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Low Estrogen

What to do if you’re experiencing hot flashes, mood changes, or vaginal dryness.

Low estrogen is a hormone deficiency that can be caused by underlying health problems like autoimmune diseases and treatments such as chemotherapy.

But the most common cause of low estrogen is menopause. This is a natural process that usually occurs during midlife, when estrogen levels drop and your menstrual periods end.

Low estrogen can lead to a range of symptoms, such as hot flashes, poor sleep, vaginal dryness, and mood changes.

Low estrogen also has long-term effects on your health, including low bone density and an increased risk of fractures. It can also raise your cholesterol levels and thicken your blood vessels, which raises the risk of heart disease and stroke.

See your doctor if you have symptoms of low estrogen. If you have low estrogen at a young age or your symptoms are affecting your quality of life, your doctor can prescribe hormone replacement therapy and other medications to treat the symptoms such as antidepressants. These can both treat your symptoms and provide protection from long-term effects like bone loss.

What does estrogen do?

Estrogen is a sex hormone responsible for normal female reproductive function and the development of female organs such as the breasts, vagina, uterus, and ovaries.

Estrogen also plays an important role in the health of your bones, the cardiovascular system, and the brain. The long-term effects of low estrogen include low bone mineral density and changes in cholesterol and blood vessel thickness. These changes can increase risk of osteoporosis, coronary artery disease, and stroke.

Symptoms

Pro Tip

While women tend to gain weight in middle age, low estrogen does not seem to cause weight gain. Women in late stages of menopause also tend to have increases in cholesterol levels, but those changes also do not correlate with weight. It’s important to maintain a healthy diet and regular exercise routine. —Dr. Rachel Arakawa

Causes of low estrogen

1. Menopause

Symptoms

Menopause is when there’s a natural decline in estrogen in women, causing ovulation and menstruation to stop. The transition usually begins between the ages of 47 and 55, and is finished when a woman does not have a period for 12 months. Hormone fluctuations and symptoms typically begin several years before your final period.

Some women do not need any treatment, but if hot flashes or other symptoms are too disruptive or uncomfortable, you can take hormone replacement therapy. This contains estrogen (and sometimes progestin) in the form of pills or skin patches. Vaginal estrogen can be applied locally for relief of vaginal dryness and pain with intercourse. Women usually take these for the short term, until the symptoms subside.

2. Surgery

Symptoms

  • An abrupt stop of menstrual periods
  • Hot flashes

If a woman has a hysterectomy and has both ovaries removed, it causes low estrogen and triggers medical menopause.

Treatment includes estrogen alone to mimic the daily production of estrogen by the ovaries. It’s usually given through a skin patch or a vaginal ring. The doses are typically higher than those given to women who reach menopause naturally.

3. Premature ovarian insufficiency

Symptoms

  • Hot flashes
  • Irregular menstrual cycles
  • In some cases, failure to ever develop a period or develop female features such as breasts

If you go through menopause before age 40, it’s referred to as premature ovarian insufficiency. Known causes are genetic diseases such as Turner syndrome, and autoimmune diseases where the body develops antibodies against the ovaries. In some cases, the cause is unknown.

Treatment includes estrogen and progestin replacement at higher doses than what’s given for natural menopause. In some women, a combined oral contraceptive pill can be used.

Pro Tip

Estrogen is produced by granulosa cells of the ovary. Signaling hormones from the pituitary gland stimulate estrogen release and eventually the release of an egg in the middle of the menstrual cycle—called ovulation. Smaller amounts of estrogen come from the adrenal glands, which are located above each kidney, as well as fat tissue. —Dr. Arakawa

4. Medical treatments

Symptoms

  • Irregular periods
  • Temporary loss of periods
  • Complete loss of periods and hot flashes depending on the drug and its dosage

Women taking anti-estrogen medication for breast cancer or endometriosis can experience low estrogen levels. Chemotherapy, radiation, and some viruses are also toxic to the ovaries and can cause low estrogen.

Sometimes low estrogen can be temporary and levels will return to normal after the medical treatment is stopped. Women with permanently low estrogen levels may consider hormone therapy with estrogen and progestin as well as egg freezing to preserve future fertility.

5. Hypothalamic-pituitary dysfunction

Symptoms

  • Headaches
  • Blurry vision
  • Milky discharge from the nipples
  • Loss of menstrual periods

Hypothalamic-pituitary dysfunction causes the pituitary gland at the base of your brain to grow and produce excess hormones such as prolactin. Prolactin suppresses other hormones that normally stimulate the release of estrogen from the ovaries, lowering estrogen levels.

In most cases prolactin levels can be lowered with medication. Less commonly, pituitary gland surgery is required.

When to call the doctor

Call your doctor if you don’t get your period for more than 6 months, and you’re not around the age of menopause (late 40s to early 50s). You should also see your doctor if your symptoms are hard to tolerate or disruptive. There are treatments that can ease your symptoms and improve your quality of life.

Should I go to the ER for low estrogen?

Rarely, low estrogen can occur with conditions that cause low cortisol, a stress hormone produced by the adrenal glands. These conditions can be serious. You should go to the ER if you’re experiencing nausea, vomiting, abdominal pain, dizziness, or low blood pressure.

Treatment

Hormone replacement therapy (HRT) is a common treatment for low estrogen. Estrogen comes in the form of oral tablets, or it can be applied to the skin in a cream or patch. HRT does increase risks of breast and uterine cancers. If you haven’t had your uterus removed, your doctor may also prescribe progestin to help prevent uterine cancer.

Hormone therapy is not recommended if you have had breast or endometrial cancer, blood clots, coronary artery disease, or liver disease. If you have had blood clots, you may be able to take estrogen vaginally in the form of rings, suppository tablets, or creams. These are less likely to cause clots.

Weaker estrogens, called selective estrogen receptor modulators, can also be used to prevent bone loss without increasing the risk of uterine and breast cancers.

Dr. Rx

Don’t be afraid to discuss mood symptoms with your doctor. Almost half of all menopausal women experience symptoms of anger, irritability, depression, anxiety, and loss of self-esteem.  Some treatments aim to target both the physical and emotional symptoms of low estrogen. —Dr. Arakawa

Non-hormone therapy

If hormone therapy isn’t advised, your doctor may suggest you take an antidepressant medication such as venlafaxine or paroxetine to treat hot flashes. Drugs that target nerve pain, such as gabapentin, may also reduce hot flashes.

At-home care

Non-prescription treatments for low estrogen are generally safe but are not proven to be effective. Some people have found relief from hot flashes by eating soy and taking red clover and black cohosh supplements. Vitamin E and omega-3 fatty acids have also been used as alternative treatments for hot flashes and depression.

There are several ways to treat symptoms:

  • Avoiding triggers of hot flashes (such as spicy foods and hot beverages).
  • Using lubricants when you have sex.
  • Use vaginal moisturizers (Replens, Vagisil)
  • Limiting alcohol and caffeine, which may worsen your sleep problems.
  • Practicing relaxation techniques (such as deep breathing) to reduce stress.
  • Quitting smoking.
  • Exercising regularly and eating a balanced diet, which can help limit bone loss and improve your heart health.
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