Is Low Estrogen Causing Your Symptoms? Here's What You Need to Know

Last Updated: February 9, 2026

Every woman's experience with menopause is different, but one common thread connects nearly everyone who goes through it: the powerful effect of declining estrogen.

Estrogen is one of your body's most influential hormones. It's not just about periods or pregnancy. It affects your skin, brain, mood, heart, bones, and energy. When estrogen levels fall during perimenopause and menopause, your body starts sending signals that something is shifting.1

If you've been feeling foggy, tired, moody, or less like yourself, you're not imagining it. These are all possible signs of low estrogen.

Before we get into low estrogen symptoms, you may not yet know what estrogen actually is. Don’t worry, many women know of it generally but don’t understand how it works in the body. We’ll start with a quick overview.

What Is Estrogen?

Estrogen is a group of hormones that help regulate the menstrual cycle, fertility, and many other systems in the body. Beyond reproduction, estrogen supports the brain, mood, bones, heart, skin, and vaginal and urinary tissues.

There are three main forms:

• Estradiol (E2): the primary and most active form during the reproductive years
  
• Estriol (E3): made mostly during pregnancy
  
• Estrone (E1): the main form after menopause
  

During perimenopause and menopause, estrogen levels fluctuate and then decline, which is why changes in this hormone can affect so many parts of how you feel.

Low Estrogen Causes

Think of estrogen as your body's master conductor, keeping your systems in rhythm. It regulates mood, supports brain and heart health, keeps bones strong, and maintains the softness and moisture of skin and tissues (1).

As estrogen levels decline in midlife, that balance changes.

Research shows that perimenopause and menopause trigger not only hormonal changes but also low-grade inflammation throughout the body (1). This inflammation can affect the brain, mood, and energy levels. This may help explain symptoms like brain fog and fatigue.

In other words, low estrogen isn't just about hot flashes. It's a whole-body shift. And your symptoms are your body's way of asking for support.

Side Effects of Low Estrogen in Women

Let's explore what low estrogen can feel like, how it affects different parts of your body, and what you can do about it.

1. Irregular or Longer Periods: The First Sign

For many women, the earliest sign of perimenopause is changes to your menstrual cycle (1). You might notice:

• Periods that are closer together or further apart
• Heavier bleeding or bleeding that lasts longer
• Unpredictable cycles that make planning difficult

These changes happen because estrogen and progesterone levels start to fluctuate before they eventually decline. While irregular periods are usually normal during this transition, it's worth discussing significant changes with your provider. This is especially important if you experience very heavy bleeding or bleeding between periods.

2. Hot Flashes and Night Sweats: Your Body's Thermostat on Overdrive

About 75% of women experience hot flashes or night sweats as estrogen levels fall (4). These are sudden waves of heat that rise through the chest, neck, and face. They are sometimes followed by chills or sweating.

Why does this happen? Estrogen normally helps regulate your body's temperature control center in the brain. When levels drop, that regulation becomes unstable, leading to those unpredictable bursts of heat (4). Hot flashes may last seconds or minutes.They can interrupt sleep and leave you drained.

The reassuring news: effective treatments are available. Hormone Replacement Therapy (HRT) can reduce the frequency and intensity of hot flashes within weeks (1).

Additional medications that help with hot flashes include low-dose paroxetine (BRISDELLE®), which is FDA-approved for this purpose, as well as fezolinetant (VEOZAH®), elizanetant (LYNKUET®), and gabapentin, which can also support sleep and reduce anxiety.

Your provider can help determine which treatment approach is right for you.

3. Sleep Struggles and Fatigue: When Rest Feels Out of Reach

Even women who have never struggled with sleep before may find themselves awake at 3 a.m. during perimenopause.

Lower estrogen disrupts the production of melatonin (the sleep hormone) and increases night sweats, making it harder to stay asleep. Fatigue follows naturally, and it's not just physical. Many women describe feeling "wired but tired," an exhaustion that doesn't lift even after rest.

4. Anxiety: When Worry Takes Over

Approximately 36% of women experience significant anxiety during the menopausal transition (5) and this is distinct from general mood changes.

