We at Bustle love giving you tips for how to tap into your sexual potential and troubleshoot when things aren’t going your way in the bedroom. But what about finding solutions to those stressful women's health situations that inevitably crop up when you’re getting down? Emma Kaywin, a Brooklyn-based sexual health writer and activist, is here to calm your nerves and answer your questions. No gender, sexual orientation, or question is off limits, and all questions will remain anonymous. This week’s topic: signs you have low estrogen levels.
Q: I’m 24, and something really weird is going on with me. I swear to you I am getting hot flashes and night chills. My mom is going through menopause right now and my symptoms seem pretty much identical to hers — except that I’m not even 30 yet! Is it possible to get menopause early? What is going on with me! I really want to have kids and, you know, not be menopausal yet.
A: There is actually a condition called premature menopause, where you go through menopause early. Menopause is called "premature" when you go through it before age 40, according to the Office of Women's Health, and can be caused by smoking, certain health conditions, or if your ovaries or uterus have been surgically removed. But if you've seen your doctor and know these conditions don't apply to you, it's possible that you're dealing with low estrogen levels, which can look a lot like menopause, since the levels of this hormone also drop during menopause.
"Estrogen can be low from breast feeding, being put on a very low dose birth control pill, or from early menopause," says Dr. Mary Jane Minkin, a clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the Yale University School of Medicine. Dr. Minkin explains that only around 1% of people enter menopause by age 40, and around 5% enter menopause by age 45. For younger people, it's more likely that you're dealing with straight-up low estrogen levels.
For some people, having low estrogen is genetic. For others, it can have to do with their menstrual cycle.
"Estrogen is secreted by the ovary after ovulation," Dr. Aimee Eyvazzadeh, an OB/GYN and advisor to Proov, an at-home progesterone urine test kit, tells Bustle. If you're not ovulating, or there's something else amiss in your menstrual cycle, that can affect your estrogen levels. Exercising too much, thyroid disorders, or ovarian cysts can also throw this out of balance, Dr. Eyvazzadeh says.
Having low estrogen means that your levels of this hormone are low compared to the other hormones in your system. Estrogen levels vary widely from person to person (and even menstrual cycle to menstrual cycle), so it’s more important to know how the levels of this hormone changes in your body over time, as opposed to the actual measurable amount. Your estrogen levels decline naturally as you get closer to menopause, so many of the signs of low estrogen are what you’ve heard of as menopause symptoms — but low estrogen can actually cause a lot of other changes.
Here are a few different signs your estrogen levels might be low, and what to do about it.
1. Your Period Disappeared
Saying goodbye to a monthly period is a dream for a lot of people, but your period actually tells you a lot about your health, including your hormones.
"If you don't ovulate, you will have both low estrogen and progesterone," says Dr. Eyvazzadeh, and if you don't ovulate, you won't have a period.
Estrogen is one of the primary drivers of your menstrual cycle. Low estrogen can make your period super light, or even cause it to go away altogether. This happens because estrogen is the hormone that causes your uterine lining to thicken every month, which is the precursor to it shedding. If you have low estrogen, your lining might not thicken enough for your body to have a full period.
2. You’re Having Trouble Sleeping And Feel Fatigued
Yale Medicine notes that estrogen has been linked to protective effects against sleep apnea, which is a condition where your oxygen flow gets blocked as you sleep. Because your oxygen flow is blocked, you wake up a bunch of times, sometimes imperceptibly, throughout the night, meaning you're unable to access deep, restorative sleep.
3. You’re Feeling Down Or Depressed
Estrogen helps your body produce serotonin, which is a neurotransmitter that helps boost your mood. If you have low estrogen, your serotonin is likely lower, too.
"Low estrogen can affect your mood by influencing neurochemical pathways linked to depression" says Dr. Eyvazzadeh. "Animal and human studies have shown how estrogen and progesterone affects brain regions involved in mood. Both estrogen and progesterone influence known regions in the brain."
Estrogen’s connection to serotonin also explains why you might be experiencing depression. Estrogen boosts serotonin, which helps your body combat depression. So if you have low estrogen, your low serotonin levels can’t stave off sad feelings.
4. Your Libido Is Low
There are tons of reasons why you might be feeling less sexual lately. Low estrogen is one of them, and it also has to do with estrogen’s ties with serotonin. Specifically, the amount of serotonin you're producing is connected to how excited you are about sex and how much you want it. Less estrogen means less serotonin, and therefore less desire.
