Headaches. Mood swings. Heavy or irregular periods. Bloating.
All of these symptoms can indicate hormonal imbalance – but what if you’re too young to be entering your menopausal transition?
The truth is, you don’t have to be pre-menopausal to have a hormone imbalance. Each of these symptoms is often associated with an imbalance called estrogen dominance.
In this article, we’ll dive into estrogen dominance – what it is, how to know if it’s affecting you, and what you can do to regain balance.
What are Estrogens?
To begin, let’s briefly discuss the roles of the “female hormones” – estrogens and progesterones.
Estrogens are steroid hormones produced primarily by your ovaries, corpus luteum (an endocrine gland within the ovary), and placenta. But small amounts can also be produced by your liver, heart, skin, and brain.1
And rather than being just one type of hormone, the word “estrogens” actually refers to a group of hormones, which can be further broken down into 3 major forms in the female human body:
- Estrone (E1): The primary form of estrogen produced by your body postmenopause.
- Estradiol (E2, also known as 17ꞵ-estradiol): The most potent form found in your body during your reproductive or premenopausal years.
- Estriol (E3): The primary form of estrogen that plays a major role during pregnancy because it’s produced in large quantities by the placenta.2 It’s also the least potent
Many people might think of estrogens only as sex hormones responsible for female reproductive development, but they’re so much more. Non-reproductive functions of estrogens include regulating:3,4,5
- Cholesterol levels
- Mood and mental state
- Blood sugar levels
- Body fluid balance
- Hydromineral homeostasis
- Bone and muscle mass
- Blood flow
- Collagen production
- Embryonic and fetal development
- Aging and age-related diseases
Scientists are still discovering more functions of estrogens. But it’s clear that estrogens have profound effects in women’s bodies, so it’s not surprising that we experience such unpleasant symptoms when estrogen levels decline during our menopausal transition.
What is Progesterone?
Progesterone is another steroidal hormone belonging to a class of hormones called progestogens.
The main function of progesterone is to prepare your endometrium (the lining of your uterus) for a potential pregnancy in the event that an egg is fertilized. It triggers the endometrial lining to thicken so that it can accept a fertilized egg and inhibit uterine contractions that can lead to miscarriage or pre-term labor. If an egg doesn’t become fertilized, your corpus luteum breaks down, leading to lower progesterone levels in your body.6
Like estrogens, the functions of progesterone extend well beyond the confines of your reproductive system. For example, progesterone influences the production of inflammatory mediators, such as T-cells within your uterine cavity.7 It is also known to affect various tissues, including your bones, your heart, and your brain.8,9
Irregular levels of progesterone have been linked to:10,11
- Abnormal menstruation
- Miscarriage and early labor
- Lower fertility
- Sleep difficulties
- Breast cancer
- Spotting and abdominal pain during pregnancy
If you’re a woman with an intact uterus who is undergoing menopausal transition, your doctor may recommend estrogen-progestin hormone replacement therapy. Progestin is a synthetic progesterone that can be used with estrogen to boost your hormone levels and provide relief from menopausal symptoms.
What Is Estrogen Dominance? The Importance of Hormone Balance
Estrogens and progesterone work together to ensure optimal function in your body. But they have different functions which sometimes oppose each others’ actions.12
For example, estradiol causes cellular growth and proliferation. While proliferation is important and powerful, it increases the risk for genetic “mistakes” if left unchecked. Progesterone, on the other hand, inhibits proliferation and causes tissue differentiation and maturation.13 Differentiation is the process through which cells become specialized.
Let’s take the uterine endometrium as an example of this opposing action. Estradiol thickens the uterine wall lining during the follicular phase, creating a proliferative endometrium. During the luteal phase, progesterone blocks proliferation and encourages the cells in your endometrium to differentiate, so that it can become an organ into which a fertilized egg can implant.14
This balancing act between estrogens and progesterone is critical and is one that challenges the traditional estrogen-centric view of women’s health. It changes our view of women’s reproductive health into one that is much more complex and nuanced.
