What to Know About Estrogen Dominance

Estrogen dominance is a common hormonal imbalance that commonly occurs in women but can also occur in men. 

My patient Jini, presented with some of common symptoms that occur with estrogen dominance: high levels of fatigue, poorly managed stress from work, bloating after lunch, insulin resistance, excruciating headaches in the afternoons, low libido, 25 pound steady weight gain over the past year and irregular periods. All of this created big mood swings.

These are classic signs of estrogen dominance and instead of taking a prescription drug to deal with the mood swings, it’s important to get to the root cause!

While this estrogen dominance picture can be seen from a symptom standpoint, it’s helpful to also look at labs where you would see higher levels of estrogen or a low progesterone/ estradiol ratio. In either case, estrogen is running the show while progesterone — which is supposed to keep estrogen in balance — is falling behind.

What is Estrogen Dominance?

Hormones such as estrogen are like a symphony: They perform best when they are in balance. When one hormone gets out of balance, chances are that other hormones will, too. 

For Jini, that big hormonal imbalance needle mover was estrogen. High estrogen levels coupled with low progesterone set the stage for her estrogen dominance.

John Lee, MD coined the phrase estrogen dominance to describe the little or no levels of a hormone called progesterone, which can give estrogen all of the control. Estrogen dominance isn’t always about having too much estrogen. Rather, the wrong kind of estrogen metabolites (more on that in a minute) coupled with low levels of progesterone can create many symptoms of estrogen dominance. Even with low levels of estrogen, you can have estrogen dominance and its many symptoms if you don’t have enough progesterone to balance out that estrogen. 

Let’s stand back for a minute and consider how estrogen plays a role in so many processes. Blood sugar balance, a strong immune system, bone health, heart health, fertility, and maintaining a healthy weight: All of these things require the right amounts of estrogen. 

The Four Forms of Estrogen

Researchers are learning that estrogen — or more correctly, estrogens — aren’t simply female sex hormones. They also play critical functions in the liver, heart, muscle, bone, and brain. These estrogens play different roles in different tissues. These estrogens communicate with each other, but they also “cross-talk” with other hormones. 

Through a multistep process, an enzyme called aromatase converts androgens or sex hormones into estrogens. The ovaries make most of that estrogen, though the adrenal glands and fat tissue also produce small amounts. Estrogen comes in three forms:

1. Estrone (E1). The most biologically active of all estrogens, primarily made in the adrenal glands. After menopause, estrone is the only type of estrogen that the body produces. 
2. Estradiol (E2). The ovaries make estradiol, which is the predominant type of estrogen during the reproductive years. Estradiol plays a role in bone and joint health, how the body manages fat storage, and more.
3. Estriol (E3). This type of estrogen is produced in the placenta, making it the predominant form of estrogen during pregnancy. 

A fourth type of estrogen, called estetrol (E4), is produced by the fetal liver and is high only during pregnancy.

The liver metabolizes the two primary forms of estrogen, estrone and estradiol, via three pathways. This creates three estrogen metabolites:

• The 2-hydroxyestrone pathway produces good estrogen metabolites.
• The 4-alpha-hydroxyestrone and 16-alpha-hydroxyestrone pathways are the “bad” pathways, and create many symptoms of estrogen dominance.

We’re still understanding how these metabolites behave. Traditionally, the 2-hydroxyestrone form is protective, whereas 16-alpha-hydroxyestrone can be harmful. High levels of 16-alpha-hydroxyestrone or a reduced ratio of 2:16 hydroxyestrone, for instance, can potentially increase risk of hormone-dependent cancers.

In other words, we traditionally classify the 2-hydroxy form as “good estrogen” and the 4-hydroxy and 16-hydroxy forms as “bad estrogens.” However, some researchers have argued the situation is more complex, claiming that 16-alpha-hydroxyestrone might be protective in other ways. 

Progesterone Keeps Estrogen in Check

Imbalances in estrogen metabolites can contribute to nearly every disease, including infectious, autoimmune, metabolic, and degenerative diseases. Those imbalances can manifest as polycystic ovary syndrome (PCOS), breast cancer, and much more. About 80 percent of endometrial cancers, for instance, can occur with too much estrogen.

Progesterone is one reason that estrogen becomes out of balance. To maintain healthy amounts of estrogen, the body requires sufficient amounts of progesterone. Progesterone can stimulate production of genes that can impact apoptosis or cellular death, for instance, in breast cancer cells. Without progesterone to keep estrogen in check, these cells can proliferate.   

