Estrogen Dominance – what it is and what you can do naturally to find hormone harmony

Estrogen dominance is a hormone imbalance that affects as many as 70% of women over the age of 35 and beyond. It occurs when there is either an excess of estrogen circulating through the body or when there is a dominance of estrogen compared to other important reproductive hormones such as progesterone. Estrogen can also become problematic if there is too much of one type of estrogen compared to the other types of estrogen.

Estrogen dominance can be a factor in infertility and recurring pregnancy loss and so should always be evaluated as part of a preconception screening programme. I will discuss testing later in this article.

Estrogen plays a number of important roles in the human body such as supporting bone and cardiovascular health and is one of the main players in regulating the reproductive system. Estrogen is made in the ovaries, fat cells, adrenal glands, and the liver. There are 3 types of estrogen and these will fluctuate depending on the stage of life you are at:

• Estrone (E1) - Is dominant after menopause when your body stops making Estradiol (E2) and Estriol (E3)

• Estradiol (E2) – Is the dominant type of estrogen in women from when they start menstruating through to menopause

• Estriol (E3) – Is increased during pregnancy

Estrogen will typically fluctuate during the menstrual cycle. Estrogen is low during menstruation and gradually rises during the follicular phase (days 1 – 14 if you have a 28-day cycle) reaching a peak at ovulation. The role of estrogen is to prepare the lining of the uterus for conception if it occurs. After its peak at ovulation, estrogen levels gradually decline during the luteal phase (the phase between ovulation and your period) as progesterone takes over as the dominant hormone.

There are two typical patterns of estrogen dominance:

1. The body makes too much estrogen

2. Estrogen is high in relation to other reproductive hormones such as progesterone. So there is not enough progesterone to balance out the estrogen during the luteal phase.

Symptoms of Estrogen Dominance

Here are the common symptoms of estrogen dominance:

• PMS

• Mood changes

• Breast tenderness and swelling

• Heavy periods

• Period pain

• Irregular periods

• Water retention

• Hair loss

• Weight gain and increased belly fat

• Bloating

• Reduced libido

Estrogen dominance is also connected to conditions such as infertility, endometriosis, fibroids, and thyroid issues as the dominance of estrogen can affect thyroid hormone production.

Let’s start by focusing on what we can do if you have the first pattern of estrogen dominance which is when your body makes too much estrogen.

The importance of the liver

Estrogen dominance is connected to the healthy functioning of your liver and whether you are recycling excess and harmful estrogens or detoxifying them from the body. The liver is responsible for converting estrogen into a water-soluble form that can be detoxified from the body. So, if your liver is not functioning optimally, rather than being eliminated the estrogen is recycled back into the bloodstream leading to estrogen dominance. This is often one of the main issues when someone has excess estrogen circulating in the body.

Here are a few suggestions of how to support your liver so it can clear estrogen effectively:

Eat foods rich in sulforaphane, a compound found in broccoli or broccoli sprouts. Sulforaphane enhances sulfation, a liver detoxification pathway, which helps with the clearance of estrogen by the liver. I often recommend broccoli spouts in supplement form and my favourite is Endura Cell BioActive from Cell Logic.

Eat lightly cooked brassica vegetables daily such as broccoli, kale, cauliflower, and cabbage as they contain a substance called DIM (Di-indolylmethane) which helps to promote healthy estrogen metabolism. It supports the liver to maintain normal estrogen levels so is useful if you have high levels of less desirable estrogen. You can also supplement with DIM. To help with my estrogen dominance, I took a DIM supplement until I found out I was pregnant and stopped.

Gut health

The liver converts estrogen into a form that can be eliminated via the gut via a process called conjugation. It is then up to a healthy gut to eliminate the estrogen from the body and regular bowel motions are extremely important for this to happen. Constipation and poor gut health allow the conjugated estrogen to be essentially undone and recycled back into the bloodstream which once again increases estrogen levels.

It is also important that our gut flora is optimal as an imbalance of gut flora can increase estrogen levels. Have you heard of the Estrobolome? This is a relatively new term circulating around which establishes a connection between the gut microbiome and the regulation of estrogen. According to Aviva Romm, the Estrobolome is “A unique microbiome within your gut microbiome, made up of a collection of bacteria with special genes that help you metabolise estrogen” (1)

It is amazing to think that our gut microbes play a role in regulating estrogen levels. An imbalance of gut bacteria can increase the production of an enzyme called beta-glucuronidase, which has a negative effect on estrogen metabolism by reducing the ability of the liver to detoxify estrogen, allowing the estrogen to be recycled into the bloodstream.

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According to Chris Kresser (2017) `Microbes in the estrobolome produce beta-glucuronidase, an enzyme that deconjugates estrogen back into its active forms. Beta-glucuronidase activity produces active unbound estrogen that is capable of binding to estrogen receptors and influencing estrogen-dependent physiological processes

We can help protect against this by supplementing with Calcium D glucarate (a combination of glucaric acid and calcium) which helps with the elimination of estrogen by inhibiting beta-glucuronidase. You can get Calcium D glucarate on its own as a powder or it can often be found in a supplement with DIM.