It also means achieving and maintaining a balance between estrogens and progesterone is paramount to avoid potentially dangerous health consequences.
Unfortunately, achieving this balance can be difficult for many women, especially as they enter their menopausal transition years. When a woman enters menopause and ovulation stops, progesterone levels fall drastically. While estrogen levels also drop, they don’t fall as quickly. A pattern of low progesterone and high estrogen occurring together is called unopposed estrogen or “estrogen dominance.”
But estrogen dominance isn’t actually a recognized condition. Rather, estrogen dominance is a term originally coined by Dr. John Lee, who stated that a drop in progesterone production, not estrogen deficiency, is the first sign of menopause. Without enough progesterone to offer balance, estrogen levels can stay high. He argued that these unnatural levels of estrogens are the cause of discomfort and severe health consequences so many women face.
Dr. Lee’s theory of estrogen dominance is real, though simplistic. As I mentioned earlier, it’s about the balance between estrogen and progesterone, or the overall ratio between them. And this ratio is highly individualistic.
Some women with low progesterone levels may benefit from supplementing progesterone. On the other hand, others may only need to focus on normalizing their estrogen levels. The only way to know which category you may fit in is to have your hormone levels checked and your symptoms assessed by a women’s health specialist.
Unfortunately, it’s not only your natural estrogen level you have to be concerned about.
Xenoestrogens, or foreign substances that mimic estrogens, can also raise your estrogen levels. That’s because xenoestrogens are so similar in structure or function to estrogen that they can bind to estrogen receptors on your cells. Once they bind to estrogen receptors, they can induce several effects, most of which are detrimental to your health, like infertility.15
Xenoestrogens can be of either synthetic or natural origin. Phytoestrogens, the most abundant class of natural xenoestrogens, are found in a variety of foods, of which soy is probably the most well-known.
Synthetic xenoestrogens are widely used in industrial products and pharmaceuticals. Many synthetic xenoestrogens are also called endocrine disrupting chemicals (EDCs) because they are known to disrupt – or interfere with – your endocrine system. EDCs can be found in many common products including pesticides, cosmetics, hair care products, metals, and some food additives.
According to the World Health Organization, EDCs are suspected to be linked to:16
- Pregnancy problems
- Increased incidence of breast cancer and other hormone-related cancers
- Abnormal growth patterns in children
- Neurodevelopmental delays in children
- Changes in immune function
- Increased risk of obesity, diabetes, and cardiovascular disease
Unfortunately, it can be difficult to remove xenoestrogens from your life completely. While there are certainly ways to reduce your exposure – such as by buying organic foods whenever possible – you can also be exposed to EDCs by inhaling gasses and particles in the air.
Signs and Symptoms of Estrogen Dominance
It’s important to recognize what estrogen dominance looks like in women. Signs include:
- Weight gain
- Endometriosis and adenomyosis
- Digestive issues (e.g., constipation, bloating)
- Hair thinning
- Difficulty sleeping or insomnia
- Irregular menstrual periods (e.g., heavy bleeding)
- Fibrocystic breasts
- Low sex drive
- Vaginal dryness
- Allergy-like symptoms
- Hot flashes
- Headaches or migraines
- Irregular heart rate
- Uterine fibroids
- Sluggish metabolism
You may have noticed that many of these symptoms are nonspecific. These symptoms are also indicative of a condition that is the exact opposite of estrogen dominance – estrogen deficiency. This is another reason why diagnosing someone with “estrogen dominance” is often too simplistic. Instead, it requires maintaining a delicate balance between estrogen and progesterone.
Health Risks Associated With Estrogen Dominance
Estrogen dominance may be a contributing cause of several different pathologies.
The fact that at least 85% of people with autoimmune disease are female leads scientists to believe that estrogen plays a key role in the development of these diseases.17 Remember from the list above that estrogen is a potent regulator of your immune system. It may not be surprising, then, that many autoimmune diseases are driven at least in part by abnormal levels of estrogen.
