Signs and Symptoms of Low Estrogen
Medically reviewed by Isabel Casimiro, MD, PhDMedically reviewed by Isabel Casimiro, MD, PhDEstrogen is a sexual and reproductive hormone. Both women and men have estrogen, but it’s much more prominent in people assigned female at birth. Estrogen is responsible for the physical changes associated with female puberty, menstrual cycle regulation, sexual desire, cognitive function, bone health, and fat metabolism. Signs of low estrogen include hot flashes, mood swings, sleep disturbances, irregular or absent periods, and vaginal dryness.Estrogen tends to peak in women during their 20s and begins to decline starting in their 40s or 50s as menopause (the end of menstruation) nears. After menopause, estrogen declines even further.Besides menopause, other causes of low estrogen include thyroid dysfunction, pituitary disorders, excessive exercise, significant stress, kidney disease, cancer treatments, polycystic ovarian syndrome (PCOS), and premature ovarian failure (POI).The symptoms of low estrogen can be confusing at times. It’s important to discuss concerning symptoms with a healthcare provider and avoid self-diagnosing. Still, it can be helpful to understand the symptoms commonly associated with low estrogen. Health recognizes that not everyone who is female was born with female reproductive organs and that not everyone who is male was born with male reproductive organs. Health also recognizes that people may not identify as any one sex or gender. The information in this article is based on how researchers present their results, and the gender- and sex-based language used most accurately reflects their research design and outcomes.
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Hot FlashesHot flashes are one of the most common symptoms of low estrogen. You will likely experience a sudden flash of heat in your face, chest, or whole body. Hot flashes that occur at night are called night sweats and can interfere with sleep.Hot flashes can range from mild to very intense. Some people only have hot flashes intermittently, while some may have them daily during menopause.Irregular PeriodsAnother common sign of low estrogen is irregular periods. You might experience longer or more unpredictable cycles, more frequent cycles, or heavier cycles.Ovulation usually doesn’t occur in these cycles, which contributes to reduced fertility. When estrogen becomes low enough, you will stop menstruating altogether.Mood ChangesWhen estrogen drops, it can significantly affect your mood. Up to 70% of people in menopause or perimenopause experience mood changes. This will look different for different people but may include:Increased irritabilityDepressionAngerAnxietyStressTrouble concentratingReduced self-confidence. Sleep difficulty and night sweats can further complicate mood changes.Weight Gain and Increased Abdominal FatLow estrogen has been linked to weight gain in women during midlife. The distribution of fat in your body also changes at this time, with more fat often accumulating in the abdominal region. This change is thought to be caused by decreased estrogen.Increased abdominal fat is linked to metabolic issues, increased blood pressure, increased cholesterol, and a higher risk of cardiovascular disease.Brain FogLower estrogen can make you feel less sharp, can make it difficult to absorb new information, and can make your brain feel foggier (sometimes referred to as “brain fog”). These cognitive changes tend to decrease when you are done with the menopause transition. If these symptoms continue past menopause, they may be caused by other factors.Difficulty SleepingPeople with low estrogen tend to have trouble sleeping. This might include having trouble falling asleep, sleeping restlessly, waking up frequently at night, or waking up in the middle of the night and not being able to fall back asleep. Night sweats may also interfere with sleep.MigrainesThe causes of migraines are usually muti-factorial, meaning that more than one factor usually causes the onset of a migraine. Still, migraines are often linked to hormonal fluctuations—specifically, drops in estrogen.Research has found that taking measures to reduce estrogen drops in menopause (such as hormone replacement therapy, or HRT) can reduce the frequency of both migraine and migraine with aura.Vaginal Dryness and Decreased LibidoEstrogen is responsible for vaginal lubrication and sexual desire. As such, when estrogen drops, you may notice decreased sexual desire as well as an increase in vaginal dryness. Increased vaginal dryness can result in pain, irritation, and burning during sex. This can further decrease sexual desire.Symptoms in Women vs. MenEstrogen is a primary sex hormone in