Have you been experiencing hot flashes, night sweats, unexplained breast tenderness, or weight gain? If so, you might want to make an appointment with your endocrinologist or gynecologist to test your estrogen levels. While your hormone levels fluctuate monthly with your menstrual cycle, they also change as you age. This is normal, but a sharp drop in estrogen may require medical intervention, depending on the severity of the symptoms. Symptoms of low estrogen can appear at any phase of life, depending on your family history. But most commonly, they're associated with perimenopause and menopause. In fact, it's during menopause that women cease producing adequate amounts of estrogen, and in some cases, require estrogen therapy. Low estrogen levels can lead to a number of health risks, so understanding the symptoms and how you might be able to both treat them and address the root cause is crucial for your overall health and well-being.

What Does Estrogen Do?

Estrogen is one of the two primary female sex hormones. The other is progesterone. You begin developing estrogen as your body prepares to have your first period. Estrogen is the hormone responsible for preparing your uterine lining for pregnancy. Therefore, it’s a critical ingredient in fertility and reproduction. It's also responsible for secondary sex characteristics, including breast development, pubic hair, and underarm hair (1). Men also produce a small amount of estrogen, but testosterone is their primary sex hormone. Along with playing a vital role in female appearance and reproductive ability, estrogen also regulates other significant functions of your body. It helps maintain bone density for both men and women, preventing brittleness and osteoporosis (2). It also provides a check on cholesterol levels and weight, keeping them in a healthy range. What’s more, estrogen plays a role in maintaining body temperature, vascular health, and organ health, including brain, skin, heart, and other tissues of the body (1).

Symptoms of Low Estrogen

After reading what estrogen does, you might be able to guess at least a few of the potential symptoms of low estrogen, also known as estrogen deficiency. You may also know the typical menopausal symptoms, which overlap with low estrogen symptoms quite a bit. That's because menopausal and postmenopausal women produce much less estrogen than women of reproductive age (1)(2)(3). Low levels of estrogen may cause the following common symptoms:

• Irregular periods
• Absence of periods (amenorrhea)
• Bone loss or osteoporosis
• Unexplained weight gain
• Foggy-headedness and concentration issues
• Mood swings and depression
• Hot flashes or night sweats
• Urinary tract infections
• Vaginal dryness and thinning vaginal skin
• Dry skin and thinning hair
• Trouble sleeping or insomnia

If you've experienced more than a few of these symptoms persistently, you may want to talk to your doctor. These symptoms could mean that you're entering perimenopause, but it's good to know for sure that you don't have some other hormone imbalance.

Risk Factors for Developing Low Estrogen

Risk factors for low estrogen can be genetic or affected by lifestyle factors. Genetic predispositions toward early menopause, for example, are hereditary. Meanwhile, some hormonal imbalances like PCOS (polycystic ovarian syndrome) may be related to both family history and lifestyle factors. In the case of PCOS, dietary changes, exercise, and stress management can help rebalance hormones. But you may still deal with some symptoms of the condition. If you have a medical issue like painful endometriosis that ends up requiring a hysterectomy (the removal of your uterus and potentially your ovaries), it will likely affect your hormone levels (1)(4). Other factors that could lead to a reduction in estrogen production and a potential hormone imbalance include (4):

• Excessive or compulsive exercise
• Eating disorders like anorexia nervosa
• Rapid, unhealthy weight loss or dieting
• Extreme physical or emotional stress that leads to amenorrhea
• Malnutrition
• Malfunctioning pituitary gland

Health Consequences of Low Estrogen

Decreasing estrogen levels in midlife are normal. But it isn't without consequences. We've already reviewed the most common symptoms of low estrogen, but we haven't discussed the potentially dangerous health consequences to look out for. Because the side effects of having low estrogen can lead to potential health problems, it's crucial to have a women's health doctor as you age. A sharp decrease in estrogen also brings a greater risk for heart attack and stroke, especially for menopausal women. That's because estrogen is such a significant hormone for regulating cholesterol and maintaining heart and vascular health. It helps keep HDL (good cholesterol) up and LDL (bad cholesterol) down. It also helps regulate blood pressure and the smooth muscles of the vascular system. We also know that estrogen helps you maintain a healthy weight, which is why it can be more challenging to stay trim as you age. And weight gain, especially midsection body weight, is associated with metabolic syndrome and cardiovascular disease(5). It's especially important for women with low estrogen, or those entering menopause, to avoid risky lifestyle choices associated with heart disease, including smoking, a sedentary lifestyle, and poor eating habits that could lead to the development of type 2 diabetes (5).

Addressing Symptoms of Low Estrogen

There are both conventional and complementary alternative treatments to help your body ease into the change of life. During perimenopause or menopause, some women experience unpleasant symptoms while others don't notice as many dramatic changes. If you're experiencing hot flashes, night sweats, and mood swings, you might feel the need for an aggressive intervention like hormone replacement therapy (HRT). This conventional medical option works well for some, but it isn't for everyone as it comes with notable side effects and contraindications. For example, it's not recommended if you've had a history of breast cancer or fibrocystic breasts, uterine or endometrial cancer, liver or gallbladder disease, or a history of blood clotting. There’s also a new recommendation that women with a history of heart disease should not take HRT. This recent recommendation—based on relatively new research—contradicts previous medical advice, so it’s something to thoroughly evaluate with your health care professional (5). If none of these risk factors applies to you, HRT might be a good fit to help you with hot flashes, insomnia, mood swings, loss of sex drive, vaginal dryness, and reducing the risk of osteoporosis (6). These symptoms of low estrogen can be treated with HRT using either estrogen therapy or progestin (synthetic progesterone) therapy. Some women also opt for hormonal birth control pills to help regulate their hormones, especially if they're of childbearing age. While it's not recommended that women take these measures indefinitely, these options offer a potentially more pleasant transition for perimenopausal and menopausal women. There are also many natural remedies for perimenopause symptoms, including lifestyle and diet changes and a number of herbs and supplements. Along with alleviating symptoms, some herbal remedies may help keep your heart and bones healthy. Balancing your gut microbiome is another potential change you could begin making to help balance your hormones. There's growing research showing that the estrobolome—the population of gut bacteria that metabolize estrogen—plays a key role in helping keep hormone levels healthy. Many symptoms of an imbalanced estrobolome overlap with symptoms of low estrogen, so the diet and lifestyle interventions are similar. These include eating lots of vegetables to feed healthy bacteria, avoiding smoking, and maintaining a healthy weight. However, synthetic hormones and birth control aren't recommended for balancing the estrobolome.

Living Your Best Life

A decrease in estrogen is a natural part of getting older, but the symptoms don't have to be overwhelming. Hormonal imbalances can have a pretty frustrating effect on your daily life if they go unchecked. Symptoms of low estrogen can range from mild inconveniences to severe discomfort. They can also lead to real health problems, so it's crucial to talk to your doctor if you're experiencing more than a few symptoms on the list. It's especially important to monitor your symptoms if you're of childbearing age and not expecting “the change” just yet, as it could be a sign of something more serious like PCOS or another hormonal imbalance. Knowing your options—whether you go with the conventional medical route, an alternative approach, or some sort of complementary hybrid—is the first step in addressing the problem. Whatever steps you take, make sure you're working with a women's health professional (MD, ND, or herbalist) to help guide you through the process.