Low Estrogen Symptoms: How to Spot Them and Start Feeling Better

Estrogen is more than just a reproductive hormone. It plays a key role in almost every part of a woman’s body and health, including cardiovascular health, sexual health, memory, mood, blood sugar regulation, bone health, and skin elasticity.

In your reproductive years, estrogen levels fluctuate each month with the menstrual cycle. But in perimenopause—which can start in a woman’s 30s or 40s—estrogen levels begin to fluctuate more dramatically. Then, as a woman nears the menopause transition, estrogen production steeply declines.

“Many women are undergoing perimenopausal hormone fluctuations or declining estrogen levels but do not recognize their symptoms, nor do their providers,” says JoAnn V. Pinkerton, M.D., Professor of Obstetrics and Gynecology.

Women may also have low estrogen for other reasons, including health conditions, certain medications, and stress.

No matter the root cause of low estrogen, you don’t have to suffer. The key is to identify the signs early and explore your treatment options.

Meet the Experts:

• Kimberly Hood, M.D., is a board-certified OB-GYN and functional medicine provider specializing in men’s and women’s hormone health, weight management, longevity, thyroid health, and sexual wellness.
• JoAnn Pinkerton, M.D., is the Mamie A. Jessup Professor of Obstetrics and Gynecology and division director of Midlife Health at the University of Virginia.

What Are the Signs of Low Estrogen in Women?

Because women have estrogen receptors all over the body, low estrogen levels can lead to a range of physical, mental, and emotional health symptoms, including:

• Irregular periods: The first sign of fluctuating estrogen during perimenopause is often an irregular period. “Some women notice midcycle spotting, due to the decline in hormones around the time of ovulation,” says Pinkerton. As estrogen levels swing from low to high in dramatic dips and peaks, you may experience missed periods, longer or shorter cycles, or heavy bleeding.
• Breast tenderness: Since the breasts have many estrogen receptors, they are highly sensitive to hormonal changes, including the rapid fluctuation from low estrogen to high estrogen in perimenopause.
• Hot flashes: There are estrogen receptors in the hypothalamus, the part of the brain that functions as the body’s thermostat. When women in perimenopause have low estrogen, the hypothalamus can become overly sensitive and reactive to small changes in body temperature. When it perceives that you’re overheating, it triggers hot flashes with flushing and sweating to cool off. ¹
• Depression, anxiety, and mood issues: Rapid shifts from low estrogen to high estrogen might affect the “feel good” chemical serotonin and GABA, a neurotransmitter, which can impact mood and mental health. Women are more likely to feel depressed or anxious during perimenopause and menopause, according to a 2024 study.² Unstable hormones can also lead to feeling irritable and angry.
• Sleep disruption and fatigue: Night sweats and hormone-driven brain changes may lead to frequent wake-ups, often leading to sleep disorders.³ It’s also a vicious cycle: Continued awakenings can lead to changes in circadian rhythms, making it even harder to get a good night’s rest.⁴
• Unintended weight gain: Low estrogen triggers weight gain through changes in metabolism, food cravings, and cortisol levels. ^{5 6} Women gain an average of 1 to 1.5 pounds per year during the menopause transition.⁷
• Urinary incontinence: Declining estrogen thins and weakens your bladder and urethra tissues. Combined with age-related muscle loss and midlife weight gain, this change can set the stage for urinary incontinence, which shows up as leaks with activity (stress incontinence), urgency, or both.
• Brain fog: Low estrogen may be linked with a decrease in the production of serotonin and dopamine, two neurotransmitters involved in cognition and memory. “Estrogen helps maintain healthy blood vessels, so the flow of oxygen and nutrients to the brain may be reduced when estrogen levels are low,” Pinkerton says.
• Joint pain: Low estrogen increases inflammation, which is partly why more than half of women experience body aches, joint pain, and stiffness (menopausal arthralgia) during the menopause transition.⁸
• Skin and hair changes: As estradiol drops, you may notice your skin and hair get thinner and drier. ⁹ After menopause, skin loses up to 30 percent of collagen, which acts like scaffolding, and up to 40 percent of its natural oils (sebum), which protects and nourishes it. ^{10 11}
• Vaginal dryness: Declining estrogen causes a thinning and drying of vaginal walls (vaginal atrophy), reducing natural lubrication and elasticity. This can make sex painful.
• Decreased libido: Lower sexual desire in menopause happens not only because of vaginal discomfort, but also due to the effect of less estradiol in the areas of the brain responsible for desire. After menopause, there are measurable differences in connectivity in brain networks related to sexual response. ^{12 13}

