High Estrogen vs Low Estrogen Symptoms: What They Mean & Treatment

Estrogen is one of the most important hormones in the body, especially for people assigned female at birth. It helps regulate the menstrual cycle, supports bone health, and even influences mood and skin. But when estrogen levels drift too high or too low, the body often lets you know through noticeable symptoms. 

Some of these changes may be temporary, tied to your cycle or stress, while others may reflect more persistent imbalances or health conditions. Understanding the differences between high estrogen vs. low estrogen symptoms can help you make sense of what your body is experiencing and when it’s time to seek care.

What does estrogen do in the body?

Estrogen isn’t just a “reproductive hormone.” It plays a vital role in almost every system of the body. Produced mainly by the ovaries (with smaller amounts from fat tissue and adrenal glands), estrogen helps regulate cycles and prepares the body for potential pregnancy. But its effects extend far beyond periods and fertility.

In the brain, estrogen interacts with neurotransmitters like serotonin and dopamine, which explains why changes in estrogen levels can influence mood, memory, and sleep quality. In the skin, estrogen boosts collagen production and helps retain moisture, keeping the skin firm and hydrated. 

Estrogen is a guardian of long-term health as well. It supports strong bones by working with calcium and vitamin D, protecting against osteoporosis. It also helps keep cholesterol levels balanced, reducing cardiovascular risk. In the vagina, estrogen maintains tissue elasticity, lubrication, and a healthy pH, creating the conditions for a balanced microbiome that protects against infections.

When estrogen levels rise too high or drop too low, these systems can be disrupted, leading to a wide range of symptoms associated with hormone imbalance.

High estrogen vs low estrogen symptoms

Hormonal imbalance doesn’t look the same for everyone. Some people may notice subtle changes, while others experience disruptive symptoms that interfere with daily life.

Symptoms of high estrogen

High estrogen can occur naturally during certain phases of the menstrual cycle, but persistently elevated estrogen levels may result from oral contraceptives, hormone replacement therapy (HRT), or rare conditions like estrogen-secreting tumors. Symptoms of too much estrogen can include:

• Irregular periods or heavy bleeding
• Breast tenderness or swelling
• Increased vaginal discharge
• Mood swings, irritability, or depression
• Decreased libido
• Weight gain, often around the hips and thighs
• Fatigue or insomnia
• Bloating or water retention
• Headaches or migraines
• Worse premenstrual syndrome (PMS), fibroids, or dense breast tissue
• Skin changes such as melasma
• Nausea.

Symptoms of low estrogen

Low estrogen is most common during the menopausal transition, after menopause, or following medical treatments that suppress estrogen. It reflects reduced stimulation of tissues and long-term risks to bone and metabolic health. Low estrogen symptoms may include:

• Hot flashes and night sweats
• Irregular or absent periods
• Vaginal dryness and discomfort with sex (dyspareunia)
• Dry skin
• Fatigue or insomnia
• Mood changes, including depression or anxiety
• Decreased libido
• Urinary urgency or incontinence
• Bone loss and increased osteoporosis risk
• Weight gain, especially abdominal fat
• Cognitive changes (brain fog, poor concentration). 

Because many of these symptoms overlap with other conditions, it’s important not to self-diagnose. Testing and professional evaluation are key.

Causes and risk factors

Hormone balance is something that naturally changes as we go through life, but there are a few factors that can cause our estrogen levels to swing too high or too low. 

High estrogen levels are often associated with things like taking birth control pills, hormone therapies, or fertility treatments. In rare cases, they might be linked to estrogen-producing tumors or liver issues, since our liver plays a big role in processing hormones. Lifestyle factors like being overweight can also raise estrogen levels, as fat cells can produce estrogen. Plus, some environmental chemicals can disrupt our hormones and have an impact.

Low estrogen is most commonly seen during perimenopause and postmenopause, when the ovaries naturally reduce their estrogen production. Other reasons for low estrogen include surgical removal of the ovaries, certain health conditions that affect the ovaries, or treatments that aim to block estrogen, like those used for breast cancer. Stress, extreme workouts, and being underweight can also put a damper on ovarian function and lead to lower estrogen levels.

Genetics, overall health, and age all play a role in how our estrogen fluctuates. Understanding what's causing the imbalance is key to figuring out the best way to treat it.

