A Functional Medicine Protocol for Estrogen Dominance

If you experience irregular, painful periods, PMS, and weight gain, you may be living with estrogen dominance and not know it. Estrogen plays many vital roles in the body, but it can cause problems when it is available in excess.

Estrogen-dominant conditions are on the rise. Endometriosis affects at least 11% of women of reproductive age. 90% of women experience PMS-related symptoms. Up to 80% of women develop fibroids by age 50. 264,000 women and 2,400 men are diagnosed with breast cancer in the United States annually.

Many factors influence hormone levels, most of which are modifiable. Functional testing and integrative therapeutic modalities can help to identify causative factors of estrogen dominance and effectively bring hormones back into a healthy balance. You don't need to be afflicted by hormonal symptoms; read how to take control below.

[signup]

What is Estrogen Dominance

Estrogen is a vital hormone for men and women, responsible for integral biologic processes involved in, but not limited to, reproductive, cognitive, bone, and cardiovascular health. There are three forms of estrogen - estrone, estradiol, and estriol - but for the sake of this article, we'll just refer to estrogen. (1, 2)

Estrogen levels naturally fluctuate throughout the menstrual cycle and are ideally highest in the follicular phase, the first half of the cycle. Estrogen and progesterone should work together to maintain hormonal homeostasis in the body. An imbalanced estrogen-to-progesterone ratio causes the onset of hormonal symptoms. Estrogen dominance is the term used to describe the state in which estrogen levels are elevated in relation to progesterone. (4)

The most common scenarios causing estrogen dominance include the following:

• High estrogen, normal progesterone
• High estrogen, low progesterone
• Normal estrogen, low progesterone
• Low estrogen, lower progesterone (so that estrogen is still the dominant sex hormone)

*Note that estrogen dominance does not typically refer to cases in which estrogen levels are elevated outside the normal laboratory reference range. Estrogen excess is another medical condition associated with a significantly higher risk for blood clots, stroke, and estrogen-related cancers. Different approaches than what are discussed in this article may be appropriate for managing estrogen excess.

Estrogen Dominance Symptoms

Symptoms indicative of an estrogen-dominant state include (2, 5):

• Painful periods
• Heavy periods
• Irregular menstrual cycles
• Mood swings and irritability, as related to PMS
• Premenstrual dysphoric disorder (PMDD)
• Tender, fibrocystic breasts
• Acne
• Frequent vaginal infections
• Insomnia
• Migraines
• Weight gain

Estrogen dominance may increase the risk of and exacerbate the following conditions (5):

• Breast cancer
• Ovarian cancer
• Uterine (endometrial) cancer
• Endometriosis
• Polycystic ovarian syndrome (PCOS)
• Fibroids

Men can experience estrogen dominance, too. Higher than optimal estrogen in men can cause sexual dysfunction, enlarged breasts, infertility, and depression.

What Causes Estrogen Dominance?

Excess Estrogen Production

In rare cases, estrogen-secreting tumors can cause measurably high levels of estrogen. This may contribute to estrogen dominance but typically is more causative of estrogen excess. (6)

Blood sugar dysregulation and insulin resistance promote increased adiposity (fat deposition). Because fat cells synthesize and store estrogen, having excess body weight can contribute to estrogen-dominant states. (6, 7)

Exposure to Exogenous Estrogens

Hormone replacement therapy and hormonal contraceptives contain bioidentical and/or synthetic estrogens that can negatively influence the balance of your hormones if not dosed appropriately. (6)

Xenoestrogens are endocrine-disrupting chemicals that mimic the behavior of estrogens inside the body. They are found in food, personal care products, pesticides, and plastics. Excessive exposure to xenoestrogens can change the body's healthy patterns of hormone homeostasis, contributing to estrogen dominance.

Poor Estrogen Detoxification

The liver metabolizes estrogen in a complex two-phase process called biotransformation, which allows the body to break down and eliminate excess estrogen. Cytochrome P450 liver enzymes convert estrogen into inactive metabolites, which are then further metabolized and eliminated from the body through urine and feces. Nutritional deficiencies, stress, and genetics can all influence the liver to favor unpreferred detox pathways that result in the formation of estrogen metabolites with higher estrogenic and inflammatory properties. (1, 2)

Furthermore, the gut microbiome significantly impacts estrogen levels through the activity of the estrobolome - the collection of bacteria capable of metabolizing estrogens in the intestines. Dysbiosis can influence the gut's ability to detoxify estrogen effectively. Overgrowth of certain gut bacteria increases an enzyme called beta-glucuronidase, preventing estrogen excretion and allowing reabsorption into circulation. (1, 2)

Chronic Stress

Pregnenolone is the building block for all sex hormones and cortisol, the body's stress hormone. The pregnenolone steal is the phenomenon that occurs when high stress forces the upregulation of cortisol synthesis from pregnenolone, reducing the availability of pregnenolone to be converted to other hormones. The pregnenolone steal contributes to estrogen dominance by impairing progesterone synthesis and creating an elevated estrogen-to-progesterone ratio.

Functional Medicine Labs to Test for Root Cause of Estrogen Dominance

DUTCH Plus is an at-home urinary and salivary test that extensively measures levels of sex and adrenal hormones and their metabolites. Comprehensive hormone testing is not only a tool to diagnose estrogen dominance but can be used to understand metabolic and stress mechanisms contributing to hormonal imbalances.