people assigned female at birth. People assigned male at birth also have estrogen but in smaller amounts. Estrogen declines in women during the menopause transition and after menopause.Estrogen can also decline because of various medical conditions, such as thyroid disease and primary ovarian failure. Men might also experience low estrogen, which can cause symptoms like:Lower sex driveErectile dysfunction (ED)Increased abdominal fatInfertilityGynecomastia (enlarged breasts)Complications of Low Estrogen and Their SymptomsNatural menopause lowers estrogen, and this is normal. The symptoms of menopause usually pass within a few years of the transition without complications. However, some people might experience complications due to the hormonal changes. Possible complications include:Bone loss, which can increase the risk of osteoporosis and bone fracturesIncreased risk of heart attack or strokeLow estrogen can cause amenorrhea, which is the absence of a period. Non-menopausal amenorrhea may be caused by a number of different conditions, including:Inflammatory bowel disease (IBD), chronic (long-term) inflammation of the gastrointestinal (GI) tractKidney diseaseMedicationsNutritional deficienciesExcessive exercisingStressPituitary, thyroid, or adrenal disordersCancer treatmentsPolycystic ovarian syndrome (PCOS), a hormonal condition that occurs when the ovaries make more androgens (the male sex hormone) than neededPremature ovarian insufficiency (POI), a term used to describe when a person's ovaries stop functioning effectively before the age of 40Breastfeeding and the postpartum period are also associated with decreases in estrogen.Complications of low estrogen not attributed to menopause have similar complications as in women during menopause, such as increased risk of bone loss and cardiovascular disease. Other complications include infertility, urogenital atrophy (e.g., thinning, dryness, and irritation of the vaginal walls), and an overall increased risk of death.When to Contact a Healthcare Provider Reach out to your healthcare provider if you experience low estrogen symptoms that affect your daily functioning or troubling symptoms of low estrogen for the first time, such as hot flashes, migraines, irregular periods, extreme mood changes, and cognitive concerns.If you are in perimenopause or menopause, your provider can usually diagnose you with low estrogen simply based on the time of life you are in and your symptoms. If you aren’t of menopausal age, your provider may need to run lab and imaging tests to determine the cause of your possible declining estrogen.Treatment for low estrogen depends on the cause and may include:Addressing the underlying issue that is causing low estrogenTrying hormone replacement therapyUsing birth control pillsImplementing lifestyle modifications, such as dietary changes, exercise, and stress reduction
Questions To Ask Your ProviderConsider asking your provider the following questions if you want to learn more about your low estrogen symptoms:Could low estrogen be causing my symptoms, or might other factors be contributing?What are the treatment options for my low estrogen symptoms?Am I a good candidate for hormone replacement therapy?How long should I expect these symptoms to last?How might shifting my diet, physical activity habits, or stress management strategies help reduce my symptoms?
A Quick Review Estrogen is a hormone that plays a primary role in women’s reproductive and sexual health. It also affects moods, cognition, cardiovascular health, and bone health.Low estrogen is usually associated with menopause. It can also be a symptom of various conditions, including thyroid issues, pituitary issues, primary ovarian insufficiency (POI), and polycystic ovarian syndrome (PCOS).The most common symptoms of low estrogen are hot flashes, mood swings, sleep issues, irregular periods, and vaginal dryness. Reach out to a healthcare provider if you experience new or extreme symptoms. They can help determine the underlying cause and develop a treatment plan.Frequently Asked Questions
Can low estrogen cause weight gain?
In some cases, low estrogen can cause weight gain. You may notice this weight gain most prominently in your abdominal area.
How do you know if your estrogen levels are off?
You might experience irregular periods, hot flashes, mood changes, and trouble sleeping if your estrogen is low. However, these symptoms can have other causes, so getting diagnosed by a healthcare provider is important.
At what age does estrogen drop?
Estrogen tends to drop during your 40s and 50s as you move through the menopause transition. They will drop further after menopause is complete.
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