Estrogen dominance is a buzz word in natural health circles. With it popping up in conversations everywhere, you might be wondering what it is, whether you need to worry about it, and how to fix estrogen dominance naturally through functional medicine. If that’s you, you’re in the right place.

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. One of the most common hormonal imbalances is estrogen dominance, which can disrupt the natural rhythm of the menstrual cycle.

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. Estrogen dominance is one key reason that cycles can get out of sync, and it’s often associated with symptoms like heavy periods, breast tenderness, weight gain and mood swings. Addressing estrogen dominance through lifestyle changes, nutrition, and targeted supplementation can make a meaningful difference in restoring hormonal balance.

Estrogen Dominance and Progesterone

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, which is classically defined by estrogen dominance, 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. We call this estrogen dominance. 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. The estrogen excess form of estrogen dominance 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 and estrogen dominance:

• 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
• PCOS
• Liver dysfunction
• Hypothyroidism
• Smoking
• Use of the fertility drug, Clomid (Clomiphene citrate)
• Inflammation

Note: I explain the details of what is and isn’t normal and how to explore natural treatment options in my book, Go with Your Flow. Click here to learn more.

What to Do About Estrogen Dominance

As with any hormonal imbalance, effective treatment for estrogen dominance 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 and estrogen dominance, 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 Modification for Estrogen Dominance

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. A disruption in the gut microbiome can easily lead to estrogen dominance.

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. 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, vitamin powders or fiber supplements aren’t going to do the trick.

Stress: In my clinical experience, the most common cause of hormonal imbalances among women, including estrogen dominance, 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 pregnenolone 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, check out this post: 5 Ways to Balance Your Hormones, Naturally

Nutrition for Estrogen Dominance

Whenever I talk about diet minutiae with my patients, 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. This is especially true of estrogen dominance.

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.) Flax is a great solution for estrogen dominance when used appropriately, in the correct context.

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 for Estrogen Dominance

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. (Fun fact: you can get the same level of DIM by eating cabbage. The equivalent would be 3 cups per day, or 1/2 cup if consuming it cooked, as the cooking process concentrates DIM six-fold.)

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 when they are problematically high in the case of estrogen dominance.

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, though I often prescribe levels that are twice or three-times this amount in my practice, depending on the patient.

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 in estrogen dominance.

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 you’re not alone. Consider making an appointment with a functional medicine doctor who can deliver personalized care and help you achieve your health goals and keep your estrogen balance in check.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

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Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post How to Fix Estrogen Dominance with Functional Medicine appeared first on Dr. Alexandra MacKillop.

Reasons for Fertility Drugs

The main reason for fertility struggles among women is ovulatory dysfunction. This means that throughout the menstrual cycle, the body struggles to mature and release a healthy egg at the correct time in relation to the hormonal fluctuations that naturally occur during a woman’s cycle.

Ovulation (and everything leading up to it)

During the first half of the cycle (the follicular phase), the pituitary gland releases luteinizing hormone. This hormone acts on the ovaries to produce estrogen, which allows ovarian follicles to mature so they can eventually release an egg. As the follicle continues to ripen and approaches ovulation, the estrogen level suddenly surges upward, and then drops very quickly. This estrogen surge/drop communicates to the pituitary gland that it is time for ovulation. The pituitary gland responds by creating a surge of its own—this time, luteinizing hormone (LH). When the ovaries receive this intense LH signal from the pituitary gland, the follicle bursts open and the egg is released—ovulation has occurred.

Because fertility struggles so often result from ovulation dysfunction, most fertility drugs target these hormonal pathways that lead up to ovulation. Here’s a list of the most common fertility drugs, why they’re used, how they work, and the natural approaches you might choose to use instead.

[As always, the information shared on this website is for educational purposes only. It is not intended to diagnose, manage, or treat any disease. Always speak with your own doctor before starting something new.]

The Most Common Fertility Drugs & Natural Alternatives

1. Clomiphene Citrate (Clomid)

Clomiphene citrate (Clomid) is the first line treatment for women with ovulatory dysfunction, as its main action is to trigger ovulation by intercepting the LH/estrogen feedback loop at the level of the pituitary gland. Once in the blood stream, the drug mimics the positive feedback given by estrogen, as it binds to estrogen receptors in the pituitary gland. This amplifies the LH surge released by the pituitary gland, giving a strong signal to the ovary that it’s time to release the egg. For some women, this results in ovulation, conception, implantation, and pregnancy. But for others, it doesn’t. One of the main reasons for this is that in addition to triggering an LH surge, clomiphene citrate limits the thickness of the endometrial lining, making implantation less likely to be successful.

Natural Alternative: Clomid dosing typically begins on the second day of the cycle (anywhere from day 2 to day 5) and continues for 5 days. In place of Clomid, 20 mg daily doses of black cohosh (Cimicifuga racimosa extract) can be used daily for 10 days beginning on cycle day 2. In addition to triggering an LH surge, black cohosh results in higher progesterone levels during the luteal phase, subsequently improving the thickness of the endometrial lining.

