Estrogen Dominance: What's The Deal?
As women, balancing our hormones is a lifelong journey...
Most of us have not been raised with the knowledge of how our hormones and endocrine system function, and have had to seek out this information as symptoms arise in our day to day lives. In our modern culture, hormonal imbalance and the associated health conditions are very much on the rise. In my clinical practice, almost every woman I see is dealing with hormonal imbalance in one way or another, often deeply affecting quality of life. Why is this?
I wanted to explore one of the root causes of many hormonal imbalances I am commonly seeing in my practice; estrogen dominance or imbalanced levels of estrogen to progesterone.
Let's start with the basics. Hormones are special chemical messengers in the body that are created in the endocrine glands. These messengers control most major bodily functions, from simple basic needs like hunger to more complex systems like reproduction, and even the emotions and mood.
Estrogen is considered the main sex hormone and acts as a growth hormone for breast, uterine and ovarian tissue. It causes puberty, prepares the body and uterus for pregnancy, and regulates the menstrual cycle. It also elevates our HDL, or good cholesterol and helps to prevent osteoporosis - one of the reasons as women age and estrogen production is decreased, they are at a higher risk for osteoporosis. It is produced in the adrenals, the ovaries as well as in adipose, or fat tissue. In the brain, it boosts the synthesis and function of neurotransmitters that affect sleep, mood, memory, libido, and cognitive functions such as learning and attention span. The first phase of the cycle, from day 1 of the menses to ovulation is the follicular phase, also known as the estrogenic phase.
Progesterone is similar to estrogen but is not considered the main sex hormone. Like estrogen, it assists with the menstrual cycle and plays a role in pregnancy. Progesterone is made primarily by the ovaries and ensures the development and function of the breasts and female reproductive system. In the brain, progesterone binds to certain receptors to exert a calming, sedating effect, aiding in sleep. It enhances the sensitivity of the body to insulin and the function of the thyroid hormones. It builds bone and benefits the cardiovascular system by lowering the levels of triglycerides. Progesterone also can increase libido and contribute to the efficient use of fat as a source of energy. The second phase of the cycle, the luteal phase is also known as the progestational phase.
"Estrogen and progesterone work in synchronization with one and other and each one requires the other to be able to perform their functions"
Estrogen dominance is a condition in which a woman has an imbalance of her progesterone to estrogen in the body. The name estrogen dominance can be misleading because a woman may have a deficient, normal or excessive level of estrogen and still have estrogen dominance because there is too little progesterone to balance the amount of estrogen. Estrogen and progesterone work in synchronization with one and other and each one requires the other to be able to perform their functions, therefore any imbalance between the two leads to a predominance of estrogenic effects without adequate balancing from progesterone. In some cases progesterone levels can be optimal but excess estrogens from the environment, known as xenoestrogens, can be causing the imbalance.
Some of the most common symptoms experienced with excess estrogen include:
water retention
weight gain
swollen, painful and cystic breasts
irregular menstrual cycles or short cycles,
cyclic headaches or migraines
mood swings
depression
premenstrual syndrome
endometriosis
amenorrhea
menorrhagia
uterine fibroid
heart palpitations
infertility
Woman who have chronic excess estrogen are also at a higher risk for uterine and breast cancer as well as clotting difficulties such as heart disease and stroke.
Estrogens circulate in the bloodstream free or protein-bound, and are conjugated or unconjugated molecules that may enter target tissues or be eliminated by the kidneys. In the words of Dr. Sara Gottfried, you need to use it, then lose it. The body produces several kinds of estrogens, all which play important roles throughout the phases of womanhood. During the reproductive years, 80% of a woman's estrogen is made in the ovaries as estradiol, 10% is estradiol and 10% is estrone . As women approach menopause, this ration changes and estrone is primarily produced. Estrogen starts as estradiol in the body, but can be broken down into estrone and metabolites. In order to maintain hormonal balance, it is vital that estrogen is properly broken down. Estrogen must be inactivated to maintain normal levels, and this process occurs in the liver via hydroxylation and conjugation - thus why the liver and its health play a key role in women’s hormonal health. Supporting liver function and detoxification through diet, lifestyle, herbs and supplements can have a huge impact on the bodies ability to regulate and balance the hormones, and should be a big focus in working with women who are experiencing symptoms of estrogen dominance.
