How to check estrogen levels

An estrogen test is a way for your doctor to help check on concerns with puberty, fertility, menopause, and other conditions.

Your doctor may also call these estradiol, estrone (E1), estradiol (E2), estriol (E3), or estrogenic hormone tests.

Estrogen is the hormone that plays a key role in many aspects of a woman’s health, such as bone and reproductive health. There are several forms of estrogen?

If your doctor needs to check to see if you might have a condition caused by too much or too little of a certain estrogen type, they may recommend that you take an estrogen test. It’s a simple blood test, and it can measure up to three types of this estrogen:

  • Estrone, or E1, the main hormone women make after menopause
  • Estradiol, or E2, the main hormone women make when they aren’t pregnant
  • Estriol, or E3, a hormone women make more of when they’re pregnant

Who Gets an Estrogen Test?

Doctors may recommend testing of estradiol or estrone for symptoms such as:

  • Vaginal bleeding after menopause
  • Problems with menstrual cycles
  • Menopausal symptoms such as hot flashes, night sweats and irregular menstrual periods

If you take hormone therapy to treat symptoms of menopause, your doctor may give you an E1 or E2 test to see how well treatment is going.

Girls whose sex organs develop earlier or later than normal may also get tested for E1 and E2 levels.

Doctors usually test E3 during pregnancy, when it temporarily becomes the main estrogen. Abnormal levels of estriol may be a sign of problems with the baby’s health — but you’d get a lot more tests to find out for sure.

You might need several tests to track changes in your estrogen levels over time.

Estrogen Testing in Men

Men also have estrogen, although their levels are usually lower than they are in women. Estrogen levels that are too low or too high in men can lead to health problems.

A man might have an estrogen test to:

  • Check if puberty is delayed
  • Diagnose enlarged male breasts, a condition with doctors call gynecomastia
  • Find if high estrogen levels are due to low levels of testosterone or androgen –two key hormones in men
  • Find tumors that make estrogen

Estrogen Test Procedure

You don’t need to do anything special to prepare for an estrogen test. You don’t need to stop eating or drinking anything before it as you do with some types of blood tests. But before the test, you should tell your doctor about all the medications and supplements you take. It’s especially important to tell your doctor if you take birth control pills or hormone therapy, which may affect the test results.

Your doctor can use your urine, saliva, or blood to test your estrogen. Here’s how these tests are done:

Saliva tests. You can often do this test with an at-home kit. Your doctor will explain which kit to get and how to prepare and collect a sample.

24-hour urine test. For this test, your doctor or a lab will give you a container to collect all your pee for a 24-hour period. Your doctor will explain all the steps for collection and how to store your samples. Then they will test your samples at their office or in a lab.

Blood test. During the blood test, your doctor or another health care professional will take a little blood from a vein in your arm. A lab will then test that blood sample.

Estrogen Test Results

Estrogen levels that are considered normal or healthy depend on your age and your gender. For women, pregnancy will also have a big effect on your estrogen levels. Where you are in your menstrual cycle could also affect the results.

High or low levels of a specific form of estrogen aren’t enough to diagnosis of your condition. The test results can help, though, to find the cause of your symptoms.

High levels of E1 or E2 could mean early puberty in girls or tumors in the ovaries in girls and women. For boys and men, increased E1 and E2 levels could signal delayed puberty, tumors in the testicles, and may be the cause of gynecomastia.

For both men and women, high E1 and E2 levels could mean:

For pregnant women, high E3 levels could mean labor will occur soon.

Low estrogen levels in women are signs of several conditions, including:

  • Low levels of pituitary hormones
  • Poorly functioning ovaries
  • Failing pregnancy (when estriol levels drop) (inherited condition caused by an abnormal or missing X chromosome)

Low estradiol levels also happen, naturally, after menopause.

Depending on your estrogen test results and your symptoms, your doctor may recommend other tests to help pinpoint a diagnosis.

