Estrogen Deficiency

Estrogen deficiency means the body has lower estrogen levels than expected for a person's age and sex. In women, the most common cause is menopause. Other causes include primary ovarian insufficiency (reduced ovarian function before age 40), hypothalamic amenorrhea from low body weight, intense exercise or stress, pituitary disease, surgical removal of the ovaries, and medicines that lower estrogen. Symptoms can include hot flashes, night sweats, vaginal dryness, irregular or absent periods, low mood and, over time, bone loss.

Lab tests linked to estrogen deficiency:

• Estrogens, total (female): a combined measure of the main estrogens. Estradiol is usually the more specific test.
• Doctors may also order estradiol, FSH and LH, prolactin, TSH, a pregnancy test and AMH, and a bone density scan if low estrogen has lasted a long time.

How results are read:

• Estrogen levels change across the menstrual cycle, so a single result is read with the cycle day in mind.
• Low estrogen with a high FSH points to the ovaries as the cause, such as menopause or ovarian insufficiency. Low estrogen with a low or normal FSH and LH points to the hypothalamus or pituitary.
• In women over 45 with typical symptoms, menopause is usually diagnosed from symptoms without blood tests.

When to see a doctor:

• See a doctor if your periods stop before age 40, or stop for three months or more at any age without pregnancy.
• See a doctor promptly about any vaginal bleeding after menopause.

Clinical takeaway: estrogen deficiency is read together with FSH and LH, which show whether the cause lies in the ovaries or in the brain's hormone signals.