Low Estrogen

What does it mean to have low estrogen?

Estrogen is an important hormone that spurs your sexual development and helps maintain your reproductive system. It plays an essential role in other body systems, too. Estrogen levels rise and fall throughout your life, often in sync with other hormones that control important body processes, like your menstrual cycle. The ever-changing highs and lows associated with estrogen levels are normal.

Having estrogen levels that are consistently low is different. Consistently low estrogen may mean that you’re going through a natural change, like menopause. Sometimes, low estrogen is a sign of a condition that slows your sexual development, which can make it harder to become pregnant.

Who does low estrogen impact most?

Estrogen affects people assigned female at birth (AFAB) most. But everyone’s bodies make estrogen.

You’re most likely to be impacted by low estrogen if:

• You’re experiencing menopause or postmenopause. Your ovaries make the majority of your estrogen in your reproductive years. During menopause and postmenopause, your menstrual cycle stops and your ovaries no longer make estrogen. Instead, fat cells start making the majority of your body’s estrogen. Menopause officially begins when you haven’t had a period for twelve consecutive months. Postmenopause is the period that follows.
• Your ovaries were removed or injured during treatment. Your body will only produce small amounts of estrogen if your ovaries were removed as part of treatment for a condition (ex. during surgery to treat cancer). Similarly, radiation therapy can injure your ovaries so that they produce small amounts of estrogen.

How does low estrogen affect the body of a woman or AFAB person?

Low estrogen can affect your body in various ways, depending on where you are in terms of your sexual development.

Low estrogen:

• May delay puberty, slow or prevent sexual development.
• Occurs in perimenopause and menopause, often leading to painful sex, lower sexual desire and hot flashes.

How does low estrogen affect the body of a man or AMAB person?

People assigned male at birth (AMAB) with too much estrogen may experience sexual dysfunction. Still, they need some estrogen for their reproductive health and overall health. Research has shown that low estrogen levels may cause:

• Belly fat.
• Reduced sex drive.
• Bone loss and osteoporosis.

For transgender women or nonbinary people with penises, low estrogen levels may prevent their bodies from having the physical appearance they’d like. If this is the case, feminizing hormone therapy may be an option. This treatment involves taking estrogen to develop secondary sex characteristics like softer facial features, less body hair, breasts and hips.

What are the symptoms of low estrogen levels?

The symptoms associated with low estrogen in your reproductive years overlap with common symptoms associated with menopause and postmenopause. Your symptoms will depend on what’s causing your low estrogen levels.

Signs of low estrogen include:

• Dry skin.
• Tender breasts.
• Weak or brittle bones.
• Trouble concentrating.
• Moodiness and irritability.
• Vaginal dryness or atrophy.
• Hot flashes and night sweats.
• Irregular periods or no periods (amenorrhea).
• Weight gain, especially in your belly.
• Headaches before or during your period.
• Decreased sex drive and painful intercourse (dyspareunia).
• Feeling fatigued and having trouble sleeping (insomnia).

What causes low estrogen levels?

The most common cause of low estrogen is age. It’s natural for your estrogen levels to fall as you get older. Low levels unrelated to menopause may be a sign of a condition.

• Age. Estrogen levels decrease during menopause. At this point, the primary form of estrogen in your body switches from estradiol (produced primarily in your ovaries) to estrone (produced primarily in body fat).
• Eating disorders. Eating disorders like anorexia and bulimia can deprive your body of the nutrients it needs to keep your hormone levels balanced.
• Genetic conditions. Turner syndrome and Fragile X syndrome both cause low estrogen.
• Autoimmune diseases. Autoimmune diseases that attack your ovaries can prevent them from making enough estrogen.
• Primary ovarian insufficiency, otherwise known as premature menopause. With this condition, your ovaries stop producing eggs before age 40. As a result, your body goes through early menopause. Your periods stop and your estrogen levels decrease.
• Treatments impacting your ovaries. Cancer treatments, like radiation and chemotherapy, may damage your ovaries. The injury may prevent your ovaries from secreting normal levels of estrogen. Having one or both ovaries removed (oophorectomy) as part of treatment can also cause low estrogen.
• Conditions affecting your pituitary gland. Your pituitary gland secretes hormones that tell your ovaries to start making estrogen. Your body may produce low estrogen levels if your pituitary gland doesn't release enough of these hormones.
• Hypothalamic amenorrhea. If your body is stressed (ex., excessive exercise) and not getting enough nourishment, you can develop hypothalamic amenorrhea. With hypothalamic amenorrhea, your brain doesn’t release enough of the hormone that activates estrogen production in your ovaries. As a result, your periods stop entirely. Athletes assigned female at birth are particularly susceptible.

What tests will be done to diagnose low estrogen?

There are three types of estrogen that your body makes. An estrogen test can measure all three: estrone (E1), estradiol (E2) and estriol (E3). Your provider will do a simple blood draw and send it to a lab for analysis.

• Estrone (E1) is the primary hormone your body produces during menopause and postmenopause. It’s a weaker form of estrogen than estradiol (E2).
• Estradiol (E2) is the primary hormone your body produces in your reproductive years.
• Estriol (E3) is the primary hormone your body makes during pregnancy.