One common test checks for levels of follicle-stimulating hormone (FSH). FSH manages the menstrual cycle in women and stimulates egg production in the ovaries. In men, FSH prompts the production of sperm. If infertility is a concern, a test of FSH and luteinizing hormone (LH) are appropriate for men and women. The same is true if early puberty is suspected in boys or girls.

If you have questions about your hormone levels or any health issue, ask your doctor. It helps when you’re as detailed as possible in describing your symptoms. The more information your health care provider has, the better.

Show Sources

University of Rochester Medical Center: “Estrogen’s Effects on the Female Body.”

How to check estrogen levels

No matter how easily one approaches menopause, there are some changes in the organism. In particular, they are connected with hormone level fluctuations. While progesterone and estrogen levels are drastically dropped, FHS and LH are greater than they have been before. But, the major influence is dictated by low estrogen symptoms. How does it happen and what they contribute to?

Symptoms of Low Estrogen in Women: What Is Going On?

Estrogen is a vital hormone that can be found in women and men. In women, it is responsible for maintaining the reproductive system and forming female features such as the development of breasts, enlargement of hips, and pubic hair. Ladies can monitor their impact when they have a menstrual cycle. Mainly, it is produced by ovaries. And, when the time comes to menopause, low estrogen symptoms start emerging and causing changes such as cessation of menstruation, ovulation. Accordingly, a woman can no longer bear a child. However, during the onset of menopause, estrogen still allows one to perform a reproductive function but only with the help of gynecologists who will appoint the correct treatment to prolong the first stage.

How to check estrogen levels

What Are the Symptoms of Low Estrogen?

How to check estrogen levels

First off, it is worth saying that low estrogen symptoms can be also a result of smoking, hereditary predisposition, and excessive exercising. So, whenever a woman wants to prevent the fast onset of menopause, she should avoid such activities, and inform a dedicated expert about signature genetic details. In such a case, he will be able to appoint hormone replacement therapy or recommend health supplements that will stabilize the levels as much as possible. Besides, such treatment can alleviate the symptoms of low estrogen, and let the woman live a comfortable life.

Decreased Libido

Some women report decreased sexual desire, some connect it to painful sex. Such events happen because of vaginal dryness. She lacks sufficient lubrication, and any sexual intercourse can be ongoing with pain and wounds. It is crucial to use medical lubrication instead of creams and gels from the mass market. This irresponsibility leads to deterioration of sexual life and may provoke additional allergies.

Irregular Menstruation

In the low estrogen symptoms list, there is a firm place for imbalanced menstruation cycle. As far as menopause already dictates its primary role, the end of reproduction, the onset of the perimenopause stage will be followed by gradual cessation of periods. Some women also report that one month they can have healthy periods, the next one nothing at all. Note, the menopause is diagnosed when a woman does not have menstruation for 12 months.

Anxiety

Anxiety is a dangerous symptom of menopause. It can lead to severe mental problems and requires prompt attention. At first, a woman feels she is worried for no reason, then she reports over anxiety toward events that seemed pretty normal before.

Mood Swings

Other symptoms of low estrogen are mood changes. One can be happy and sad in no time and again for no reason. Doctors prescribe health supplements or HRT that are efficient to stabilize the mental state. If letting this state go, nothing will change except for more severe manifestations. It is no surprise that mood swings spoil relationships or lead to divorce. To prevent such consequences, psychological therapy is more than encouraged.

Hot Flashes

This is the first sign that your menopause is here and ready to spoil your well-being. Hot flashes are irregular temperature balance. One faces sweating or cannot tolerate warm weather, everything brings discomfort. Besides, simply walking on the street or staying in transport may be intolerable. Thus, it is necessary to have a bottle of water with you at all times.

Night Sweats

If your hot flashes manifest themselves during the night, they are called night sweats. Normally, there are recommendations for setting up the right temperature and sleep in free clothes. But, menopausal women may find it a nonworking solution. Excessive sweating, and violated sleep at night are common low estrogen levels symptoms.

Sleeping Disorders

Menopausal women do not have enough sleep and both cannot wake up fast and fall asleep immediately. Such a problem leads to stress and sometimes depression. Besides, women report irritability caused by lack of sleep. It is recommended to air the room prior to sleeping, and exercise to feel a little bit exhausted to fall asleep with no trouble.