Women need to properly and efficiently metabolize estrogen in order to break it down and eliminate it, or it will build up in the blood and cause estrogen dominance.
Let’s take a look at some of the root causes of excess estrogen, which can interfere with normal estrogen metabolism leading to too much estrogen relative to progesterone and uncomfortable symptoms.
A few of these factors include:
the natural aging of ovaries
cortisol dysregulation
exposure to xenoestrogens
impaired liver function
nutritional factors & underlying nutrient deficiencies
Perimenopause, and the natural aging process has an affect on the amount of estrogen produced in a woman’s body. In the years that preceded menopause, around ages 35-50 the ovaries will begin to produce more estrogen, in some cases it’ s been found that this level can almost double that of a woman in her early 20’s. Women are born with one to two million eggs in their ovaries, and by the time perimenopause comes around there be only as many as three thousand left. As the HPO axis (hypothalamus- pituitary- ovarian axis) senses that a woman is running out of eggs, it will produce more hormones to stimulate egg production so that she may become pregnant before it is too late. Ultimately, estrogen will decrease at the end of perimenopause as a woman comes close to her final menstrual cycle, but leading up to that she can produce more than she needs leading to estrogen dominance and associated symptoms.
HPA axis and cortisol dysregulation also play a factor in excess estrogen. Stress increases the body's need for cortisol, and depletes progesterone as some of it is converted to cortisol (via the pregnenolone steal) to provide the body with what it needs to survive. The pregnenolone steal can occur with prolonged chronic stress. Without sufficient amounts of pregnenolone the body will struggle to keep up with many of its most basic needs, including the production of progesterone. The pregnenolone steal is a heist that occurs with the body’s reaction to perceived stress. This stress response triggers the release of cortisol. Like other hormones in the adrenal cascade, cortisol relies upon the precursor hormone pregnenolone. Because of this, heightened stress can over-stimulate the adrenal glands and cause them to steal pregnenolone away from the creation of other hormones such as progesterone, in an attempt to produce adequate precursor supplies for the production of cortisol. When this happens, the bodies natural cortisol rhythm can also get thrown off, causing more HPA axis dysregulation which continues this negative feedback loop lowering progesterone levels and the result is estrogen dominance. Cortisol rhythm imbalance also can affect a woman’s ability to get good quality sleep, further complicating the problem. HPA axis dysregulation and chronic stress also have a direct effect on weight gain and obesity, specifically in the belly region for women as well, which as we will see in a moment, is another root cause of estrogen dominance.
"Heightened stress can over-stimulate the adrenal glands and cause them to steal pregnenolone away from the creation of other hormones such as progesterone, in an attempt to produce adequate precursor supplies for the production of cortisol."
Xenoestrogen exposure is another root cause of excess estrogen for women, one that can easily be missed and is only increasing in our modern society. Xenoestrogens are synthetic chemicals that mimic estrogen in the body and come from artificial chemicals that we get exposed to on a daily basis, such as plastics in the environment, agricultural chemicals, bioidentical hormones ( hormone replacement therapy, hormonal birth control and spermicides) as well as synthetic body care products. Xenoestrogens get stored in the adipose (fat) tissues in the body, unfortunately for women this usually means the breasts. Long term exposure of these xenoestrogens creates a significant risk for breast cancer in women. These known endocrine disruptors disturb the action of natural, endogenous hormones with both reproductive and developmental consequences. Just living our day to day lives, we are exposed to hundreds of these chemicals from household cleaners, to furniture and household off-gassing, to plastics and food packaging and personal body care products.
Xenoestrogens get stored in the adipose (fat) tissues in the body, unfortunately for women this usually means the breasts.
Obesity and weight gain have many known health risks, one of which is the potential for estrogen excess. Estrogen is produced in fat cells, therefore excess fat cells make excess estrogen. Excess weight and lack of exercise can lead to higher levels of insulin in the body, and the possibility of Type 2 diabetes and Insulin Resistance, which is yet another risk factor for hormonal imbalance in women. Diabetes involves insulin and its ability to regulate blood sugar.
Cells that get too much insulin can become resistant to it, and chronically high insulin increases estrogen, and increases the cells’ resistance to insulin. This creates a vicious cycle where higher insulin creates higher estrogen, which can lead to higher insulin and insulin resistance, which usually leads to weight gain, which then leads to the production of more estrogen!
