What does low estrogen mean?
Estrogen is an important hormone that stimulates sexual development and helps maintain the reproductive system. It plays an important role in other body systems. Estrogen levels rise and fall throughout your life, often in combination with other hormones that control important bodily processes, such as the menstrual cycle. Normal highs and lows are normal due to the constantly changing estrogen levels.

Persistently low estrogen levels vary. Persistently low estrogen levels mean you’re going through natural changes like menopause. Sometimes low estrogen levels are a symptom of a condition that can slow down your sexual development and make it harder to get pregnant.

Who is most affected by low estrogen?
Estrogen has the greatest effect on those assigned to women at birth (AFAB). But everyone’s body produces estrogen.

You may have low estrogen if:

You are going through menopause or post-menopause. Your ovaries make most of your estrogen during your reproductive years. During menopause and postmenopause, your menstrual cycle stops and your ovaries stop making estrogen. Instead, fat cells start producing most of your body’s estrogen. Menopause officially begins when you have not had a period for twelve consecutive months. Postmenopause is the following period.
Your ovaries were removed or damaged during treatment. Your body will only produce small amounts of estrogen if your ovaries are removed as part of medical treatment (for example, during surgery to treat cancer). Similarly, radiation therapy can damage the ovaries and cause them to produce less estrogen.
How does low estrogen affect the body of a woman or an AFAB?
Low estrogen levels can affect your body in different ways depending on where you are in your sexual development.

Low estrogen:

Puberty may be delayed and sexual development may be delayed or delayed.
Occurs during perimenopause and menopause, and is often accompanied by painful intercourse, decreased libido, and hot flashes.
How does low estrogen affect the male or AMAB body?
Individuals assigned male at birth (AMAB) with excess estrogen may experience impotence. However, they do need a certain amount of estrogen for their reproductive health and overall health. Studies have shown that a drop in estrogen levels can cause:

Belly fat.
Decreased libido.
Bone loss and osteoporosis.
For transgender women or non-binary people with genitalia, low estrogen levels can prevent them from shaping their bodies into the desired shape. If so, female hormone therapy may be an option. This treatment uses estrogen to help develop secondary sex characteristics such as softer facial contours, receding hairline, and breasts and hips.

Symptoms and causes
What are the symptoms of low estrogen levels?
Symptoms associated with low estrogen during the reproductive years overlap with common menopause and postmenopausal symptoms. Your symptoms will depend on what’s causing your estrogen levels to drop.

Symptoms of low estrogen include:

Dry skin.
Soft breast.
Weak or brittle bones.
There is a problem with concentration.
Depression and irritability.
Vaginal dryness or atrophy.
Hot flashes, night sweats.
Irregular or no periods (amenorrhea).
Weight gain, especially in the stomach.
Headache before or during menstruation.
Decreased libido and painful intercourse (dyspareunia).
fatigue, sleeplessness (insomnia).
What causes low estrogen levels?
The most common cause of declining estrogen is age. It’s natural for your estrogen levels to decline as you age. Low levels unrelated to menopause can be a sign of a disorder.

Age Estrogen levels drop during menopause. At this point, your body’s primary form of estrogen changes from estradiol (which is usually made in your ovaries) to estrone (which is usually made in your body fat).
Eating disorders. Eating disorders like anorexia and bulimia deprive your body of the nutrients it needs to keep its hormone levels balanced.
Genetic conditions. Both Turner syndrome and Fragile X syndrome produce low estrogen.

Autoimmune disease. An autoimmune disease that attacks your ovaries prevents them from producing enough estrogen.
Primary ovarian failure, otherwise known as early menopause. In this condition, your ovaries stop producing eggs before the age of 40. As a result, your body goes through early menopause. Your period will stop and your estrogen levels will drop.
Treatments that affect your ovaries. Cancer treatments such as radiation and chemotherapy can damage the ovaries. This damage may prevent the ovaries from releasing normal levels of estrogen. Removal of one or both ovaries (oophorectomy) as part of treatment can lead to estrogen deficiency.
A condition that affects your pituitary gland. Your pituitary gland releases hormones that tell your ovaries to start making estrogen. If your pituitary gland is not producing enough of these hormones, your body may have low estrogen levels.
Hypothalamic amenorrhea. Hypothalamic amenorrhea can occur if your body is under stress (eg, too much exercise) and not getting enough nutrition. With hypothalamic amenorrhea, your brain does not produce enough of the hormone that stimulates the ovaries to produce estrogen. As a result, your period stops completely. Athletes assigned female at birth are particularly susceptible to this disease.
What tests are used to diagnose low estrogen?
Your body produces three types of estrogen. Estrogen testing can measure estrone (E1), estradiol (E2) and estriol (E3). Your provider will do a simple blood test and send it to a lab for testing.

Estrone (E1) is the primary hormone your body produces during menopause and postmenopause. It is a weaker form of estrogen than estradiol (E2).
Estradiol (E2) is the primary hormone your body produces during your reproductive years.
Estriol (E3) is the main hormone your body produces during pregnancy.
If your provider is unsure about your hormone status, you can evaluate estrogen (for example, to check hormone levels in someone who has gone through menopause or had a hysterectomy). That being said, there are several FDA-approved conditions for hormone replacement therapy.