Urinary Tract Infections

The lining of female urethra becomes thinner and thinner, and undesired bacteria feel easier to enter and cause infection. It is crucial to take care of the vaginal environment and use designated gels or soap for washing. If you have any and even the slightest problems with urination or you experience pain, it may be the first sign of infection.

Weight Gain

Unfortunately, among the most popular symptoms of low estrogen levels after menopause is fast weight gain. Women cannot drop it fast, and the previously efficient gym does not adjust the bodyweight to fit conditions. HRT can help to prevent it or at least substitute estrogen in medication to stabilize your weight loss.

Breast Tenderness

Together with tenderness women are at higher risk of having breast cancer. Usually, when menopause is diagnosed, a gynecologist will check up the overall condition, and may prescribe medical examination to exclude its possibility. Besides, ladies may come across stretch marks on breasts, it is also pretty normal and occurs because of lack of collagen. HRT may solve this issue as well.

The Bottom Line

Low estrogen symptoms in all women differ. Some do not have them at all, some suffer from them daily. To prevent the possibility of their negative influence, speak to a physician about hormone replacement therapy or supplement treatment. Otherwise, when you approach the postmenopause stage, you will no longer experience the joy of life. Note, the list can be prolonged. If you have any changes after you reached menopause or perimenopause, address them to a doctor. They may alert you about the presence of other illnesses.

Resources

  • Wikipedia – Estrogen. 3.5Levels.
  • Hormone. org – Estrogen Hormone.

👌 How can I help yourself with low estrogen in menopause?

You should follow a healthy lifestyle and reduce smoking. The doctor, in turn, will prescribe you the treatment either with HRT or supplements.

👩‍🔬 What tests need to be done to define low estrogen?

It can be an estradiol test or simple blood test which will show the level and changes occurred lately.

👩‍⚕️ Do I need to visit a doctor for low estrogen treatment in menopause?

Yes, you need it if you do not want to worsen your health condition.

🙅 What happens when estrogen levels are low in menopause?

The number of symptoms appears such as decreased libido, weight gain, hot flashes.

Michelle Pugle is an expert health writer with nearly a decade of experience contributing accurate and accessible health information to authority publications.

Lauren Schlanger, MD, is a board-certified primary care physician with a focus on women's and transgender health.

If you notice changes to your period, moods, or sex life, you could be experiencing symptoms of low estrogen. That’s because estrogen has an impact on your entire body. It is a hormone responsible for maintaining vaginal blood flow and lubrication, thickening the lining of the uterus during the menstrual cycle, and preserving bone density.

Low estrogen can happen across life stages. If you suspect you may have a low estrogen level, talk to your doctor to find out and address what's causing it.

How to check estrogen levels

Nicky Lloyd / Getty Images

Frequent Symptoms

Symptoms of low estrogen include:

    and night sweats
  • Amenorrhea (missing periods often, or never starting your period)
  • Headaches or worsening of migraines
  • Difficulty concentrating
  • Fatigue
  • Weight gain
  • Decreased sex drive
  • Adverse affect on sexual development for people going through puberty
  • Thinning of skin and hair

Complications

Women with low estrogen levels may not have noticeable symptoms. This can increase the likelihood of not catching the problem early on and experiencing complications.

Potential complications of untreated low estrogen include:

    : Estrogen has protective effects on your artery walls and helps keep blood vessels flexible while also increasing healthy cholesterol (HDL) and decreasing unhealthy cholesterol. So when estrogen levels decline, the reverse happens. It can lead to the buildup of fat and cholesterol in the arteries that contributes to the risk of heart attack and stroke.
  • Mood disorders and depression: Mood disorders and depression are associated with fluctuating estrogen levels, particularly during perimenopause, the period of time right before menopause that’s linked to increases in new-onset and recurrent depression.
  • Skin changes: Your skin has receptors for estrogen, which helps with moisture retention. Estrogen-deficient skin is associated with aging. It has fine wrinkles and less elasticity, as well as dryness and poor wound healing. : Low levels of estrogen are associated with osteoporosis, which weakens bones and makes them more prone to fractures, and a reduced ability to rebuild bone and preserve density. The loss of estrogens and androgens in elderly men can contribute to the development of osteoporosis as well.

