Most women don’t have to think about how important estrogen is until perimenopause makes it impossible to ignore. Estrogen affects nearly every system in women’s bodies, not just the reproductive one. 

When the ovaries stop functioning normally during the approach to middle age, estrogen levels can rise and fall dramatically. The result is a wide-ranging, often confusing mix of symptoms. To help you make sense of this transition, we explain the connection between estrogen and menopause and symptoms to look out for.

Symptoms of menopause: Hormonal changes and why they happen

When estrogen production becomes unreliable, the fluctuations can cause these common symptoms.

Body

During menopause, women’s bodies can undergo a series of physical changes, including:

  • Hot flashes, night sweats, and cold chills: Lower estrogen levels affect the temperature at which the brain tells you that you feel comfortable. Even small changes in core body temperature can trigger sudden flushing or sweating.
  • Vaginal dryness and pain during sex: Estrogen keeps vaginal tissue thick, elastic, and well-lubricated. As hormone levels drop, this tissue thins and produces less moisture. As well as discomfort, this dryness can cause pain during sex.
  • Urinary urgency, frequent urination, and recurrent urinary tract infections (UTIs): Thinning vaginal tissue also affects the urethra and bladder lining, raising the risk of infection and irritation. Bladder tissue becomes less stretchy and muscles weaken, making it difficult to control the urge to pee.
  • Racing heart, irregular heartbeat, and dizziness: Fluctuations in estrogen levels can affect the heart’s electrical rhythm. This causes up to 42% of perimenopausal women to experience heart palpitations and dizziness.
  • Joint pain, muscle aches, and headaches: Estrogen supports cartilage (the tissue that cushions joints) by promoting joint lubrication and reducing inflammation. Lower hormone levels can cause it to break down faster, leading to stiffness, soreness, and migraines.
  • Skin, hair, and eye changes: Collagen is a protein that affects the strength and elasticity of skin, hair, and bones. Estrogen supports collagen production and helps the skin hold moisture. According to the European Medical Journal, women lose about 30% of skin collagen in the first five years after menopause. This results in a higher number of wrinkles and weaker skin that’s more prone to injury. 

Mind

Besides physical changes, the following mental symptoms are also common:

  • Mood swings and irritability: Estrogen helps regulate serotonin, an important brain chemical for emotional steadiness. When estrogen levels fall, the brain can’t absorb as much serotonin, meaning mood often dips, too.
  • Anxiety and panic-like feelings: The brain has two primary calming signals: gamma-aminobutyric acid (GABA) and serotonin. When estrogen levels drop, these signals weaken, leaving the nervous system more reactive to everyday stress.
  • Depression and feeling "not yourself": In addition to serotonin, estrogen supports dopamine production, also known as the “feel-good hormone.” When both drop, motivation and pleasure can fade.
  • Disrupted sleep and insomnia: Lower estrogen disrupts the brain chemicals responsible for relaxation, making it harder to sleep. It can also disrupt the brain’s ability to control body temperature, leading to night sweats, which make it harder to sleep through the night.
  • Brain fog: Estrogen helps regulate the regions of the brain responsible for attention, focus, and word recall. Changes in hormone levels can make thinking feel slower or less sharp.
  • Memory lapses: The hippocampus, the brain region responsible for learning and memory, is especially rich in estrogen receptors. When hormone levels drop during menopause, the hippocampus doesn’t work as effectively, leading many women to experience issues with recall.

Hormone chaos: Estrogen, progesterone, and follicle-stimulating hormone (FSH)

Perimenopause feels chaotic because three hormones are in flux at once. In premenopausal women, estrogen and progesterone normally take turns running the menstrual cycle: Estrogen builds the uterine lining, and after ovulation, the empty follicle produces progesterone to stabilize it. 

But in perimenopause, ovulation becomes irregular. Progesterone, which the body only produces after it releases an egg, is the first hormone to drop and stay low. The brain responds by releasing more FSH, trying to spur the ovaries back into action. The ovaries react unpredictably, sometimes producing too much estrogen, sometimes too little.