Poor diet is one of predominant root causes of estrogen dominance. It has been found that the Standard American Diet, as well as diets high in conventionally raised meats, refined carbohydrates, trans fats and low in good quality fats and dietary fiber are likely to cause estrogen overload in the body. Conventionally raised meat is full of hormones that serve as endocrine disruptors, and can throw off a woman’s hormone balance, not to mention the antibiotics they are pumped with and the GMO feed they eat that all contribute to microbiome disruption and poor digestion and elimination. Diets high in refined carbohydrates, sugar can raise blood sugar, reduce progesterone and worsen estrogen dominance. The SAD diet is also very low in fiber, which helps to keep our bowels moving regularly. When there is inadequate dietary fiber in the diet, digestion slows down and constipation can occur. When this happens, the de-conjugated estrogens that are trying to be excreted from the body can get reabsorbed through the colon leading to excess estrogen. Dietary fiber actually increases the conjugation of estrogen in the liver, therefore more fiber lowers overall estrogen levels. Paying attention to the type of fats in the diet is also an important factor. Dietary fat encourages your gut to reabsorb estrogen by slowing down the conjugation process. Diets that are too high in poor quality fats, especially trans fats with partially hydrogenated oils contribute to poor estrogen clearance.
As I mentioned before, impaired liver function slows the clearance of estrogen from the body. This can be caused by excessive consumption of alcohol or other toxins, hypothyroidism or nutrient deficiency. Nutrient insufficiencies can impair the liver’s ability to detoxify as well as the bodies ability to properly eliminate waste, specifically estrogen metabolites.
Birth control pills and hormone replacement therapy can also put an extra tax on the liver, as well as depleting the body of magnesium, zinc, copper, and B complex vitamins which are vital to the regulation of hormones in the body.
Luteal insufficiency, or a short luteal cycle where the corpus luteum is making too little progesterone as well as anovulatory cycles where menstruation occurs but no ovulation and no ovarian progesterone can also be factors leading to an imbalance of progesterone and estrogen in the body. The best way for a woman to know if this is occurring is to use the Fertility Awareness Method and track her menstrual cycles so that she may know when and if ovulation is occurring. This method of cycle tracking can also shed light as to when the hormones are rising and falling within the menstrual cycle and can help to discover the root causes of her hormonal imbalance.
Dietary and Lifestyle Suggestions For Lowering Excess Estrogen:
In order to balance hormones and prevent excess estrogen there are a variety of dietary, lifestyle recommendations as well as supportive vitamins and minerals, herbs and supplements
reducing alcohol and caffeine
avoiding xenoestrogens
eating an organic, whole foods diet focused on good quality proteins, fats and complex carbohydrates
increasing dietary fiber
exercising and maintaining a healthy body weight
getting a good night's sleep
Nutritional Considerations:
Eating for Health: eating fresh, whole foods that are organic whenever possible. Produce should be fresh, and in season whenever possible, unrefined and as locally grown as possible. Eating a rainbow of colors will ensure we are getting a wide range of phytonutrients supplying us with vitamins, minerals and antioxidants. Make sure you are getting plenty of clean proteins, healthy fats and a rainbow of vegetables with each meal. Avoid refined carbohydrates, conventionally raised meats and dairy products, processed and refined foods, sugar and excess caffeine and alcohol.
Increase dietary fiber: with whole grains, legumes, fruits and vegetables. Soaking and sprouting seeds, nuts and legumes helps to remove phytic acid as well as predigest these foods, making them more highly digestible. Ideally we want to be eating at least 35 grams of fiber per day. This helps to keep our digestion and elimination regular, which helps us remove excess estrogen from the body.
Balancing the blood sugar: this is a crucial step in the dietary approach to adrenal and hormonal health. Low blood sugar triggers the stress response, which disrupts our overall hormonal cascade and can lead to hormonal imbalance.
Eat 3 meals a day, and 2 snacks if needed to keep blood sugars even, and eat before becoming hungry
As much as possible eat whole, unrefined preferably organic foods to ensure nutrient density.
Try and not eat after 8pm and give yourself at least 2-3 hours after dinner before you go to bed so your sleep is not disturbed and your liver can focus on detoxification.
Be sure that each meal has a serving of protein: 2-4 ounces for animal proteins and 4-6 ounces of plant proteins. Proteins is the building block upon which all hormones, neurotransmitters and enzymes are made, so adequate protein is crucial.