Some of the common symptoms associated with low progesterone are weight gain around the abdominal area, irregular cycles, mood changes, and frequent headaches. Why do progesterone levels drop? For Jini, stress was a big reason. Progesterone is made from pregnenolone, sometimes referred to as the “mother of all hormones” because it goes on to make sex hormones such as estrogen, progesterone, and cortisol. 

One theory explaining why this happens is called the pregnenolone steal.  Being constantly stressed out, Jini’s body was “stealing” the pregnenolone that would make progesterone and using it to create more cortisol. That process can contribute to other hormonal imbalances. The progestin or synthetic progesterone in Jini’s birth control pills further inhibited the natural progesterone to balance those high estrogen levels.

Some of the common contributors to estrogen dominance include constipation which decreases estrogen excretion, low physical activity, birth control, poorly managed stress, excessive sugar intake, and increased exposure to environmental pollutants. 

Environmental Toxins and Estrogen Dominance

A big contributor to estrogen dominance is exposure to environmental toxins, especially when coupled with a low fiber diet, in adequate fluids and therefore infrequent bowels to aid in estrogen excretion. These man-made and naturally occurring chemicals are ubiquitous: In our food, water, plastics, industrial waste products, car exhaust, meat, furniture, and in many products such as cosmetics that you probably use every single day.  

Consider pesticides, which are rampant in our food and water supply. According to the Environmental Working Group (EWG), nearly 70 percent of fresh produce in America contains residues of potentially harmful pesticides. 

Studies have shown that these pesticides can disrupt all stages of hormonal regulation. 

They can:

• Increase production of certain hormones
• Decrease production of other hormones 
• Imitate hormones
• Interfere with hormone signaling
• Bind to essential hormones
• Accumulate in organs that produce hormones

While the effects of many pesticides are studied in isolation, they also work together, and we don’t always know the cumulative effects of these pesticides. 

Many of these pesticides can bind to and activate estrogen receptors. Others bind but don’t activate these receptors. That’s why we refer to some of these toxins as endocrine disruptors: They can impair multiple hormonal pathways. 

These endocrine disruptors can behave as xenoestrogens, meaning they can bind to estrogen receptors and mimic the effects of estrogen. These xenoestrogens — or xenohormones, as Dr. Lee calls them — are sneaky and disruptive to the body’s internal balance or homeostasis. 

They can “disrupt” healthy estrogen levels in a number of ways. Some toxins that contaminate food, water, and household products, for instance, can induce an enzyme that creates 4-hydroxy estrogens, a “bad” estrogen.

Toxins can also increase the demand for glutathione, which helps the body detoxify estrogen. As a result, the body uses more and makes less of this master antioxidant that supports immune health and much more.

Unfortunately, many products we use daily contain ingredients that are potential endocrine disruptors. According to the U.S. Environmental Protection Agency (EPA), there are over 86,000 chemicals available for commercial production and use in America. Very, very few have been evaluated for their long-term safety.

Researchers have connected these endocrine disruptors with many health problems, including obesity, impaired thyroid, reproduction problems, and certain cancers. They are in our food, but they also lurk where we store our food. Some plastic products including food storage containers contain bisphenol A (BPA). Researchers have noted the estrogen-mimicking properties of BPA since the 1930s.

Phthalates, another endocrine disruptor, are ubiquitous: In shower curtains, air fresheners, plastic wrap, and many other products we are exposed to daily. They can disrupt estrogen metabolism and increase the risk of breast cancer. 

The EWG estimates women use on average 12 beauty products daily, potentially exposing you to 168 chemical ingredients.

You cannot totally avoid exposure to these toxins, which can adversely impact hormonal balance. You can, however, minimize your exposure to them. Becoming aware of where they exist is the first step. The EWG provides some helpful guides to better pinpoint where these chemicals lurk:

• When you absolutely can’t buy organic food, use the EWG’s 2020 Shopper’s Guide to Pesticides in Produce™ to identify the fruits and vegetables most and least contaminated with pesticides.
• The Skin Deep® guide can help you make more informed cosmetic-product choices.
• For greener cleaners, use the EWG’s Guide to Healthy Cleaning. They’ve evaluated over 2,500 laundry detergents, home cleaning products, and more. 

10 Ways to Balance Estrogen Levels With your Fork

What you put on your body matters for healthy estrogen metabolism, but so does what you put in your body. Changes in estrogen metabolism — when you have too many “bad” estrogen metabolites and not enough good ones — can contribute to estrogen dominance. Restoring estrogen and overall hormonal balance will involve leveraging the power of your fork and changing your lifestyle patterns.