When to See a Doctor

If you notice signs and symptoms of low estrogen, you should contact your doctor to discuss what’s happening. You can discuss with your doctor if there are blood tests recommended to check your overall health. Make sure you are up to date on your Pap smear test, which checks for cervical cancer.

Call your doctor if:

  • You’ve missed a period or more: This could be a sign of pregnancy or the result of certain medications, an underlying illness, or perimenopause.
  • You’ve not had a period for a year and start bleeding or spotting: In women who have gone through menopause, spotting or light bleeding could be caused by endometrial cancer or other serious health problems.
  • You are 16 or older and have not started menstruating: This could be a sign of delayed puberty due to hormonal imbalance.
  • You think you may have an eating disorder: Eating disorders can wreak havoc on your physical and mental health. They can cause deficiencies that can compromise estrogen production.
  • You are feeling overwhelming sadness or having suicidal thoughts: Reach out to a mental health professional to get the help and support you deserve, and talk to your doctor about possible treatment options.

Summary

Low estrogen levels affect your whole body. While they could be a normal part of life, especially during puberty and perimenopause, they could also be a result of certain medications or conditions. If you have symptoms of low estrogen, check with your doctor to make sure there isn't something more serious going on.

A Word From Verywell

Whether you're in the diagnostic process or still working to balance your hormones, having low estrogen is something you can't put to the side every morning when you start work or when you need to be there for your partner, friends, children, or pets. Sometimes it can be hard for others to understand what you are going through, and it's not because they are purposely trying to misunderstand.

The more you communicate what you're comfortable sharing about your experience, the better your loved ones and support network can rally together however you need as you work with your doctor to determine the best next steps.

When your estrogen levels are off, your body can feel off too. Estrogen is a sex hormone that has many functions: It controls the menstrual cycle; keeps cholesterol in check; protects bone health; and affects your brain, bones, heart, skin, and other tissues.

"There are many reasons you can have low estrogen, but most commonly, it is a normal change women go through during menopause," explains Navya Mysore, MD, family provider at One Medical. "Symptoms at that time can be hot flashes, excessive sweating, and vaginal dryness. One sign that is common is low bone mass, as we have reduced estrogen levels in menopause."

Your estrogen levels are highest in the middle of your menstrual cycle and lowest during your period. According to the Endocrine Society, other symptoms of low estrogen levels include menstrual periods that are less frequent or that stop, trouble sleeping, low sexual desire, mood swings, and dry skin.

You can get your estrogen levels checked through a blood or urine sample at your doctor's office. And your doctor may treat low estrogen levels with hormone therapy (pills, skin patches, gels, or creams). But there are some lifestyle changes you can make that can help you manage your estrogen levels naturally, which we've outlined below.

Ultimately, it's important to note that you should discuss with your doctor what's the best course of action to take.

Foods to Eat

Phytoestrogens are plant-derived dietary compounds that have a structure similar to estradiol, the primary female sex hormone in women of childbearing age. "Phytoestrogens mimic estrogen in the body and are found in plants and plant-based foods," Yasi Ansari, MS, RD, CSSD, a national spokesperson for the Academy of Nutrition and Dietetics told us. "When they enter the body, they are recognized by the body's estrogen receptors. Although their effects may be weaker, their similarity to estrogen makes them beneficial in helping the body during times when estrogen deficiency may cause health concerns."

One big source of phytoestrogens are flaxseeds. Nicole Glathe, DAOM, LAc, Dipl OM, co-founder of Elix, says that the phytoestrogen lignans contribute to the plant's hormonal effects. Glathe adds that other dietary sources include soybeans, hummus, chickpeas, and dried apricots, prunes, and dates.

