisted by those who wish to influence my behavior, and how, and why.

Ann Marie McQueen is the founder of the global perimenopause platform Hotflash Inc; founding editor-in-chief of Livehealthy and The Livehealthy Podcast. Former features editor for The National. Former national trends writer and columnist for Sun Media.

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