1. Increase Intake of Broccoli and Indole-3-Carbonole

You can shift this ratio in your favor by eating more nutrient-rich foods such as broccoli. Broccoli, cauliflower, arugula, brussels sprouts, kale and other sulfur containing cruciferous vegetables contain Indole-3-Carbonole (I3C) which are important for detoxification support.

2. Eat More Fiber

Incorporating additional sources of vegetables, fruits, nuts, and seeds provide additional fiber. Dietary fiber binds excess estrogen that the gut can then eliminate. I especially recommend ground flaxseeds due to their combination of fiber and lignans, which aid in preventing estrogen dominance.

Plenty of fiber can also help inhibit the body from reabsorbing estrogen and can aid in having a daily bowel movement which is critical for estrogen clearance!

3. Upgrade your Meat

Studies show that cows who graze on their natural diet of grass and other plant foods are healthier, and produce healthier meats. Animals raised with conventional methods often receive high amounts of estrogen to increase milk production. Guess where that excess estrogen ends up when you consume meat and milk from these animals? This is just one additional reason to purchase organic poultry and dairy and grass-fed, pasture raised beef and animal protein.

4. Decrease Alcohol Consumption

Patients of mine like Jini, are very fond of a nightly glass (or two) of chardonnay to unwind after a stressful day. But lowering your alcohol intake can improve estrogen balance. You may even discover that practicing deep breathing in the evenings helps you de-stress as well as that glass of wine did. As an added bonus, when you taper off the alcohol, you will have far less of an urge to snack in the evening.  

5. Add Maca Root To your Diet

Maca is a cruciferous root that is a native Peruvian plant that aids in improving progesterone balance. Maca has a high nutritive value and does not contain plant hormones (unlike black cohosh and licorice root). Native people of Peru have been using maca for centuries to support hormonal imbalances, menstrual irregularities, fertility, and menopausal symptoms such as hot flashes and vaginal dryness.

In my virtual practice, I recommend adding gelatinized maca powder to smoothies and for some who need additional supplementation, I recommend the Femmenessence supplement.

6. Find your Healthy Weight

Body fat absorbs and stores estrogen, but it also makes estrogen from other hormones. High levels of estrogen, in turn, can increase the production of fat cells. Carry excess weight can disrupt the estrogen/ progesterone balance and contribute to excess amounts of estrogen. Following my BeingBrigid Plate Method and eating mostly whole foods helped Jini lose seven pounds over the first two weeks alone. It’s also important to have the proper antioxidant support during times of weight loss as this can mobilize toxins, especially when you are experiencing extreme fluctuations in weight loss and weight gain. 

7. Manage Stress Levels

As I discuss in this article, when stress gets out of hand, everything suffers, including the immune system, gut health, blood sugar balance, and nutrient intake. This is also the case for your hormonal health! Stress management is a necessity, not a luxury, to restore hormonal balance. How you manage stress depends on what works for you. I would highly encourage you to prioritize 10 minutes of breathing or meditating daily, ensure that you are not overexercising, adding two days of yoga per week, and possibly work with a dietitian to incorporate adaptogenic support.

8. Get Great Sleep

Insufficient sleep can also increase estrogen levels while lowering progesterone. Too much estrogen can interfere with production of melatonin, a hormone secreted by the pineal gland that regulates circadian rhythm. Good sleep doesn’t come easily for most. What I recommend is establishing a sleep ritual — a hot bath and chamomile tea — along with a sleep-support supplement to improve the quality and quantity of your sleep. You can learn more about how to get better sleep in this article.

9. Support the Gut

The gut regulates estrogen levels. When clients have estrogen dominance, I always consider underlying gut issues, such as dysbiosis or imbalances in gut flora, which might be impacting estrogen levels. For a few clients, I’ve found small intestinal bacterial overgrowth (SIBO) can impair estrogen metabolism. It’s also common to see elevated levels of Beta-glucuronidase in a stool test which indicates an inability of the colon to remove estrogen. Conversely, impaired estrogen levels can impact the gut. Focusing on gut health and ensuring daily bowel movements is key. You may also want to subsequently address bloating.  

10. Love your Liver

The liver helps remove excess estrogen and other hormones. An accumulated toxic burden from repeated exposure to pesticides and other toxins can take its toll on the liver. You can always incorporate a simple detox protocol that provides the liver with replenishing nutrients as well as liver-supporting foods such as organic cruciferous vegetables. You may also need therapeutic doses of supplements such as glutathione, N-acetyl cysteine and other detox supporting nutrients.