Low estrogen levels: Causes, Symptoms, Diagnosis and Treatment

Estrogen is a hormone that is primarily associated with female development during puberty and the reproductive cycle.

Updated: June 16, 2022

Estrogen is a hormone that is primarily associated with female development during puberty and the reproductive cycle. But it can affect everything from bone health to emotional well-being.
Although men do produce small amounts of estrogen, it is most often associated with females. Declining estrogen can lead to a variety of health concerns and symptoms in women of all ages which could be for several reasons.

Causes of low estrogen levels:

Estrogen is largely produced by the ovaries. Any condition that affects or damages the ovaries can cause a decrease in estrogen levels in the body.
Ageing is the most significant risk factor for having low estrogen in women. It is normal for estrogen levels to drop as women age and approach menopause.
In fact, estrogen levels start to lower in perimenopause, that is the phase several years before menopause occurs.
Estrogen levels can also decline for several other reasons. These includes:

  • premature ovarian failure
  • thyroid disorders
  • excessive exercise
  • being severely underweight
  • congenital conditions, such as Turner syndrome
  • low functioning pituitary gland
  • chemotherapy

Having a family history of hormonal problems can also increase the risk of developing low estrogen in a woman.

Symptoms of low estrogen:

Symptoms of low estrogen can be quite wide ranging. These include:

Irregular periods:

As estrogen is one of the main hormones driving the menstrual cycle, low estrogen levels may lead to missed or irregular periods.


Low estrogen levels can prevent ovulation, making pregnancy difficult, leading to infertility.

Weak bones:

Estrogen helps maintaining bone health. It keeps the bones healthy and strong. Bone loss may occur with decreased level of estrogen. Post menopause, women are at higher risk of developing osteoporosis and bone fractures.

Painful intercourse:

Estrogen can affect vaginal lubrication. Vaginal dryness can occur if levels become too low, which often leads to painful sex.

Hot flashes:

Hot flashes often happen during menopause due to low estrogen levels.


Estrogen is thought to increase serotonin, which is a chemical in the brain that boosts mood. Estrogen deficiency may cause a reduction in production of serotonin that contributes to mood swings or depression.

Urinary tract infections:

Thinning of the tissue in the urethra can occur due to decreased level of estrogen, which can develop urinary tract infections more frequently.

Weight gain:

Estrogen also plays a role in weight management and how much fat the body stores. Low estrogen levels, such as during perimenopause and menopause, may contribute to weight gain. An increase in abdominal fat is associated with the decrease in estrogen level in most middle aged women. However, eating a healthy diet and getting regular exercise can help women reduce their chances of weight gain.

Diagnosis of low estrogen levels:

A diagnosis of low estrogen often begins with a physical examination, medical history, and a review of symptoms. Although hot flashes and missed periods are indicator of low estrogen levels, but some of these symptoms can also occur as a result of other conditions, such as thyroid problems.
A blood test to check hormone levels is usually done to confirm the diagnosis. Sometimes, additional tests may also be recommended to rule out other conditions that might be causing symptoms similar to low estrogen.

Treatment options for low estrogen levels:

Treatment is usually based on the cause of low estrogen and the symptoms present.

Hormone replacement therapy:

Typically, a hormone replacement therapy (HRT) is prescribed for low estrogen levels. Different types of HRT are available. Sometimes, a combination hormone therapy that contains estrogen and progesterone are used as treatment option.
This may be effective in balancing estrogen levels for women who are approaching menopause or are experiencing post-menopausal symptoms. Side effects from HRT may include bloating, headaches, and vaginal bleeding. HRT can be used orally, topically, vaginally, or have pellets inserted under the skin. It can be given in the form of injection in some instances. The dose given varies according to the individual. Usually, doctors prescribe the lowest dose to start with that relieves symptoms.
HRT may not be suitable for  women who have had a history of a stroke, heart attack, or high blood pressure. The risks and the benefits of using HRT should be discussed with your doctor.

Estrogen therapy:

In estrogen therapy only estrogen is used to treat some women with estrogen deficiency. This is beneficial for women who have had their ovaries removed. Estrogen therapy is also use to treat bothersome symptoms at menopause. In addition a few lifestyle and diet changes may help increasing the estrogen level. Being extremely underweight can cause reduced estrogen levels. Therefore a regular exercise in moderate amount can help maintain a healthy weight. Soy isoflavones present in soy product might reduce menopausal symptoms caused by declining estrogen levels. However, increasing soy may not be appropriate for all women. Therefore, consult your doctor before adding more soy or taking a soy supplement.

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