Both low estrogen and estrogen dominance can lead to health and well-being challenges.
Symptoms of low estrogen may include hot flashes, bone and joint pain, sleep disturbances, and vaginal dryness.
Lifestyle changes, including stress management, sleep improvements, a whole-foods diet, and gut health improvements can help reduce symptoms.
As women begin moving into their 30s and then to middle age, their female hormone production declines. It doesn’t happen all at once — the transition from perimenopause to menopause can take a number of years (sometimes 10 or more). But as it takes place, hormonal imbalances may begin to take hold, causing discomfort and frustration.
Low estrogen symptoms may include hot flashes, sleep disturbances, mood swings, low sex drive, vaginal dryness, and breast pain. In our western culture, we assume that the low estrogen symptoms associated with menopause are an inevitable part of this life change. But the truth is, there are ways to curb or prevent the unpleasantness of hot flashes, vaginal dryness, and poor sleep during the transition. Hormonal changes happen daily, monthly, and throughout a person’s life. How extreme the changes are and how they affect you can, at the very least, be better understood if not mitigated with lifestyle changes, especially when it comes to chronic stress.
Let’s start with a quick overview of female reproductive hormones to help you better understand the roles and functions of estrogen and progesterone. Then, we’ll unpack the symptoms of low estrogen, the potential causes/risk factors, and some tips and treatments for rebalancing your hormones and improving your quality of life during this transition.
Quick Overview of Female Reproductive Hormones
Estrogen and progesterone are the primary female sex hormones. They’re mostly produced in the ovaries and adrenal glands and require cholesterol for proper production . Estradiol, one of the four types of estrogen, can also be made by the brain, smooth muscle of blood vessels, and fat . Both estrogen and progesterone play an important role in healthy female reproductive function, in addition to mental health and mood, sleep quality, sex drive, and temperature regulation.
Estrogen is responsible for development of female-specific sex characteristics and reproductive function, including breast and hip development, higher body fat (when compared to males), smaller amounts of body and facial hair (when compared to males), and the healthy development of the female sexual organs (vulva, uterus, ovaries) .
There are four types of estrogen, each of which plays a critical role in a healthy menstrual cycle: estrone (E1), estradiol (E2), estriol (E3), and estetrol (E4). Estradiol is the most potent and abundant during reproductive years .
Importantly, in every step of the reproductive cycle, progesterone is also present to balance out the effects of estrogen. The presence of progesterone prevents tumor growth and helps maintain healthy bone density, uterine lining and cervical tissue, breast tissue, heart and blood vessels, and brain function and sleep patterns . So keeping these two hormones in balance is really important.
Low Estrogen or Estrogen Dominance?
When in adequate supply, progesterone and estrogen moderate each other — progesterone has a more calming effect, while estrogen has a more excitatory effect, for example. The most well-studied diseases of the female reproductive system, including breast cancer, ovarian cancer, endometriosis, and PCOS (polycystic ovary syndrome) are all results of unopposed estrogen (or too much estrogen productionin comparison to progesterone) . This may also be referred to as estrogen dominance. But there are also conditions and diseases that result from a dominance of progesterone or an underproduction of estrogen.
The most commonly known of these (which are associated with menopause specifically) are osteoporosis and joint pain. Other diseases you may not realize are associated with low estrogen levels include Alzheimer’s disease, Parkinson’s disease, type 2 diabetes, and eclampsia .
Symptoms of Low Estrogen Levels
Current research seems unable to answer the question of whether low estrogen symptoms are often caused by imbalanced estrogen and progesterone . However, we can surmise that when estrogen and progesterone are insufficient to moderate the effects of each other, at the very least, we’ll get disruptions in several important areas that may lead to common symptoms of low estrogen. Those disruptions and symptoms may include :
Bone density/bone loss, which can contribute to weak or brittle bones
Uterine lining and cervical tissue disruption, which may contribute to:
Low sex drive
Irregular menstrual periods
Vaginal dryness/reduced sexual function or lubrication
Thinning of vaginal tissue
Breast tissue disruptions, which may contribute to breast tenderness
Heart and blood vessel disruptions, which may contribute to:
Headaches before or during your period
Moodiness and irritability
Brain/sleep pattern disruptions, which may contribute to:
Difficulty concentrating and brain fog
Mood swings, irritability
Weight gain, especially as belly fat
While having the right levels of each hormone is important, the balance between the two also seems to make a big difference.