How to test estrogen

There's no single "estrogen test," so if you’re noticing symptoms that suggest an estrogen imbalance, testing can help figure out what’s going on:

• Blood test: The most accurate way to measure blood estrogen levels is with a liquid chromatography–tandem mass spectrometry (LC-MS/MS) test. This method is very precise, especially for low estrogen levels in postmenopausal women, men, or children. Regular immunoassays are more common but can be less accurate at low levels.
• Urine test: Measures how your body breaks down estrogen. It can give extra insight into hormone metabolism, but doesn’t directly measure blood levels.
• Saliva test: Convenient but less reliable than blood tests. Sometimes used in alternative health settings.
• Comprehensive hormone panels: Some labs measure estrogen along with progesterone, testosterone, and other hormones to provide a broader picture of hormone balance.

It’s important to look at test results in context. Estrogen levels naturally fluctuate during the menstrual cycle and after menopause. Since estrogen levels fluctuate, a single test may not tell the full story. The timing of the test matters, too, so tracking trends over time and considering symptoms alongside lab results gives a clearer picture. Your clinician can help determine the best window for accurate results.

Treatment for high & low estrogen

Estrogen imbalance can often be improved with the right combination of medical treatment and lifestyle support.

Treatment options

• Hormonal therapy: For estrogen deficiency, this may include systemic hormone replacement (oral, patch, or gel) or localized vaginal estrogen. For high estrogen, therapy may be adjusted or reduced.
• Non-hormonal medications: Selective estrogen receptor modulators (SERMs), antidepressants, or bone-supporting drugs may be used depending on symptoms and risks.
• Contraceptive adjustments: Switching types or doses of birth control can sometimes help balance estrogen levels.
• Surgery: Rarely, if high estrogen is caused by an ovarian tumor, surgical removal may be necessary.
• Lifestyle interventions: Diet, exercise, and stress management strategies complement medical treatments.
• Regular monitoring: Blood tests and follow-ups help track progress and adjust treatment as needed.

Always consult a healthcare professional before starting or stopping hormone-related treatments, as risks and benefits vary by individual.

Diet and lifestyle strategies to support balanced estrogen

While medical treatments are incredibly effective (and often necessary), making some lifestyle changes can help manage estrogen levels. A diet rich in fiber helps the body eliminate excess estrogen, while cruciferous vegetables like broccoli and brussels sprouts contain compounds that aid estrogen metabolism. It’s also a good idea to cut back on alcohol and ultra-processed foods.

Staying physically active is another way to promote hormonal balance, reduce stress, and help manage body weight, which is important because extra fat tissue can produce more estrogen. 

Don’t forget about the power of a good night’s sleep. Prioritizing quality rest and incorporating stress-relief practices like yoga or meditation can really help stabilize your hormones. While these tips aren’t a magical fix, they’re definitely great steps toward feeling better and achieving overall health. 

How estrogen levels affect the vaginal microbiome

Estrogen is really important for vaginal health. When estrogen levels are normal, it helps good bacteria, like Lactobacillus, to flourish. These friendly bacteria produce lactic acid, which keeps the vaginal pH low (acidic), helping to fend off infections.

However, when estrogen levels decrease — like during menopause — the vaginal lining can become thinner and drier, making it harder for those good bacteria to thrive. This change leads to a higher vaginal pH, which can allow bad bacteria to take over. This shift is often associated with genitourinary syndrome of menopause (GSM), which can bring about discomfort such as vaginal dryness, burning, and urinary issues, along with an increased risk of infections.

So, maintaining normal estrogen levels is essential for keeping that balance in the vaginal microbiome. That’s why localized vaginal estrogen treatments can be really effective and helpful.

When to see a healthcare provider

Mild fluctuations in estrogen are normal, but certain symptoms warrant professional evaluation. Make an appointment if you experience:

• Heavy, prolonged, or irregular periods
• Severe menstrual pain unrelieved by over-the-counter medications
• Breast changes such as new lumps, persistent tenderness, or discharge
• New or worsening headaches or migraines
• Fainting or severe dizziness
• Persistent gastrointestinal issues
• Infertility concerns after trying to conceive for 6–12 months
• Symptoms of menopause that interfere with quality of life. 

Prompt evaluation can help rule out serious conditions and lead to effective treatments tailored to your needs.

FAQs

How do I know if estrogen is high or low?

