Medically reviewed on January 3, 2023 by Amy Harris, MS, RN, CNM. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.
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Genetic conditions, age, malnutrition, ovarian surgery, and even intense physical or emotional stress can lower estrogen levels . Low estrogen levels can trigger various symptoms and contribute to more serious issues, like delayed sexual development, difficulty becoming pregnant, depression, sexual dysfunction, and osteoporosis .
Understanding the underlying cause of any hormonal imbalance in estrogen levels can help you to find the correct treatment for the underlying cause of your imbalance.
Read on as we dive into the importance of estrogen, especially for those people assigned female at birth (AFAB), cisgender women, transgender men, and nonbinary people with vaginas. Then, we’ll investigate common causes of low estrogen levels and whether any lifestyle tweaks could help you feel better sooner.
Estrogen is one of several sex hormones that play a fundamental role in sexual and reproductive health in people born with ovaries .
Produced in your adrenal glands and fat tissue, but mainly by the ovaries, estrogen works in concert with other female sex hormones to shoot you into puberty and establish regular monthly menstrual cycles.2 Ovulation, the release of an egg from one ovary and occasionally both, is caused by a surge of estrogen. Estrogen is also responsible for building up the lining of the uterus (called the endometrium) so that if fertilized, that egg will implant and begin to grow into an embryo.
Perimenopause is the transition from regular menstrual cycles to no longer having menstrual periods. As your ovaries age, ovulation becomes less frequent, periods become erratic, and estrogen levels fall. The perimenopausal transition to a complete cessation of periods (called menopause) is a natural, healthy process that all people with ovaries experience, usually in their 40s or 50s .
Estrogen does not only control your reproductive health. Estrogens are important for both males' and females' heart, bone, and brain health (yes, males have estrogen too). Males just need estrogen in much smaller amounts.
Estrogen influences :
It is normal for estrogen levels to rise and fall throughout your life and even your monthly menstrual cycle. Other medications you are taking (especially hormonal birth control), and other conditions, such as Polycystic Ovarian Syndrome (PCOS), cause high estrogen levels. Estrogen deficiency or high estrogen levels (sometimes called estrogen dominance) can impact your body and your symptoms.
Estrogen dominance is not an official medical term used by physicians or reproductive endocrinologists. Still, it is often used in health and wellness circles to describe when estrogen levels are higher than two other hormones important for sexual reproductive health: progesterone and testosterone. Depending on your hormone levels, age, other health conditions, and what symptoms you are experiencing, your healthcare provider may or may not choose to treat a hormone imbalance.
Females and those AFAB produce three types of estrogen [1, 4]:
Estrogen, as well as progesterone and testosterone (yes, females have testosterone too), fluctuates around the clock and throughout your life . That means that rising and falling estrogen levels are a perfectly normal part of being a woman or AFAB. This is also important to remember when taking a single measurement of estrogen (via a blood, urine, or saliva sample) at one point in time. While one measurement might be low, that estrogen level could jump back to the normal range the next hour, day, or month .
But what causes your estrogen levels to fall? Let’s look more closely at some possible reasons.
A healthcare provider can help you interpret your hormone level test results to understand better what could be causing your low estrogen levels. A healthcare provider is also the best person to help you determine whether any treatment may be needed.
Women’s estrogen levels usually peak in the mid-to the late-20s then decline by one-half by age 50 . Perimenopause is the transitional period before you go a whole year without having a menstrual period (menopause). During perimenopause, many people notice the physical symptoms caused by low estrogen most intensely.
When does perimenopause occur? Most people experience menopause between ages 40 and 58 . The average age of menopause for U.S. women is 52 years old . Perimenopause typically lasts between 4 and 8 years. However, some women go through menopause prematurely, before age 40, which is called primary ovarian insufficiency .
Endometriosis, benign cysts, ovarian torsion, and ovarian cancer all require surgical removal of one or both of your ovaries. Surgeons remove both ovaries, uterus, and fallopian tubes in a full or total hysterectomy .
