How Do I Know if I Have Low Estrogen? Which Symptoms to Look for?

As women transition to menopause, their body's estrogen levels naturally decline, and they begin to feel low estrogen symptoms. If you are still far away from going through actual menopause, it can take you by surprise. You may encounter problems getting pregnant, migraine headaches, trouble concentrating, or mood swings, and you may not connect this to the low estrogen levels in your body.

Estrogen plays a vital role in women's bone health, cardiac health, reproductive development, organ performance, muscular-skeletal strength, and cognitive ability. Estrogen is such a crucial hormone in a woman's body that having low estrogen levels can affect puberty. Low estrogen levels can delay female maturity characteristics such as breast development and menstrual periods. Irregular periods can extend into later years, interfering with the ability to get pregnant. As women age and enter their thirties, forties, and fifties, perimenopause symptoms can develop. The decreased estrogen levels can increase susceptibility to bone fractures and cardiovascular disease in the long term.

Low estrogen symptoms include:

  • Irregular menstrual periods
  • Hot flashes
  • Night sweats
  • Fatigue, trouble sleeping, and difficulty concentrating
  • Vaginal dryness leading to painful intercourse
  • Urinary tract symptoms such as infections due to thinning of urethral tissue
  • Low sexual desire
  • Mood swings, irritability, or depression

Many of these symptoms mirror those listed in the Menopause Rating Scale (MRS). You can use the scale to monitor whether your symptoms increase or change over time, and you can take an at home hormone test to get an idea about your hormone levels. 

If you feel more and more that things are not quite right, you should see a doctor. Before the examination, make a list of the symptoms you are experiencing related to low estrogen levels. You will not get confirmation that low estrogen is your problem, however, until the doctor has checked you.

The doctor will order lab work to measure estrogen levels in the form of estradiol along with hormone levels such as FSH, progesterone, luteinizing hormone (LH), thyroid, and others to measure your overall health.

Normal Estradiol Level Chart for Adult Females: 

  • Follicular phase: 20-350 pg/mL
  • Midcycle peak: 150-750 pg/mL
  • Luteal phase: 30-450 pg/mL
  • Postmenopause: ≤ 20 pg/mL

While urine collection is less preferred: 

Reference ranges for urine estradiol (mcg/24 hours)

  • Follicular phase: 0-13
  • Midcycle peak: 4-14
  • Luteal phase: 4-10
  • Postmenopause: 0-4

Source: https://emedicine.medscape.com/article/2089003-overview

If your estradiol levels are high, the doctor will further explore whether you are experiencing estrogen dominance, medication side effects, pregnancy, tumors of the ovaries, or adrenal glands are the cause. High estrogen symptoms can overlap with symptoms of low estrogen, so a thorough workup is required.

What causes low estrogen levels?

There are several potential causes of low estrogen levels.

  • Endocrine dysfunction: of the pituitary or other hormone-secreting glands
  • Eating disorders: anorexia, bulimia, or other severe diets that reduce body fat
  • Extreme exercise: excessive exercise pulls energy away from estrogen production
  • Pregnancy-related: during breastfeeding and right after childbirth, a woman's estrogen's levels naturally are low
  • Polycystic ovarian syndrome (PCOS): high testosterone levels affect estrogen production
  • Perimenopause and menopause: this is the start of the natural decline of estrogen (estradiol) levels.

How can estrogen levels be increased?

  1. Hormone replacement therapy can increase estrogen levels. Estrogen supplementation comes in different formulations and routes that can deliver doses to treat your low estrogen levels. A doctor can discuss and help you decide which one is best suited based on the severity of your low estrogen symptoms. 
  • Oral: Estrogen hormones come in pill forms combined with different chemicals. For some women, taking birth control pills may help control heavy menstrual periods and perimenopausal symptoms. Those who have transitions to menopause can begin hormone replacement therapy (HRT) or take other supplements. For women who still have an intact uterus, combination therapy that contains both estrogen and progesterone should be taken to reduce the risk of uterine cancer. 
  • Topical patches: Women can take hormone replacement therapy through transdermal patches, gels, or implants. Taken in this way, estrogen bypasses the liver, so there is a more sustained blood level. 
  • Vaginal: Estrogen can be inserted vaginally as a ring, a tablet, suppository, or a cream. The benefit of vaginal delivery is that estrogen is applied directly to the tissue that needs it, avoiding concerns in those for whom there might be risk when the entire body is exposed to the hormone replacement therapy (HRT). 

There has been discussion about whether bioidentical hormones, which are chemically identical to those the body produces, versus synthetic estrogen compounds, are safer. You will want to do some research and discuss with your doctor which type you prefer. 

  1. Certain food choices may help with low estrogen symptoms.First and foremost, eating a healthy diet that is low in fat and sugar will improve your overall health. Other food sources such as soy, flax seeds, nuts, and vegetables like broccoli and cauliflower contain phytoestrogens, which may help reduce menopausal low estrogen symptoms. 
  1. Herbs can be explored to increase estrogen levels. Black cohosh, evening primrose oil, or red clover are herbs often tried to improve low estrogen symptoms. Care must be taken when trying different herbs to boost estrogen levels as supplements are not FDA approved. There is no regulatory agency that ensures the quality and safety of herbs available for purchase. 

It is also a good idea to check with the doctor or a pharmacist to make sure there are no interactions between the herbs and your other medications.