When it comes to getting older, there are certain things we take steps to prevent and others that we accept as unavoidable. Changes in estrogen levels, especially for women in perimenopause and menopause, tend to fall into the second category. Still, knowing the most common signs of low estrogen and taking action accordingly may seriously improve your quality of life.
“Low estrogen is a natural consequence of aging,” affirms Elizabeth West, M.D., an ob/gyn with MemorialCare Medical Group in Long Beach, CA. “After menopause, estrogen levels will become low.” However, low estrogen can manifest differently in different people. That’s why knowing how declines in your estrogen levels are most likely to present can be helpful for communicating with your physician and getting the care and treatment you need to maintain optimal health.
Meet the experts: Elizabeth West, M.D., an ob/gyn with MemorialCare Medical Group in Long Beach, CA; Brynna Connor, M.D., a family medicine physician in Austin, TX, and the healthcare ambassador at NorthwestPharmacy.com
Here, doctors share the most common signs of low estrogen, plus all the ways that low estrogen levels may impact your health (some of them may surprise you).
Signs of low estrogen
“While patients most commonly associate estrogen with the reproductive system, it’s not solely a reproductive hormone,” says Brynna Connor, M.D., a family medicine physician in Austin, TX, and the healthcare ambassador at NorthwestPharmacy.com. As such, low estrogen levels may present in a variety of ways. According to the experts we spoke to, the most common signs of low estrogen may include:
- Hot flashes and night sweats
- Trouble sleeping
- Joint pain or inflammation
- Vaginal dryness
- Pain with intercourse
- Mood swings
- Anxiety and/or depression
- Brain fog or forgetfulness
- Thinning hair, nails, or skin
- Reduced bone density
- Decreased sex drive
- Irregular or missed periods (in pre-menopausal women)
How low estrogen impacts your health
Estrogen naturally declines with age. Even though declining estrogen is natural and expected, it still carries some side effects. “Low estrogen can be a health problem because it increases the risk of osteoporosis, cardiovascular disease, metabolic dysfunction, vaginal dryness, and cognitive decline,” says Dr. West. Here’s how estrogen impacts all these areas of health.
Bone health
“Estrogen is crucial for maintaining bone density, and chronically low levels can accelerate bone breakdown, significantly increasing the risk of osteoporosis and fractures,” Dr. Connor explains. According to the Bone Health and Osteoporosis Foundation, women may lose up to 20% of their bone density in the five to seven years following menopause, largely due to the drop in estrogen. It’s also why women make up about 80% of the Americans who have osteoporosis, a condition in which the bones become weak, brittle, and more prone to breaking.
Heart health
“Estrogen helps protect the heart and blood vessels,” Dr. West says. So when levels decline, she adds, heart disease risk goes up. Research in the Archives of Medical Science explains that cardiovascular disease is more common in men than in women before menopause, but once the drop in estrogen occurs after the transition, risk of heart disease increases drastically.
Temperature regulation
Hot flashes and night sweats are a hallmark sign that estrogen levels are low. Dr. Connor says that this is because of the role the hormone plays in regulating and maintaining your body temperature. “A drop in estrogen levels confuses the hypothalamus (the brain’s thermostat), making it believe the body is overheating, which triggers a rapid cooling response like blood vessel dilation,” she explains. “This causes the flash or flushing of the skin and sweating to shed heat.”
Vaginal and sexual health
“After menopause, women can experience genitourinary syndrome of menopause, which is vaginal dryness, painful intercourse, frequent urinary tract infections, and other recurrent vaginal infections,” explains Dr. West. “Sex can become painful as well.” Per the National Library of Medicine, this condition is directly caused by declining estrogen levels.
Cognition
“In the brain, estrogen supports cognition, memory, and mood regulation, and low levels have been linked to brain fog, memory changes, anxiety, and symptoms of depression, such as sadness, withdrawal, loss of motivation, and/or irritability,” says Dr. Connor. Estrogen plays such a key role in brain health that a 2025 review in Frontiers in Molecular Biosciences suggests that the neuroprotective effects of estrogen should be utilized as part of treatment plans for preventing Alzheimer’s disease.
Skin and muscle maintenance
Yup, the hormone even impacts your appearance. “Estrogen contributes to skin elasticity, hair health, and muscle maintenance, and a subsequent deficiency can lead to thinning skin, hair changes, and/or muscle loss,” Dr. Connor says. Similar to the way low estrogen may cause dryness and thinning in vaginal tissue, it can do the same for skin. Likewise, research suggests there may be a link between low estrogen and increased sarcopenia, or age-related muscle loss.
The bottom line
If you’re worried, see your doctor. “If left untreated, chronic estrogen deficiency can significantly reduce quality of life and increase long-term health risks across multiple body systems,” says Dr. Connor. That’s why it’s critically important to discuss any of the signs above with your doctor, regardless of your age. There are different treatment options that may both limit symptoms in the short term and reduce health risks and promote healthy aging in the long term.
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