You might notice:

• Persistent worry that feels hard to control
• Racing thoughts or feeling on edge
• Physical symptoms like rapid heartbeat or shortness of breath
• Panic attacks that seem to come out of nowhere

Here's why: Estrogen influences neurotransmitters like serotonin and GABA, which help regulate anxiety. When estrogen drops, these calming signals can weaken, leaving you more vulnerable to anxious feelings (1).

Research shows that anxiety during menopause has one of the largest impacts on mental quality of life, even more than some other common symptoms (5).

What helps:

• HRT can stabilize hormone levels and reduce anxiety for many women
• Non-hormonal medications like SSRIs or SNRIs may be recommended
• Mind-body practices like meditation, yoga, or deep breathing exercises
• Regular exercise, which naturally boosts mood-regulating chemicals

If anxiety is interfering with your daily life, don't hesitate to reach out to a healthcare provider. This is treatable, and you don't have to suffer through it.

5. Depression: More Than Just Feeling Down

About 33% of women experience depression during perimenopause or menopause and this isn't just sadness (5). Depression can show up as:

• Loss of interest in activities you once enjoyed
• Persistent low mood or feelings of hopelessness
• Changes in appetite or sleep
• Difficulty concentrating or making decisions
• Physical symptoms like fatigue or unexplained aches

Research confirms that depression has the single largest negative impact on mental health quality of life during menopause.

The connection to estrogen is clear: estrogen supports the production and function of serotonin and other mood-regulating neurotransmitters. When levels fall, the risk of depression increases, even in women with no prior history (1).

Treatment options:

• HRT may significantly improve mood for some women
• Antidepressants (SSRIs or SNRIs) are effective and sometimes specifically indicated for menopausal depression
• Therapy or counseling provides tools for managing symptoms
• Lifestyle approaches including exercise, social connection, and stress management

Depression is a medical condition, not a personal failing. If you're experiencing these symptoms, please reach out for help, effective treatment is available.

6. Brain Fog and Memory Changes: The Cognitive Side of Menopause

Mood swings, irritability, forgetfulness, and that frustrating "foggy" feeling can all trace back to fluctuating estrogen.

Here's why: Estrogen supports neurotransmitters like acetylcholine and dopamine that are critical for memory, focus, and processing speed. When estrogen dips, these neurotransmitter levels can drop too, which leaves you more vulnerable to brain fog, difficulty concentrating, and memory lapses.

At the same time, inflammation linked to estrogen decline can affect the brain's mitochondria, which produce energy for brain cells. This combination can explain why your thoughts feel slower or your memory feels less sharp (3).

A quick tip: If you find yourself misplacing words or feeling "off," it doesn't mean you're losing your memory. Your brain is adapting to new hormone patterns, and with support, clarity often returns.

7. Weight Gain and Body Composition Changes

Many women notice weight gain during perimenopause, particularly around the abdomen (2). Research shows that women with menopausal symptoms are more likely to have a higher BMI compared to those without symptoms (5).

Why does this happen? Declining estrogen affects how your body stores fat, shifting it from hips and thighs to the midsection. Estrogen also influences metabolism, hunger signals, and how efficiently your body burns calories (2).

What helps:

• Strength training to preserve muscle mass and metabolism
• A diet rich in protein, fiber, fruits, and vegetables
• Managing stress, which affects cortisol and fat storage
• HRT may help some women maintain a healthier body composition

Remember: This isn't about willpower. It's about hormonal shifts that affect every woman differently.

8. Heart Racing or Pounding

About 25% of women experience heart palpitations during menopause (5). Heart palpitations feel like a sensation that your heart is racing, pounding, or fluttering.

While this can be alarming, it's usually harmless and related to estrogen's effect on the cardiovascular system. Estrogen helps regulate heart rate and rhythm, so when levels fluctuate, you may notice these sensations more frequently (1).

Research shows that heart palpitations are among the symptoms with the largest effects on physical quality of life (5).

When to seek care:

• If palpitations are frequent, severe, or accompanied by chest pain, dizziness, or shortness of breath, see a healthcare provider promptly
• Your provider can rule out other heart conditions and discuss whether HRT or other treatments might help

9. Vaginal Dryness and Urinary Changes: The Hidden Side of Menopause

Low estrogen can thin the lining of the vagina and urinary tract, leading to dryness, burning, or pain during sex. You might also notice more frequent urinary infections or urgency (4).

These changes are part of what's now called Genitourinary Syndrome of Menopause (GSM), a medical term for vaginal and bladder symptoms caused by estrogen decline (4).

