Let's Talk Estrogen Dominance

There are 3 forms of estrogen (estrone, estradiol, and estriol). For the purposes of this article, just assume when I say estrogen, I am referring to estradiol, as this is the form we have in highest concentration during our reproductive years and is the most potent, causing most of the issues we will chat about.

Estrogen Dominance is either an excess amount of estrogen in the body or an imbalance in the estrogen-progesterone ratio. It’s a pretty common issue these days, affecting perimenopause and post-partum patients as well as those going off birth control. Typically, these women are dealing with a few of these symptoms:

Irregular or heavy periods
PMS (premenstrual syndrome)
Breast tenderness or fibrocystic breasts
Mood swings, anxiety, or depression
Gallstones/Gallbladder attacks
Weight gain, particularly around the abdomen and hips
Fatigue
Low libido
Bloating or water retention
Headaches or migraines
Uterine fibroids or endometriosis

Common Causes of Estrogen Dominance

Stress: High levels of stress can deplete progesterone. This is because progesterone is a precursor to cortisol, and your body will shunt its resources to create cortisol when stressed. This will cause an imbalance in the estrogen-progesterone ratio leading to estrogen dominance.
Poor Liver Function: The liver is the main player in metabolizing estrogen (this means it either turns it into useable forms or sends it to the intestines to be eliminated). If liver function is compromised (due to toxins, poor diet, alcohol, etc.), estrogen isn’t activated or excreted, and hormone levels will increase.
Hormonal contraceptives: Birth control pills contain synthetic estrogen, which can lead to higher overall estrogen levels over time.
Environmental estrogens: Chemicals found in plastics, pesticides, and personal care products (xenoestrogens) can mimic estrogen in the body and contribute to imbalance.
Hypothyroidism: The link between liver dysfunction and hypothyroidism is well established. As discussed before, poor liver function means poor estrogen metabolism.
Gut dysbiosis: An enzyme in the gut known as beta-glucuronidase allows for absorption of estrogen from the intestines. Too much of this enzyme may mean too much estrogen.
Excessive body fat: Fat tissue produces estrogen, so higher levels of body fat can contribute to elevated estrogen levels.

Before we get ahead of ourselves, it is important to make sure you are dealing with estrogen dominance and not something else. The following diseases can present similarly and should be removed from your differential diagnosis by a medical professional:

Hypothyroidism
Polycystic ovarian syndrome (PCOS)
Perimenopause/menopause
Adrenal dysfunction
Uterine fibroids

Think you’ve got estrogen dominance?

To accurately diagnose this, I run a serum (blood) hormone panel. This includes estradiol, progesterone, FSH, LH and testosterone. This panel should be done twice, one on day 3 (or the third day of bleeding) to see what your follicular levels are, and one on day 21 (or 7 days after ovulation) to see what your luteal levels are. Typically, estradiol should roughly double from day 3 to day 21. So, if your estradiol is 150pmol/L on day 3, you should aim for roughly 300pmol/L on day 21. I typically want estradiol levels to stay below 500pmol/L during the luteal phase.

It is also worth it to run a 4-point salivary cortisol test, a thyroid panel (TSH, T3, T4, Anti TPO), and a liver panel to ensure these are not contributing to a worsening of your symptoms.

Treatment Options

It’s actually pretty easy to drop your estrogen with supplementation and lifestyle. While there are pharmaceutical options such as progesterone (to optimize the estrogen-progesterone ratio), SERMs (Selective estrogen receptor modulators), and aromatase inhibitors (to prevent androgens being turned into estrogen), I highly recommend avoiding them and trying natural means first.

Supplements

Calcium-D-Glucarate: This guy inhibits beta-glucuronidase (remember that enzyme in the gut that reabsorbs estrogen), which means you will excrete estrogen instead of reabsorbing it.
DIM (Diindolylmethane): A compound found in cruciferous vegetables. DIM inhibits an enzyme called aromatase which will stop androgens (hormones) from turning into estrogen. This would be a good option for people who are dealing with more PCOS-like symptoms.
Vitex (Chaste Tree Berry): This is an option if you’ve got lower progesterone levels, as it will help raise them to optimize the estrogen ratio.

Diet

Increase fiber intake: Fiber helps bind estrogen in the gut, making it easier to excrete. Women should aim for roughly 30 grams/per day.
Eating cruciferous vegetables such as broccoli, cauliflower, and kale will provide you with natural DIM to help stop androgens from turning to estrogen.
Avoiding Alcohol: This is to support the liver and allow it to metabolize estrogen.
Maintain a healthy weight: Since fat tissue produces estrogen, maintaining a healthy body weight can help regulate hormone levels.

Acupuncture

Acupuncture can be used to help balance hormones by supporting liver function, regulating menstrual cycles, and reducing stress. It is particularly useful for reducing PMS symptoms, promoting regular ovulation, and improving overall energy flow.