How estrogen levels change across the stages of menopause

There are three stages to menopause, each marked by a different hormonal pattern:

  • Perimenopause (typically starts in the early-to-mid-40s): This is the most unsteady phase of the menopausal transition. It typically lasts around four to eight years, though it can rarely last 10 or more. The ovaries are still functioning, but the menstrual process is uneven. Some cycles produce a normal amount of estrogen, while others produce far more or less. Unpredictability makes this stage difficult, resulting in cycle changes, mood swings, and disrupted sleep.
  • Menopause (typically starts around age 51): Doctors consider women to be in menopause when they’ve not had a period in 12 consecutive months. By this point, the ovaries have stopped releasing eggs, and estrogen levels have fallen well below reproductive-age norms. Hot flashes and night sweats often hit the hardest around this time as the body adjusts to operating with much less of the hormone. 
  • Postmenopause (the rest of life after menopause): In the years following menopause, estrogen settles at a low, stable baseline. The ovaries continue to produce trace amounts, but fat tissue takes over as the body’s primary source of estrogen. This is one reason many women struggle with weight post-menopause. Other common postmenopause symptoms include decreased bone density, increased cardiovascular risk, and vaginal dryness.

What can help with low estrogen symptoms?

Estrogen replacement is the most effective treatment for disruptive menopause symptoms. Hormone replacement therapy (HRT) for menopause delivers estrogen (and sometimes progesterone) directly into the body. This eases hot flashes, night sweats, and vaginal and urinary changes. It can also slow bone loss.

For women who can’t or prefer not to use hormones, certain nonhormonal medications can reduce hot flashes. Lifestyle changes like regular exercise and undergoing cognitive behavioral therapy (CBT) can also ease sleep and mood disruptions.

A note on the "critical window"

While there are some risks of starting HRT, these are much less significant if you begin treatment within 10 years after menopause and before age 60. This offers women the best chance to protect heart health, slow bone loss, and preserve cognitive function. Clinicians call this pattern the “critical window.” Beginning HRT later than this point carries more risks. You also miss out on preventative benefits, like cardiovascular and bone density protection.

With Maven Clinic, you don’t need to go through menopause alone

If you're approaching middle age and experiencing symptoms like brain fog, joint pain, or heart palpitations, they likely trace back to the same hormonal source. But because estrogen levels vary so much day to day, a single blood test can rarely tell you where you are in the menopause process. Maven Clinic's Hormone Care can help you make sense of what you're experiencing by connecting you with expert clinicians.

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FAQ

Can you get pregnant during perimenopause? 

While pregnancy is rarer during perimenopause, until 12 months have passed without a period, it can still happen. If you want to avoid this, you should still consider using contraception when you have sex.

Does estrogen completely disappear after menopause?

No, but levels remain far lower than they were during your reproductive years. This is why many hormonal menopause symptoms emerge. After menopause, the ovaries continue producing trace amounts of estrogen, but fat tissue takes over as the body’s main source. The adrenal glands can contribute small amounts, too.

Can low estrogen cause anxiety and depression?

Yes, low estrogen can cause anxiety and depression because this hormone helps regulate serotonin and dopamine—the brain chemicals tied to mood, motivation, and pleasure. A 2024 study of more than 9,000 women found that those in perimenopause faced about a 40% higher risk of depression than premenopausal women.

Why do menopause symptoms vary so much from person to person?

Estrogen levels fluctuate differently in every woman, and each body responds to those changes uniquely. Factors that influence how symptoms emerge and their intensity include:

  • Genetics
  • Body composition
  • Smoking history
  • Stress levels
  • Overall health

What’s hormone replacement therapy for women?

HRT replaces the estrogen (and sometimes progesterone) that the body stops producing during menopause. The therapy comes in several forms:

  • Pills, patches, gels, and sprays: These medications release hormones into the bloodstream, reaching the whole body and easing symptoms like hot flashes and bone density loss. 
  • Vaginal creams and rings: Topical medications stay on the skin, treating dryness and urinary changes without affecting the rest of the body. Similarly, rings typically deliver small doses of hormone directly to vaginal tissue.

The right form of treatment will depend on your specific medical history.

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