So, you can see that it is important that the gut microbiome and estrobolome are kept in a delicate balance. There are many things that can affect this balance including genetics, age, weight, diet, alcohol use, and environmental toxins.

We can support our gut health by:

• Drinking plenty of water – aim for 30mls for each KG of body weight daily

• Eat plenty of fibre from fruits and vegetables (5 – 8 servings a day)

• Eat prebiotic foods such as garlic, onions, leeks, unripe bananas, and asparagus to provide fuel for the beneficial bacteria. Prebiotic foods are non-digestible fibre foods that pass through the stomach and small intestines without being broken down by stomach acid and enzymes. As prebiotic foods are unable to be broken down, they reach the colon where they feed our beneficial gut bacteria. They are fuel for our beneficial bacteria to thrive.

• Eat probiotic foods such as kefir, sauerkraut, and kombucha. Probiotic foods provide billions of naturally occurring gut microbes.

• Eating a range of polyphenol rich foods such as berries, grapes, spinach, broccoli, orange, dark chocolate, and green tea. They help to feed our beneficial gut microbes and increase our microbiome diversity. Polyphenols contain antioxidants that have prebiotic properties and exert anti-microbial action against pathogenic gut microbes.

• Eliminate refined sugar, processed foods, and excess alcohol

• Eat for the season

• Rotate your foods for increased variety, which helps with microbiome diversity. Try not to have the same foods every day.

Xenoestrogens

We also have to be aware of the estrogens that we get from environmental toxins known as xenoestrogens which are endocrine disrupters that alter the normal function of hormones and have an estrogen-like effect. Xenoestrogens can be found in common things we use every day around the house such as plastic drink bottles and containers, pesticides, household cleaning chemicals, unfiltered drinking water, as well personal care products such as cosmetics, skin creams, sunscreen, and sanitary items.

`Xenoestrogens are `foreign’ estrogens, substances that are close enough in molecular structure to estrogen that they can bind to estrogen receptor sites with potentially hazardous outcomes’ (3)

It’s hard to totally eliminate all xenoestrogens as they are from multiple sources in the environment that we live in, however, there are a few things we can do to reduce our exposure. These are:

• Choose organic, locally grown fruit and vegetables that are in season

• Buy organic meat, poultry, and dairy products to avoid added hormones and pesticides

• Avoid all pesticides, herbicides, and fungicides

• Reduce the use of plastics around the home, use glass rather than plastic containers

• Do not microwave food in plastic containers

• Avoid the use of plastic wrap to cover food where possible

• Avoid drinking from a plastic water bottle and never leave it in the sun or a hot car

• Use natural chemical free laundry and household cleaning products

• Choose products that are unbleached and chlorine free such as natural tampons and pads as well as toilet paper

• Filter drinking water

• Choose natural creams, cosmetics, soaps, and toothpaste that does not contain estrogenic chemicals

• Avoid nail polish and nail polish remover unless you find a natural brand

The impact of stress on hormone balance

Let’s now focus on the second estrogen dominance pattern now which is when estrogen is high in relation to progesterone but is not in excess in the body. This is known as relative estrogen dominance.

When estrogen is high in relation to the other reproductive hormones, this is often related to stress and the function of the Hypothalamic-pituitary-adrenal (HPA) axis, which comprises the hypothalamus, pituitary gland, and adrenal glands. It regulates the body’s adaptive response to stress. Adrenal fatigue, or HPA Axis dysfunction which is otherwise known, is when our adrenal glands function below normal levels, usually as a result of prolonged, chronic stress.

The adrenal glands are situated on top of the kidneys and regulate our stress response by producing stress hormones such as cortisol and adrenaline in response to stress. Long-term stress can lead to the depletion of the adrenal glands and can result in imbalances in the production of cortisol. When the body is in a long-term stress state, non-essential functions that are not important for immediate survival such as the digestive system, reproduction system, and thyroid start to slow down or switch off altogether.

Stress is a huge factor as it can interfere with our reproductive hormones. In particular progesterone, one of the most important hormones for fertility and pregnancy, is not only produced by the corpus luteum of the ovary but also produced by the adrenal glands. This means that if you are under a lot of stress then your adrenal glands may have shut down your production of progesterone in favour of stress hormones such as cortisol and adrenaline. This is one of the reasons you might have low progesterone, especially after an anovulatory cycle where you might not have ovulated, which leads to relative estrogen dominance. I really believe this was a huge factor in my fertility journey and is likely to be a major factor with a lot of women in this day and age. When we are under stress our body tends to shut down our reproductive hormones as getting pregnant is not essential for our survival. `The stress response serves to prioritise survival over less essential physiological functions, inclusion growth, and reproduction’ (4)

The priority is to look to stress management as well as increasing progesterone to balance estrogen levels, while also supporting the liver and gut as mentioned before to support the detoxification of estrogen. For further information on supporting stress and adrenal function check out my previous blog post: Is Stress and Adrenal Function affecting your ability to conceive?

Supporting healthy progesterone levels