Estrogen can be assessed when your provider is unsure about the status of your hormones (for instance, to check the hormones of a person who is menopausal or who’s had a hysterectomy). That being said, only a couple of conditions are FDA-approved for hormone replacement therapy.

Can you increase estrogen through diet and lifestyle?

You can often address low estrogen levels related to certain behaviors by making lifestyle adjustments.

• Aim for a healthy body weight: Being underweight is a risk factor for low hormone levels. Talk with your provider about dietary changes needed to ensure you’re getting the right amount of calories each day.
• Moderately exercise: Overexercise can contribute to low estrogen. Exercise in moderation is good. Overdoing it can deplete the important resources your body needs to function.
• Reduce stress: Too many stress hormones can cause the hormones that regulate your reproductive system to become imbalanced. Incorporating stress-reduction techniques into your daily routine is good for your overall well-being and your hormones, too.
• Get enough sleep: Sleep recharges your body so that your hormones can function properly. On average, adults need from seven to nine hours of sleep each night.

What medications treat low estrogen?

Hormone replacement therapy (HT) is a common treatment for low estrogen, especially during menopause and postmenopause. With HT, you take synthetic forms of estrogen and/or the hormone progesterone to boost your levels. There are two types of HT, estrogen therapy and estrogen progesterone/progestin hormone therapy (EPT). Providers prescribe the lowest doses possible to treat your symptoms while preventing side effects.

The only FDA-approved reasons for body-wide hormone replacement therapy are low bone mineral density and hot flash treatment, typically in the form of pills or patches. Vaginal estrogen — in the form of rings, creams, and vaginal inserts — are formulated to treat vaginal dryness and painful intercourse. Sometimes "body wide" estrogen can affect the vaginal tissue. Sometimes it doesn’t. Vice versa, vaginal estrogen is not approved for the treatment of hot flashes.

It’s not unusual to need vaginal estrogen in addition to body-wide estrogen if you’re experiencing hot flashes and painful sex.

Estrogen therapy

You’ll take estrogen supplements only, with no progesterone. Your provider will only prescribe this therapy if you no longer have a uterus (ex., you’ve had a hysterectomy).

Estrogen progesterone/progestin hormone therapy (EPT)

If you still have a uterus, you’ll take a combination of estrogen and progesterone. Taking both is important because progesterone balances the action of estrogen in the uterus. Estrogen thickens your uterine lining. Too much thickening can also cause overgrowth in the uterus that can lead to uterine cancer. Progesterone prevents overgrowth.

HRT isn’t without risks. Research has shown that long-term use of combination therapy (5 years or more) may increase your risk of breast cancer, blood clots, heart attacks and stroke.

Discuss whether you’re a good candidate for hormone replacement therapy with your provider. They can talk you through any risks and side effects associated with any treatment you may receive. The most common reasons you may not be a good candidate for hormone therapy include:

• Menopause more than 10 years ago.
• A history of breast cancer, ovarian cancer or melanoma.
• History of blood clots in your legs, lungs and brain.

How can I prevent low estrogen levels?

You can’t avoid drops in estrogen associated with getting older. You can put healthy habits into place that lead to overall balance in your life – including more balanced hormones. These changes don’t always require hormone therapy. For instance, exercising in moderation and meditation can help with sleep disturbances and fatigue associated with low estrogen. Getting enough calories and the right kinds of nutrients can improve every aspect of your health. Using a lubricant can make sex more pleasurable.

Depending on what’s causing your low levels and the severity of your symptoms, you may need medicine to help. Speak with your provider about your options.

How can I increase my estrogen naturally?

Foods and supplements that contain ingredients similar to estrogen may help boost your levels. Speak to your provider before starting any regimen to increase your estrogen.

Foods that contain phytoestrogens

Phytoestrogens are plant-based estrogens. Some studies suggest that eating foods that contain phytoestrogens helps with menopause symptoms like hot flashes. Some phytoestrogens may help promote heart health, bone health and skin elasticity. More research is needed to know for sure.

Foods that contain phytoestrogens include:

• Legumes (soybeans, lentils, chickpeas, peanuts).
• Seeds (flaxseed, sunflower seed).
• Berries (strawberries, raspberries, blueberries).
• Fruits (plums, pears, apples, grapes and berries).

Supplements that contain phytoestrogens

The FDA doesn’t regulate the safety and effectiveness of supplements, so it’s important to check with your provider before taking supplements. Some supplements contain phytoestrogens similar to the ones found in foods and may help manage symptoms associated with low estrogen:

• Black cohosh.
• Red clover.

What questions should I ask my provider?

• How will I know that I need an estrogen test?
• Are my low estrogen levels a sign of a condition?
• What lifestyle changes can I put into place to manage low estrogen symptoms?
• Do I need to increase my estrogen levels to manage my symptoms?
• Would you recommend hormone replacement therapy for me? What are the risks?
• What foods, vitamins or supplements would you recommend to prevent or treat hormone imbalances?

A note from Cleveland Clinic

Many people shrug off the symptoms associated with low estrogen as an unpleasant part of getting older. But you should address symptoms that interfere with your quality of life. If you’re noticing bothersome signs of low estrogen, see your provider and discuss the hormonal and non-hormonal ways to manage your symptoms.