At Healthfully, we strive to deliver objective content that is accurate and up-to-date. Our team periodically reviews articles in order to ensure content quality. The sources cited below consist of evidence from peer-reviewed journals, prominent medical organizations, academic associations, and government data.

  • FDA: Bio-Identicals: Sorting Myths from Facts
  • Harvard Health Publications: What are bioidentical hormones?

The information contained on this site is for informational purposes only, and should not be used as a substitute for the advice of a professional health care provider. Please check with the appropriate physician regarding health questions and concerns. Although we strive to deliver accurate and up-to-date information, no guarantee to that effect is made.

  • Bio-Identical Hormone Creams
  • Estriol Cream
  • Soy Cream

Over-the-counter estrogen creams typically contain bio-identical, or plant-based estrogen called phytoestrogen. As with prescription creams, they are supposed to relieve common symptoms of menopause, such as hot flashes, vaginal dryness and mood swings. The American College of Obstetricians and Gynecologists cautions that there has been insufficient research on the effectiveness and safety of over-the-counter estrogen creams, and they are not regulated by the FDA. Discuss using over-the-counter hormone products with your medical provider.

If you are experiencing serious medical symptoms, seek emergency treatment immediately.

Bio-Identical Hormone Creams

Bio-identical hormone creams are often marketed as bio-identical hormone replacement therapy (BHRT) 1. Bio-identical hormone creams are often compounded with estrogen, estriol or phytoestrogen, progesterone and androgen. Estriol had not yet been FDA-approved in 2010, although it is not illegal to dispense it over the counter. The FDA cautions that BHRT is not a recognized medical term, but a marketing phrase. It advises that consumers should be cautious about claims that these creams are safer than prescription estrogen creams, and that they may carry the same health risks and side effects as creams your doctor prescribes. In 2008, the International Academy of Compounding Pharmacists issued a press release stating that women should be given the choice to purchase over-the-counter bio-identical hormone creams, and that estriol was legal, safe and effective.

  • Bio-identical hormone creams are often marketed as bio-identical hormone replacement therapy (BHRT) 1.
  • In 2008, the International Academy of Compounding Pharmacists issued a press release stating that women should be given the choice to purchase over-the-counter bio-identical hormone creams, and that estriol was legal, safe and effective.

Estriol Cream

What Other Hormones Are Available Besides Prempro?

Although estriol isn’t FDA-approved for prescription use, you can still buy estriol creams legally over the counter. Estriol is a relatively weak form of estrogen, and according to an article on the Women’s Health website, it has fewer side effects than other estrogen treatments. When applied vaginally, estriol cream can reduce vaginal dryness. Women’s Health reports that a study also indicated that estriol cream may significantly improve the appearance of facial skin, reducing the size of pores and fine wrinkles. It’s also been used in Europe to treat menopausal symptoms.

  • Although estriol isn’t FDA-approved for prescription use, you can still buy estriol creams legally over the counter.
  • Women’s Health reports that a study also indicated that estriol cream may significantly improve the appearance of facial skin, reducing the size of pores and fine wrinkles.

Soy Cream

Soybeans contain phytoestrogens, a weak form of plant-based estrogen 1. While dietary soy in the form of food or supplements may be helpful in reducing menopausal symptoms, there is not enough evidence yet to prove that they are effective when applied as a cream or gel. However, soy estrogen cream is widely available over the counter. It is often combined with wild yam, which contains natural progesterone and is thought to complement the estrogen.

SHBG is short for sex hormone binding globulin and it is a serum blood test that can give you valuable insight about your hormones!

Low levels of SHBG may be associated with low thyroid function and low estrogen status while high levels may bind up testosterone leading to weight gain, depression, and other symptoms.

Most physicians don’t put a lot of emphasis on this lab test but it is critical to understanding what is happening with the hormones in your body.

Learn how to understand your lab results, but more importantly what to do about changes to your SHBG.

We will discuss high levels, low levels and what to do about both:

Sex Hormone Binding Globulin – Why it is important

So what is SHBG?

SHBG stands for Sex Hormone Binding Globulin.

And it does exactly what it sounds like it does – binds up sex hormones.

But why is this important?