Read more about natural alternatives to Clomid…

2. Letrozole

Letrozole functions similarly to Clomid, by stimulating the pituitary gland to create a surge of luteinizing hormone. However, Letrozole is different from Clomid in the way it brings about this LH surge. Instead of binding to estrogen receptors like Clomid, Letrozole artificially creates an estrogen drop by blocking the enzyme that produces estrogen (aromatase). For this reason, Letrozole is considered an aromatase inhibitor. In women who suffer from elevated estrogen levels (or estrogen toxicity), Letrozole can artificially balance hormones long enough to allow ovulation to take place.

Natural Alternative: Instead of using a prescription drug, some women prefer to use natural means for reducing estrogen levels. In addition to lifestyle behaviors like a balanced diet and moderate exercise, diindolylmethane and calcium-d-glucarate can be used to promote estrogen detoxification.

Diindolylmethane (DIM) inhibits aromatase, preventing excess production of estrogen when dosed at 100-400 mg daily, with 200 mg being most common.

Calcium-D-Glucarate promotes estrogen metabolism and excretion, and prevents absorption of exogenous estrogens and estrogen-like hormones when dosed at 1500-3000 mg daily.

Read more about other natural alternatives to Letrozole…

3. Metformin

In women with insulin resistance, (a common associated manifestation of PCOS,) the pancreas produces larger than normal levels of insulin. Insulin acts on ovarian follicles during the maturation process, causing them to respond to luteinizing hormone too early, preventing ovulation. Although Metformin is typically considered to be a drug for diabetes, it can be used to treat ovulatory dysfunction triggered by insulin resistance. Many patients want to avoid the use of Metformin due to side effects, such as loose stools, nausea, and vitamin deficiencies. Others don’t feel comfortable using prescription drugs. Whatever your reasoning, these natural alternatives may be a better option for you.

Natural Alternative: Lifestyle behaviors are the #1 way to improve insulin resistance (moderate exercise, managing stress, dietary methods for blood sugar control) but in the case of PCOS, insulin resistance is triggered by hormones. Lifestyle behaviors are still highest on the list, but sometimes they aren’t enough.

• Berberine doses of up to 1500 mg a day (three 500 mg doses with meals) have been shown to improve blood sugar control and insulin resistance as well as or better than Metformin.
• Myo-Inositol prevents the effects of insulin on the ovaries, supporting healthy maturation of follicles and subsequent ovulation. Myo-Inositol is dosed at 4000 mg daily, along with 400 μg of folic acid, taken with meals.

4. Bromocriptine

Another important hormone in the pathway leading to ovulation is prolactin. This hormone is typically credited for stimulating the production of breast milk, so levels are expected to be elevated in late pregnancy and during the postpartum period. Prolactin levels normally remain elevated for as long as a woman is breastfeeding. But sometimes, they stay elevated even after weaning. This is called hyperprolactinemia, and sometimes women struggle with it even if they’ve never been pregnant. (In some cases, elevated prolactin may be the result of a pituitary tumor or other pathology, so you should speak with your doctor if you have concerns about this.)

When prolactin levels are high, they communicate with the pituitary gland, inhibiting the production of luteinizing hormone. (As we discussed earlier, luteinizing hormone stimulates ovulation.) In the postpartum period, this makes sense–getting pregnant isn’t the best idea if you’ve just had a baby. But most women eventually want to have more children! So, doctors prescribe Bromocriptine to inhibit the production of prolactin in patients with hyperprolactinemia.

Natural Alternative: Vitex (Chasteberry, Chastetree, Agnus-Castus) fruit extract has been proven as an effective option for managing a variety of fertility concerns, including ovulation dysfunction resulting from latent hyperprolactinemia. Dosage typically ranges from 20-40 mg daily for 2-3 menstrual cycles. Vitex should not be used for longer than this.

To sum things up…

Trying to conceive can be an overwhelming and deeply emotional journey, especially when ovulation doesn’t occur as expected and medical interventions feel stressful or unsustainable. The good news is that natural alternatives for fertility drugs do exist, targeting the same hormonal pathways involved with common fertility drugs like Clomid, Letrozole, Metformin, and Bromocriptine. Whether dealing with ovulatory dysfunction linked to estrogen imbalance, insulin resistance, or elevated prolactin, you have options, including natural ones. Ultimately, you are the one in charge of your fertility journey, and when you know your options, only then are you empowered to make decisions that align with your body, values, and health needs.

I’m Dr. Alexandra MacKillop, a functional medicine doctor, food scientist and nutrition expert.

I specialize in women’s nutrition & hormonal health, addressing concerns like longevity, fertility, postpartum, PCOS, endometriosis, and gut symptoms like bloating, constipation, diarrhea and more.

If you’re looking for a new way to approach your health, I’m here to help you through it.

Become a Patient

Don’t miss out! Join the email list.

Sign Me Up!

Love this post Share it!

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Want more Grab a copy of my new book, The Postpartum Check-In !

Reminder: The information on this post or anywhere else on this blog or other writing is purely educational, and is not intended to diagnose, treat, prevent, or cure any health condition.

The post Natural Alternatives to Fertility Drugs appeared first on Dr. Alexandra MacKillop.