What causes low estrogen levels?

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.

Table of contents

• What is estrogen?
• Six causes of low estrogen levels
• What are the symptoms of low estrogen?
• What are the health risks of having low estrogen levels?
• How can I increase my estrogen levels?
• Find peace of mind with Everlywell
• Related content

Genetic conditions, age, malnutrition, ovarian surgery, and even intense physical or emotional stress can lower estrogen levels [1]. 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 [1].

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.

What is estrogen?

Estrogen is one of several sex hormones that play a fundamental role in sexual and reproductive health in people born with ovaries [2].

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 [3].

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 [2]:

• Mood and behavior
• Muscle mass and function
• Blood sugar levels
• Cholesterol levels
• Overall circulation
• Collagen production and the suppleness of your skin

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.

What are the different types of estrogen?

Females and those AFAB produce three types of estrogen [1, 4]:

• Estrone (E1) – Estrone is the main form of estrogen you produce after you’ve gone through menopause (postmenopause).
• Estradiol (E2) – Estradiol is the most powerful type of estrogen your body makes. It dominates during your reproductive years.
• Estriol (E3) – No less important in the estrogen trio, estriol is the chief form of estrogen you produce when/if you’re pregnant.

Estrogen, as well as progesterone and testosterone (yes, females have testosterone too), fluctuates around the clock and throughout your life [2]. 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 [5].

But what causes your estrogen levels to fall? Let’s look more closely at some possible reasons.

Six causes of low estrogen levels

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.

Menopause

Women’s estrogen levels usually peak in the mid-to the late-20s then decline by one-half by age 50 [3]. 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 [6]. The average age of menopause for U.S. women is 52 years old [3]. Perimenopause typically lasts between 4 and 8 years. However, some women go through menopause prematurely, before age 40, which is called primary ovarian insufficiency [6].

Ovarian surgery

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 [1].

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 [1].

Excessive exercise or psychological stress

Another reason for estrogen imbalance can be too much exercise or extreme stress [7]. 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 [7]. 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) [8].

Eating disorders and low body mass index

Just as excessive exercise can cause hypothalamic amenorrhea and low estrogen levels, so can eating disorders such as anorexia nervosa and bulimia [7].

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 [7]. 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 [9]. These hormonal relationships speak to the importance of estrogen in health and wellness across the lifespan.

Pituitary gland conditions

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 [8].

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:

• Empty sella syndrome
• Hyperpituitarism (excessive pituitary hormones)
• Hypopituitarism (a lack of one, some, or all of your pituitary hormones)
• Pituitary adenomas (benign, non-cancerous growths on your pituitary gland)

Genetic conditions

Some genetic conditions can also cause estrogen levels to decline. These conditions include:

• Turner Syndrome
• Fragile X Syndrome

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 [1].

What are the symptoms of low estrogen?

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]:

• Night sweats
• Hot flashes and/or heat intolerance
• Sleep disturbances
• Skin changes
• Irritability and mood changes, including depression and anxiety
• Irregular menstrual cycles
• Headaches
• Fatigue or feeling tired
• Difficulty concentrating

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.

What are the health risks of having low estrogen levels?

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:

