Estrogen Dominance: The Struggle is Real
Meet Sarah. 35. Mom of two. Estrogen dominance “running her life” in her own words: Tired (All. The. Time.). Despite sleeping 7 to 8 hours most nights, she needs coffee to function—like a pot before noon. She can’t lose those last 10 post-pregnancy pounds for the life of her (despite eating a perfectly clean keto diet). Oh and that time of the month? Don’t even talk to her! Mood swings and cramps galore!
Then there’s Becky, 58. Well into menopause, and still feeling the effects. Menopause hit her hard. Migraines. Hot flashes. Constipation. Brain fog. Oh my!
And Hayley. 22. Senior in college. History of taking the birth control pill since she was 15—hormonal acne. The thing is, the acne never really fully got better. She still breaks out. Her gut is a mess—bloating 24/7. And anxiety dominates her mind—even with the “littlest” of things (like anxiety over eating out on vacation, her stats test in 3 weeks, or that emoji in the text message).
Lastly, Mitch. 28. No one would ever peg him for being “overly hormonal’ (estrogen dominance). He’s a big dude. Former high school line backer and rec Rugby player. Fairly active. But pudgy. Never been able to get that ‘six pack.’ Extra tummy and chest adipose tissue that makes him self conscious at the beach. Also some low energy and mental sluggishness. Nothing a Red Bull can’t help, but still.
Three different women. One dude.
Four different life seasons.
Four cases of estrogen dominance.
The struggle is real!
The thing is, most of these folks did not come to me stating, “I have estrogen dominance.” Rather, they were byproducts of the estrogen dominance symptoms.
Which is why you may be reading this article too—The Ultimate Guide to Heal Estrogen Dominance Naturally: Diet, Supplements & More.
First let’s chat a few estrogen dominance logistics, then I’ll share my 5 essentials to healing estrogen dominance naturally (from a functional medicine perspective).
What is estrogen dominance?
Estrogen dominance is a common hormone imbalance affecting countless women, teens (and men).
Estrogen dominance is exactly what it sounds like—higher than normal amounts of estrogen and/or an imbalance in your progesterone to estrogen ratio.
As a refresher, estrogen is best known as the “female hormone”, although guys have it too and it actually plays multiple roles in overall health and hormone balance, including:
- Promotes fertility, sexual features (breasts, curves), libido and menstruation
- Balances other hormones (cortisol, progesterone, testosterone)
- Preserves of bone health and body fat levels
- Keeps histamine levels and immune system in check
- Boosts mood, cognition and energy
- Keeps cholesterol, cardiac health and thyroid hormones in check
- In guys, estrogen helps in maturation of the sperm and maintenance of a healthy libido.
Healthy estrogen levels equal a healthy, balanced, vibrant you. Estrogen dominance (higher than normal estrogen levels) equals an imbalanced you.
Symptoms of estrogen dominance
Common signs and symptoms of estrogen dominance include:
Skin breakouts- “Skinny fat”—difficulty putting on muscle
- PMS
- Heavy periods, cramping
- Visceral sensitivity (bloated easily, gut discomfort easily)
- Gut problems—constipation and bloating
- Fatty foods make you feel poorly/failed ketogenic diets
- Brain fog
- Fatigue
- Cold hands and feet
- High cholesterol
- Hypothyroidism
- PCOS
- Rely on coffee to function
- Headaches/migraines
- Histamine intolerance (foods, environment)
- Gain weight easily
- Hair loss
- Insomnia/poor sleep
- Anxiety/panic attacks
- Mood swings and irritability
- Low libido
- Fibroids
- Lumps, tenderness or swelling in your breasts (women)
- Man boobs or gynecomastia (men)
- Erectile dysfunction (men)
- Infertility
It’’s important to note that, contrary to popular belief, estrogen dominance does NOT just happen in women with “horrible” PMS, cystic acne or those going through menopause.
Estrogen dominance CAN occur in women with amenorrhea (no period), women with PCOS (often mistakenly just known for high testosterone), post menopausal women and males.
How estrogen dominance happens
You aren’t born with estrogen dominance, as if it was a genetic disease or condition. Estrogen dominance is a byproduct of several lifestyle, nutrition and other health imbalances.
There are several triggers to estrogen dominance I see in clinical practice.
Trigger 1: Poor gut health.
