Estrogen in Menopause: What It Does, Low Estrogen Symptoms and Treatment

Estrogen is the main female sex hormone, made mostly by the ovaries. It does far more than control periods: it helps look after your bones, vaginal and bladder tissue, skin, sleep and mood. In perimenopause estrogen levels swing up and down, and after menopause they settle at a much lower level. This is behind many of the changes women notice at midlife.

This page explains what estrogen does, what happens to it around menopause, which symptoms can be linked to low estrogen, and the treatment options a doctor may discuss with you. It sits alongside our pages on progesterone and testosterone, and our overview of hormone replacement therapy (HRT).

What estrogen does in a woman's body

"Estrogen" is really a family of hormones. Before menopause the main one is estradiol, made by the ovaries. After menopause the body still makes small amounts of a weaker estrogen called estrone, mainly in fat tissue.

Estrogen acts on many parts of the body, including:

• The womb and ovaries: it builds up the lining of the womb each month, as part of the menstrual cycle.
• Bones: it slows down the natural breakdown of bone, which helps keep bones strong.
• Vagina, vulva and bladder: it keeps these tissues thick, moist and elastic.
• Brain: it plays a part in body-temperature control, sleep, mood and memory.
• Skin and hair: it supports collagen, the protein that keeps skin firm.
• Heart and blood vessels: it has effects on cholesterol and blood vessel walls.

What happens to estrogen in perimenopause and menopause

Perimenopause is the time of change before your final period. It often starts in the 40s and can last several years. During this time the ovaries work less predictably. Estrogen does not simply fall in a straight line. It can rise high one month and drop low the next. This is why periods can become irregular, heavier or lighter, and why symptoms can come and go. You can read more in our guide to irregular periods in menopause.

Menopause is your last period. It is confirmed when you have not had a period for 12 months (if you are not using hormonal contraception). After this, the ovaries make very little estrogen. Women who have both ovaries removed in surgery go through this change suddenly, and symptoms can be stronger.

Symptoms that can be linked to low estrogen

Every woman's experience is different. Some have few symptoms; others find daily life badly affected. Changes that can be linked to falling or low estrogen include:

• Hot flushes and night sweats
• Poor sleep, often made worse by night sweats
• Low mood, irritability and anxiety
• "Brain fog": poor concentration and forgetfulness
• Vaginal dryness, itching, or pain during sex
• Needing to pass urine more often, or repeated urine infections
• Joint aches, and dry or thinner skin
• Hair thinning
• Bone loss over time, which raises the risk of osteoporosis and fractures

An important note: many of these symptoms have other possible causes too. Thyroid problems, anaemia, low vitamin D or B12, diabetes, depression, stress and some medicines can all cause similar complaints. A good doctor will think about these as well, rather than putting everything down to menopause. See our full list of menopause symptoms.

Do you need a blood test for estrogen?

For most women, no. Because estrogen levels go up and down so much in perimenopause, a single blood test can look "normal" even when symptoms are caused by hormonal change.

The UK's National Institute for Health and Care Excellence (NICE) advises that in otherwise healthy women aged 45 or over, perimenopause and menopause should be identified from symptoms and periods, without laboratory tests. NICE specifically advises against using estradiol, anti-Müllerian hormone (AMH) and similar tests to diagnose menopause in this age group.

The Indian Menopause Society also says menopause is diagnosed from your history, and that hormone tests such as FSH (follicle-stimulating hormone, a hormone from the brain that rises when the ovaries slow down) are kept for special situations. These include:

• Women under 40 with symptoms or missed periods, where early menopause (premature ovarian insufficiency) is possible
• Women aged 40 to 45 with symptoms and period changes, where NICE says an FSH test can be considered
• Women who have had a hysterectomy, or who use hormonal contraception, where periods cannot be used as a guide

Your doctor may still suggest other blood tests, for example thyroid function, haemoglobin or vitamin D, to rule out other causes of your symptoms.

Treatment options with estrogen

Estrogen is the main part of HRT (also called menopausal hormone therapy, or MHT). It is the most effective treatment for hot flushes and night sweats, and it helps prevent bone loss. Major medical bodies, including the North American Menopause Society (now called The Menopause Society), say that for most healthy women with troublesome symptoms who are under 60, or within 10 years of their last period, the benefits of HRT outweigh the risks.

Forms of estrogen

Form	How it is used	Points to know
Gel or spray	Rubbed or sprayed onto the skin once a day	"Transdermal" (through the skin). Does not raise the risk of blood clots in the way tablets can.
Patch	Stuck on the skin and changed once or twice a week	Also transdermal. Some women get skin irritation.
Tablet	Taken by mouth daily	Simple to use, but linked with a higher risk of blood clots and stroke than skin forms.
Vaginal estrogen	Cream, pessary, gel or ring placed in the vagina	Treats vaginal dryness and bladder symptoms. Very little reaches the bloodstream.

Why women with a womb also need a progestogen

If you still have your womb (uterus), taking estrogen on its own makes the womb lining grow. Over time this raises the risk of thickening of the lining and of womb (endometrial) cancer. To protect the lining, women with a womb are given a progestogen as well. This is called "combined HRT". Women who have had a full hysterectomy can usually take estrogen alone. Our progesterone page explains the options, including micronised progesterone and the hormonal coil.

Low-dose vaginal estrogen used on its own for vaginal symptoms works mainly where it is placed, and generally does not need a progestogen. Your doctor will advise you.

