Estrogen Dominance (what it is and what you can do about it)

Women’s health concerns tend to follow predictable patterns. In healthy women, cyclic changes in sex hormones throughout the month make it possible to track fertility—everything from ovulation, to an expected period, to optimal days for conceiving or avoiding pregnancy. In the same way, dysfunctional cycles tend to follow predictable patterns according to measurable imbalances in estrogen, progesterone, and testosterone. Whether or not the imbalance clinically correlates to a formal diagnosis—such as endometriosis or PCOS—there’s a lot that can be done to help balance female hormones and alleviate symptoms beyond a prescription for birth control pills or Midol. [Learn more about hormonal imbalances, such as estrogen dominance and deficiency in this post: What Your Period Reveals About Your Health]

Throughout the female cycle, two hormones tend to be held responsible for triggering key events such as ovulation and the start of a period. In the first half of the cycle, estrogen rises and falls, correlating with a hormonal signal from the brain that triggers the release of an egg. Following ovulation, the ovary produces progesterone, which is responsible for thickening the uterine lining in anticipation of pregnancy. After about seven days, progesterone levels peak and begin to steadily decline; once they drop low enough, the lining starts to shed, signaling the start of a period and another cycle.

However, that delicate balance between estrogen and progesterone can easily become disrupted by other hormonal imbalances such as thyroid hormones, or cortisol—the stress hormone. Often, this leads to a relative excess of estrogen in comparison to progesterone, creating symptoms like hot flashes, moodiness, fatigue, painful periods, and more. Long-term elevation of estrogen can also increase risk for cardiovascular disease, breast and ovarian cancers, diabetes, and infertility. If monthly symptoms aren’t bad enough, the long-term risks mean that addressing estrogen dominance is really important for lifelong health and well-being.

What Causes Estrogen Dominance?

The production of estrogen from the ovaries is regulated by the hypothalamic-pituitary-gonadal axis, a delicate web of signals between the brain and reproductive organs. Estrogen excess can result from interruptions along the entire axis, whether from a signaling problem at the brain level, or from dysfunction of the ovaries themselves. Many women also experience high estrogen because the pathways involved in the synthesis of estrogen can be interrupted by hormone-disrupting chemicals (such as BPA and plastics), because the precursor hormones are being diverted into the production of other hormones (like cortisol), or because of autoimmune diseases or medication use. Here are a few other reasons for high estrogen:

  • Adrenal dysfunction
  • Perimenopause
  • Exogenous estrogen use (such as hormonal contraceptives)
  • Exposure to xenoestrogens (BPA, phtlalates, DEHP, and other chemicals found in plastic; insecticides; food additives such as BHA and those found in red dye)
  • Insulin resistance
  • Liver dysfunction
  • Hypothyroidism
  • Smoking
  • Clomiphene use (Clomid, a fertility drug)
  • Inflammation

What to Do About Estrogen Dominance

As with any hormonal imbalance, effective treatment starts with identifying the root cause. This is why it’s so important to work with a naturally-minded healthcare provider to review diagnostic tests and lifestyle/history to get to the bottom of the estrogen dominance. If adrenal dysfunction is the driving force behind high estrogen, for example, no amount of estrogen-clearing supplements will effectively solve the problem. The adrenal dysfunction needs to be addressed, first!

Once an appropriate diagnosis is made and healing efforts are underway, there are a number of steps that can be taken to help the body clear out excess estrogen, balance out the production of progesterone, and get the hormone levels back to a functional status quo.

Lifestyle

Gut Health: As with many other areas of health, the gut microbiome plays a huge role in hormonal balance. Not only do the naturally-occurring bacteria and yeast in our digestive tract aid in digestion of food and absorption of nutrients, they also produce a large proportion of the body’s hormones and neurotransmitters. They also are involved in the metabolism and excretion of hormone breakdown products. The group of bacteria responsible for metabolizing estrogen and estrogen breakdown products is called the estrobolome.

The more different types of bacteria we have in our gut, the greater the number of functions our microbiome has. (This is why microbial diversity is important.) When our gut diversity is limited, functions such as those carried out by the estrobolome are interrupted. Contrary to popular belief, the #1 way to support microbiological diversity and gut health is to avoid dieting. Instead, eating a diverse and varied diet with many different types of fiber (found in all kinds of plant foods) is extremely important. Rather than restricting your diet, as many “estrogen dominance diets” encourage, focus on including as many different types of plant foods and fibers in your diet as you can. No, a vitamin powder or fiber supplement aren’t going to do the trick.