The good news? Treatment is simple and effective.

Local estrogen therapy (a cream, ring, or vaginal tablet) restores moisture and elasticity within weeks. Unlike systemic HRT, local therapy works directly on tissues and has minimal absorption elsewhere in the body (1,4).

Other helpful habits:

• Use fragrance-free moisturizers or lubricants
• Maintain pelvic health through regular activity that promotes blood flow. This can include pelvic floor exercises (kegels), clitoral or vulvar stimulation, vaginal insertion with dilators or other aids, and orgasm (partnered or solo)
• Don't hesitate to talk to a provider about these common and treatable symptoms

10. Urinary Incontinence: More Common Than You Think

About 34% of women experiencing menopause symptoms report urine leakage (5). This can include:

• Stress incontinence (leakage when coughing, sneezing, or exercising)
• Urgency incontinence (sudden, strong urges to urinate)
• Increased frequency of urination

Estrogen helps maintain the strength and elasticity of tissues in the bladder and urethra. When levels drop, these tissues can weaken, leading to control issues (4).

Treatment options:

• Local vaginal estrogen can significantly improve urinary symptoms
• Pelvic floor physical therapy strengthens supporting muscles
• Lifestyle changes like bladder training and limiting caffeine

Don't let embarrassment stop you from seeking help. These symptoms are common, treatable, and not something you need to live with.

11. Hair, Skin, and Nail Changes: What You See in the Mirror

Estrogen helps your skin stay hydrated and elastic as it stimulates collagen production in the body. When levels drop, the skin loses collagen and hyaluronic acid, leading to dryness, fine lines, and thinner texture (4).

In fact, research shows that women can lose up to 30% of their skin's collagen within the first five years after menopause (4). Hair can thin, nails can become brittle, and wounds may take longer to heal, all because estrogen also supports circulation and repair (4).

Supportive options include:

• Topical estrogen creams or systemic HRT to restore hydration and collagen
• Balanced nutrition, especially protein, vitamin C, and healthy fats
• Gentle retinol or peptide serums for skin renewal

If you've noticed your skin suddenly feels "different," know that it's not vanity, it's physiology. Restoring estrogen often restores confidence, too.

12. Joint Aches and Muscle Stiffness

Many women in midlife notice new joint discomfort or morning stiffness, even without arthritis.

Why? Estrogen helps control inflammation. When it declines, inflammatory molecules (like IL-6 and TNF-α) rise. This low-grade inflammation can make joints ache and muscles feel sore.

Gentle exercise, stretching, and anti-inflammatory foods help ease pain. HRT may also improve mobility by calming inflammation at its source.

13. Low Libido and Sexual Wellbeing

Estrogen affects more than lubrication. It influences arousal, blood flow, and even emotional connection. When estrogen and testosterone both drop, many women feel less desire or find intimacy uncomfortable (1).

You're not alone in this. It's estimated that over half of women experience a noticeable decline in libido during menopause.

Treatment can include:

• Estrogen therapy to restore comfort
• Testosterone or in select cases
• Open conversations (with partners and clinicians) about what feels right

The right balance of hormones can revive both comfort and confidence.

Low Estrogen Treatments: Types of Care

Modern menopause care offers multiple pathways to relief. The most effective treatments remain hormone-based therapies, which directly address the root cause of symptoms.

Systemic Hormone Replacement Therapy (HRT)

Estrogen (with progesterone if you have a uterus) delivered through pills, patches, or gels that work throughout your whole body. HRT remains the most effective treatment for menopausal symptoms and is safe for most women when started during perimenopause or early menopause (1).

Best for: Hot flashes, night sweats, mood symptoms, brain fog, sleep disturbances, joint aches, and long-term bone and heart health (1).

Forms available: Oral tablets, transdermal patches, and gels. Today’s estrogen medications, whether FDA-approved or formulated by a compound pharmacy are plant derived and share the same chemical makeup as the hormones your body naturally produces. (1)

Local Vaginal Estrogen: A Highly Effective Option

Low-dose estrogen applied directly to vaginal tissues through creams, tablets, inserts, or rings. According to 2025 medical guidelines, this is a strong recommendation for treating genitourinary symptoms (6).

