What Women Should Know About Having Low Estrogen

Estrogen is a hormone produced in the ovaries. It plays a major role in the female reproductive system.

Estrogen is a sex hormone because it controls sexual development in females. It's also present in small amounts in males. Depending on the cause and effects of low estrogen, females who have low levels are sometimes prescribed synthetic estrogen. 

The Function of Estrogen

Estrogen is the hormone that's mainly responsible for sexual development in girls as they reach puberty. 

Other functions of estrogen include:

• Initiates changes in breast tissue during teenage years and pregnancy
• Helps regulate menstrual cycles  
• Helps regulate body weight by helping to control metabolism 
• Involved in the development and growth of healthy bone tissue (prevents bone loss by promoting absorption and retention of calcium levels)
• Plays a role in promoting healthy cardiovascular (heart and blood vessels) health, according to the American Heart Association

Causes of Low Estrogen Levels

A number of different conditions can result in low estrogen levels in females.

Some causes include:

• Damage or removal of the ovaries, such as a complete hysterectomy—a surgical procedure removing the uterus and ovaries
• Excessive exercise
• Thyroid conditions
• Pituitary gland dysfunction
• Anorexia, bulimia, or other eating disorders
• Malnutrition 
• Turner syndrome, a genetic defect in which a person has only one X chromosome, instead of two sex chromosomes, which causes developmental abnormalities and infertility
• Genetic defects that cause premature ovarian failure
• Autoimmune conditions
• Chronic (long term) kidney disease
• Perimenopause, the time before menopause, during which estrogen levels fluctuate
• Menopause, which is defined as 12 consecutive months without a period, with very low estrogen
• Effects of chemotherapy

Risk Factors

Age is the number one risk factor for low estrogen. As a female approaches age 47—perimenopause age—she experiences fluctuating estrogen levels for several years until full menopause. 

A family history of hormonal problems is also a risk factor for low estrogen.

Symptoms

There are several effects of low estrogen. Many of these mimic the symptoms of menopause.

Symptoms of low estrogen may include:

• Hot flashes
• Night sweats
• Insomnia
• Amenorrhea (missing periods often)
• Breast tenderness
• Headaches
• Worsening migraines
• Depression 
• Difficulty concentrating
• Fatigue
• Weight gain
• Infertility
• Painful sex due to a decrease in vaginal lubrication
• Osteoporosis, which is the weakening of bones that can lead to fractures
• Impaired sexual development and sexual function

Diagnosis

If you have symptoms of low estrogen, your healthcare provider will likely begin a diagnostic evaluation of your symptoms. The tests your doctor selects will be determined by your symptoms, risk factors, and other medical conditions.

Diagnosis may involve:

• Family history to assess for possible genetic causes of low estrogen
• A medical history and physical examination
• Blood tests to check hormone levels
• Testing for underlying causes, such as thyroid disease or a pituitary disorder
• A brain scan
• DNA testing to evaluate genetic abnormalities of the endocrine system

Treatment

Synthetic hormone supplementation, hormone replacement therapy (HRT), is a common treatment for low estrogen in females. And sometimes lifestyle or dietary adjustments are recommended.

Natural remedies can include:

• Maintaining a healthy weight
• Reduction of exercise if you are over-exercising
• Natural foods or supplements such as soy

Note that the use of soy or soybean isoflavones in the setting of low estrogen is controversial, according to a 2010 report by Harvard Health, which explains that soy may increase the risk of breast cancer. It's best to speak to your healthcare provider before adding this or any supplement to your diet.

There are several modes of administration your healthcare provider may choose for HRT therapy, including:

• Oral (by mouth)
• Topical (such as patches or creams)
• Injections
• Subdermal (pellets inserted under the skin)
• Vaginal

The type of HRT therapy, the mode of administration, and the dosage that you are prescribed depend on many factors. These include the underlying cause, severity, and symptoms of your low estrogen. 

Basic facts about HRT include:

• Not all females qualify for estrogen therapy. It is contraindicated in people who have had conditions such as breast cancer, high blood pressure, heart attack, stroke, or another type of blood clot.
• There are various types of HRT available. Some combine estrogen with progesterone, another female sex hormone.
• When used for treating symptoms of menopause, estrogen alone is commonly prescribed after hysterectomy, whereas estrogen and progesterone combinations are used for people who have a uterus. Progesterone is needed to protect the uterine lining from cancerous changes that can occur when using estrogen alone.
• High doses of estrogen may be given to females who are not menopausal and who have very low estrogen levels—such as those who have had a hysterectomy— to prevent other hormonal imbalances, bone fractures, and heart disease.
• The healthcare provider usually prescribes the lowest effective dose of estrogen, or estrogen/progesterone combinations, to reduce the risk of side effects.
• There are many side effects of HRT including vaginal bleeding, leg cramps, headaches, nausea, breast tenderness, and more.
• The duration of HRT treatment depends on each person’s individual situation.
• Serious risks of HRT may involve conditions such as blood clots or cancer.

Takeaway

Low estrogen levels can impact many aspects of overall health and wellbeing, including physical, emotional, and sexual health. They may also increase the risk of serious conditions, including heart disease, osteoporosis, and obesity. 

The outcome of treatment for females with low estrogen levels varies. 

Frequently Asked Questions

How common is it for women to experience side effects with hormone replacement therapy?

About 5% to 10% of females have some common side effects when treated with HRT. These may include mood swings, headaches, fluid retention, stomach cramps, or bloating.

How serious are side effects of hormone replacement therapy?

Most side effects of HRT are not severe. However, HRT can rarely cause severe side effects, including double vision, depression, extreme weakness and fatigue, fever, and severe abdominal pain. If you experience these or any other concerning or persistent symptoms, call your healthcare provider immediately.

A Word From Verywell

If you are experiencing symptoms of low estrogen, you should consult with your healthcare provider as soon as possible. Many experts say that earlier treatment for low estrogen levels leads to a more effective treatment outcome. A Mayo Clinic report stated, “Some data also suggest that estrogen can decrease the risk of heart disease when taken early in the postmenopausal years.” As a rule, it's best to consult with your healthcare provider to discuss what is best for your individual case.