What Women Should Know About Having Low Estrogen

Estrogen is a hormone produced in the ovaries and commonly associated with the female reproductive system. However, it is also present in small amounts in men’s bodies. Hormones are substances that regulate the activity of specific cells and organs. There are many hormones, many of which work together to release other regulatory hormones in the body. 

Estrogen is considered a sex hormone because it regulates sexual development in females. There are also synthetic (man-made) hormones used in supplementation for women with low hormone levels—such as low estrogen. 

The Function of Estrogen

Estrogen is the hormone that is primarily responsible for the sexual development in girls as they reach puberty age. Other functions of estrogen include:

• initiates changes in breast tissue during adolescence and pregnancy
• helps to regulate menstrual cycles  
• regulates bodyweight 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)
• may play a role in promoting healthy cardiovascular (heart and blood vessels) activity, according to the American Heart Association

Causes of Low Estrogen Levels

There are various health conditions that can result from low estrogen levels. This is because estrogen impacts a wide range of bodily functions (such as healthy bone development, emotional health, and more). There are several reasons that a woman’s estrogen level can be low, these include:

• any condition that damages the ovaries (such as a complete hysterectomy—a surgical procedure removing the uterus and ovaries)
• excessive exercise
• thyroid conditions
• pituitary gland dysfunction
• anorexia or bulimia (or other eating disorders)
• malnutrition (causing a woman to be severely underweight)
• Turner syndrome (a genetic defect involving only one X chromosome, which causes developmental abnormalities and infertility)
• genetic defects (causing conditions such as premature ovarian failure)
• autoimmune conditions
• long-term kidney disorder
• perimenopause (in women over age 40 who are approaching menopause)
• menopause (as a woman approaches menopause, estrogen levels continue to decline, once estrogen is no longer being produced, a woman is in menopause)
• effects of chemotherapy (medication given for cancer)

Risk Factors

There are several risk factors for low estrogen levels in women, the number one risk factor is age. As a person approaches age 40—perimenopause age—she gradually begins to experience lower estrogen levels until full menopause. Other risk factors for low estrogen include:

• having a family history of hormonal problems (which cause conditions such as ovarian cysts)
• having an eating disorder (such as anorexia)
• engaging in extreme dieting for weight loss
• participating in excessive exercise
• having pituitary gland problems

Symptoms

There are several telltale signs and symptoms of low estrogen; many of these symptoms mimic those of menopause and may include:

• Hot flashes
• Night sweats
• Insomnia
• Amenorrhea (missing periods often)
• Breast tenderness
• Headaches
• Worsening of migraines (for those with pre-existing migraines)
• Depression (as a result of lower serotonin levels, estrogen is thought to increase serotonin)
• Difficulty concentrating
• Fatigue
• Weight gain
• Infertility
• Painful sex (due to a decrease in vaginal lubrication)
• Osteoporosis (weakening of bones as a result of low estrogen levels, estrogen keeps bones healthy)
• Adverse affect on sexual development and sexual function

Diagnosis

When a woman complains of hot flashes and missed periods, the healthcare provider may assess the patient for low estrogen levels. Diagnosis may involve:

• a family history to assess for possible genetic causes of low estrogen
• a physical examination and medical history
• a blood test to check hormone levels
• an assessment of underlying causes (such as thyroid disease or a pituitary disorder)
• a brain scan or DNA testing (to evaluate abnormalities of the endocrine system)

Treatment

A common treatment for women with low estrogen levels is synthetic hormone supplementation, called hormone replacement therapy (HRT). Treatment for low estrogen may include:

Natural Remedies:

• maintaining a healthy weight
• reduction of exercise
• natural foods or supplements such as soy

Note that soy or soybean isoflavones are 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.

HRT Therapy:

There are several modes of administration the healthcare provider may choose for HRT, 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 depends on many factors including the underlying cause, severity, and symptoms of low estrogen. Basic facts about HRT include:

• Not all women qualify for estrogen therapy (it is contraindicated in women who have had conditions such as high blood pressure, heart attack or stroke).
• There are various types of HRT available, some combine estrogen with progesterone (another female sex hormone known to maintain pregnancy).
• Estrogen alone is commonly prescribed for women who have had a hysterectomy, whereas estrogen and progesterone combinations are often used for women experiencing symptoms of menopause.
• High doses of estrogen may be given to women (who are not menopausal) who have very low estrogen levels—such as those who have had hysterectomies— to prevent other hormonal imbalances, bone fractures, and heart disease.
• The healthcare provider usually prescribes the lowest dose of estrogen, or estrogen/progesterone combinations, to relieve symptoms.
• 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 a woman’s overall health and wellbeing, including her physical, emotional, and sexual health. They may also increase a woman’s risk of serious conditions, including heart disease, osteoporosis (softening of bone tissue), and obesity. 

The outcome of treatment for women with low estrogen levels varies, depending on the cause, severity, and other related factors such as the age. Treatment for low estrogen levels has improved in recent times and overall HRT can be very effective. 

Frequently Asked Questions

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

About 5% to 10% of women have some common side effects when treated with HRT. These may include mood swings, headache, fluid retention, and 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 more 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

Any women experiencing symptoms of low estrogen should consult with the healthcare provider as soon as possible. Many experts say that the earlier a woman is treated for low estrogen levels, the more effective the outcome of treatment may be. 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 if so he/she can help you decide what is best for your individual case.