Eat within the first hour of awakening and never skip breakfast, even if you are not hungry. Focus on nutrient dense, protein rich breakfasts and skip the sweet ones.
Make sure you have at least 1 serving of healthy fats per meal, to support and nourish the nervous system and prevent sugar and starch cravings.
Examples include olives, nuts/ seeds and their butters. Extra virgin olive oil, coconut oil, pastured butter and ghee.
Decrease the use of substances that you use to bolster energy and mood such as caffeine, tobacco, alcohol, refined carbohydrates and sugar
Nutrients to Reduce Estrogen Dominance & Regulate Hormones:
Vitamin B6 - Vitamin B6 has been studied to regulate blood sugar, regulate hormones as well as regulate luteal phase defects. There has been dozens of studies done on vitamin B6 and PMS, showing it to have a board effect on PMS symptoms, particularly increasing the synthesis of several neurotransmitters in the brain including serotonin, dopamine, norepinephrine and epinephrine. This is particularly helpful because estrogen dominance leads to an imbalance in these neurotransmitters making women prone to anxiety, nervous tension and PMS symptoms. The ideal form of is pyridoxal-5-phosphate, which is the most easily absorbed and recommended therapeutic dose is 50mg-100mg /day. This can be found in a multivitamin or can be supplemented separately.
Vitamin B6 rich foods include animal proteins (organic and grass fed whenever possible), organ meats, nutritional yeast, legumes, sweet potatoes and other starchy vegetables as well as fruits, especially bananas
Vitamin B12 - Along with B6 and Folate B12 is involved in the methylation process, which is vital for the liver to be able to metabolize and remove estrogens from the body. Vitamin B12 is also important in fertility for women wanting to conceive, as deficiency of this vitamin can cause anovulation as well as changes to the ovum, resulting in infertility. Excess estrogen can be the underlying causative factor in the lack of ovulation and infertility in women, so it is important that they get adequate B12 in the diet to support estrogen clearance. Deficiency of this vitamin is common and can result from a variety of factors including low stomach acid, SIBO, Crohn's disease, parasites -pretty much all disruptions of the gut microbiome as well as vegan and vegetarian diets. Daily recommended dose is between 2.4-2.8 mcg/day and can be found in a multivitamin or can be supplemented separately. The recommended forms are methyl-, adenosyl-, or hydroxycobolomine.
Vitamin B12 rich foods include animal proteins (organic and grass fed whenever possible), wild caught fish, pastured dairy and eggs. As far as plant based foods that contain B12, the only foods that contain the bioavailable form are seaweeds such as nori and chlorella.
Magnesium - Magnesium is often overlooked and so important for women's health! This mineral is in such short supply due to poor diet (too many refined carbohydrates and not enough leafy greens), agricultural chemicals and conventional farming practices and soil erosion. Magnesium is essential for the functioning of more than 300 different enzymes in the body, specifically the ones produce, transport, store and utilize energy. Magnesium is also involved in the release and binding of adequate amounts of serotonin in the brain. It also normalizes blood pressure, transmission of nerve cell signals and blood flow. Magnesium is depleted by hormonal changes in the luteal phase, therefore supplementation has been shown to have beneficial effect in the treatment of PMS symptoms such as bloating, breast swelling as well as relief of premenstrual mood fluctuations & depression. Magnesium also helps keep bowels regular by maintaining normal bowel muscle function, which helps the body remove excess estrogen efficiently. Suggested dose is 300mg 1-3 times per day. It is most bioavailable when it’s in chelated form, and magnesium citrate and glycinate are recommended for supplementation.
Magnesium rich food include dark leafy greens, nuts, seeds, millet, whole wheat, kelp, molasses, dulse, and bananas.
Calcium- Estrogen enables the body to retain and utalize calcium more efficiently. Symptoms of calcium deficiency also mimic many PMS symptoms, especially water retention and mood fluctuations. Adequate dietary calcium can also protect women from osteoporosis. Eating calcium foods is best during the luteal phase of the menstrual cycle it is thought because estrogen levels never drop as low in the luteal phase as they do in the follicular phase. It’s absorption and metabolism are aided by vitamins D and K2 as well as magnesium, zinc, silica and boron. Ideal supplementation is 1000-1200 mg/ day.
Foods that are high in calcium are pastured organic dairy, dark leafy vegetables and canned fish with bones.
