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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:
The body makes too much estrogen
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
Here are some diet and lifestyle suggestions to help support healthy progesterone levels:
Reduce stress
Reduce stress and make space for a baby in your life. If you have too many projects on the go cut back. Try yoga and meditation. Deal with any health issue that you have that is causing stress to your body and mind.
DUTCH Hormone Testing
If you are over 40 don’t waste time trying different supplements, go straight for the DUTCH hormone test through a practitioner then you know what you are dealing with. Depending on your test results you may benefit from some natural support to increase progesterone. I used a homeopathic remedy called Prog Aid from a New Zealand company called Lifeforce which I found very effective for keeping my progesterone levels in a healthy balance. There are also a number of other nutritional and herbal supplements that can support progesterone levels if you need them. It is best to work with a qualified practitioner to find the best hormonal support for you.
DIM
As already mentioned, support your liver’s detoxification of estrogen by including plenty of brassica vegetables such as broccoli, cauliflower, kale, Brussels sprouts, and cabbage in your diet. They contain a substance called DIM which helps your liver detoxify excess estrogens by converting estrogen into a water-soluble form that can be detoxified by the liver. If you have thyroid issues lightly steam them rather than having them raw as raw brassicas contain active goitrogens which can block the thyroid glands' absorption of iodine.
Ground Linseed
1 tablespoon of ground linseed, add to smoothies or breakfast. Ground flaxseeds (or linseed as they are otherwise known) contain Lignans, a phytochemical that helps to balance estrogen and progesterone and can help to lengthen a short luteal phase. One of the things I recommend is adding 1 tablespoon of ground linseed to smoothies, yogurt, or breakfast muesli each day. According to research, Lignans from flaxseeds have been shown to increase levels of Sex Hormone Binding Globulin (SHBG) a glycoprotein that binds excess estrogen and makes it inactive. So it helps balance out any estrogen dominance by helping the body to eliminate harmful or excess estrogens.
Reduce exposure to xenoestrogens
As already mentioned reduce exposure to Xenoestrogens from the environment. These are plastics (drink bottles, lunch boxes) solvents and adhesives (paint, nail polish, household cleaners) non-organic meats (they contain hormones to help them grow quickly) pesticides, herbicides, fungicides, emulsifiers in soap and cosmetics, PCBs (Polychlorinated Biphenyl) from industrial waste.
Multivitamins with activated B Vitamins
Take a good prenatal multivitamin with activated B vitamins to make sure you are getting the essential nutrients to support your hormones and liver function. I recommend the prenatal multivitamin from NaturoBest as the ingredients are high quality and research-based. It also contains a good dose of active folate to support methylation and not synthetic folic acid.
Avoid any foods that stress the body such as refined sugar, caffeine, alcohol, processed foods, and gluten. Caffeine in particular stresses the adrenals and elevates cortisol.
Vitamin B6
Eat foods rich in vitamin B6. As a hormone regulator, vitamin B6 is a very important nutrient for fertility and pregnancy as it helps to regulate the hormones estrogen and progesterone. Vitamin B6 is very helpful if you have a luteal phase defect (short second half of the cycle) as it helps to increase progesterone levels and adequate progesterone levels are necessary for preparing the endometrium for the fertilised ovum. If you are deficient in vitamin B6 the ovaries respond by shutting down progesterone production. Adequate vitamin B6 levels are also important for liver health (methylation) and the clearance of old and excess hormones. Foods that are rich in vitamin B6 to include in your diet regularly: chicken, pork, eggs, banana, liver, salmon, sweetcorn, Brussels sprouts, spinach, capsicum, garlic, cauliflower, celery, cabbage, broccoli, Brewer’s yeast, and wholegrain cereals.
Eat enough fat
Ensure you are eating enough fat in your diet as good fat is essential for the manufacture of hormones. If you are eating a low-fat diet, there is a chance you may not be ovulating as your body doesn’t have the building blocks to make important reproductive hormones such as progesterone. I see this a lot in the clinic as many of my female clients do not eat enough dietary fats. I think as a society we are still a bit afraid of eating fat, after being conditioned with the `fat is bad’ message for so long from public health agencies over the previous few decades. The problem is fat is so critical for fertility and if you are not eating enough you may not be ovulating. A lack of fat will also affect the function of all your cells, organs, and tissues so not an ideal environment for conception. So, if you are trying to conceive, I recommend having some form of good fat with every meal (breakfast, lunch, and dinner). Some good choices are:
Avocado
Deep sea oily fish such as salmon, tuna, mackerel, and sardines - 2 times a week
Full fat organic dairy products – organic milk, butter, cheese, yogurt, kefir, etc
Coconut oil, olive oil, flaxseed oil
Grass-fed meat
Meat stock
Nuts and seeds
Sleep
Make sure you are getting plenty of sleep. In bed by 10 pm at least 3 times a week as sleep deprivation is a stress for the body that can lead to hormone imbalances.
Exercise
Lots of walks in nature, moderate exercise but not high intensity as this can be another stressor to the body.
Next steps
So, in summary, if you suspect you may have estrogen dominance I would recommend in the first instance increasing foods that help to support the detoxification of estrogen such as foods rich in sulforaphane (broccoli and broccoli sprouts) and lightly cooked brassica vegetables. Also, look at reviewing what xenoestrogens you may be exposed to in your environment and look at reducing the use of plastic containers and changing your cosmetics if necessary.
You may also need to look at your stress levels and how you can find more relaxation and balance in your life as high amounts of stress can lead to HPA Axis dysfunction which could be affecting progesterone levels.
If you regularly experience a few digestive issues then it would be worth trying to resolve these by focusing on the steps mentioned in the gut health section of this blog post such as increasing water intake, probiotic and prebiotic foods, and foods rich in polyphenols. If your gut issues do not resolve by taking these actions you may wish to work with a practitioner like myself to investigate further the root cause of your symptoms. It could be that you have food intolerances aggravating your symptoms or a bacterial or fungal overgrowth that needs attention.
DUTCH testing
We are very fortunate these days to be able to investigate hormones on a deeper level with a dried urine test called the DUTCH test. The DUTCH test offers a comprehensive hormone test that includes hormone metabolites, organic acids, and methylation and oxidative stress markers. It is especially useful for investigating adrenal function, estrogen and progesterone balance, androgen deficiency or excess, and whether the metabolism of hormones is sluggish or overactive.
I am able to organise a DUTCH test for my clients and I am trained to be able to interpret the results, which can seem quite complex when you first look at them as there is so much valuable information. The DUTCH test is a great way to investigate what is really happening with your hormones as it not only provides information on free hormones but downstream metabolites as well which tells us how the hormones are functioning.
Please reach out if I can help you in any way. For New Zealand clients, why not take advantage of my FREE 15-minute consultation so we can have a brief chat about your situation and how I may be able to help you with your health journey. You can book this here: FREE 15 Minute Consultation.
References
(1) Romm Aviva The Estrobolome: The fascinating way your gut impacts your estrogen levels www.avivaromm.com (sourced 5/9/22)
(2) Kresser C How Gut Microbes Influence Estrogen Levels, 15/11/2017, www.kresserinstitute.com (source 5/9/22)
(3) Oyelowo T, Mosby’s Guide to Women’s Health, 2007, p 8 – 10, Elsevier Inc.
(4) Dana N j, Whirledge S, Stress, and the HPA Axis: Balancing Homeostasis and Fertility (2017) International Journal of Molecular Sciences, Oct 18 (10) 2224