What Happens When Estrogen Levels Are Low?

Estrogen is a female hormone produced in women, but it is also produced in small quantities in men.^{(1, 2, 3)} Hormones play a huge role in maintaining one’s health.

• When girls reach puberty, estrogen is the hormone which is responsible for sexual development in women.
• Estrogen causes changes in breasts in pregnant women and teenagers.
• Estrogen also controls the uterine lining growth during the menstrual cycle and at the start of the pregnancy.
• Estrogen is also involved in metabolism of cholesterol and bone.
• Estrogen is also responsible for regulating food intake, insulin sensitivity, glucose metabolism and body weight.

Women approaching menopause and young girls who have not attained puberty often have low estrogen. However, there are other causes for development of low estrogen levels in women. When estrogen levels are low in the body the following symptoms are experienced by women:

• Low levels of estrogen cause absent or irregular periods.
• When the estrogen levels are low, women experience painful sex because of decrease in vaginal lubrication
• Low levels of estrogen causes thinning of the urethra, which results in increase in urinary tract infection.
• Women having low estrogen levels experience mood swings, breast tenderness, depression, hot flashes, fatigue, difficulty in concentrating, headaches or exacerbation of old migraine history.
• Low estrogen levels also cause infertility in women, if it is not treated.

Low levels of estrogen causes decrease in bone density, which makes the bones weak or fragile with increased risk of fracture. Estrogen functions in conjunction with vitamin D, calcium and other minerals for keeping the bones strong. Any decrease in any of these elements causes reduction in bone density.

Ovaries primarily produce estrogen. Whatever affects the ovaries will also cause problems with production of estrogen. Low levels of estrogen in young women can occur due to:

• Eating disorders, such as anorexia can cause estrogen levels to dip.
• Excessive exercise can also lead to decreased estrogen levels.
• Toxins, genetic irregularities or an autoimmune disease can cause premature ovarian failure which leads to low estrogen levels.
• Estrogen levels are low if the pituitary gland function is affected.
• Certain conditions like chronic kidney disease and Turner syndrome also cause estrogen levels to drop.
• A low estrogen level in females over the age of 40 is an indication of peri-menopause, which is a transition period before menopause.
• In peri-menopause the ovaries continue to produce estrogen; however, it gradually slows till the woman has reached menopause.

• Having a family history of hormonal problems, such as PCOS or ovarian cysts.
• Older age, as the ovaries start to produce less estrogen as one gets older.
• Extreme dieting and rigorous exercise also increases the risk for low levels of estrogen.
• Eating disorders and problems with pituitary gland also increases the risk of suffering from low estrogen levels.
• The risk of low estrogen levels also increases with substance use disorder.
• Radiation therapy and chemotherapy also increases the risk of low levels of estrogen.

Early diagnosis and treatment of low levels of estrogen helps in preventing many health issues in women. Diagnosis of low estrogen levels is made on the basis of medical history, family history, symptoms, physical exam and blood tests to check the hormone levels.

Hormone therapy is the standard treatment prescribed by doctors for women suffering from low levels of estrogen. Non-hormonal options are also given to alleviate the symptoms and are preferred for females with increased risk for stroke, blood clots, breast cancer or liver disease.

Estrogen Therapy for Treating Low Estrogen Levels⁽⁸⁾

This is the treatment prescribed for women who are aged between 25 to 50 and are suffering from decreased estrogen.  Estrogen therapy can reduce the risk of: cardiovascular disease, bone loss and other hormonal problems. Estrogen therapy also helps in relieving severity of symptoms caused by menopause and also cuts down on the risk of fractures.

Dose and Duration of Estrogen Therapy: The dose of estrogen therapy depends on the method of application and the severity of the condition. Estrogen can be administered to the patient in the following ways: Orally, vaginally, topically and via injection.

High doses of estrogen are not prescribed anymore since the Food and Drug Administration (FDA) advised women to take the lowest dose possible for the shortest duration of time. ⁽⁹⁾

Long-term treatment may be required in some patients even after the levels of estrogen have returned to normal. This is to maintain the current estrogen level with low doses of estrogen over a period of time.

It is recommended to give Estrogen therapy for 1 to 2 years only as it can increase the risk of cancer in women.

Hormone Replacement Therapy is prescribed to increase the patient’s natural hormone levels. HRT is recommended if the patient is close to menopause and menopause causes significant decrease in the estrogen and progesterone levels.

Treatment done with Hormone Replacement Therapy can be adjusted in length, dosage and the combination of hormones used. Depending on the diagnosis, if the patient has her uterus then progesterone is needed, but if the patient has had hysterectomy, then progesterone is not required.

A study has shown that women who take combination hormone therapy, which includes estrogen and for treatment of menopause symptoms were at increased risk for heart disease, breast cancer, blood clots, stroke and urinary incontinence.⁽¹¹⁾

Estrogen affects the amount of fat present in the body and this hormone is also responsible for regulating the metabolism of glucose and lipid. If there are decreased levels of estrogen, then it can cause weight gain.

Research also shows that this is the reason why females who are near menopause tend to gain weight, which in turn increases the risk for cardiovascular disease and diabetes.⁽¹²⁾

If low estrogen levels are affecting the weight, then one should consult their doctor to assess the symptoms and for advice on what to do next. Following a healthy lifestyle with nutritious diet and adequate exercise helps a lot.

Prognosis for low estrogen levels is good. Treatments for low estrogen levels have changed and have gotten better over the years.

Hormones play a vital role in woman’s general health. Certain diseases, age and inherited disorders are some of the reasons for estrogen levels to decrease. If the estrogen levels are low then it can cause interference with sexual functions and sexual development along with increasing the risk for cardiovascular disease and osteoporosis.

The exact cause of low estrogen will determine the treatment, its duration and dosage.

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