From the Guidelines
Low estrogen in postmenopause can manifest through several distinct signs, including vaginal dryness, painful intercourse, recurrent urinary tract infections, and thinning of the vaginal tissues (vaginal atrophy), as well as hot flashes, night sweats, and sleep disturbances that persist beyond the menopausal transition. Many women experience mood changes such as depression, irritability, and anxiety, and cognitive effects like memory issues and difficulty concentrating are reported by some women 1. Physical changes include decreased skin elasticity, increased wrinkling, and joint pain. Bone density loss accelerates, increasing fracture risk. Some women notice changes in breast tissue, with breasts becoming less full and tender. These symptoms occur because estrogen levels, which naturally decline during menopause, fall to very low levels in postmenopause. Estrogen affects multiple body systems including the brain, skin, urogenital tissues, and bones, which explains the diverse range of symptoms.
Key Symptoms
- Vaginal dryness
- Painful intercourse
- Recurrent urinary tract infections
- Thinning of the vaginal tissues (vaginal atrophy)
- Hot flashes
- Night sweats
- Sleep disturbances
- Mood changes (depression, irritability, anxiety)
- Cognitive effects (memory issues, difficulty concentrating)
- Physical changes (decreased skin elasticity, increased wrinkling, joint pain)
- Bone density loss and increased fracture risk
- Changes in breast tissue If these symptoms significantly impact quality of life, hormone replacement therapy or targeted treatments for specific symptoms may be considered after discussing risks and benefits with a healthcare provider 1. The U.S. Preventive Services Task Force (USPSTF) recommends against the routine use of estrogen and progestin for the prevention of chronic conditions in postmenopausal women, citing that the harmful effects are likely to exceed the chronic disease prevention benefits in most women 1. However, the decision to use hormone therapy should be individualized based on a woman's personal preferences, individual risks for specific chronic diseases, and the presence of menopausal symptoms 1.
From the FDA Drug Label
Estradiol is used to: reduce moderate to severe hot flashes ... treat dryness, itching, and burning in or around the vagina, difficulty or burning on urination associated with menopause Estrogens are hormones made by a woman’s ovaries Between ages 45 and 55, the ovaries normally stop making estrogens. This leads to a drop in body estrogen levels which causes the “change of life” or menopause When the estrogen levels begin dropping, some women develop very uncomfortable symptoms, such as feelings of warmth in the face, neck, and chest, or sudden strong feelings of heat and sweating (“hot flashes” or “hot flushes”).
The signs of low estrogen in postmenopause include:
- Hot flashes: feelings of warmth in the face, neck, and chest, or sudden strong feelings of heat and sweating
- Vaginal dryness: dryness, itching, and burning in or around the vagina
- Urination problems: difficulty or burning on urination associated with menopause These symptoms are caused by the drop in body estrogen levels during menopause 2 3.
From the Research
Signs of Low Estrogen in Postmenopause
The signs of low estrogen in postmenopause can be diverse and affect various aspects of a woman's health. Some of the common signs include:
- Vasomotor symptoms such as hot flashes, flushing, night sweats, and sleep disturbances 4
- Genito-urinary symptoms, including vaginal dryness and genital irritation 5, 6
- Increased risk of osteoporosis, which can lead to bone fractures 5, 7
- Urogenital atrophy, which can cause discomfort and pain during sexual intercourse 5
- Cardiovascular disease, as estrogen has protective effects on the heart 5, 7
- Cognitive impairment and an increased risk of Alzheimer's disease 7
- Dermal aging, including wrinkles and skin dryness 7
- Macular degeneration and cataract formation, which can affect vision 7
- Colorectal cancer, as estrogen may have protective effects on the colon 7
- Breast cancer, although the relationship between estrogen and breast cancer is complex and not fully understood 5, 8
Effects of Low Estrogen on Daily Life
Low estrogen levels in postmenopause can significantly impact a woman's daily life, causing:
- Sleep disturbances, which can lead to fatigue and mood changes 4, 6
- Mood changes, including depression and anxiety 7
- Decreased libido, which can affect sexual relationships 5
- Vaginal discharge, genital irritation, and uterine bleeding, which can be uncomfortable and require medical attention 6
- Breast symptoms, including tenderness and pain 6
Importance of Estrogen Replacement Therapy
Estrogen replacement therapy can help alleviate some of the symptoms associated with low estrogen levels in postmenopause. However, the decision to undergo hormone replacement therapy should be made after careful consideration of the potential benefits and risks, and in consultation with a healthcare provider 5, 6.