The common symptoms of low estrogen are hot flashes and night sweats, irregular or missed periods, vaginal dryness, painful sex, trouble sleeping, mood changes and a lower sex drive. The usual cause is the natural drop in estrogen around menopause, but low levels at a younger age can point to a medical condition. This guide covers the symptoms, causes, testing and treatment.
Symptoms of low estrogen in women
Cleveland Clinic lists these signs after puberty:
- hot flashes and night sweats;
- irregular periods or no periods;
- vaginal dryness;
- painful sex;
- trouble sleeping;
- moodiness and irritability;
- difficulty concentrating;
- decreased sex drive;
- dry skin;
- headaches before or during a period.
The National Institute on Aging describes hot flashes and night sweats as among the most common symptoms of the menopause transition. A hot flash is a sudden feeling of heat, most often in the upper body and face, and most last between 30 seconds and 10 minutes.
The Institute also notes that bladder problems can develop around menopause, including leakage and a higher risk of urinary tract infections.
In men
Men make estrogen too. Cleveland Clinic lists increased belly fat and a lower sex drive as symptoms of low estrogen in men.
What causes low estrogen?
Estrogen falls naturally with age. The American College of Obstetricians and Gynecologists (ACOG) explains that menopause happens when the ovaries stop making estrogen, at an average age of 51. In the years before, called perimenopause, estrogen levels fluctuate.
Low estrogen that is not explained by menopause or recent childbirth may have another cause. Cleveland Clinic lists:
- removal of the ovaries;
- primary ovarian insufficiency, where the ovaries stop working normally before age 40;
- early menopause, before age 45;
- pelvic radiation therapy;
- conditions of the pituitary gland or hypothalamus, including the effects of stress on the body;
- Turner syndrome.
Being underweight and over-exercising can also contribute.
Why the symptoms of low estrogen matter
The effects go beyond comfort. Cleveland Clinic says low estrogen can contribute to weak or brittle bones, heart disease, depression and pain during sex. During the reproductive years it can cause infertility.
Symptoms can be more severe in some people than others. If they are affecting daily life, that is reason enough to seek help.
How low estrogen is tested
A provider may check estrogen with a blood test. There are limits to what one result shows. Cleveland Clinic notes that blood tests may not be accurate in someone who still has periods, because estrogen rises and falls through the cycle. MedlinePlus adds that because levels change so often, you may need to be tested more than once to see the trend.
Our guide to the labs required for hormone therapy explains what is usually checked.
Treatment for low estrogen
Hormone therapy is the main treatment, particularly around and after menopause. ACOG describes what it does:
- systemic estrogen, as pills, patches, gels or sprays, “has been shown to be the best treatment for the relief of hot flashes and night sweats”;
- local estrogen, as a vaginal ring, tablet or cream, relieves vaginal dryness;
- systemic estrogen protects against the bone loss that occurs early in menopause.
Women who have a uterus take a progestin with estrogen. ACOG explains that this reduces the risk of cancer of the uterus that occurs when estrogen is used alone.
Risks of hormone therapy
ACOG lists these risks:
- estrogen-only therapy can increase the risk of uterine cancer in women who have a uterus;
- combined therapy is associated with a small increased risk of heart attack and of breast cancer;
- both types are associated with a small increased risk of stroke and blood clots in the veins, which may be lower with forms not taken by mouth;
- there is a small increased risk of gallbladder disease.
Whether the benefits outweigh the risks depends on your age, your health and when you start. That is a decision to make with your provider. Our posts on HRT safety and what HRT is go further.
Other options
ACOG notes that several non-hormonal prescription medicines can reduce hot flashes. Cleveland Clinic lists a healthy body weight, moderate exercise, stress reduction and enough sleep as ways to support healthy hormone levels.
When to see a provider
See a provider if symptoms are unexpected for your age, severe, or disrupting your sleep or daily life. The National Institute on Aging also advises seeing a doctor for heavy bleeding, periods very close together, bleeding after sex or between periods, or any bleeding more than a year after your last period.
Frequently asked questions
What are the first symptoms of low estrogen?
Around menopause, a change in periods is often the first thing noticed. Hot flashes and night sweats are among the most common symptoms.
Can low estrogen cause weight gain?
The sources used here do not list weight gain among the symptoms of low estrogen in women. Weight often changes at midlife for other reasons.
Can low estrogen be treated without hormones?
Some symptoms can. ACOG lists non-hormonal medicines for hot flashes, and lifestyle measures may help. ACOG describes estrogen as relieving vaginal dryness and protecting against early bone loss.
Next step
Low progesterone often occurs alongside low estrogen in perimenopause; see the symptoms of low progesterone. You can also read about hormonal imbalances and hormone therapy at Beauté Medical Aesthetics, or book a consultation.
Sources
- Cleveland Clinic. Low Estrogen. Updated April 2026.
- American College of Obstetricians and Gynecologists. The Menopause Years. Patient FAQ.
- National Institute on Aging. What Is Menopause?
- MedlinePlus, U.S. National Library of Medicine. Estrogen Levels Test.
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