What it treats: Vaginal dryness, painful intercourse, urinary urgency, recurrent UTIs, and urinary incontinence (4).

Why it's so effective: Studies show up to 81% of women experience complete resolution of vaginal dryness. For recurrent UTIs, local estrogen reduces infection rates by 52-91% (4).

Safety profile: Remarkably safe with minimal absorption into the bloodstream, no increased risk of endometrial or breast cancer, and safe for most breast cancer survivors (1).

Formulations:

• Creams: Flexible dosing, used 1-3 times weekly after initial period
• Tablets/Inserts: Very low dose, used twice weekly
• Ring: Inserted once and usually lasts 3 months
• DHEA inserts: Alternative to estrogen, used daily

It’s important to note that the United States does not currently have an FDA-approved estriol vaginal option. All FDA-approved vaginal estrogen products instead contain estradiol and some, including a popular ring, actually produce systemic absorption. For a cream or insert that contains estriol, the gentler hormone, and produces localized absorption, women need to use a compound pharmacy medication.

Special benefit: If you experience recurrent UTIs (2+ per year), local vaginal estrogen can be life-changing, with strong research support (4).

Your treatment plan should be personalized to your specific symptoms, health history, and preferences.

How Low Estrogen Is Diagnosed

In midlife, low estrogen usually isn’t diagnosed from a single lab number. Instead, healthcare providers rely primarily on symptoms, age, and life stage to understand what’s happening hormonally.

Here’s what you can typically expect during an evaluation.

Your Symptoms Guide the Conversation

Hormone levels can swing widely during perimenopause, so your symptom pattern often provides the clearest information.

A clinician will usually ask about:

• Changes in your menstrual cycle
  
• Hot flashes or night sweats
  
• Sleep disruption or new fatigue
  
• Mood changes, anxiety, or low mood
  
• Brain fog or memory issues
  
• Vaginal dryness or pain with sex
  
• Urinary urgency or leakage
  
• Joint aches or body stiffness
  
• Changes in libido
  

Looking at how these symptoms cluster together helps determine whether estrogen changes are likely playing a role.

Life Stage Is a Key Clue

Your age and reproductive stage matter as much as symptoms.

At these stages, symptom patterns are widely recognized as the most reliable way to assess hormone-related changes.

Are Hormone Blood Tests Always Needed?

Often, no.

During perimenopause especially, estrogen levels can change hour to hour. A single blood test may look “normal” even when symptoms are significant.

Because of this, many providers use symptom-based evaluation to guide care and adjust treatment based on how you feel rather than targeting a specific lab value.

Testing may be more helpful when:

• You are under 45 with menopause-like symptoms
  
• Periods stop suddenly
  
• You’ve had a hysterectomy (no cycle to track)
  
• Symptoms are severe or don’t follow typical patterns

Bringing It All Together

Low estrogen can touch nearly every part of your life; how you think, feel, move, and connect. But it's not an ending; it's a transition.

Today's research shows that when guided by knowledgeable clinicians, hormone replacement therapy is safe, effective, and life-enhancing for most women (1,2). Combined with good nutrition, movement, and stress care, it can help you feel like yourself again. Vibrant, strong, and clear-minded.

If you're noticing the signs of low estrogen, you don't need to wait. Relief and balance are possible.

Most Common Questions on Low Estrogen Symptoms

When should I see a healthcare provider about my symptoms?

You should reach out if symptoms are affecting your quality of life, sleep, work, or relationships. You don't need to wait until symptoms are severe.

Is Hormone Replacement Therapy (HRT) safe?

Yes, for most women. Modern research shows that HRT is safe and effective when started during perimenopause or early menopause (typically before age 60 or within 10 years of your last period). The outdated concerns from older studies have been clarified by newer research. Your provider will review your personal health history to determine if HRT is right for you. Local vaginal estrogen therapy is particularly safe, with minimal systemic absorption and no increased cancer risk.

How long do menopause symptoms typically last?

This varies widely. Some women experience symptoms for a few years, while others may have them for a decade or longer. The average duration of hot flashes is 7-10 years, but every woman's experience is different. Vaginal and urinary symptoms (GSM) tend to persist or worsen without treatment, which is why local estrogen therapy is so valuable.

Can I have low estrogen symptoms even if I'm still having regular periods?

