What happens when estrogen levels are low?

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People with low estrogen do not always have symptoms. If symptoms do occur, they may resemble those of other conditions. As a result, it can be hard to determine whether someone has low estrogen based on symptoms alone.

As a person gets close to menopause, they may notice symptoms such as irregular periods, hot flashes, and vaginal dryness. Other symptoms of low estrogen, which may happen during or outside of menopause, include:

• absent or irregular periods
• bone fractures due to osteoporosis
• infertility in males or females
• decreased libido in males or females
• erectile dysfunction in males
• high cholesterol or high triglycerides
• coronary heart disease

Estrogen levels vary for many reasons. One of the most important factors is age.

In males and females, estrogen levels increase during puberty. For females of reproductive age, hormonal fluctuations during the menstrual cycle also mean that estrogen levels are constantly rising and falling. In perimenopause, the first stage of menopause, estrogen levels begin to decline.

Some health conditions can also decrease estrogen. In females, any condition that affects the ovaries may decrease estrogen levels. In males, conditions that cause low testosterone may also cause low estrogen.

Health conditions or circumstances that may lead to low estrogen include:

• polycystic ovary syndrome
• thyroid disorders
• low functioning pituitary gland
• recent experience of giving birth
• breastfeeding
• low body weight
• congenital conditions such as Turner syndrome
• chemotherapy
• primary ovarian insufficiency

Estrogen is essential to many bodily functions in people of all sexes. Effects of low estrogen include:

• Irregular periods: Estrogen helps regulate the menstrual cycle. Estrogen levels rise right before ovulation and again halfway through the luteal phase, which is the second half of the cycle after ovulation. If this does not happen, a person may experience late, skipped, or absent periods.
• Infertility: Because estrogen has a significant impact on the menstrual cycle, low estrogen can cause difficulty getting pregnant in females. In males, low estrogen may affect sperm count, sperm health, or libido, potentially impacting the ability to conceive.
• Osteoporosis: Estrogen helps protect the bones. When estrogen levels drop, a person may develop osteoporosis and have a higher risk of bone fractures.
• Pain during intercourse: Estrogen helps the vagina lubricate itself. If a person develops vaginal dryness, they may find sexual intercourse painful.
• Urinary tract infections (UTIs): Decreased estrogen can thin the vaginal tissues, increasing the risk of UTIs.
• Mood changes: According to a 2018 review article, females are more susceptible to depression during certain stages of life in which hormonal fluctuations are frequent.

Effect on weight

The effect of estrogen on body weight is complex, and researchers do not yet fully understand it.

Research on animals suggests that removing rats’ ovaries triggers weight gain. This may be because estrogen helps regulate the metabolism, so having low estrogen slows it down. However, more research on humans is necessary.

Learn more about estrogen and weight gain.

A doctor may suspect low estrogen based on a person’s symptoms or age. If they do, they may recommend a blood test to determine a person’s estrogen levels.

In people who menstruate, estrogen levels will fluctuate depending on where a person is in the menstrual cycle. A doctor may ask to carry out the test at a specific point in the cycle in order to get the most useful reading.

While a blood test can identify low estrogen, it does not indicate the cause. Sometimes, a person’s life stage or recent experiences shed light on this. For example, a person who is nursing may have low estrogen as a result.

When the cause is not clear, a doctor may recommend additional tests such as:

• a physical exam
• further blood tests, such as thyroid function tests
• scans of the ovaries

If a person’s low estrogen levels are the result of a typical physiological process, such as menopause, and a person has few symptoms, doctors may recommend taking no action.

However, if the symptoms are significant, a person may need medical care. The right treatment depends on the symptoms, the root cause, and a person’s treatment goals.

Hormone replacement therapy

Hormone replacement therapy (HRT) can restore levels of estrogen and other hormones. Sometimes, doctors recommend combination therapy that provides both estrogen and progesterone to people going through menopause.

A person may take HRT as an injection, vaginally, topically, or orally. Doctors usually recommend using the lowest effective dose.

However, HRT is not safe for all people. People with a history of stroke, high blood pressure, or heart attack may not be able to safely take HRT.

Estrogen therapy

Estrogen therapy is a type of HRT that uses only estrogen. For example, a doctor may prescribe vaginal estrogen cream to reduce vaginal dryness and address thinning of the vaginal skin.

Symptom management

Doctors may recommend additional treatments to manage symptoms, including:

• vaginal lubricants or moisturizers
• pelvic floor physical therapy
• drugs to lower cholesterol

Treatment for underlying conditions

If a person has an ongoing health condition or is undergoing medical treatment that affects their estrogen levels, doctors may suggest other treatments. For example, a person with a thyroid condition may benefit from taking thyroid hormone medication.

The additional treatments a doctor may recommend will depend on the person’s unique circumstances, so it is important to consult a professional if a person does not know the cause of their symptoms.

No natural remedies can reliably raise estrogen levels, but some may help reduce the symptoms of low estrogen levels.

Maintaining a moderate weight

Reaching or maintaining a moderate weight can improve overall health and may reduce the risk of some consequences of low estrogen, such as cardiovascular disease.

People with low estrogen due to low body weight may need support to reach a healthier weight, particularly if their low weight is the result of another health condition or an eating disorder.

Moderate exercise

In conjunction with diet, moderate exercise can help a person with low estrogen reach or maintain a moderate weight. Strength training, in particular, can help increase bone strength, which can be beneficial for people at risk of osteoporosis.

However, people who have low body weight or engage in intense exercise may need to change their routine, as this combination can cause low estrogen levels rather than increase them.

Soy

Research on the role of soy in improving estrogen levels is ongoing. A 2021 review suggests that soy may modestly improve estrogen levels, but not all studies support this conclusion.

Learn more about phytoestrogens in food.

There is no compelling evidence that vitamin D increases estrogen levels. However, vitamin D may counteract some of the effects of low estrogen.

Vitamin D is important for preventing osteoporosis because it helps the bones use calcium, which makes them stronger. Vitamin D levels may also play a role in the risk of cancer, heart disease, and depression.

Learn how to safely get more vitamin D from the sun.

Estrogen does not only affect the sexual organs and fertility — it also affects brain and heart health, mood, and more. Therefore, low estrogen levels can affect many aspects of health in people of all sexes.

If a person suspects that they have low estrogen, they can consult a healthcare professional for a diagnosis. A healthcare professional will be able to identify an underlying cause and suggest the best ways to improve or manage it.

Treatment varies depending on the cause of a person’s low estrogen levels, so it is important to seek medical advice whenever possible.