Estrogens are metabolized, activated and cleared through the gut and the liver/gallbladder, Leaky gut, fungal overgrowth and dysbiosis increase a compound called beta glucaronidase, preventing the clearance of estrogen in the estrobolome.
Trigger 2: Liver and gallbladder congestion
The liver and gallbladder are the body’s filtration system to clear out excess estrogens through bile, urine and wastes in our stool. Poor liver and gallbladder health create the perfect storm for estrogen dominance.
What impairs liver and gallbladder health in the first place?!
#1. Excess toxin exposures (like mycotoxins from mold, BPA in water and plastic bottles, pesticides and hormones in non-organic foods, medications/NSAIDS)
#2. Nutrient deficiencies—macronutrient deficiencies (long term low fat, no meat or very low carb diets), excess alcohol, industrial seed oils, high processed food intake, and low intake of fruits and veggies all contribute to a fatty or congested liver.
Trigger 3: Birth control pill history
Exogenous estrogens—also known as “xenoestrogens”—discombobulate your body’s natural hormone production. Doctors rarely discuss side effects with women when they prescribe them the contraceptive pill. Birth Control Pills disrupt your body’s normal hormone production with synthetic versions of estrogen and/or progesterone (called progestin) which suppresses ovulation, thickens your uterine lining, and stops the production of the Luteinizing Hormone (LH) in your pituitary gland—tricking your body into thinking it is pregnant all month. However, when you are taking daily doses of synthetic hormones, your body registers that you are getting unusually high levels of estrogen and progesterone throughout your cycle. Overtime, excess hormones build up in the body.
Trigger 4: Blood sugar dysfunction
High insulin levels lower sex hormone binding globulin (SHBG) — this dumps estrogen in your system and can contribute symptoms of estrogen excess like sore breasts, fibroids, and heavy menses. This is why PCOS patients can still have estrogen dominance at the same time as testosterone.
Trigger 5: Chronic stress
Estrogen and cortisol work hand in hand. Cortisol abnormality creates a domino effect on estrogen and the hypothalamus-pituitary-adrenal axis . Chronic stress is one of the main reasons women become estrogen dominant. When you are stressed, or overly busy, your cortisol levels go sky high and your body must use up its progesterone to keep up, which will ultimately deplete progesterone, in turn elevating estrogen. This can even occur in amenorrhea (no period), wherein chronic stress drives up high estrogen levels, causing the lining of the uterus to grow and thicken. As the lining of the womb thickens, your body releases an egg into one of the ovaries. The egg will break apart if a man’s sperm doesn’t fertilize it. This causes estrogen levels to drop.
“Chronic stress” goes far beyond mental stress. It entails things like sleep deprivation, circadian rhythm dysfunction, overtraining or sedentary lifestyles, chronic dieting and under eating, toxin exposures, social isolation/loneliness, or saying “yes” to everything (poor boundaries).
How to test for estrogen dominance
Do you have estrogen dominance?
A few lab tests and a signs and symptoms assessment can provide you and your clinician with answers.
Test #1: Bloodwork
A complete hormone panel (estrone, estradiol, progesterone, testosterone/free testosterone, DHEA sulfate, complete thyroid panel—including thyroid antibodies, TSH, Free T4, Free T3, T4/T3 Uptake). In addition to hormones, include complete iron, metabolic, lipids and CBC panels.
Fun fact: Estrogen markers may appear low on bloodwork or you may even have amenorrhea (no cycle). However, you can still have estrogen dominance if your progesterone levels are lower, compared to estrogen levels. This is where the Progesterone : Estrogen Ratio comes into play.
The Progesterone : Estrogen Ratio is a parameter used to determine hormonal dominance in patients with results within normal ranges of progesterone and estradiol (measured in luteal phase of the menstrual cycle):
- Ideal: Progesterone (P or Pg): 11 – 29 ng/mL or 35 – 92 nmol/L
- Ideal Estradiol (E2): 19 – 160 pg/mL or 70 – 600 pmol/L
In healthy women, progesterone/estradiol ratio should be between 100 and 500. If it’s higher than that, it may indicate progesterone dominance, and if it’s lower, then estrogen dominance is more likely. Use a calculator like this to see if your estrogen dominant!
Test #2: DUTCH Plus Test
A urine and saliva test to assess how well you are metabolizing hormones in the liver gallbladder.
Test #3: Comprehensive Stool Analysis & Gut Testing
Assess the state of your terrain to rule out dysbiosis, digestive dysfunction and beta glucuronidase levels. (I like Doctor’s Data Comprehensive Stool Analysis x 3, The Gut Zoomer and/or GI Effects by Genova).