Absolutely. Perimenopause can begin in your 40s (or even late 30s for some women) while you're still menstruating. Estrogen levels fluctuate significantly during this time, causing symptoms even before your periods become irregular. In fact, irregular cycles are often one of the later signs of perimenopause.

What's the difference between perimenopause and menopause?

Perimenopause is the transitional phase when your hormones begin to fluctuate and decline. You may still have periods (regular or irregular) and can experience many low estrogen symptoms. Menopause is officially diagnosed after you've gone 12 consecutive months without a period. Postmenopause refers to all the years after that point.

Are there non-hormonal treatment options?

Yes, though hormone therapy remains the most effective for most symptoms. Non-hormonal options include:

• For hot flashes: Fezolinetant (VEOZAH®), elizanetant (LYNKUET®), low-dose paroxetine (BRISDELLE®), gabapentin, or SSRIs/SNRIs
• For mood: SSRIs, SNRIs, or cognitive behavioral therapy
• For low libido: Flibanserin (Addyi®) or bremelanotide (Vyleesi®)
• For urinary symptoms: Pelvic floor physical therapy
• For vaginal dryness: Moisturizers and lubricants (though less effective than local estrogen)
• Overall support: Lifestyle modifications including exercise, stress management, and dietary changes

Your provider can help you determine the best combination of treatments for your situation.

How quickly does HRT work?

Many women notice improvement in hot flashes and night sweats within 2-4 weeks. Mood and sleep improvements may take 4-8 weeks. Vaginal symptoms typically improve within 6-12 weeks of starting local estrogen therapy. Brain fog and cognitive symptoms may take several months to fully resolve. Be patient, your body needs time to adjust to more stable hormone levels.

Do I need blood tests to diagnose low estrogen?

Not necessarily. Menopause is primarily a clinical diagnosis based on your age, symptoms, and menstrual pattern. Hormone levels fluctuate significantly during perimenopause, so blood tests may not be reliable or helpful for diagnosis. However, your provider might order tests if you're under 45, have had a hysterectomy, or have ambiguous symptoms.

Is it normal to have only some symptoms and not others?

Yes, completely normal. Every woman's experience is unique. Some women primarily have physical symptoms like hot flashes, while others mainly experience mood or cognitive changes. Some have nearly all the symptoms, while others have just a few. The severity also varies widely. Your individual symptom profile doesn't make your experience any less valid.

Can low estrogen affect my risk for other health conditions?

Yes. Long-term estrogen deficiency increases your risk for osteoporosis (bone loss), cardiovascular disease, and possibly cognitive decline. This is especially important for women who experience early menopause (before age 45) or surgical menopause. This is one reason why early intervention with HRT can be protective for long-term health, not just symptom relief.

Will I gain weight no matter what I do?

Not necessarily. While declining estrogen does shift how your body stores fat and affects metabolism, weight gain isn't inevitable. Many women maintain a healthy weight through strength training (which preserves muscle mass and metabolism), balanced nutrition with adequate protein, stress management, and sometimes HRT. The key is understanding that the approach that worked in your 30s may need adjusting in your 40s and 50s.

References

1. Yang JL, Hodara E, Sriprasert I, Shoupe D, Stanczyk FZ. Estrogen deficiency in the menopause and the role of hormone therapy: integrating the findings of basic science research with clinical trials. Menopause. 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC12072814/
2. McCarthy M, Raval AP. The peri-menopause in a woman's life: a systemic inflammatory phase that enables later neurodegenerative disease. Journal of Neuroinflammation. 2020;17:317. https://jneuroinflammation.biomedcentral.com/articles/10.1186/s12974-020-01998-9
3. Sagili H, Rajan S. Cutaneous manifestations of estrogen excess and deficiency. GREM Journal. 2021. https://gremjournal.com/journal/03-2021/cutaneous-manifestations-of-estrogen-excess-and-deficiency/
4. Whiteley J, DiBonaventura M, Wagner JS, Alvir J, Shah S. The Impact of Menopausal Symptoms on Quality of Life, Productivity, and Economic Outcomes. J Womens Health. 2013;22(11):983-990. 
5. Camon C, Garratt M, Correa SM. Exploring the effects of estrogen deficiency and aging on organismal homeostasis during menopause. Nature Aging. 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC11785355/
6. American Urological Association, Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, American Urogynecologic Society. Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline. 2025. https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-of-menopause