Low estrogen is a normal part of aging, but low levels at a younger age may be associated with atypical sexual development. If you’re experiencing hot flashes or you’re older than 16 and haven’t gotten your period, call your provider.
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.
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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:
Low estrogen can affect your body in various ways, depending on where you are in terms of your sexual development.
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:
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.
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:
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.
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.
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.
You can often address low estrogen levels related to certain behaviors by making lifestyle adjustments.
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.
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).
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:
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.
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.
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:
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:
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.
Last reviewed by a Cleveland Clinic medical professional on 02/08/2022.
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