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.
The good news? You have options for feeling better, and you don't have to go through it alone.
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.
Let's explore what low estrogen can feel like, how it affects different parts of your body, and what you can do about it.
For many women, the earliest sign of perimenopause is changes to your menstrual cycle (1). You might notice:
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.
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.
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.
You deserve restful, restorative sleep.
Some women find relief through bioidentical hormone therapy. You can also combine gentle adjustments like consistent bedtime routines, less screen time at night, or a magnesium supplement. To develop the right solution for personalized care, consult with a menopause specialist.
If you're constantly exhausted, don't write it off as "just aging." Fatigue can be one of the earliest and most disruptive signs of low estrogen.
Approximately 36% of women experience significant anxiety during the menopausal transition (5) and this is distinct from general mood changes.
You might notice:
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:
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.
About 33% of women experience depression during perimenopause or menopause and this isn't just sadness (5). Depression can show up as:
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:
Depression is a medical condition, not a personal failing. If you're experiencing these symptoms, please reach out for help, effective treatment is available.
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).
There's no need to push through this silently. Many women feel relief with HRT, and lifestyle approaches help the brain stay resilient.
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.
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:
Remember: This isn't about willpower. It's about hormonal shifts that affect every woman differently.
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:
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:
About 34% of women experiencing menopause symptoms report urine leakage (5). This can include:
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:
Don't let embarrassment stop you from seeking help. These symptoms are common, treatable, and not something you need to live with.
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:
If you've noticed your skin suddenly feels "different," know that it's not vanity, it's physiology. Restoring estrogen often restores confidence, too.
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.
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:
The right balance of hormones can revive both comfort and confidence.
If these symptoms are affecting your daily life, sleep, or relationships, it's time to reach out. Low estrogen is not something you need to "tough out."
In fact, early support can protect long-term health. Estrogen plays a key role in bone strength, heart protection, and cognitive health. Studies show that women who experience early or abrupt menopause (before age 45) have higher risks of osteoporosis and cardiovascular issues if estrogen levels remain low for too long (2,3).
Working with a knowledgeable menopause specialist can help you understand your hormone profile and design a treatment plan that fits your life.
Modern menopause care offers multiple pathways to relief. The most effective treatments remain hormone-based therapies, which directly address the root cause of symptoms.
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).
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:
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.
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.
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. If you're experiencing irregular periods with very heavy bleeding, bleeding between periods, new heart palpitations with chest pain or dizziness, or signs of depression or anxiety that interfere with daily activities, seek care promptly. Early support can protect your long-term health and help you feel better sooner.
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.
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.
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.
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.
Yes, though hormone therapy remains the most effective for most symptoms. Non-hormonal options include:
Your provider can help you determine the best combination of treatments for your situation.
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.
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.
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.
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.
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.
While this article focuses on women, men do produce small amounts of estrogen, and very low levels can affect bone health and other functions. However, the dramatic symptoms described here are specific to the female experience of menopause when estrogen levels drop significantly.