The most reliable way to know whether your estrogen is high or low is through lab testing, usually with a blood test that measures estradiol, the most active form of estrogen. However, your symptoms often provide important clues. High estrogen is usually associated with heavy or irregular periods, bloating, breast tenderness, headaches, or mood swings. Low estrogen symptoms include hot flashes, vaginal dryness, poor sleep, or irregular periods. Because many of these symptoms overlap with other conditions like thyroid disorders, polycystic ovary syndrome (PCOS), or perimenopause, it’s important not to self-diagnose. If you’re noticing persistent changes in your cycles, mood, or energy, talk to a clinician who can order the right tests and interpret the results in context with your health history.

Is it better to have low estrogen or high estrogen?

Neither high nor low estrogen is ideal, and both can have uncomfortable symptoms and potential long-term health risks. High estrogen, especially when unopposed by progesterone, can increase the likelihood of heavy bleeding, fibroids, endometriosis-related pain, and, in some cases, a higher risk of blood clots or gallbladder disease. Low estrogen, on the other hand, is linked to hot flashes, night sweats, vaginal dryness, bone loss, and a higher risk of osteoporosis over time. In short, balance is key. Estrogen is meant to fluctuate naturally across the menstrual cycle, but consistently high or low estrogen levels outside of expected phases of life (like menopause) can signal an imbalance. 

How do you feel when estrogen levels are high?

When estrogen is high, many people describe feeling “puffy” or “bloated” due to water retention. Breast tenderness or swelling is another common sign, along with headaches or migraines that worsen around the menstrual cycle. Emotionally, high estrogen may contribute to irritability, mood swings, or even feelings of anxiety or low mood. Some notice changes in their skin, like dark patches (melasma), and others may gain weight, especially around the hips and thighs. Because high estrogen stimulates tissues, it can also worsen PMS or contribute to the growth of fibroids. Not everyone feels the same, but if you regularly notice these patterns, testing can clarify whether estrogen levels are contributing.

Does estrogen cause diarrhea?

Estrogen itself doesn't directly cause diarrhea, but it can influence how our digestion works. Estrogen interacts with the gut-brain connection and plays a role in how our gut moves. During different phases of the menstrual cycle, when estrogen and progesterone levels change, some people might notice symptoms like loose stools, bloating, or cramping. High estrogen levels can sometimes lead to feelings of nausea or changes in appetite, while low estrogen might lead to constipation. If diarrhea becomes a regular issue or feels particularly intense, it's always a good idea to check for other potential causes like infections, irritable bowel syndrome (IBS), or food sensitivities. Keeping track of your symptoms alongside your cycle can be a helpful way to figure out if estrogen is a factor.

What does a woman with high estrogen look like?

There's no one-size-fits-all "look" for high estrogen, as everyone experiences hormone changes differently. That said, there are some common signs you might notice. For example, some people experience breast tenderness or enlargement, bloating, and weight gain around the hips, thighs, or tummy. You might also see hair thinning on your scalp, darker patches of skin on your face (called melasma), or some puffiness from fluid retention. These signs aren't exclusive to high estrogen; they can also be influenced by other conditions, medications, or lifestyle choices. That’s why it's so important to get tested and have a clinical evaluation done. While physical changes can give us hints about hormone levels, they shouldn't be seen as the final word on your hormone health.

What are the signs of low estrogen?

Low estrogen is often associated with some pretty uncomfortable symptoms that can be hard to overlook, like hot flashes and night sweats. Many also experience vaginal dryness or discomfort during intimacy, since estrogen plays a key role in keeping vaginal tissue healthy and well-lubricated. Missed or irregular periods, fatigue, sleep disturbances, and mood swings can also pop up when estrogen levels drop. Over time, low estrogen can lead to bone thinning (known as osteoporosis) and changes in body fat distribution, often accumulating around the abdomen. Some people even notice a shift in memory or concentration, which is often referred to as “brain fog.” While these symptoms are especially common during perimenopause and menopause, they can sometimes appear earlier due to various medical conditions or treatments. 

How to flush out excess estrogen?

“Flushing out” excess estrogen is really about supporting your body’s natural detoxification and hormone metabolism pathways. Your liver is a key player in breaking down estrogen, while your gut helps get rid of it. One of the best things you can do is eat a high-fiber diet filled with fruits, veggies, whole grains, and legumes, which helps move estrogen through your digestive system so it doesn’t get reabsorbed. Staying active, drinking plenty of water, and cutting back on alcohol can also lighten the load on your liver. Plus, keeping an eye on your body weight is important since fat tissue can produce estrogen. For some people, medical help might be needed, whether that’s adjusting hormone therapy, exploring certain medications, or tackling any underlying health issues.