February 20, 2011

Low Estrogen Causes

low estrogen causesLow Estrogen Causes and Symptoms

Low estrogen causes are many.  If you have these symptoms there’s a pretty good bet you have low estrogen levels.

  • vaginal dryness
  • hot flashes
  • night sweats
  • painful intercourse
  • memory difficulty
  • urinary tract infections
  • dry/thinning skin
  • depression

Estrogen refers to a group of hormones that along with progesterone regulate a woman’s menstrual cycle.  There are three main estrogens in women, estrone (E1), estradiol (E2), and estriol (E3).  Estradiol is the most potent and important.

Estrogen: Physiology and Function

Estrogen is primarily produced in the ovaries (some estrogen is produced by the adrenal glands and some from fatty tissues).  Two other glands, the hypothalamus and pituitary tightly control its production.  A disorder or dysfunction of the hypothalamus or pituitary can lead to low estrogen.

What normally happens is that the hypothalamus secretes GnRH or gonadotropin-releasing hormone, which then stimulates the pituitary to secrete follicle stimulating hormone (FSH) and luteinizing hormone (LH).  FSH triggers the ovary to produce a follicle and estrogen.

Estrogen is responsible for regulating a woman’s menstrual/reproductive cycle and development of women’s secondary sex characteristics.  It has many other health benefits particularly on the brain, heart, and bones.

Low Estrogen Causes

The main cause for low estrogen in middle-aged women is menopause.  As women age estrogen production declines as the ability to produce follicles with each cycle eventually ceases.

Eating disorders adversely affect the hypothalamus-pituitary axis and is a more common cause of low estrogen in teen-age and young women.  Too little body fat in women is associated with low estrogen.  Very heavy athletic training is also associated with low estrogen by contributing to lower body fat, and adversely affecting the hypothalamic-pituitary axis.

Genetic disorders like Turner’s syndrome are associated with low estrogen.  Delayed onset of puberty in young women is associated with low estrogen. Low estrogen can be induced by surgery as in the case of a hysterectomy, and can be caused by chemotherapy, and radiation treatment to the pelvic region.

Ovarian disorders including ovarian cancer can also contribute to low estrogen.  Thyroid disease and other hormonal imbalances can cause low estrogen.   Excess cortisol, known as the “stress” hormone, leads to lower estrogen levels.  Too much thyroid medication can lower estrogen levels.

Women receiving testosterone and/or progesterone sometimes require higher doses of estrogen replacement.  And, high melatonin doses above 10 mg/day are associated with lower estrogen levels.

Low Estrogen Causes in a Nutshell

  • Menopause
  • Late onset of puberty
  • Eating disorders
  • Heavy athletic training
  • Too low body fat
  • Ovarian disorders
  • Genetic disorders
  • Hysterectomy
  • Chemotherapy
  • Radiation to pelvic region
  • Hormonal imbalances (either natural or secondary to hormone replacement)

Work-up for Low Estrogen

In many cases low estrogen causes can be identified through careful history taking and performance of a physical examination along with laboratory tests. Laboratory tests generally include levels of estradiol, progesterone, cortisol, FSH, LH, prolactin, testosterone, and thyroid hormones.

On occasions imaging studies like an ultrasound of the pelvis or a MRI scan to evaluate the pituitary and hypothalamus are sometimes necessary.

Related articles include “Low Estrogen Symptom: Who Wants Them?”, “Anti Aging Hormones“, Hormone Balance and, Causes of Elevated Estrogen Levels.

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Dr. Joe Jacko


Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio. Read more about Dr. Joe Jacko

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