In order to understand we need to talk about some basic physiology.

First, you need to know that hormones float around in your serum in 2 major forms:

#1. Bound to proteins (1) -> the binding of hormones to certain proteins leaves them INACTIVE.

If a hormone is bound to a protein it is NOT available for use.

Consider this like hormones that your body “stores” for later use, similar to you putting food in a deep freezer.

#2. Free and active -> if a hormone is not bound to a protein it is considered “free” and can actually enter into cells and do its job.

Free hormones (such as “free t4” or “free testosterone”) can turn on cellular function and promote genetic changes.

*Side note: this reasoning is why it’s so important to check your free thyroid hormones if you have hypothyroidism. Checking “total t3” or “total t4” has less clinical utility than the free hormones!

How to check estrogen levels

You can consider the free hormones as the ACTIVE hormones and the more clinically useful measurement of almost all hormones.

The amount of “free” hormone is usually a VERY small percentage when compared to the “bound” hormone in your blood.

Your body uses this binding system as a way to regulate certain hormones and keep everything in balance or in check.

So where does SHBG fit in?

Sex hormone binding globulin acts as a binding hormone which means that it may be helpful to think of SHBG as a way to inactive hormones floating around in your serum.

For this reason, you can consider SHBG to be a “Goldilocks” type of protein, meaning you don’t want too much but you also don’t want too little – you need just enough.

Small changes to SHBG levels can bind up free hormones and result in serious symptoms.

It also has a strong affinity (meaning it likes to bind) to certain sex hormones.

It will preferentially bind to hormones in this way:

Preference on dihydrotestosterone or DHT (2) (this is the most potent androgen), then testosterone, then androstenediol, then estradiol, then estrone.

You will notice that SHBG prefers to bind to and inactivate the various androgens in the body.

This is very important because of how this impacts androgens and therefore symptoms in both women and men.

High SHBG will bind up and INACTIVATE both testosterone and DHT meaning that both men and women may start to experience the symptoms of low testosterone (weight gain, depression, loss of muscle mass, irritability, etc.).

While low levels will leave more testosterone ACTIVE meaning that women may start to experience the symptoms of high testosterone (facial hair growth, weight gain, PCOS, irritability, acne, etc.).

What’s worse is that most physicians don’t even test for SHBG even though they understand the difference between “free” and “total” hormone concentration in the blood.

This makes SHBG a VERY important test to ask for if you are experiencing hormone any hormone imbalance as it may shed light on your current problem.

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What Causes Increased SHBG?

SHBG is influenced by 2 major hormone systems in the body:

#2. Estrogen levels (4).

Both of these hormones may stimulate or INCREASE the circulating amount of sex hormone binding globulin in the serum.

So what does that mean for you if you have high SHBG?

If you are a woman and you have high SHBG the most likely cause is due to excessive estrogen use.

This can be either from a condition known as estrogen dominance – meaning you have too much estrogen in your serum.

Or because you are taking birth control (5) or some other form of exogenous hormones.

If you are taking OCP or other hormones and it is causing excessively high levels of SHBG you should take caution!

Increasing your SHBG will influence the amount of free testosterone in your serum and may be one of the reasons that women on OCP tend to gain weight and experience mood changes (6).

Another cause of high SHBG is due to excessive thyroid hormone replacement therapy.

This is most often seen in those who are taking T3 containing medications (T3 has a direct influence on hepatic SHBG production) like natural desiccated thyroid hormone or liothyronine/cytomel.

It can also occur in those taking T4 medication such as Levothyroxine, but this is less common.

Assessing SHBG accurately in menstruating women can be difficult, though, as women may commonly present with both excess estrogen and hypothyroidism.

If you are taking thyroid hormone replacement and your SHBG is high you should look at both estrogen levels and your current thyroid dose.

But how do we “define” a high SHBG?

Like other hormones, we need to look at “optimal ranges” and not just the reference range.

If you are a woman you want your SHBG to be in the 60-80 nmol/L range.

Anything higher is considered “too much” and anything lower is considered “insufficient”.

