Low Estrogen Signs and Symptoms and How to Treat Low Estrogen

Dr. Jolene BrightenPublished: Last Reviewed: Balancing Your Hormones, Perimenopause/ Menopause Leave a Comment

Low estrogen levels can be the cause of hot flashes, missing periods, vaginal dryness, joint pain, and other symptoms. Understanding the cause of low estrogen is important in selecting the right treatment.

Low estrogen is most often associated with menopause, but it can happen throughout your lifetime due to a variety of factors. Sometimes, the low estrogen signs and symptoms are subtle and easily attributed to other possible causes, so knowing what to look for can make it easier for you to get the support you need to feel better.

Below, you'll find signs and symptoms of low estrogen, plus how to treat low estrogen, including using estrogen therapy.

What Does Estrogen Do in Your Body?

Levels of estrogen begin to rise around puberty and decline with menopause. Estrogen production happens primarily in the ovaries. It is a key hormone in sexual development—breast development, regulating menstrual cycles, and body shape. It is also involved in maintaining bone health and maintaining the health of your heart, including playing a role in the risk of heart disease.

There are three types of estrogen:

  • Estradiol: Primary during reproductive years (and the focus of most of the symptoms discussed below)
  • Estriol: Primary during pregnancy
  • Estrone: Primary after menopause

Estrogen is responsible for breast development (both during puberty and pregnancy) and the softening of curves associated with the female body. An estrogen surge triggers ovulation and prepares the uterine lining for implantation in case pregnancy occurs.

But estrogen does more than regulate your cycle─it also keeps the skin hydrated and plump and plays a significant role in sexual function, both for libido and vaginal health. It has metabolic benefits, including regulating appetite, metabolism, and blood sugar regulation. It’s considered anti-inflammatory and influences heart health, cognition, bones, and mental health.

It’s entirely normal for estrogen levels to vary throughout your lifetime, but symptoms can arise when estrogen imbalances arise.

Signs and Symptoms of Low Estrogen

When estrogen production declines, symptoms can arise in multiple systems in the body. Hot flashes and night sweats are common symptoms of low estrogen that are associated with menopausal women, but there are a variety of other signs and symptoms that can occur when your estrogen levels are low.

Common Symptoms of Low Estrogen:

  • Joint pain
  • Brain fog
  • Depression and mood changes
  • Increased cravings
  • Breast tenderness
  • Change in breast volume
  • Dry or thinning skin
  • Itching or ringing ears
  • Headaches or migraine
  • Painful sex
  • Vaginal dryness
  • Low libido
  • Frequent UTIs
  • Fatigue
  • Difficulty concentrating
  • Irregular or missing menstrual periods
  • Hot flashes, night sweats

Joint Pain

As estrogen is anti-inflammatory, it may protect against joint inflammation and osteoarthritis. When estrogen levels are low, this protective effect decreases, often leading to pain. In addition, estrogen plays a role in the health of connective tissue and bones, which is why a decline can contribute to joint stiffness and pain. 

What can help:

Brain Fog

Brain fog is one of those symptoms that is easily dismissed and often brushed aside as typical signs of aging. But that feeling of fogginess isn't just in your head─it’s a real symptom and can be debilitating. The brain is filled with estrogen receptors, especially in areas responsible for learning and memory.

Brain fog may also occur with low estrogen because the hormone influences serotonin levels. Serotonin is a neurotransmitter, a chemical that sends messages between nerve cells, and it's linked to mood, learning, and memory. As serotonin levels drop, concentration and memory may be affected.

What can help:

Signs and symptoms of low estrogen in women

Depression

Estrogen is needed in the brain to create 5-HTP from tryptophan, a necessary step in serotonin production. Aside from cognitive function, with low serotonin, your mood regulation can also take a hit.

Low estrogen can manifest as irritability, sadness, mood swings, and even clinical depression. There can be many reasons for mood changes and depression, so it’s essential to find out what’s going on, but ruling out hormone imbalance is always a good idea.

What can help:

  • Work with a mental health provider to develop tools and discuss your individual needs.
  • Consider saffron, which has been shown to have mood benefits.
  • Daily exercise, especially going outside, can help improve mood symptoms. 
  • Sunlight exposure in the early morning or investing in a sunrise alarm clock can help with elevating mood.
  • Discuss hormone replacement therapy treatment options with your provider.