A methylation panel, and micronutrient panel are helpful tools to assess signs and causes of liver stagnation that may contribute to estrogen-dominant states.

A comprehensive stool test can diagnose elevated levels of beta-glucuronidase and intestinal dysbiosis contributing to poor estrogen elimination.

If a thorough history is insufficient in identifying exposure to environmental xenoestrogens, an environmental toxins screen can quantify exposure to various endocrine-disrupting chemicals.

Other Lab Tests to Check

Estrogen increases levels of thyroxine-binding globulin (TBG). This protein binds and transports thyroid hormones. Bound thyroid hormones are inactive, so elevated TBG can contribute to a hypothyroid state. A thyroid panel with added TBG can assess for hypothyroidism due to estrogen dominance.

For women experiencing symptoms like vaginal itching and discharge, a vaginosis panel can identify vaginal bacterial and yeast overgrowth.

Conventional Treatment for Estrogen Dominance

Conventional treatment for estrogen dominance is very much a symptomatic-based approach. Doctors often prescribe hormonal birth control to achieve a fixed level of estrogen and progesterone throughout the menstrual cycle. Pharmaceutical anti-inflammatories and antidepressants are also commonly recommended as palliative therapy to address common symptoms of estrogen dominance, like painful periods and PMS.

Functional Medicine Treatment for Estrogen Dominance

Optimize Estrogen Levels

Dietary interventions specific to estrogen-dominant states are collectively called the "anti-estrogenic diet." The fundamental principles of this dietary style include a plant-based diet high in cruciferous vegetables and fiber. Why is this?

• High-fiber diets are associated with reduced estrogen levels in circulation.
• Women eating a vegetarian diet have a three-fold increase in fecal estrogen excretion and 15-20% lower blood estrogen levels.
• This 2006 study found that women following a Mediterranean diet for six months decreased their estrogen levels by 40%.
• Dietary modifications that reduce animal fats and refined carbohydrates and incorporate healthy fats and fiber improve markers of insulin resistance and reduce circulating estrogen.
• Cruciferous vegetables are naturally high in a compound called diindolylmethane (DIM), which improves estrogen metabolism and supports liver health.

Reduction of alcohol consumption improves liver health and decreases estrogen levels. One study found that estrogen levels are higher in women who drink alcohol than in non-drinkers.

Ways to reduce your exposure to xenoestrogens include (9):

• Minimize plastic use. Use metal and glass water bottles and food storage containers. Avoid reheating food in plastic Tupperware.
• Use natural household cleaning and personal care products. The EWG Skin Deep website is an excellent resource for checking personal care product safety and ingredient profiles.
• Buy organic foods when possible to avoid pesticide exposure. The EWG's Clean 15 and Dirty Dozen lists can help in prioritizing which foods to buy organic.

Optimize Progesterone Levels

Therapies that bring progesterone into optimal range are often necessary when treating estrogen dominance.

Eating foods high in vitamin B6 and zinc will help with progesterone synthesis. (3)

• Foods high in vitamin B6 include chickpeas, liver, tuna, salmon, potatoes, bananas, and squash.
• Foods high in zinc include oysters, beef, crab, pumpkin seeds, and lentils.

Supplements

Low doses of chaste berry (Vitex agnus-castus) can decrease estrogen levels and increase progesterone (3).

Supplemental DIM preferentially changes the cytochrome enzyme metabolism of estrogen in the liver to favor the preferred estrogen detoxification pathways.

Additional supplements and herbs shown to support liver health and detoxification include curcumin, quercetin, fish oil, methylated B vitamins (vitamin B12 and folate), milk thistle, licorice, and cinnamon (9).

Calcium D-Glucarate inhibits bega-glucuronidase and upregulates fecal estrogen excretion.

A combination of herbal antibiotics, prebiotics, and probiotics may be required to treat intestinal dysbiosis and to restore the healthy balance of beneficial intestinal bacteria.

Lifestyle Modifications

Seed cycling is the practice of eating specific seeds during certain phases of the menstrual cycle. It can help to balance estrogen and progesterone levels and reduce symptoms of estrogen dominance.

Sleep and exercise are two habits that can support healthy hormonal levels and body weight. Be mindful of how you are exercising. While a healthy amount of mild-to-moderate intensity exercise can reduce stress and assist healthy hormonal balance, overexercising can create the opposite effect and increase cortisol and estrogen levels. (3, 5)

Sweating through exercise and the sauna can improve the elimination of endocrine disruptors from the body. (9)

High stress can cause excessive production of cortisol, negatively impacting estrogen and progesterone levels. Stress management will look different for everyone but may include

yoga, meditation and mindfulness practices, and acupuncture.

Summary

Estrogen dominance is a common cause of many female-related health complaints. A high estrogen-to-progesterone ratio can cause many disruptive symptoms. Functional testing allows a detailed analysis of hormonal balance and insight into underlying mechanisms causing higher-than-ideal estrogen, suboptimal progesterone, or both. Dietary and lifestyle modifications with natural supplementation can support healthy hormone synthesis and estrogen detoxification, successfully bringing hormones back into the optimal range.