You can see an example of high SHBG below with relevant laboratory reference ranges:

Symptoms of High SHBG

It’s important to realize that high SHBG doesn’t necessarily cause negative symptoms by itself. Instead, symptoms related to your SHBG may be due to an indirect effect that SHBG has on other hormones in your body.

If you have high SHBG you are more likely to experience negative symptoms related to excess estrogen and/or low testosterone:

Men are often unaware that estrogen (estradiol) plays a critical role in their day-to-day health.

Estrogen is found in small-but-critical concentrations in men. It needs to be in balance with the rest of your hormones, especially testosterone, for you to feel well.

How to check estrogen levels

1. The Connection Between Low T and Estrogen

Estrogen levels and testosterone levels are closely related. In fact, one of the primary causes of low estrogen is actually low testosterone.

Men’s bodies produce estradiol, a form of estrogen, as a byproduct the breakdown of testosterone through an enzyme called aromatase. Aromatase is found in estrogen-producing tissue, such as the adrenal glands, the brain, fatty tissue, and even the testicles.

Estradiol is often referred to as E2 and is one hormone in a class of hormones called “Estrogens.” This class includes estradiol, estriol, and estrone, among others.

Estradiol is likely the main estrogen you need to worry about.

The production of estrogen in a male body is a completely normal and necessary process. Estrogen is required for the healthy physiologic functions of your brain and other important organs, including:

  • Erectile function and sex interest
  • Maintenance of bone health
  • Regulation of fat mass vs. lean mass
  • Brain functions
  • Lipid metabolism
  • Skin metabolism

Since the necessary level of estradiol that men require is derived from testosterone, a correlation develops.

If your testosterone is low, your body doesn’t have the raw materials needed create more estradiol. If you have low testosterone, you may have low estrogen (estradiol) too, probably leading to the symptoms of hormone imbalance.

That’s why low testosterone symptoms and low estrogen symptoms often look so similar: they’re occurring at the same time, and it’s hard to determine what’s causing what.

Check out this list of signs and symptoms from the book Natural Hormone Balance for Women – Look Younger, Feel Stronger, and Live Life with Exuberance by Uzzi Reiss, MD/OB-GYN:

  • Mental fogginess. “I’ve lost my mind.”
  • Forgetfulness. “I can’t remember the birthdays of my grandchildren anymore.”
  • Depression. “It’s like I’m living in a dark tunnel.”
  • Minor anxiety. “I can’t seem to control my worries.”
  • Mood change. “Sometimes I wonder how I’m going to feel tomorrow.”
  • Difficulty falling asleep. “My mind is racing and I can’t stop it.”
  • Hot flashes. “This wave of heat spreads through my body.”
  • Night sweats. “I wake up soaking wet.”
  • Temperature swings. “I feel like a broken air conditioner.”
  • Day-long fatigue. “I can’t keep my head up.”
  • Reduced stamina. “I can’t push it like I used to.”
  • Decreased sense of sexuality and sensuality. “I have lost all pride in my body.”
  • Lessened self-image and attention to appearance. “I could care less how I look.”
  • Dry eyes, skin, and vagina. “My body is like a dry summer.”
  • Loss of skin radiance. “I’ve lost my skin glow.”
  • Sense of normalcy only during second week of cycle: “I am myself only one week out of the month.”
  • Sagging breasts and loss of fullness. “These aren’t the breasts I used to have.”
  • Pain with sexual activity. “I’m not lubricating as well.”
  • Weight gain, with increasing lack of concern about it. “I’m like a balloon that can’t pop.”
  • Increased back and joint pain. “My body is stiff and hurts.”
  • Episodes of rapid heartbeat, with or without anxiety. “Out of nowhere my chest feels strained and I get palpitations.”
  • Headaches and migraines. “I seem to be controlled by pain that I never knew before.”
  • Gastrointestinal discomfort. “I feel bloated.”

What’s the best way to test estrogen levels?

The best way to test estrogen levels is with a simple blood test for Estradiol.

Estradiol is usually only tested in women to confirm if they are actually in menopause or not, along with the FSH test (Follicle Stimulating Hormone).