Increased Appetite and Cravings

Hormone imbalances can impact your metabolism and appetite. Estrogen plays a role in regulating energy, affecting both food intake and energy expenditure. Low estradiol is associated with weight gain and increased appetite.

Among other hormones, estradiol may also interact with leptin, a hormone that helps suppress appetite, and insulin, which helps regulate blood sugar. The relationship between insulin and estrogen is well-established, as estrogen appears protective against metabolic syndrome and blood sugar dysregulation by improving insulin sensitivity.

What can help:

  • Eat a protein packed breakfast. You can find some of the best breakfast ideas for hormones here.
  • Include fiber at every meal and aim to get a total of 25 grams daily. My free recipe guide can help you get the fiber you need.
  • Get quality sleep, which can have a positive effect on cravings. 
  • Address stress, which can be a common cause of cravings.
  • Swap milk chocolate for 70% dark chocolate. If you're going to eat chocolate, make it dark so that you get the antioxidant and brain benefits it provides.
  • Try 5-HTP 100-200 mg and alpha lipoic acid 600 mg to help regulate cravings. Note: 5-HTP can be problematic with certain psychiatric meds. Discuss with your doctor before supplementing.

Breast Tenderness

Breast tenderness due to perimenopause or other reasons for low estrogen may feel a bit different than tenderness related to your period. Some women describe it more as sore or like a sharp pain, and it can happen in one or both breasts. Once a woman is in menopause, the pain should go away.

You should always have breast pain examined by your doctor.

What can help:

  • Make sure you are wearing a well fitting bra. I know it sounds obvious, but double check just in case.
  • Try a combination of DIM, sulforaphane, and calcium D-glucarate to support healthy estrogen metabolites.
  • Stop smoking. 
  • Reduce or limit caffeine. 

Shrinking Breasts

As estrogen keeps the skin plump and full, it also impacts breast tissue in the same way. Low estrogen decreases collagen in the skin, making the breast appear smaller due to loss of elasticity. Remember that during puberty, estrogen is responsible for breast development, so as levels drop, mammary glands also shrink.

What can help:

  • Increase dietary vitamin C, consider a supplement and topical application. 
  • Because this is a common low estrogen symptom, addressing the cause of low estrogen is important.
  • Maintain a healthy body weight.

Reduced breast volume is a natural part of aging. 

Dry and Thinning Skin

Dry skin can be caused by multiple factors (like hypothyroidism), but low estrogen can be a culprit. Smooth, plump skin is dependent on estrogen as it stimulates the production of collagen and elastin in the skin, giving it hydration and fullness.

Low estrogen can affect skin health by reducing the production of collagen and healthy oil production. The result is skin may appear thin with fine lines or feel dry and itchy.

What can help:

  • Meet with your provider to rule out other issues, such as hypothyroidism.
  • Topical retinoids.
  • Regularly using body oils and lotions to support the moisture of the skin.
  • Increase dietary vitamin C, consider a supplement and topical application.
  • Use only mild soaps and cleansers. 

Itching or Ringing in Ears

This symptom is one of the less known or recognized signs of low estrogen, but the connection is real. Since estrogen hormone level influences the mucous membranes throughout the body, the inner ear may also be affected, causing itching, irritation, or even ringing ears (called tinnitus).

Some research suggests that tinnitus is much more common for women during menopause who aren’t using HRT, suggesting a close connection with estrogen hormone levels.

What can help:

Headaches or Migraines

Menstrual migraines or headaches (sometimes called estrogen withdrawal migraines) can be caused by low estrogen in the days right around or during your period. Low estrogen at any time during the menstrual cycle can lead to similar migraines.

Studies also suggest that women who get migraines may have increased sensitivity to changing estrogen levels compared to others.

Consistent hormone levels can help improve headaches, but drops and changes can make them worse. This is why some estrogen related headaches resolve in menopause or with hormone replacement therapy. 

What can help:

Painful Sex

In the same way, estrogen keeps the skin on the outside of your body plump and hydrated; it also helps maintain mucous membranes and thickness of vaginal walls and tissue. Low estrogen can lead to vaginal atrophy, which is where there is thinning skin, inflammation of the vaginal walls, and vaginal dryness, all of which causes painful sex.

Even when vaginal atrophy, also known as atrophic vaginitis, isn't present, the reduced capacity to self lubricate can result in pain during sex. 