Stress: In my clinical experience, the most common cause of hormonal imbalances among women are related to stress. Whether that source of stress is emotional, relational, physical, nutritional, or otherwise, stress management is key. In an estrogen dominance hormonal pattern, progesterone is also typically low. Progesterone and cortisol a both produced from the same hormonal precursor, called pregnenolone. When stress levels are high, the body allocates its resources towards producing cortisol, which means there aren’t many leftovers for producing progesterone. (This is called progesterone steal.) The end result is functionally low progesterone, either creating or amplifying an existing pattern of estrogen dominance.

For more information about lifestyle methods for balancing hormones, checkout this post: 5 Ways to Balance Your Hormones, Naturally

Nutrition

Whenever I talk about diet minutiae with my clients, the emphasis is almost always on adding rather than restricting (except in the cases of allergies/intolerances, of course.) In terms of hormonal balance, research has shown that certain foods help drive or suppress certain dysfunctional hormonal pathways because of the biochemical compounds found in those foods.

Flax: When estrogen is metabolized, it converts into one of three breakdown products: 4-hydroxyestrone, 2-hydroxyestrone, and 16-alpha-hydroxyestrone. Each of these metabolites plays an important role in the body, but when levels of 16 and 4 hydroxyestrone get too high, it increases the risk of hormonal symptoms and even the risk of breast cancer. On the other hand, 2-hydroxyestrone has been shown to prevent these negative health effects. The lignans found in flax help drive the metabolism of estrogen down the 2-hydroxyestrone pathway. (In order to access the lignans found in flax, the flax must be freshly ground rather than whole or pre-ground.)

Cruciferous Vegetables: Cabbage, broccoli, cauliflower and brussel sprouts sometimes have a bad reputation because of their smell. But those stinky, sulfur compounds (such as indole-3-carbinol and di-indolylmethane) also support the estrobolome in metabolizing and excreting estrogen breakdown products. They also help protect against estrogen-receptor-positive type breast and ovarian cancers, which is an important consideration in women presenting with an estrogen dominance pattern.

Avoid Excess Alcohol: A glass of wine (or beer, or whiskey, or whatever you enjoy) a few times a week won’t harm your health, but drinking above and beyond this inhibits the enzymes responsible for estrogen metabolism, furthering symptoms of estrogen dominance.

Supplements

Calcium-D-Glucarate (CDG): This supplement inhibits enzymes responsible for reabsorption of partially-metabolized estrogen, helping the body with excretion. Oral doses of CDG have been shown to lower serum estrogen levels and reducing risk of estrogen-receptor-positive breast cancer as well as associated symptoms of high estrogen. CDG also has a concurrent lipid-lowering effect, which is especially beneficial in women whose estrogen dominance is driven by insulin resistance. (In addition to managing blood sugar, insulin drives the production of cholesterol and blood lipids.) Calcium-D-Glucarate is typically used in the range of 1500-3000 mg daily.

DiindolylMethane: This is one of the main compounds found in cruciferous vegetables, responsible for estrogen-detoxifying effects. This supplement is often dosed in the range of 100-400 mg daily.

Indole-3-Carbinol: This is another compound found in cruciferous vegetables, contributing to the estrogen-detoxifying effect. Research shows that supplementing at levels of 300 mg/day has been helpful in reducing estrogen levels.

Cod Liver Oil: This is one of the best dietary sources of omega-3 fatty acids, especially DHA and EPA which are not found in plant sources. Since inflammation is one of the major drivers of estrogen-dominance patterns (and has a high association with elevated stress levels due to cortisol’s pro-inflammatory effect), supplementing with cod liver oil helps reduce estrogen dominance at the root cause. Supplementation should be in levels of at least 2,000 mg daily.

B Vitamins: The metabolic pathway responsible for estrogen breakdown and excretion uses a variety of enzymes which require B vitamins as cofactors in order to function, especially B12 (100 μg), B6 (50-100 mg) and folic acid (800 μg daily). These methylation reactions are also important in supporting the 2-hydroxyestrone pathway.

Closing thoughts…

As if the symptoms of estrogen dominance aren’t difficult enough, the journey towards a diagnosis to explain the symptoms, and finding a treatment strategy that works for you in the context of your own life can add enormous loads of stress to an already challenging life experience. There is a whirlwind of information out there, which only adds to the confusion and frustration of trying to manage your health. It can be a lonely and scary place, but I want you to know that I am here to support you! If you need help navigating the waters of hormonal imbalance, I’m here for you. As always, please feel free to message me or send me an email at any time, and I’ll do my best to help you find answers. You can also check out my natural health services if you think you might benefit from individualized, one-on-one care.


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