The only other time to use the Estradiol test is in a younger women (one who is still in their childbearing years known as ‘premenopause’) who has stopped having their menstrual cycle.

In this case the Estradiol levels are tested along with some other hormones like Progesterone, FSH, and LH (Luteinizing Hormone) to help differentiate between Amenorrhea, Anovulation, and even Premature Ovarian Failure.

Still have questions about your estrogen levels?

Hormones can be very confusing. Finding the root causes of your hormonal problems requires thorough investigation from a doctor trained in Functional Medicine.

Check out my other blog posts, podcasts, and videos about hormones. They should shed a lot of light…give you many a-ha moments…and answer most…if not all…of your questions.

Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be.

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

To answer the question of whether conjugated estrogens like Premarin can cause depression or anxiety, we must first talk about what estrogen is. Estrogen is a group of hormones which play a vital role in women’s sexual and reproductive health.   They are often referred to as sex hormones because of this. Estrogen helps to regulate a woman’s sexual development, as well as her ability to conceive and bear children.

Conjugated Estrogens

Premarin is a brand of conjugated estrogens, which are a type of hormonal medication containing a mixture of estrogens. In Premarin's case, these have been isolated from the urine of pregnant mares: PREgnant MARes' urINe. It is used to treat symptoms associated with menopause and other low-estrogen conditions, such as hot flashes and vaginal dryness. It is also used in the prevention of osteoporosis (thinning of the bones) after menopause, some breast, and prostate cancer symptoms, and certain premenopausal conditions.

The Link Between Estrogen and Mood

It is well known that estrogen affects depression and anxiety.   Women who are in their peak estrogen-producing years or transitioning to menopause tend to be affected by these disorders more often than either men or postmenopausal women. In addition, when women are experiencing hormonal fluctuations, such as prior to their menstrual periods and after giving birth, they tend to be more prone to mood disorders.

Perhaps not too surprisingly, depression and anxiety are also potential side effects of medications like Premarin, which affect hormone levels. The reason that estrogen-containing medications have the potential to affect mood is that estrogen plays many roles in the body, affecting more than just the sex organs. It can exert effects on the urinary tract, the heart, the blood vessels, bones, breasts, skin, hair, mucous membranes, pelvic muscles, and the brain.  

Though Premarin can cause the side effects of depression or anxiety, some studies have shown that women who take conjugated estrogen during late menopause and early postmenopause have markedly less depression and anxiety than those who received a placebo.  

Estrogen's Effects on the Brain

Some of estrogen's effects on the brain and nervous system include:  

  • Regulating neurotransmitter systems that affect mood, like serotonin, dopamine, epinephrine, and norepinephrine
  • Sensitivity to the fluctuation of estrogen levels in the amygdala, which is linked to mood regulation
  • Stimulating beneficial mood-related actions in the hippocampus

Some women may be exceptionally sensitive to changes in hormone levels, causing them to be more susceptible to depression when these levels are off.

Signs of Depression

While it isn't known how often women become depressed while using Premarin, it is a potentially serious side effect. Symptoms of depression include:

  • Sadness
  • Inability to enjoy things that used to be pleasurable
  • Fatigue or low energy
  • Problems with thinking, concentration, or memory
  • Feelings of guilt, worthlessness, or helplessness
  • Feelings of hopelessness
  • Problems with sleep
  • Problems with weight or appetite
  • Irritability or restlessness
  • Thoughts of death or suicide

If you are using Premarin and experience any of these symptoms, especially if they are accompanied by thoughts of death or suicide, you should immediately consult with your healthcare provider for advice.

If you or a loved one are struggling with depression, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

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Estrogen Balance with DIM

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Form: Capsules

Serving size: 2 capsules

Servings per container: 30

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Nutrients and ingredient list for Estrogen Balance with DIM

Bioperine is a trademark of Sabinsa Corporation

*Percent Daily Values are based on a 2000 calorie diet.

**Daily Value not established.

Vegetarian capsule, microcrystalline cellulose, magnesium stearate and stearic acid

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