What can help:

  • Adequate use of lubricants during sex. See our lube guide.
  • Communicate with your partner about your needs.
  • Extend foreplay time.
  • Explore different positions.
  • Talk with your doctor about estrogen or DHEA vaginal HRT.

Low Libido

While testosterone is often thought as the primary libido driver, estrogen also plays a significant role in your desire, fantasies, and arousal. When either or both of these hormones decline, libido or sexual desire can also follow. 

So many factors can influence libido and can change from day to day depending on emotional stress, physical health, and your relationship with your partner. If you are worried sex is going to hurt, or you're just not feeling sexy due to low estrogen levels, your sex drive can take a hit. Low estrogen may also reduce blood flow to the vagina, which lowers sensitivity and arousal.

What can help:

  • Consider taking adaptogenic herbs like Ashwagandha, Rhodiola, Maca, Shatavari (asparagus racemosus), and Ginseng.
  • Eat watermelon rinds, which are rich in citrulline, a compound that increases nitric oxide and can support adequate blood flow to the clitoris.
  • Address underlying relationship issues. 
  • Discuss testosterone and estrogen replacement therapy with your provider.

Increased UTIs

Estrogen supports the health of the urogenital tissue, adequate tissue lubrication, and helps regulate a healthy pH in the vagina.

When the vaginal tissue is dry, it becomes more prone to tears and micro-abrasions where bacteria can hide. UTIs can also be caused when the urethra is not adequately lubricated during sex. 

What can help:

  • Daily probiotics that contain Lactobacillus species, along with prebiotics and urinary tract support.
  • UTI prevention practices, like drinking plenty of water and wearing loose clothing
  • Adequate lubrication during sex
  • Vaginal estriol therapy

What Causes Low Estrogen?

The years leading up to menopause (perimenopause) and menopause are the primary reasons for low estrogen levels in the body (and why many of these symptoms are associated with menopause).

But any other health condition that influences the production of estrogen in the ovaries can cause low estrogen, such as:

  • Eating disorders like anorexia
  • Excessive exercise
  • Low body weight
  • Chronic kidney disease
  • Autoimmune diseases
  • Breastfeeding
  • Hysterectomy or ovarian surgery
  • Turner syndrome (a genetic condition)
  • Chronic stress or hypothalamic pituitary adrenal axis (HPA- axis) dysfunction
  • Chemotherapy or radiation
  • Pituitary gland dysfunction
  • Premature ovarian failure or primary ovarian insufficiency

Risk Factors for Low Estrogen

All women going through menopause will experience low estrogen levels, but low estrogen levels related to the above are more likely to occur if you have:

  • A history of hormone imbalance
  • A history of severe calorie restriction, dieting, or disordered eating behavior
  • A medical history involving pituitary dysfunction or cancer treatments
  • A history of opioid or other substance abuse

How is Low Estrogen Diagnosed?

The first step is meeting with a healthcare professional you trust who can perform an in-depth evaluation of your family history, medical history, current symptoms, and potential risk factors. They may also conduct a physical exam and order additional tests or imaging to rule out other possible causes of your symptoms.

They may order blood tests to measure your hormone levels, such as estrogen, follicle-stimulating hormone (FSH), and progesterone, to help determine overall hormonal imbalance and explore why your estrogen is low.

It may not be necessary to evaluate the amounts of estrogen or other hormones if you are experiencing menopausal symptoms after the age of 45. 

Low Estrogen Treatment

Treatment for low estrogen involves a comprehensive approach and depends on the root cause of the imbalance. Sometimes, this may mean medical interventions through hormone replacement therapy, while others may find relief with more natural support or a combination of the two. An individualized approach is the best course of action when someone is experiencing low estrogen symptoms.

Hormone Replacement Therapy

Hormone replacement therapy (HRT) can be a safe and effective option when used correctly.

Women under the age of 35 who have low estrogen but aren’t in perimenopause or menopause may be prescribed estrogen to prevent common health risks and conditions like cardiovascular disease, bone loss, dementia, and bone fractures. .

During menopause, HRT may be used to help ease the transition and alleviate some of the symptoms of menopause associated with low estrogen levels, like hot flashes, brain fog, mood symptoms, and vaginal atrophy.

Some studies also suggest that estrogen replacement could support insulin sensitivity to improve glucose metabolism and reduce the overall risk of developing type 2 diabetes.

Hormone therapy is not without side effects, but you and your provider can weigh the benefits and risks to decide if it’s the right choice for you.

