What Are the Symptoms of Low Estrogen?

Medically Reviewed By Sanaz Ghazal, MD, FACOG
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Low estrogen is a common occurrence after menopause. Though symptoms can vary from person to person, they can include dry skin, hot flashes, vaginal dryness, and sleep troubles. Estrogen, a hormone that affects many tissues in the body, has two key functions: help regulate your menstrual cycle and lubricate your vagina, and help preserve bone density and regulate body weight.

Estrogen levels may decline with age and significantly during perimenopause and menopause. This decline may cause irregular periods, vaginal dryness, and changes in your sex drive.  

Sex and gender exist on a spectrum. This article uses the terms “female” and/or “male” to refer to sex that was assigned at birth. 

Learn more about the difference between sex and gender here.

Keep reading to learn more about the symptoms and effects of low estrogen. The article also provides tips on managing estrogen levels and relieving menopausal symptoms. 

What are the symptoms of low estrogen?

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The most common symptoms of low estrogen include:

  • dry skin
  • tender breasts
  • hot flashes
  • vaginal dryness
  • reduced sexual interest
  • trouble falling asleep
  • changes in mood

A 2017 article explains that some people may not have noticeable symptoms of low estrogen levels, and this may increase their risk of developing complications, such as: 

  • Heart disease: Estrogen is responsible for increasing healthy cholesterol and keeping unhealthy cholesterol low. However, low estrogen levels may lead to cholesterol buildup in the arteries, increasing your risk of a heart attack.
  • Reduced bone density: If you have low estrogen levels, your bones may be more prone to weaken or fracture easily. This also tends to happen if you’re going through menopause.
  • Skin aging signs: Low estrogen may accelerate skin aging, especially after menopause. A person may notice that they have dry skin, fine lines, and wrinkles. Wounds may also take longer to heal. 

Read more about estrogen.

What causes low estrogen?

Several factors may lead to low estrogen: 

  • Age: After menopause, the ovaries do not produce as much estrogen. 
  • Eating disorders: Eating disorders such as anorexia may also cause a reduction in estrogen levels. Eating disorders can disrupt the hypothalamic-pituitary-ovary axis, which helps regulate estrogen levels.
  • Autoimmune disorders: These conditions develop when the immune system fights healthy tissue. For example, one study states some females may develop Sjogren’s syndrome or rheumatoid arthritis during menopause. The decrease in estrogen levels can increase the risk of developing autoimmune disorders and symptoms.
  • Primary ovarian insufficiency: This condition occurs when the ovarian follicles stop functioning before a person turns 40. This reduces estrogen levels and may increase the risk of conditions like osteoporosis.
  • Cancer treatment: According to the American Cancer Society, chemotherapy may damage the ovaries, preventing them from producing estrogen. The effect may be permanent or may resolve within months or years.
  • Nursing: The author of a 2017 study states that estrogen decreases before giving birth and remains like that during the nursing phase. 

What are the effects of low estrogen?

These are some of the effects that may occur in people who have low estrogen levels:

  • Irregular menstrual cycle: Estrogen helps regulate the menstrual cycle and the growth of the uterine lining. The levels increase during the first half of your menstrual cycle, which is important for ovulation. Low estrogen can cause difficulty with ovulating and irregular menstrual cycles.
  • Infertility or difficulty getting pregnant: Generally, females have higher estrogen levels, though the hormone is present in all people. Pregnancy may be difficult if estrogen levels are low. Also, low estrogen can affect sperm count and sperm health. 
  • Bone loss: A 2015 study notes that estrogen helps regulate bone metabolism. Menopause is a factor responsible for reduced bone mineral density. Estrogen protects the bones from fractures, but low levels may speed up bone loss.  
  • Pain while urinating: Urinating may be painful. You may also notice that your bladder feels painful or full even after going to the bathroom. 
  •  Pain during sexual intercourse: Authors of a 2020 study associate pain during sexual intercourse with having low estrogen. Estrogen helps support healthy vaginal tissue and lubricate the vagina, so the pain mostly occurs due to vaginal dryness. 

How are low estrogen and weight gain connected?

Research on the relationship between weight and low estrogen is limited. 

However, one study from 2017 on rats indicates that removing ovaries may lead to weight gain. This may be possible because estrogen helps regulate body weight and metabolism. 

A study from 2012 also found that the participants who had obesity and lost weight experienced a decrease in estrogen. 

What are the risk factors for low estrogen?

Age is one of the main factors that may increase the risk of low estrogen levels. 

Estrogen also allows blood to pass easily through the vessels. After age 55, estrogen levels decline, increasing the risk of heart disease.  

According to a 2017 study, if you have a close relative who has had hormonal problems, you may also be at risk of developing low estrogen.

Other possible risk factors for low estrogen include:

How is low estrogen diagnosed?

If you have any unusual symptoms or suspect you may have low estrogen, consult a doctor. To determine whether you have low estrogen, a doctor may ask about your symptoms, your menstrual cycle, and whether you have been through menopause. 

They may also perform an estrogen test to measure the levels in the blood or urine. The test may also be beneficial if you meet any of the following criteria:

  • have symptoms of menopause, such as hot flashes and night sweats
  • have difficulty getting pregnant
  • have vaginal bleeding after menopause
  • use hormonal replacement therapy

How is low estrogen treated?

Hormone replacement therapy (HRT) may be an effective treatment for people with low estrogen. 

HRT uses estrogen to replace low hormone levels and comes in skin patches, gels or sprays, implants, or tablets. 

Physicians may recommend progesterone to protect the uterus from the harmful effects that estrogen therapy may produce. This typically comes in tablets, a coil, or patches. 

HRT may help relieve hot flashes, brain fog, and vaginal dryness. 

If you have vaginal dryness or itching, ask your doctor for a prescription for estrogen tablets, creams, or rings that you can insert inside your vagina. These may also reduce the discomfort or pain you may have while urinating. 

Read more about hormone replacement therapy.

What are natural remedies for low estrogen?

Some lifestyle changes may help address low estrogen and other menopausal symptoms, such as:

  • quitting smoking, if you smoke
  • getting regular exercise
  • following a healthy and balanced diet, such as eating foods rich in fiber and nutrients
  • using sexual barrier methods, such as condoms, as these protect against sexually transmitted infections (STIs), especially if the vagina is dry
  • taking calcium supplements to support bone health

Summary

Estrogen helps regulate your menstrual cycle, protects your bones from fractures, and keeps the vagina lubricated. 

As people age, their ovaries may not produce enough estrogen, which may lead to a decline in hormone levels. This may cause irregular periods, insomnia, and hot flashes. 

A blood test can tell whether a person has low estrogen. HRT, creams, and tablets may help relieve symptoms. 

Lifestyle changes and taking supplements may relieve menopausal symptoms. 

If you experience low estrogen symptoms or believe you may be going through menopause, speak with your doctor.

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Medical Reviewer: Sanaz Ghazal, MD, FACOG
Last Review Date: 2022 Dec 6
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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