Symptoms of low estrogen include fatigue, weight gain, hair loss, depression, insomnia, dry skin, recurrent bladder infections, and vaginal dryness. Of those symptoms, vaginal dryness is the most characteristic sign and is diagnostic of estrogen deficiency.
Treat the underlying cause
Treatment for estrogen deficiency depends on your situation of which there are three possibilities, each requiring a different approach.
- Low estrogen because you don’t ovulate but are not in menopause.
- Low estrogen even though you do ovulate.
- Low estrogen because you’re in menopause so can no longer ovulate.
Low estrogen because you don’t ovulate but are not in menopause
Ovulation is how you make estradiol, which is the strongest and best type of estrogen. If you’re low in estradiol, the next question is: “Can you still ovulate?”
You can ovulate if your blood test for FSH is less than 40 IU/L. That’s true even if you’ve had a partial hysterectomy (uterus removed). If you have ovaries, you can ovulate.
Treatment: Figure out why you don’t ovulate. Are you on the pill? Do you have a type of PCOS? Are you eating enough? (For a full discussion of obstacles to ovulation, see Chapter 7 of my book Period Repair Manual.)
Once you identify your obstacle to ovulation, simply correct that obstacle and your estradiol will rise dramatically. That’s all you need to do.
In the case of PCOS or hypothalamic amenorrhea, eating phytoestrogens like soy or flaxseed will not raise estrogen because phytoestrogens are not estrogen.
👉 Hormonal birth control is not the solution. The pill stops ovulation and therefore shuts down estradiol. It replaces it with a synthetic estrogen called ethinylestradiol, which is similar to estradiol but not identical. That’s why being on the pill can cause vaginal dryness.
Low estrogen even though you do ovulate
If you ovulate, then, by definition, you have enough estrogen. Why? Because if you did not have enough estrogen, you would not be able to ovulate.
👉 Tip: It’s normal to have very low (menopausal levels) of estradiol on day 2 or 3 of your cycle.
If you have light scanty periods (but you ovulate), then you may have slightly lower than average estradiol. I call this relative estrogen deficiency.
Treatment: Relative estrogen deficiency can occur at any age and is usually the result of smoking, undereating, stress, gluten sensitivity, a vegan diet, or too many phytoestrogens. Your best treatment is to correct that underlying problem.
You’re in menopause so can no longer ovulate
With menopause, your ovaries naturally make far less estradiol than they used to. Adjusting to the drop in estrogen can cause symptoms such as hot flashes, depression, and insomnia. If your symptoms are strong, you may want to think about taking menopausal hormone therapy. In particular, you’ll probably want a body-identical or bioidentical estradiol patch like Estradot together with a natural progesterone capsule like Prometrium or Utrogestan.