Nutritional Therapy

Nutrition can be a powerful tool for hormone balance. Phytoestrogens, compounds found in plants that chemically look like estrogen, can behave like estrogen and attach to receptors in your body. Some research suggests that eating more foods with phytoestrogens can be a way to naturally increase estrogen levels in the body (although there is also research that indicates the opposite, where phytoestrogens can lower estrogen levels).

Foods with phytoestrogens include:

  • Flax seed
  • Soybeans and edamame
  • Apples
  • Berries
  • Barley
  • Oats
  • Broccoli
  • Kale

Other nutrients to emphasize for hormone balance include healthy fats like avocado and olive oil and adequate protein to balance blood sugar and support lean body mass.

Changing your diet can feel overwhelming, so I created a free Hormone Balancing Start Kit filled with tips, a 7-day meal plan, and recipes to help you get started.

Supplements

Supplements play a supportive role, helping to balance hormones alongside other lifestyle habits. In addition to those discussed previously, it is also worth considering:

  • Vitamin D: Vitamin D is a nutrient critical in hormone production and regulation, including estrogen. Since vitamin D is challenging to get from your food, and many of us don’t get enough from the sun, supplementing becomes essential.
  • Probiotics. Keeping your gut health in check is critical for hormone balance. Probiotics help to maintain a healthy balance of bacteria in the gut and vagina, which plays a role in hormone production and regulation. Dr. Brighten's Women's Probiotic contains bacterial strains specific to women's health.
  • Magnesium. This mineral is involved in over 300 biochemical reactions in the body, including hormone production and regulation. It also helps to reduce stress and improve sleep, which are both essential for hormone balance. I recommend taking magnesium glycinate before bed for best absorption and to help with sleep.
  • DHEA: DHEA is a hormone produced by the adrenal glands and is needed to make estrogen and testosterone. Research suggests DHEA supplements can increase estrogen levels. It is not wise to begin supplementing with DHEA without first speaking with your provider.

Lifestyle

Daily habits can also really support your hormones. Exercise, for example, keeps stress at bay and promotes a positive mood while helping with hormone balance, but it has to be the right form of exercise. If you are over-exercising, pushing, and pushing too much, it can have the opposite effect. Consider gentle movements like walking, yoga, and strength training as a starting place.

Sleep and Stress Management

Sleep and stress management can’t be ignored. Both are closely linked to healthy hormone balance. Keep your sleep routine consistent with a dark room, avoiding screens and a calming wind-down.

If stress is a factor in your life (and who isn’t dealing with it), it’s time to take a look at ways to either reduce it or, if that’s not possible, help your body better deal with stress by working on management techniques like journaling, breathing, yoga, walking in nature, or spending time with friends.

Low Estrogen Signs and Symptoms Summary

Low estrogen can cause a range of symptoms, including irregular periods, hot flashes, and mood changes. It can also increase the risk of osteoporosis and heart disease. Whether you're entering perimenopause or menopause or just looking to support your hormone balance, there are steps you can take to boost estrogen levels naturally.

Focus on nutrition, supportive supplements, and lifestyle habits like exercise and stress management. If you're really struggling, you may also consider speaking with a healthcare provider about hormone replacement therapy if appropriate for your situation.

Get Your FREE Hormone Starter Kit with

7 Day Meal Plan & Recipe Guide

This starter pack is exactly what every woman needs to bring her hormones back into balance!

Hormone Starter

Kit

About The Author

Dr. Jolene Brighten

Facebook Twitter

Dr. Jolene Brighten, NMD, is a women’s hormone expert and prominent leader in women’s medicine. As a licensed naturopathic physician who is board certified in naturopathic endocrinology, she takes an integrative approach in her clinical practice. A fierce patient advocate and completely dedicated to uncovering the root cause of hormonal imbalances, Dr. Brighten empowers women worldwide to take control of their health and their hormones. She is the best selling author of Beyond the Pill and Healing Your Body Naturally After Childbirth. Dr. Brighten is an international speaker, clinical educator, medical advisor within the tech community, and considered a leading authority on women’s health. She is a member of the MindBodyGreen Collective and a faculty member for the American Academy of Anti Aging Medicine. Her work has been featured in the New York Post, Forbes, Cosmopolitan, Huffington Post, Bustle, The Guardian, Sports Illustrated, Elle, and ABC News. Read more about me here.