• Depression, Anxiety, and Mood Disorders – Studies observe a correlation between low estrogen levels and feelings of depression and anxiety during the perimenopausal transition [10]. While not an approved treatment for mood disorders, hormone therapy replacement therapy, when specific safety criteria are met, may help protect mental health during perimenopause and postmenopause.
• Cardiovascular disease – Estrogen may be most frequently associated with puberty and fertility, but it also provides some protection for your heart before menopause, including the ability to absorb damaging free radicals and smooth blood vessels to bolster circulation. A mounting body of research indicates that estrogen may shield women against cardiovascular disease earlier in life [11]. On the other hand, after menopause, when estrogen levels plunge, cholesterol levels rise, causing blocked arteries and increasing older females’ risk for heart attack and stroke [11].
• Skin changes – As we mentioned earlier, estrogen is involved in synthesizing collagen—the protein that gives your skin elasticity and helps keep it smooth and wrinkle-free. It makes sense, then, that depleted estrogen levels may impact your skin and accelerate the signs of aging, including dryness, fine lines and wrinkles, and a loss of firmness [12].
• Endometriosis – While estrogen does not cause endometriosis—a condition in which uterine tissue grows outside of your uterus—low estrogen levels can aggravate its symptoms [1].
• Difficulty conceiving – If your low estrogen is due to primary ovarian insufficiency, you may face challenges conceiving [13]. While healthcare providers can’t reverse or cure primary ovarian insufficiency, healthcare providers can treat your symptoms of low estrogen with hormone replacement therapy and advise lifestyle changes such as weight-bearing exercise to protect your bones.
• Osteoporosis – Healthcare providers diagnose osteoporosis when you have brittle bones and an increased risk for fracture. Given estrogen’s effects on bone metabolism and strength, low levels of this crucial hormone may increase your osteoporosis risk, especially in postmenopausal females [14].

How can I increase my estrogen levels?

Following a lifestyle that prioritizes health and wellness may help boost your estrogen levels. These lifestyle modifications include [1]:

• Obtaining adequate rest – Sleep is central to every physical function—including hormone balance. Aim to receive seven to nine hours of sleep per night.
• Dealing with stress smartly – Chronic stress can wreak havoc on your hormones and lead to an imbalance. Reduce stress with yoga, meditation, and sufficient (though moderate and enjoyable) exercise.
• Maintain your ideal weight – As discussed, a low BMI may increase your vulnerability to low estrogen levels. Your healthcare provider can help you figure out a weight that works for you—and your hormones.

Find peace of mind with Everlywell

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.

Related content

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How to lower estrogen: what you need to know

How to test estrogen levels at home

How to test for PCOS: here's what to know

Does estrogen make you gain weight?

References

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2. Estrogen: Hormone, function, Levels & Imbalances. Cleveland Clinic. Updated February 28, 2022. Accessed December 6, 2022. URL
3. The Menopause Years: FAQs. ACOG. Updated November 2021. Accessed January 2, 2022.URL
4. Estrogen Levels Test. MedlinePlus. Updated October 4, 2022. Accessed January 2, 2022. URL
5. Stanczyk F and N Clarke. Measurement of Estradiol—Challenges Ahead. The Journal of Clinical Endocrinology & Metabolism. 2014;99(1): 56–58. doi.org/10.1210/jc.2013-2905
6. Menopause 101: A primer for the perimenpausal. North American Menopause Society (NAMS). Accessed January 2, 2022. URL
7. Shufelt CL, Torbati T, Dutra E. Hypothalamic Amenorrhea and the Long-Term Health Consequences. Semin Reprod Med. 2017;35(3):256-262. doi:10.1055/s-0037-1603581
8. Pituitary gland: What it is, Function & Anatomy. Cleveland Clinic. Updated April 4, 2022. Accessed December 7, 2022. URL
9. Farahmand M, Bahri Khomamid M, Rahmati M, Azizi F, Ramezani Tehrani F. Aging and changes in adiposity indices: the impact of menopause. J Endocrinol Invest. 2022;45(1):69-77. doi:10.1007/s40618-021-01616-2
10. Wharton W, Gleason CE, Olson SR, Carlsson CM, Asthana S. Neurobiological Underpinnings of the Estrogen - Mood Relationship. Curr Psychiatry Rev. 2012;8(3):247-256. doi:10.2174/157340012800792957
11. Estrogen & The Heart: Risks, Benefits & Side Effects. Cleveland Clinic. Updated April 29, 2019. Accessed December 7, 2022. URL
12. Rzepecki AK, Murase JE, Juran R, Fabi, McLellan SG. Estrogen-deficient skin: The role of topical therapy. International Journal of Women's Dermatology. 2019;5(2):85-90.
13. Primary ovarian insufficiency. Mayo Clinic. Updated October 27, 2021. Accessed December 7, 2022. URL
14. Menopause and your health. Office on Women’s Health (OASH). Updated December 15, 2022. Accessed January 2, 2023. URL