Low estrogen: the signs and how to raise it

What is low estrogen?

Low estrogen most often means the drop in the hormone that comes with the menopause transition. Perimenopause usually starts in your 40s and lasts until 12 months after your final period, and postmenopause is everything after that point.

Estrogen does not fall in a straight line on the way there. Estradiol, the main form of estrogen, is highly variable during perimenopause and drops mainly in the late part of the transition, according to a 2018 review of perimenopause management. As a result, the level on a given day does not always match how a woman feels.

A small number of women reach low estrogen much earlier. When periods stop before age 40, the name is primary ovarian insufficiency in the US and premature ovarian insufficiency in the UK, and it affects about 1% of women, according to the StatPearls review of menopause. It is a good reason to see your ob-gyn or, in the UK, your GP, so the cause can be looked into.

At the usual age, lack of estrogen symptoms are common, and there are treatments for them. It is worth an appointment whenever they get in the way of sleep, work or daily life.

What does the evidence say about the signs of low estrogen?

Hot flashes and night sweats affect 75 to 80% of women, with varying severity, according to the StatPearls review. They become more common as the transition goes on: in the SWAN cohort (Study of Women's Health Across the Nation), reported in the 2018 review, the share rose from 39% early in the transition to 67% later.

SWAN also tracked body fat and bone changes through the transition, and its findings sit behind the point that falling estrogen speeds up muscle loss, bone loss and belly fat gain. These changes are not felt the way a hot flash is, so strength and bone health are worth attention whatever the symptom picture.

Postmenopause begins after the final period and runs for the rest of life, as the StatPearls review describes, and it often covers a third of a woman's lifespan or more. Hot flashes usually ease during it, while low estrogen keeps affecting bone, muscle, heart, brain and vaginal health. NICE guideline NG23 (updated 2024) is the UK reference for these years. The NHS adds that joint pain and vaginal dryness may continue after menopause, so a lingering symptom is common and worth mentioning at an appointment.

Estrogen is raised by replacing it. The treatment is called menopausal hormone therapy in the US, where the Menopause Society's 2022 position statement is a key reference, and HRT in the UK. The NHS notes that estrogen taken through the whole body needs a progestogen alongside it for anyone who still has her womb (uterus).

Vaginal estrogen is given locally, not through the whole body. It treats vaginal dryness, soreness and urinary symptoms after menopause. US pages describe it as a cream, ring or tablet, and the NHS as a cream or a pessary, the UK word for a small vaginal insert.

How long does low estrogen last?

After menopause, low estrogen is lasting. The transition that leads into it runs for a median of 4 or more years, according to the 2018 review, and your own timeline may look quite different from a friend's.

The NHS says menopause symptoms typically last 7 to 9 years, sometimes longer. Bone health becomes a long-term matter over that stretch and beyond it, and osteoporosis has its own page here.

One timing point is easy to miss. The NHS in the UK advises that contraception is still needed for 1 year after the last period for women aged 50 or over, and for 2 years for women aged 40 to 49.

What have the studies shown, and what have they not?

The studies show wide variation between women. In the 2018 review, the transition lasted noticeably longer in the group of women who entered it earliest than in the group who entered it latest, so the length depends partly on when it starts.

The headline share for hot flashes and night sweats counts every degree of severity, from mild and occasional to frequent and intense. It describes how many women notice the symptom, not how many want treatment for it.

What the studies do not show is the course any one woman will follow. They describe groups, and two women with the same symptoms can reasonably choose different paths.

None of the figures above measures what a food, herb or supplement does to estrogen levels either, so they neither support nor dismiss a product sold for that purpose.

Next steps

A good place to start is a short note of what you have noticed, how often, and how much it affects your day. It is worth taking that note to your ob-gyn or primary care doctor, or to your GP in the UK. Any of the red flags listed on this page is a reason to book promptly instead of waiting for a routine visit, and so are periods that stop before age 40. From there you can talk through hormone therapy, vaginal estrogen or a bone check, and the life-stage table points to what else may be changing. Some women want treatment and some prefer to wait and watch. Not one size fits all, and the choice of what fits is yours.