Vaginal estrogen

Vaginal dryness, discomfort and bladder symptoms often get worse with time after menopause, and do not settle on their own. NICE recommends offering vaginal estrogen for these symptoms, including to women already on HRT. It can be used alongside non-hormonal moisturisers and lubricants. NICE notes that serious side effects are very rare and that symptoms often return if it is stopped.

Who estrogen therapy may suit

• Women with hot flushes, night sweats, sleep or mood changes that affect daily life
• Women with vaginal or bladder symptoms (vaginal estrogen)
• Women with early menopause or premature ovarian insufficiency, who are usually advised to take hormones at least until the natural age of menopause, to protect bone strength and long-term health

Who may not be able to take it, and the key risks

HRT is not right for everyone. Your doctor will look at your personal and family history before suggesting it. Systemic estrogen (the kind that works through the whole body) is usually avoided or used only with specialist advice if you have, or have had:

• Breast cancer or another hormone-sensitive cancer
• Unexplained vaginal bleeding that has not been checked
• A blood clot in the leg or lung, or a known clotting disorder
• A recent heart attack or stroke
• Active liver disease

The main risks to discuss honestly are:

• Breast cancer: NICE says breast cancer risk rises with combined HRT. The increase grows the longer HRT is used, falls after stopping, but some extra risk remains for at least 10 years. With estrogen-only HRT (for women without a womb), NICE says there is very little or no increase in risk.
• Blood clots (VTE, venous thromboembolism): estrogen tablets raise the risk of clots. A large UK study found that estrogen through the skin (gels, patches) was not linked with a higher clot risk. NICE says the same.
• Stroke: NICE says the risk rises with estrogen tablets, especially at higher doses or if started after 60, but is unlikely to rise with skin forms.
• Womb cancer: raised if estrogen is taken without a progestogen by a woman who still has her womb.

For most women in their 40s and 50s, the starting risk of these conditions is low, so the extra risk from HRT is small in absolute terms. Age, weight, smoking and family history all change the picture. That is why the decision should be personal and shared between you and your doctor, and reviewed regularly. NICE advises using the lowest dose that controls your symptoms.

Body-identical vs "bioidentical" compounded hormones

"Body-identical" hormones are regulated medicines with the same chemical structure as the hormones your body makes, such as estradiol gels and patches and micronised progesterone. They are tested, licensed and made to a consistent standard.

"Bioidentical" compounded hormones are mixed by a pharmacy in custom doses, often based on saliva or blood tests. The British Menopause Society (BMS) says compounded products are not recommended, are not evidence based for effectiveness and safety, and that there is not enough evidence to support the repeated hormone testing often used to "personalise" them. The North American Menopause Society raises similar safety concerns, including over- or under-dosing and a lack of safety information. Read more on our BHRT page.

Questions women often ask

Will estrogen make me put on weight?

Weight gain at midlife is common whether or not women take HRT. Age, loss of muscle, poor sleep, stress and changes in activity all play a part. If weight is a worry for you, tell your doctor, so it can be looked at as part of your overall plan.

Is it too late to start estrogen if I am past 60?

Not always, but the balance changes. Expert bodies say that starting HRT after 60, or more than 10 years after menopause, carries higher risks of heart disease, stroke, clots and dementia. Vaginal estrogen for vaginal and bladder symptoms can be used at any age.

How long can I stay on estrogen?

There is no fixed cut-off for everyone. Many women take it for several years. Your doctor should review the benefits and risks with you at least once a year and help you decide whether to continue, reduce or stop.

I had breast cancer. Can I use vaginal estrogen?

This needs a specialist conversation, ideally with your cancer team. Non-hormonal moisturisers and lubricants are usually tried first.

Are there non-hormonal options?

Yes. Lifestyle changes, cognitive behavioural therapy (CBT, a talking therapy) and some non-hormonal medicines can help with hot flushes, sleep and mood. These may suit women who cannot or prefer not to take hormones.

Talk to a NuHer doctor

If you think low estrogen may be behind your symptoms, you do not have to guess or struggle on. NuHer is a doctor-led menopause clinic. We see women in person at Nariman Point, Mumbai, and by video across India, Monday to Saturday, 10 am to 7 pm. A good first step is to take the free menopause assessment. You can also book a consultation to talk through your options with one of our doctors.

References

1. National Institute for Health and Care Excellence (NICE). Menopause: identification and management (NG23). Published 2015, updated 2024. https://www.nice.org.uk/guidance/ng23
2. Meeta M, Digumarti L, Agarwal N, Vaze N, Shah R, Malik S. Clinical practice guidelines on menopause: an executive summary and recommendations: Indian Menopause Society 2019–2020. J Midlife Health. 2020;11(2):55–95. https://pmc.ncbi.nlm.nih.gov/articles/PMC7688016/
3. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767–794. https://pubmed.ncbi.nlm.nih.gov/35797481/
4. Vinogradova Y, Coupland C, Hippisley-Cox J. Use of hormone replacement therapy and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ. 2019;364:k4810. https://pmc.ncbi.nlm.nih.gov/articles/PMC6326068/
5. British Menopause Society. Consensus statement: Bioidentical HRT. https://thebms.org.uk/publications/consensus-statements/bioidentical-hrt/
6. British Menopause Society. Tool for clinicians: Progestogens and endometrial protection (May 2026). https://thebms.org.uk/wp-content/uploads/2026/05/14-NEW-BMS-TfC-Progestogens-and-endometrial-protection-MAY2026-A.pdf