Potential Risk Factors or Causes of Low Levels of Estrogen
The risk factors for low estrogen range widely. They include age, eating disorders, genetic conditions, autoimmune disorders, premature menopause, medical treatments, and glandular disorders.
Genetic conditions such as Turner syndrome (when a female is missing or partially missing an X chromosome) and Fragile X syndrome (just how it sounds: the X chromosome of a male or female is easily damaged, especially by folic acid deficiency, and can result in limited intellectual function) can cause low estrogen levels. Autoimmunity that damages the ovaries, premature menopause, in which a woman stops producing eggs around age 40, and medical treatments like chemotherapy and radiation can all lead to increased risk for low estrogen production .
As we’ve already mentioned, aging is a common cause of hormonal imbalance, specifically low estrogen. As females approach perimenopause and menopause, the primary form of estrogen, estradiol (which is largely made in the ovaries) changes to estrone (made in body fat), and overall estrogen levels diminish . Menopause occurs when ovarian cells and follicles become reduced, typically around the age of 51, and estradiol levels decrease. Follicle stimulating hormone (FSH) and luteinizing hormone (LH) increase, and the lower estrogen levels disrupt the communication between the hypothalamus, pituitary gland, and ovaries, causing irregular menstrual cycles that eventually stop .
Eating disorders, whether over- or under-eating, cause a massive amount of stress on the human body. Whether the unhealthy weight is far too low or far too high, if the body perceives that it’s not fit to carry a child to term, the reproductive system will often be too taxed or stressed to function properly. This is why women with overeating or binging disorders may also experience a halt in menstruation (amenorrhea) similar to women with anorexia, bulimia, or compulsive exercise disorders. Anorexia and bulimia deprive the body of nutrients that are required to produce female hormones, namely cholesterol and fats .
Hypothalamic amenorrhea can also result from extreme exercise in the absence of proper nutrition. It’s a condition in which the communication between the hypothalamus, the pituitary gland, and the ovaries breaks down, due to excessive stress (rather than age, as in menopause). In a healthy person, that communication kickstarts the production of estrogen .
Since the pituitary gland tells the ovaries to make estrogen, a disorder of the pituitary gland can also result in estrogen deficiency .
Many of the risk factors (like age, premature menopause, or genetic conditions) can’t be prevented or controlled for, but it’s important to know your family history and seek medical advice to better understand your risks and what you might be able to do to mitigate them, when possible. Ask your doctor for a blood test or DUTCH urine test to check your hormone levels and get an idea of your health status, especially if you’re considering HRT (hormone replacement therapy) or hoping to get pregnant [9, 10, 11].
Tips and Treatments for Low Estrogen Symptoms
While there are a number of medications (including HRT, which was just mentioned) that can help moderate your hormone levels, it’s always best to try lifestyle changes first.
Maintain a Healthy Weight
Maintaining healthy weight (namely not being underweight) and avoiding excessive exercise are both key ways to maintain healthy estrogen levels. Swap extreme exercise for moderation and consider more gentle activities like yoga, meditation, or walking meditation to reduce stress hormone levels, which can throw reproductive hormones off-balance (this is true if you have too much estrogen as well) .
Reduce Your Stress and Get Some Sleep
Sleep is also a crucial piece of the hormonal health puzzle, so set a goal to get seven to nine hours per night. It’s a bit of a chicken and egg though, as hormonal disruptions can lead to sleep disruptions. This is true whether you have too much estrogen or too little.