What Are the Lesser-Known Signs of Low Estrogen?

Not all low estrogen symptoms are well known. “There are over 30 symptoms associated with menopause, and can include itching skin, burning feet, or changes in vaginal or body odor,” Pinkerton says. Some of these weird symptoms of low estrogen overlap with other low-estrogen complaints. Itching and body odor, for example, stem from changes in skin oils that cause wrinkles and thinner skin. Here are some of the less obvious signs of low estrogen:

• Body odor
• Burning mouth syndrome
• Itchy skin
• Cold flashes
• Vivid dreams
• Wine flush
• Dizziness

What Causes Low Estrogen in Women?

The main reason for low estrogen in women is menopause, which is officially defined as a full year without a menstrual period. The average age of menopause is 51, according to the American College of Obstetricians and Gynecologists.¹⁴

Low estrogen symptoms may begin during perimenopause, when fluctuations in estrogen and progesterone can send estrogen levels spiking and crashing. As women enter menopause, the ovaries stop making estradiol (e2), the primary form of estrogen produced during the reproductive years, triggering problems related to estrogen deficiency.

Women can also have low estrogen levels due to these other possible causes:

• Surgery to remove the ovaries (oophorectomy)
• Certain medications, including breast cancer drugs, such as Tamoxifen and aromatase inhibitors
• Cancer treatments (chemotherapy and radiation)
• Primary ovary insufficiency¹⁵ (also called premature menopause, or menopause before 40)
• Stress
• Health conditions, such as pituitary and thyroid disorders
• Eating disorders and nutritional deficiencies

Low Estrogen vs Estrogen Deficiency

While low estrogen can happen at any time throughout a woman’s monthly cycle, estrogen deficiency (hypoestrogenism) is a medical condition associated with consistently low estrogen levels. ¹⁶ While the symptoms of low estrogen and estrogen deficiency are similar (hot flashes, irregular periods, breast tenderness), women diagnosed with estrogen deficiency have experienced these symptoms consistently over several months. ¹⁷

Low estrogen can be a temporary condition and might describe a woman’s current state before her estrogen levels recover naturally later in her cycle. Estrogen deficiency can occur during menopause, when the body stops ovulation and its production of estrogen. ¹⁸

Hormone Replacement Therapy for Low Estrogen

HRT is the most effective medical treatment for symptoms caused by low estrogen because it supplements estrogen and progesterone. “If a woman is struggling with symptoms, adding hormone replacement therapy will help,” says Kimberly Hood, M.D., a board-certified OB-GYN and functional medicine provider. “HRT is very effective and safe for most women.”

Hormone replacement therapy is available in:

• Patches
• Pills
• Topical creams
• Vaginal suppositories

Systemic HRT

Systemic forms of HRT commonly deliver a combination of estrogen and progesterone via an estrogen patch along with micronized progesterone in a pill. “Estrogen relaxes blood vessels, keeping blood pressure in good ranges, and if balanced properly with progesterone, can improve cholesterol levels in women,” Hood explains. “When the estrogens are not balanced with progesterone, then glucose and lipids can actually increase.” Progesterone also keeps the growth of the endometrial lining in check, which is important for preventing overgrowth and endometrial cancer.