Other recommended synergistic foods, nutrients, and herbs:
Zinc- Zinc is an important cofactor in hundreds of enzymatic reactions as well as important for proper functioning of many of our sex hormones. It also plays a role in the the synthesis and secretion of hormones. Zinc deficiency can lead to impaired synthesis and secretion of follicle stimulating and luteinizing hormones, abnormal ovarian development and disruption of the menstrual cycle. Zinc supplementation has also been studied to improve mood and reduce depressive symptoms associated with the menstrual cycle. A recommended daily therapeutic dose is 15-30 mg./day.
Zinc rich foods include pumpkin seeds, sesame seeds, oysters, grass fed beef, lamb, chickpeas, cashews and spinach.
Melatonin- Melatonin lowers estrogen and has also been shown to prevent breast cancer. It is also helpful to take at night if there are sleep problems present. By getting a better night sleep, and regulating the natural cortisol rhythm Melatonin is helping to work on the HPA axis and its effect as a root cause for estrogen dominance. Recommended therapeutic dosage is .5 - 1 mg taken in the evenings.
Resveratrol- Resveratrol is a potent botanical compound, antioxidant and phytoestrogen found in grapes, berries among other plants and helps estrogen metabolize into the more protective pathways. It has also been shown to lower insulin levels, helping prevent obesity - yet another root cause factor for estrogen excess.
Resveratrol can be found from food sources such as grapes, blueberries, blackberries, raw cocoa and pistachios.
Indole-3-Carbinol- This potent antioxidant compound is known for its ability to absorb excess estrogen and its role in supporting liver detoxification. When taking I3C it help to create more of the good estrogen and less of the bad estrogen. Therapeutic supplemental dosage suggests 200-400 mg/ day.
I3C is also found in cruciferous vegetables such as cabbage, cauliflower, broccoli and kale.
Essential Fatty Acids - Getting good quality fats is essential in regulating hormones, especially in the form of Essential Fatty Acids. Many omega 3 rich EFA’s, specifically Evening Primrose oil have been studied and been found effective in the management of PMS symptoms such as decreasing swelling and bloating, weight gain, breast tenderness, joint pain, dysmenorrhea and emotional symptoms. EFA’s, particularly Evening Primrose oil contain gamma linolenic acid and raise natural prostaglandin levels in the body. Recommended therapeutic dosage is 3-4 g/ day or 3-4 TBS of raw EFA rich oils per day.
Evening Primrose oil is a specific here, but other sources include borage oil, black currant oil, hemp oil, cold pressed olive oil, flax oil and fish oil supplements
Bitters- Bitters are a class of herbs that contain bitter compounds that help to stimulate the flow of bile from the liver to the gallbladder. This class of plants have alterative actions, helping to assimilate nutrients and eliminate waste from the body without having a laxative effect. Bitters can help to stimulate digestion and support liver function, which is a key player in the root cause of estrogen dominance. Bitters can be taken 15-30 minutes before a meal to help stimulate digestive juices and prime the system. Including bitter foods in the diet is key here as well including mustard greens, dandelion greens, escarole and arugula.
There a variety of herbs that contain these bitter flavors that support the liver , including dandelion root , burdock root, artichoke, oregon grape root, milk thistle seed, gentian, angelica, wormwood among many others.
As always, not every herb will work for every person. I recommend working with an herbalist or looking into herbal energetics in order to find the bitter herbs that would be the most balancing for your unique constitution!
I hope this has given you at bit more context in how Estrogen Dominance plays a central role in our health as women, and how we can begin to support our hormonal balance through diet, lifestyle and of course our plant allies!
In health dear ones!
References:
Gottfried, S. (2013). The Hormone Cure. New York, NY: Scribner.
Hudson, T. (2008). Women’s Encyclopedia of Natural Medicine: Alternative Therapies and Integrative Medicine for Total Health and Wellness. New York, NY:McGraw Hill Education.
Murry, M & Pizzorno, J. (2012). The Encyclopedia of Natural Medicine (3rd ed.). New York, NY: Atria Papererback.
Northrup, C. (2010). Women’s Bodies Women’s Wisdom: Creating Physical and Emotional Health and Healing. New York, Ny: Bantam Books.
Romm, A. (2017). Botanical Medicine for Women’s Health (2nd ed.). St.Louis, MO: Elsevier