Signs of Low Estrogen in Women
Low estrogen levels in women cause hot flashes, night sweats, vaginal dryness, painful intercourse, mood changes, sleep disturbances, and increased risk of osteoporosis and cardiovascular disease. 1, 2
Vasomotor Symptoms
- Hot flashes and night sweats are the most common manifestations of low estrogen, affecting 50-80% of menopausal women 3, 4, 5
- These vasomotor symptoms typically manifest as sudden feelings of warmth in the face, neck, and chest, or sudden strong feelings of heat and sweating 6, 7
- Vasomotor symptoms typically last more than 7 years and can significantly interfere with quality of life in 15-20% of women 3, 8
- Night sweats occur in approximately 44% of postmenopausal women with low estrogen 9
Genitourinary Symptoms (Genitourinary Syndrome of Menopause)
- Vaginal dryness affects approximately 48-50% of postmenopausal women and is often chronic 2, 3, 9
- Vaginal itching and burning sensation are common manifestations of estrogen deficiency 2
- Painful intercourse (dyspareunia) occurs in approximately 26% of women with low estrogen levels 2, 9
- Vaginal discharge, discomfort during urination, and urinary urgency are associated with hypoestrogenism 2
- Unlike vasomotor symptoms which may resolve over time, genitourinary symptoms often persist indefinitely and typically worsen without treatment 2
Psychological and Sleep-Related Symptoms
- Mood lability and feelings of depression affect approximately 44% of postmenopausal women with low estrogen 1, 9
- Difficulty sleeping occurs in 44% of women and increases in frequency with increasing severity of vasomotor symptoms 9
- The frequency of depression and sleep disturbance increases significantly with worsening vasomotor symptoms (P for trend ≤ 0.001) 9
Musculoskeletal and Systemic Effects
- Pelvic soft tissue atrophy develops as a consequence of prolonged estrogen deficiency 1
- Osteoporosis (thin, weak bones that are more prone to fracture) is a long-term consequence of hypoestrogenism 1, 6
- Increased risk of cardiovascular disease is associated with low estrogen states 1
Athletic and Reproductive-Age Women
- In exercising women with low energy availability, decreased estradiol levels occur alongside menstrual dysfunction (oligomenorrhea or amenorrhea) 1
- Low estrogen in athletic women leads to decreased bone mineral density, decreased trabecular number, decreased cortical thickness, and increased risk of bone stress injuries 1
- Hormonal alterations in low estrogen states include decreased progesterone, decreased leptin, increased ghrelin, and dysregulation of the growth hormone/IGF-1 axis 1
Clinical Context
- The sudden drop in estrogen levels occurs naturally between ages 45-55 years during menopause, or can occur surgically when both ovaries are removed before natural menopause 6, 7
- Approximately 50-75% of women experience vasomotor symptoms during the menopausal transition, and more than 50% experience genitourinary symptoms 3
- Women using aromatase inhibitors (which inhibit peripheral conversion of androgens to estrogens by >95%) experience more severe symptoms of estrogen deficiency 2