For example, scientists have observed immunological changes from declining estrogen levels comparable to those observed in patients with multiple sclerosis. Such changes include increased production of pro-inflammatory cytokines (small signaling proteins) and decreased production of anti-inflammatory cytokines.18
Some autoimmune conditions, such as rheumatoid arthritis (RA) and systemic lupus erythematosus, are linked to high estrogen levels. The prevalence of RA is four times higher in women than in men, and studies have found significantly elevated levels of estrogen relative to androgens in RA patients of both sexes.19,20
Some types of cancers, like breast cancer, ovarian cancer, and endometrial cancer rely on estrogen to grow. And according to recent data, breast cancer incidence increased among women aged 20 to 49 years between 2010 and 2018.21
As discussed above, hormones drive cell proliferation, which increases the number of cell divisions and the opportunity for genetic errors.
For some types of hormonal cancers, such as breast cancer, obesity has emerged as a risk factor. The link is the strongest for postmenopausal women, suggesting a role of estrogens in the development of obesity-associated breast cancer growth.22
Endometriosis is a well-known condition in which cells that look and act like those of the endometrial tissue grow outside of the uterus. This misplaced tissue builds up and breaks down with each menstrual cycle in response to hormonal changes, just like the endometrium does. But because this tissue has no way to exit your body, the surrounding tissue becomes irritated leading to pain, scar tissue, and adhesions.
Endometriosis can also involve your ovaries, increasing your risk of developing ovarian cancer.23
The role of unopposed estrogen in endometriosis is well documented. Endometriotic tissues express aromatase – an enzyme responsible for the last step in the synthesis of estradiol. In contrast, normal endometrium doesn’t have the ability to synthesize estrogen due to the absence of aromatase.24
The estrogen produced by the endometriosis lesions is used to fuel self-growth. So unopposed estrogen leads to endometriosis, which creates even more unopposed estrogen, perpetuating and worsening the cycle.
High estrogen levels can also affect your body’s response to pathogens, such as Candida albicans. In one study, three C. albicans strains were tested in the presence of estradiol. All 3 strains showed increased growth and survived incubation at 48°C better than the estrogen-free control group. Estrogen also strengthened the 3 strains’ multidrug resistance.25
How to Find Balance From Estrogen Dominance
Think of your body as an orchestra and hormonal balance as the music it plays. Just as no two orchestras would play a piece in exactly the same way, your path to hormonal balance will be different from another woman’s. The demands and stress you place on your body differ from those of others, so your treatment plan needs to be individualized to your unique situation.
Here are some general tips that may help you clear out excess estrogens from your body.
1. Support Estrogen Detoxification
Your liver is your main detoxification organ, which means it can play a huge role when it comes to ridding your body of excess estrogen.
Detoxification in your liver occurs in 2 phases:26
- Phase 1 (hydroxylation): This phase yields 3 estrogen metabolites, 2-hydroxyestrone (2-OH), 16-hydroxyestrone (16ɑ-OH), and 4-hydroxyestrone (4-OH). The 2-OH metabolite is considered to be the “good” estrogen because it has the weakest estrogenic activity in the body. The other two metabolites show persistent estrogenic activity.
- Phase II (methylation and glucuronidation): The 2-OH and 4-OH metabolites are further detoxified by methylation. This process renders the potentially harmful 4-OH metabolite less active and activates 2-OH into the more active and beneficial 2-methoxyestrone (2-MeOE1 & 2). If 2-OH and 4-OH are not methylated, they can become highly reactive molecules that may damage your DNA.
In other words, phase I breaks down estrogen into substances that have the potential to be more toxic. In phase II, these substances are combined with another compound to make them less toxic.