As mentioned up top, progesterone is referred to as the “calming hormone,” so it makes sense that a lack of progesterone would lead to sleep disturbance. But low estrogen can also cause sleep problems. Estrogen stimulates the production of serotonin, a brain chemical that converts to melatonin, which is a sleep hormone. So low estrogen may lead to low serotonin, which can lead not only to sleep problems, but also depression and anxiety.
To help with this feedback loop, introducing some stress-reduction techniques (like meditation) can help with this. Other interventions include cognitive behavioral therapy (CBT), hypnosis, yoga, and mindfulness-based stress reduction [12, 13]. If this isn’t sufficient, or you find this advice itself to be stressful, there are other options to help with sleep.
Acupuncture for hormonal balance can help with sleep improvements . The antidepressant medication escitalopram (Lexapro) was also shown in a systematic review of 53 studies to be effective, alongside CBT and menopausal hormone therapy .
Focus on Nutrition
Reducing dietary stress is also a wise way to curb low estrogen symptoms. This means eating fewer refined carbohydrates to prevent blood sugar swings, avoiding inflammatory foods and dietary triggers, minimizing alcohol, and supporting your overall gut health.
A whole-foods, anti-inflammatory diet generally includes lots of fresh fruits and veggies, fish, meat, dairy products, whole grains, nuts, and seeds. It significantly reduces or eliminates processed foods, sugars, and refined carbohydrates and increases healthy fats.
Healthy fats include omega-3 fatty acids from foods like walnuts, flax, chia, and fatty fish, in addition to monounsaturated fats like avocado, extra virgin olive oil, and healthy saturated fats like coconut oil, eggs, and full-fat yogurt. Research supports this type of diet for reducing menstrual cramps and overall PMS symptoms, as well as generally improving gut health and reducing inflammation [16, 17].
The Gut-Hormone Connection
Speaking of gut health, research has found numerous links between gut health and hormone health [1, 3, 18]. Some signs of hormonal imbalances (such as PCOS and painful periods) have been associated with low microbial diversity, stress, inflammation, IBS, and leaky gut [19, 20, 21, 22, 23, 24]. Although it’s unclear whether poor gut health causes hormonal imbalances or vice versa, a healthy gut may contribute to stable hormone levels, and stable hormones may improve gut health [25, 26, 27, 28, 29].
Furthermore, gut microbes play a substantial role in metabolizing phytoestrogens and transforming them into their bioactive forms, ideally helping to relieve menopause symptoms, reduce the risk of certain cancers, heart disease, and type 2 diabetes . Studies investigating the effects of probiotic supplements on women with PCOS, and others with IBS symptoms associated with PMS and menstruation, showed improvements over the control groups on inflammatory markers (PCOS) and bloating, abdominal pain, and diarrhea (PMS) [31, 32].
Taking steps to improve the health of your microbiome, especially via dietary improvements and taking a good quality probiotic may help balance your hormones naturally and reduce the need for estrogen therapy or other medical interventions, whether your imbalance is due to age or some other factor.
Low Estrogen Symptoms Can Be Manageable
Symptoms of low estrogen can include joint pain, a lack of sex drive, brain fog, headaches, hot flashes, night sweats, mood swings, anxiety, depression, and more. It might not be immediately apparent that you’re dealing with an estrogen deficiency when looking at each symptom individually, so understanding the big picture is really important when you go to talk to your doctor.
Whether you’re reaching the age of perimenopause/menopause or struggling with a hormonal imbalance that isn’t age-related, understanding the role of estrogen and the importance of balance is key. There are medical interventions that you can employ, (such as HRT in the case of menopause, or birth control in the case of non-age-related issues), but by starting with lifestyle changes, you’ll be more likely to get at the root cause of the issue and balance your hormones naturally.
Maintaining a healthy weight, enjoying moderate exercise, getting better sleep, minimizing stress, and eating well seem to be the solution to all of life’s health problems, and this one is no different. Each of these will positively impact your hormone levels, in addition to improving your gut health, which is linked directly to your hormones as well.