Note: Systemic HRT is generally not recommended for women who have had estrogen receptor-positive breast cancer because it may increase the risk of a recurrence, but talk to your provider about your individual risk factors to weigh the pros and cons.

Vaginal HRT

Vaginal low-dose estrogen—available by prescription in a cream, suppository, estradiol ring and estradiol tablets—can relieve vaginal and urinary symptoms caused by low estrogen in menopause. “The tissues in the pelvis/vagina have estrogen receptors and need estrogen to stay healthy,” Hood notes. You can use vaginal estrogen alone or along with systemic HRT. You can also try DHEA creams or suppositories, which add both estrogen and testosterone.

Vaginal estrogen can also drive up libido, helping women restore a healthy sex life. “Estrogen given locally at low doses in the vaginal tissue keeps the vagina lubricated and rebuilds the vaginal cells, connective tissue, and elasticity so that sex is enjoyable,” Pinkerton says. Using a vaginal moisturizer with hyaluronic acid and a water-based lube before intercourse also helps low-estrogen vaginal symptoms, by increasing moisture and reducing friction.

Can Lifestyle Changes Help With Low Estrogen?

Healthy habits can make it easier to manage menopausal issues driven by low estrogen or fluctuating estrogen. A few strategies experts recommend include:

Focus on nutrition: Support healthy hormone levels by eating a whole food, plant-forward diet with lean protein and plenty of produce. Certain dietary choices keep blood sugar steady, manage your mood, and stave off weight gain. Including phytoestrogen-rich foods such as soy, flaxseed, sesame seeds, and nuts can help reduce the frequency of hot flashes.¹⁹

Manage stress: Stress management is crucial to hormonal health at every stage, but especially now. “As we age, the majority of our hormones are made in the adrenals,” Hood says. “So, it’s important to get good sleep and stay as low-stress as possible. When the body is stressed, the adrenals will make stress hormones and won’t make sex hormones [like estrogen] as much.” ²⁰

Prioritize sleep: Menopause messes with sleep, and that can throw off your circadian rhythm. In turn, short or broken sleep has been linked to lower estradiol, as throwing off your circadian rhythm disrupts the brain’s hormone signals that tell the ovaries to make estrogen.

To avoid this sleep challenge, get outside in the morning light, avoid caffeinated beverages and foods after noon, and stay off screens for an hour before bedtime, since blue light can disturb brain chemicals, disrupting sleep. Taking an over-the-counter sleep supplement may also help.

Which Health Problems are Linked with Low Estrogen?

Estrogen deficiency can put you at risk for other health conditions. Once you hit the menopause transition, it’s important to get checked for them:

• Cardiovascular risks (including high cholesterol and heart disease risk): Sustained estrogen loss leads to a gradual decline in HDL (“good” cholesterol) and an increase in LDL (“bad” cholesterol) as liver receptor sensitivity shifts ²¹. And a lack of estrogen leads to stiffening in the blood vessels, which raises blood pressure and increases risk for heart disease.²²
• Osteoporosis: Estrogen helps maintain bone density by balancing the activity of osteoclasts, cells responsible for bone resorption, and stimulating osteoblasts, cells responsible for bone formation. The first stage of bone loss is osteopenia, or mild bone loss, which can progress to osteoporosis (severe thinning and fracture risk). ²³
• Headaches and migraines: Drops in estrogen are a well-established trigger for migraine attacks, which can become more frequent in perimenopause. Estrogen usually keeps pain signals, blood vessel tone, and inflammation in check. When levels dip or bounce around, that balance breaks, setting the stage for migraine attacks. ²⁴

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About the reviewer

Dr. Shelly Chvotzkin, D.O., F.A.C.O.O.G., is a physician board certified in obstetrics and gynecology. She is a member of the American College of Osteopathic Obstetricians and Gynecologists (ACOG), the American Osteopathic Association (AOA), the American Society for Colposcopy and Cervical Pathology (ASCCP) and the Menopause Society (formerly known as the North American Menopause Society or NAMS).