Here are some ways to support these detoxification phases:
- Consume medicinal foods, such as sprouts, broccoli, cabbage, cauliflower, kale, flaxseed, green tea, and pomegranate
- Support gut health and digestion by eating fermented or high-fiber foods
- Use herbs that support liver health (e.g., milk thistle, dandelion, burdock root), under the guidance of a physician
- Replenish nutrient deficiencies
Regular exercise is key to your wellbeing. In addition to helping you maintain a healthy weight, it can boost your mood and keep your heart healthy. Yoga, in particular, may help balance your estrogen levels.
3. Support Ovulation
Ovulation allows progesterone to be produced. If ovulation doesn’t occur, it may set your body up for progesterone deficiency and estrogen dominance. You can support ovulation by doing the following:
- Adding more antioxidant-rich leafy greens to your diet
- Eliminating trans fats and opting for high-quality omega-3 fatty acids instead
- Maintaining a healthy weight
- Keeping your blood sugar levels balanced
- Prioritizing stress reduction
4. Know Your Genetics
The gene for methylenetetrahydrofolate reductase, better known as MTHFR, provides instructions for processing folate. Certain MTHFR mutations compromise your ability to absorb B vitamins, which affects the methylation activity described above. Eventually, the impaired methylation leads to the accumulation of potentially harmful estrogen metabolites.
Another important genetic mutation is COMT, which stands for catechol-o-methyltransferase. COMT is an enzyme that breaks down catechol-estrogens into methoxy-estrogens. Alterations in this gene slows down phase 2 of the detoxification pathway, leading to a build-up of estrogen metabolites.
If you are exhibiting estrogen dominance, genetic testing for these mutations would be beneficial. Generally, the addition of a few supplemental vitamins and minerals can correct the problem.
5. Balance Stress
Chronic stress can wreak havoc on your hormones, so I highly recommend prioritizing stress reduction. Practicing daily meditations or yoga has been shown to reduce stress levels and improve sleep quality. You can also consider getting a massage or keeping a journal to release tension in your body.
For more tips on self-care, check out How to Get Through the Phases of Menopause With Ease.
6. Sync Your Cycle With Lifestyle Practices and Foods
Cycle syncing is about making lifestyle and food choices according to your menstrual cycle. Although there aren’t any scientific studies to support cycle syncing yet, some experts believe it may provide these benefits:
- Help you feel more energized
- Make workouts more effective
- Support fertility
- Experience less mood swings
The backbone of cycle syncing is listening to your body. Here are some general guidelines for the exercises and foods that may be beneficial during each phase of your menstrual cycle:
- Menstrual: Rest is key here. Focus on light movements like yoga and gentle stretching. Since your estrogen is on the rise, replenish your body with soups, stews, and mineral-rich foods. You can also drink soothing tea and avoid fatty foods, alcohol, and salty foods.
- Follicular: Try light cardio that still works up a sweat, like short runs and biking. Incorporate foods that support estrogen metabolism, such as sprouted and fermented foods.
- Ovulatory: This phase is when your estrogen levels are peaking. This is the time to maximize your potential with high-intensity workouts. Eat anti-inflammatory foods and those that support your liver.
- Luteal: Your energy levels may be low as your body prepares for the start of another cycle. During this time, progesterone is on the rise as estrogen levels decline. Try light to moderate exercises, such as strength training or some intense versions of yoga. Eat foods like leafy greens, quinoa, and magnesium-rich foods like dark chocolate and pumpkin seeds.
A Balanced Approach to Estrogen Dominance
For many years, we’ve taken a rather simplistic approach to women’s reproductive health. But treating estrogen dominance isn’t about taking a magic pill to reduce your estrogen levels. If your symptoms are ongoing, I encourage you to have your hormone levels monitored on a regular basis.
As a women’s health expert, I work with my patients to develop a multi-pronged approach to restoring balance to their hormones. This may involve nutrition, supplements, stress reduction techniques, or other lifestyle changes that support hormonal balance.
If you’re wondering whether your symptoms are caused by estrogen dominance, I’m here to help.