To get more support in balancing your hormones, reach out to our clinic at the Ruscio Institute for Functional Medicine to become a patient.
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Hariri L, Rehman A. Estradiol. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. PMID: 31747204.
Delgado BJ, Lopez-Ojeda W. Estrogen. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. PMID: 30855848.
Prior JC. Women’s reproductive system as balanced estradiol and progesterone actions—A revolutionary, paradigm-shifting concept in women’s health. Drug Discovery Today: Disease Models. 2020;32:31–40. DOI: 10.1016/j.ddmod.2020.11.005.
Roos J, Johnson S, Weddell S, Godehardt E, Schiffner J, Freundl G, et al. Monitoring the menstrual cycle: Comparison of urinary and serum reproductive hormones referenced to true ovulation. Eur J Contracept Reprod Health Care. 2015 May 27;20(6):438–50. DOI: 10.3109/13625187.2015.1048331. PMID: 26018113.
Koothirezhi R, Ranganathan S. Postmenopausal Syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. PMID: 32809675.
Ghaffarilaleh G, Ghaffarilaleh V, Sanamno Z, Kamalifard M, Alibaf L. Effects of yoga on quality of sleep of women with premenstrual syndrome. Altern Ther Health Med. 2019 Sep;25(5):40–7. PMID: 31221931.
Chiu H-Y, Hsieh Y-J, Tsai P-S. Acupuncture to Reduce Sleep Disturbances in Perimenopausal and Postmenopausal Women: A Systematic Review and Meta-analysis. Obstet Gynecol. 2016 Mar;127(3):507–15. DOI: 10.1097/AOG.0000000000001268. PMID: 26855097.
Silvestri R, Aricò I, Bonanni E, Bonsignore M, Caretto M, Caruso D, et al. Italian Association of Sleep Medicine (AIMS) position statement and guideline on the treatment of menopausal sleep disorders. Maturitas. 2019 Nov;129:30–9. DOI: 10.1016/j.maturitas.2019.08.006. PMID: 31547910.
Bajalan Z, Alimoradi Z, Moafi F. Nutrition as a potential factor of primary dysmenorrhea: A systematic review of observational studies. Gynecol Obstet Invest. 2019 Jan 10;84(3):209–24. DOI: 10.1159/000495408. PMID: 30630172.
Esmaeilpour M, Ghasemian S, Alizadeh M. Diets enriched with whole grains reduce premenstrual syndrome scores in nurses: an open-label parallel randomised controlled trial. Br J Nutr. 2019 May;121(9):992–1001. DOI: 10.1017/S0007114519000333. PMID: 30761961.
Goedert JJ, Jones G, Hua X, Xu X, Yu G, Flores R, et al. Investigation of the association between the fecal microbiota and breast cancer in postmenopausal women: a population-based case-control pilot study. J Natl Cancer Inst. 2015 Aug;107(8). DOI: 10.1093/jnci/djv147. PMID: 26032724. PMCID: PMC4554191.
Lindheim L, Bashir M, Münzker J, Trummer C, Zachhuber V, Leber B, et al. Alterations in Gut Microbiome Composition and Barrier Function Are Associated with Reproductive and Metabolic Defects in Women with Polycystic Ovary Syndrome (PCOS): A Pilot Study. PLoS ONE. 2017 Jan 3;12(1):e0168390. DOI: 10.1371/journal.pone.0168390. PMID: 28045919. PMCID: PMC5207627.
Torres PJ, Siakowska M, Banaszewska B, Pawelczyk L, Duleba AJ, Kelley ST, et al. Gut microbial diversity in women with polycystic ovary syndrome correlates with hyperandrogenism. J Clin Endocrinol Metab. 2018 Apr 1;103(4):1502–11. DOI: 10.1210/jc.2017-02153. PMID: 29370410. PMCID: PMC6276580.