Can You Increase Estrogen Through Diet and Lifestyle?
You can address low estrogen levels associated with certain behaviors through lifestyle changes.

Aim for a healthy body weight: Being underweight is a risk factor for low hormone levels. Talk to your provider about dietary changes to ensure you get the right amount of calories each day.
Moderate exercise: Exercising too much can lead to low estrogen levels. Moderate exercise is good. Consuming too much of it can deplete important resources your body needs to function.
Reduce stress: Excessive stress hormones can lead to an imbalance of hormones that regulate the reproductive system. Incorporating stress-relieving techniques into your daily routine is good for your overall well-being and your hormones, too.
Get enough sleep: Sleep recharges your body so your hormones can function properly. On average, adults sleep seven to nine hours each night.
What medications treat low estrogen?
Hormone replacement therapy (HT) is a common treatment for low estrogen, especially in menopause and postmenopause. With HT, you take a synthetic form of estrogen and/or progesterone and increase your levels. There are two types of HT: estrogen therapy and estrogen progesterone/progestin hormone therapy (EPT). Providers prescribe the lowest dose to treat your symptoms and prevent side effects.

The only FDA-approved reason for body-wide hormone replacement therapy is to treat low bone mineral density and hot flashes, usually in the form of pills or patches. Vaginal estrogen—in the form of a ring, cream, or vaginal insert—is used to treat vaginal dryness and painful intercourse. Sometimes “body-wide” estrogen affects vaginal tissue. Sometimes it doesn’t. In contrast, vaginal estrogen is not approved for the treatment of hot flashes.

If you have hot flashes and painful intercourse, it’s not unusual to need vaginal estrogen in addition to total body estrogen.

Estrogen therapy
You will take an estrogen-only pill that does not contain progesterone. If you no longer have a uterus (for example, you have had a hysterectomy), your doctor will prescribe this treatment.

Estrogen Progesterone/Progestin Hormone Therapy (EPT)
If you still have a uterus, use a combination of estrogen and progesterone. Progesterone balances the action of estrogen in the uterus, so it’s important to get both. Estrogen thickens the lining of the uterus. Excessive thickening can cause excessive growth in the uterus, which can lead to uterine cancer. Progesterone prevents excessive growth.

HRT is not without risks. Studies have shown that long-term use of combination therapy (5 years or more) increases the risk of breast cancer, blood clots, heart attack, and stroke.

Talk to your doctor about whether you are a good candidate for hormone replacement therapy. They can discuss any risks or side effects associated with treatment with you. The most common reasons for not being suitable for hormone therapy are:

Menopause more than 10 years ago.
A history of breast cancer, ovarian cancer, or melanoma.
A history of blood clots in your legs, lungs, or brain.
How can I prevent low estrogen levels?
Aging-related declines in estrogen are unavoidable. You can develop healthy habits that lead to overall balance in your life, including more balanced hormones. These changes do not always require hormone therapy. For example, moderate exercise and meditation can help with insomnia and fatigue associated with low estrogen. Getting enough calories and the right types of nutrients can improve all aspects of your health. Using lubricant makes sex more enjoyable.

Depending on your low levels and the severity of your symptoms, you may need medication to help. Talk to your provider about your options.

How can I increase estrogen naturally?
Foods and supplements that contain estrogen-like ingredients can help boost your levels. Talk to your provider before starting any regimen to increase your estrogen levels.

Foods containing phytoestrogens
Phytoestrogens are plant-based estrogens. Some studies show that eating foods containing phytoestrogens can help with menopausal symptoms like hot flashes. Certain phytoestrogens can help improve heart health, bone health, and skin elasticity. More research is needed to know for sure.

Foods that contain phytoestrogens include:

Legumes (soy, lentils, peas, peanuts).
Seeds (flax seeds, sunflower seeds).
Fruits (strawberries, raspberries, blueberries).
Fruits (plums, pears, apples, grapes, berries).
Supplements with phytoestrogens
The FDA does not regulate the safety or efficacy of supplements, so it is important to consult your provider before taking any supplements. Some supplements contain phytoestrogens that are similar to those found in foods and may help relieve symptoms associated with low estrogen.

Black cohosh.
Red clover.
What questions should I ask my provider?
How do I know if I need an estrogen test?
Are my low estrogen levels a sign of illness?
What lifestyle changes can be made to relieve low estrogen symptoms?
Do I need to increase my estrogen levels to relieve my symptoms?
Would you recommend hormone replacement therapy for me? What are the risks?
What foods, vitamins, and supplements do you recommend to prevent or treat hormonal imbalances?
Annals of the Cleveland Clinic

Many people consider the symptoms associated with low estrogen to be an unpleasant part of aging. But you need to eliminate the symptoms that interfere with your quality of life. If you notice symptoms of estrogen deficiency, see your doctor to discuss hormonal and non-hormonal symptoms.

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