5. Sex Is Suddenly Painful
Low estrogen can also make sex itself feel more painful (which can itself decrease desire). Dr. Eyvazzadeh points to vaginal dryness as a symptom of low estrogen from menopause: if you don't have enough estrogen, your vagina can dry out, and having sex without enough lubrication can be seriously painful. Dr. Minkin also notes that for some people, being on a low-estrogen form of birth control can increase vaginal dryness: "The amount of moisture in your vagina is sort of dependent on the amount of estrogen in the pills, and ... one of the side effects could be vaginal dryness."
A lack of estrogen also can thin your vaginal walls, another thing that contributes to pain during penetration. Dr. Minkin suggests a vaginal moisturizer like Replens if vaginal dryness is an issue for you.
6. Your Eyes Are Dry
Your vagina is not the only body part that can dry up from lack of estrogen. Estrogen is actually linked to how much tears your body can produce. So if you have low estrogen, you might notice your eyes getting parched.
7. You’re Getting Hot Flashes And Night Sweats
You’ve probably heard of these symptoms through menopause. These really annoying symptoms occur during perimenopause (the phase where you’re getting toward menopause but haven’t gotten there yet), but they can also occur at other times when your estrogen is low. People can "start having perimenopausal symptoms in their late 30s," Dr. Minkin says, so it's not something to rule out.
Hot flashes and night sweats happen because low estrogen messes with your hypothalamus, the part of your brain that controls your body temperature, among other things. When you don’t have enough estrogen, your body is tricked by this part of your brain to think it’s too hot. In an attempt to get rid of the fake excess heat, your body expends heat in a hot flash — opening the blood vessels in your head and neck skin more than usual. These may be another reason why you’re having trouble sleeping — because it’s hard to sleep when your body is on a temperature rollercoaster.
8. You’re Getting More Urinary Tract Infections Than Usual
Some of us are more susceptible to urinary tract infections (UTIs) than others. Low estrogen can also lead to UTIs or other urinary tract changes, Dr. Eyvazzadeh says. If you don’t have enough estrogen, the lining of your urethra (the tube that you pee out of) can get thinner, making it easier for unwanted bacteria to get in.
9. You’re Getting Frequent Headaches
It's a known fact that people with uteruses are more likely to get headaches and migraines overall; the hormonal reasons why this is aren't super well understood, but fluctuations in estrogen levels are one potential reason. You might notice that you get headaches during your luteal phase, right before your period starts, when your estrogen is at its lowest during your cycle. If your estrogen is low throughout your cycle, it could lead to more headaches, but it's important to check with a doctor to make sure your headaches don't have another, potentially more serious cause.
10. You’re Feeling Anxious
Not having the right balance of estrogen can also result in anxiety as a result of the change in your serotonin levels. A study published in 2012 from researchers at Harvard and Emory Universities linked low estrogen to increased fear responses in women with PTSD, and suggested that low estrogen could increase vulnerability to PTSD for people who'd experienced trauma.
11. You’re Having Trouble Getting Pregnant
If you’re trying to get pregnant and you have low estrogen, it could be a challenge to conceive. This is connected to symptom #1 — if you don’t have enough estrogen in your body for it to grow a thick uterine lining, you won’t have enough nourishment to grow a baby. Similarly, if you're not ovulating, your body isn't releasing an egg, meaning there's nothing for sperm to fertilize.
What You Can Do About It
If you think you might have low estrogen, the first thing to do is talk to your doctor. They can test your hormone levels to make sure this is the case. Then they can work with you to figure out why this might be happening so you can get the correct treatment.
"If you have symptoms of low estrogen, you shouldn't tough it out. There's help for you!" Dr. Eyvazzadeh says. "And if you don't have a doctor that is listening and paying attention to your symptoms then find another one. A gynecologist should be able to help [anyone] with symptoms of low estrogen."
It's important, though, to rule out menopause as a factor. "If you suspect premature menopause, you do want to see your gynecologist, because women with premature menopause need to be on hormonal therapy," says Dr. Minkin. "The rate of premature menopause is high enough that everyone should know how to check for it and the symptoms," says Dr. Eyvazzadeh.
Having low estrogen isn’t immediately dangerous per se but it definitely affects your body’s performance on a number of levels. If you’ve read the symptoms and think your estrogen might be low, talk to your doctor about getting your levels tested. Your doctor can help you get your levels, and your life, back on track.
Glover, E. M., Jovanovic, T., Mercer, K. B., Kerley, K., Bradley, B., Ressler, K. J., & Norrholm, S. D. (2012). Estrogen Levels Are Associated with Extinction Deficits in Women with Posttraumatic Stress Disorder. Biological Psychiatry, 72(1), 19–24. doi: 10.1016/j.biopsych.2012.02.031
Dr. Mary Jane Minkin, MD, clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the Yale University School of Medicine
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