Vanuytsel T, van Wanrooy S, Vanheel H, Vanormelingen C, Verschueren S, Houben E, et al. Psychological stress and corticotropin-releasing hormone increase intestinal permeability in humans by a mast cell-dependent mechanism. Gut. 2014 Aug;63(8):1293–9. DOI: 10.1136/gutjnl-2013-305690. PMID: 24153250.
Karl JP, Margolis LM, Madslien EH, Murphy NE, Castellani JW, Gundersen Y, et al. Changes in intestinal microbiota composition and metabolism coincide with increased intestinal permeability in young adults under prolonged physiological stress. Am J Physiol Gastrointest Liver Physiol. 2017 Jun 1;312(6):G559–71. DOI: 10.1152/ajpgi.00066.2017. PMID: 28336545.
Tremellen K, Pearce K. Dysbiosis of Gut Microbiota (DOGMA)–a novel theory for the development of Polycystic Ovarian Syndrome. Med Hypotheses. 2012 Jul;79(1):104–12. DOI: 10.1016/j.mehy.2012.04.016. PMID: 22543078.
Meleine M, Matricon J. Gender-related differences in irritable bowel syndrome: potential mechanisms of sex hormones. World J Gastroenterol. 2014 Jun 14;20(22):6725–43. DOI: 10.3748/wjg.v20.i22.6725. PMID: 24944465. PMCID: PMC4051914.
Baker JM, Al-Nakkash L, Herbst-Kralovetz MM. Estrogen-gut microbiome axis: Physiological and clinical implications. Maturitas. 2017 Sep;103:45–53. DOI: 10.1016/j.maturitas.2017.06.025. PMID: 28778332.
Zhou Z, Zhang L, Ding M, Luo Z, Yuan S, Bansal MB, et al. Estrogen decreases tight junction protein ZO-1 expression in human primary gut tissues. Clin Immunol. 2017 Oct;183:174–80. DOI: 10.1016/j.clim.2017.08.019. PMID: 28867253. PMCID: PMC5673541.
Plottel CS, Blaser MJ. Microbiome and malignancy. Cell Host Microbe. 2011 Oct 20;10(4):324–35. DOI: 10.1016/j.chom.2011.10.003. PMID: 22018233. PMCID: PMC3264051.
Nuriel-Ohayon M, Neuman H, Ziv O, Belogolovski A, Barsheshet Y, Bloch N, et al. Progesterone Increases Bifidobacterium Relative Abundance during Late Pregnancy. Cell Rep. 2019 Apr 16;27(3):730-736.e3. DOI: 10.1016/j.celrep.2019.03.075. PMID: 30995472.
Zhou Z, Bian C, Luo Z, Guille C, Ogunrinde E, Wu J, et al. Progesterone decreases gut permeability through upregulating occludin expression in primary human gut tissues and Caco-2 cells. Sci Rep. 2019 Jun 10;9(1):8367. DOI: 10.1038/s41598-019-44448-0. PMID: 31182728. PMCID: PMC6558054.
Peirotén Á, Bravo D, Landete JM. Bacterial metabolism as responsible of beneficial effects of phytoestrogens on human health. Crit Rev Food Sci Nutr. 2020;60(11):1922–37. DOI: 10.1080/10408398.2019.1622505. PMID: 31161778.
Shamasbi SG, Ghanbari-Homayi S, Mirghafourvand M. The effect of probiotics, prebiotics, and synbiotics on hormonal and inflammatory indices in women with polycystic ovary syndrome: a systematic review and meta-analysis. Eur J Nutr. 2020 Mar;59(2):433–50. DOI: 10.1007/s00394-019-02033-1. PMID: 31256251.
McFarland LV, Dublin S. Meta-analysis of probiotics for the treatment of irritable bowel syndrome. World J Gastroenterol. 2008 May 7;14(17):2650–61. DOI: 10.3748/wjg.14.2650. PMID: 18461650. PMCID: PMC2709042.
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