Because your ovaries are the body’s primary estrogen producer, these surgeries can result in low estrogen levels. A full hysterectomy is also called surgical menopause, if completed prior to natural menopause. Similarly, radiation therapy or chemotherapy for cancer can injure your ovaries so that they produce less estrogen .
Another reason for estrogen imbalance can be too much exercise or extreme stress . Exercise can be great for your mental and physical health, but when taken to the extreme, excessive amounts of exercise can cause your estrogen levels to take a nosedive.
Why? Extreme exercise and stress can trigger what’s known as hypothalamic amenorrhea . The pituitary gland controls your menstrual cycle. Disrupted by intense exercise (often co-occurring with an eating disorder), the pituitary gland no longer signals the ovaries to secrete estrogen or ovulate. The resulting hormonal imbalance, most commonly seen in premenopausal females, stops their regular menstrual cycles and puts them at risk for problems in their cardiac, skeletal, psychological, and reproductive systems.
Similarly, opioid use, acute stress, nutritional imbalances, and genetic defects can also disrupt the pituitary gland’s control of the ovaries, essentially shutting off estrogen production and halting menstrual cycles in older females (called hypogonadotropic hypogonadism) .
Just as excessive exercise can cause hypothalamic amenorrhea and low estrogen levels, so can eating disorders such as anorexia nervosa and bulimia .
Low body weight and a lack of fat tissue (which can also synthesize estrogen), with or without an eating disorder, are related to low estrogen levels . However, low estrogen hormone levels in perimenopausal and postmenopausal women can also play a role in weight gain in later life, particularly in the abdominal area . These hormonal relationships speak to the importance of estrogen in health and wellness across the lifespan.
Your pituitary gland may only be the size of a raisin, but it influences plenty—including your body’s capacity to manufacture hormones. Indeed, your “master gland,” as it’s frequently called, generates follicle-stimulating hormone (FSH), which in turn instructs your ovaries to generate estrogen .
Pituitary gland conditions can disrupt this chemical messaging, and causes changes in estrogen levels, menstrual cycles, sexual and reproductive health. These pituitary conditions may include:
Some genetic conditions can also cause estrogen levels to decline. These conditions include:
However, note that this is not an exhaustive list of what causes low estrogen levels—and other factors indirectly related to your genetics may be involved, too. For example, autoimmune conditions, radiation, and chemotherapy can also slow or stop estrogen production .
The symptoms of low estrogen can feel subtle, dramatic, or somewhere in between. They can also mimic PMS and other conditions. Common low estrogen symptoms include [1, 3, 6]:
It is important to discuss your symptoms with your healthcare provider. Which symptoms you are experiencing will depend on the cause of your low estrogen levels. It can be confusing to make sense of your symptoms, mainly because they can come and go. Keeping track of your symptoms on a calendar, in a journal, or on your phone and noting what makes them better or worse will also help figure out the best treatment plan.
In addition to experiencing the symptoms listed above—which, it’s safe to say, most of us would rather do without—low estrogen can cause health problems for some people at high risk for complications from estrogen deficiency. These health conditions can include:
Following a lifestyle that prioritizes health and wellness may help boost your estrogen levels. These lifestyle modifications include :
A low level of estrogen due to the passage of time is natural. Still, other conditions and situations can shape how much estrogen you make or how severe your symptoms and complications of lower estrogen levels may be.
If you’re concerned that you have low estrogen hormone levels, you may want to consider the benefits of testing with Everlywell. Our Women’s Health Test measures hormone and antibody levels to check for any abnormal levels that may keep you from feeling your best.
Designed for women and AFAB at any stage of life, this test is also affordably and transparently priced, as we believe everyone deserves the opportunity to access insightful lab test results.
More than 1 million people have used our tests and digital health platform to manage their health and wellness. Get to know your hormones by joining them today.