You and your clinician may also consider food sensitivity and gluten screening, as well as a SIBO breath test if SIBO is indicated.
Work with a functional medicine practitioner to run appropriate testing.
How to heal estrogen dominance naturally: 5 essentials
Conventional treatment of estrogen dominance often entails a handful of things:
- Medication
- Surgery
- Hormone—especially progesterone
- Weight loss diets (to lose excess weight associated with higher estrogens)
- “Just dealing with it”—often times, women are told estrogen dominance is normal
While these tactics mean well, they don’t really address the root causes of estrogen dominance (why your estrogen got high in the first place)—things like lack of foundational nutrients, excess toxin exposures or bad gut health.
This is where a functional medicine (root-cause) approach comes into play— helping you balance your hormones and send your estrogen dominance into remission.
There are 7 essentials I’ve found help women clear their body of estrogen dominance, including:
Essential #1: Eat an Estrogen Dominance Diet
Essential #2: Love Your Gut
Essential #3: Move Bile
Essential #4: Balance Blood Sugar
Essential #5: Detox Xenoestrogens
Essential #6: Supplement Smart for Estrogen Dominance
Essential #7: Chill Out
Essential #1: Eat an Estrogen Dominance Diet
Providing your body with consistent quality nutrition may be the simple shift you need to improve your energy and stress levels, balance out cortisol and decrease estrogen dominance while also improving gut microbiome at the same time.
When we are under-nourished (even accidentally under eating) or exposed to toxicants in our food and lifestyle, our body and our hormones are not in an optimal state of ‘homeostasis’, as a result, hormone imbalance and estrogen dominance occurs.
Basically: More nutrients (not less) promotes hormone balance. (Translation: restrictive dieting, like fasting and intermittent fasting, keto diets, carnivore or vegan diets and calorie counting are not necessary to balance your hormones).
For all the details on an estrogen dominance diet for minimizing estrogen dominance.
Essential #2: Love Your Gut
Excess estrogens are degraded and cleared through either the liver or the gut. As previously mentioned, the gut is known as the “estrobolome” where gut bacteria help break down toxins, hormones and wastes. However, if your bacteria are out of whack or your digestion is off, beta-glucuronidase levels increase.
Beta-glucuronidase is a gut bacteria enzyme which can limit or completely inhibit the excretion of compounds from the body such as medications, hormones, neurotransmitters and environmental toxins by reversing a detoxification process known as glucuronidation. Hello hormone imbalance! Love your gut.
- Boost stomach acid and enzymes.
Supplemental digestive enzymes, hydrochloric acid plus chewing your food really well can help improve digestion.
- Probiotic up.
Not just any probiotics or prebiotics. A vast majority of probiotics on shelves do not contain the probiotics they claim, much less survive stomach acid or transit to your colon (where you want them). A couple red flags of probiotics include: (a.) they make you feel worse, not better (note: after 3 to 7 days symptoms should subside, if not, that formula is not for you); and (b.) they are cheap (a good probiotic is not $10-$20; the average is between $50 to $160 for a reputable formula). A couple of my favorite formulas include Dr. Ruscio’s Triple Probiotic Therapy, Seed Probiotic, Terraflora and BifidoMaximus. Work with a clinical to customize your supplements for you.
- Clear out dysbiosis.
Do a stool and SIBO test to rule out any underlying dysbiosis and work with a clinician to clear any bacterial or final overgrowths out naturally. Examples of natural herbs that clean sweep dysbiosis include oregano oil, berberine, caprylic acid, olive leaf, allicin and goldenseal.
- Emphasize dietary fiber.
Fiber found primarily in vegetables has a nourishing effect on gut bacteria (healthy gut bacteria need plenty of veggies and probiotics found in foods like leeks, jicama, cooked and cooled potatoes, cooked and cooled winter squash, apples, onions, green tipped bananas and plantains, cassava, dandelion, asparagus, artichokes, soaked and dried beans, flax, seaweed and believe it or not.
Essential #3: Move Bile
Bile is the sludge-like liquid substance produced by the liver and stored in the gallbladder that helps clear out toxins, wastes and excess hormones (a hem, estrogen). Many women with estrogen dominance present with gallbladder congestion from a history of birth control pills, xenoestrogens in your shampoo and Beyond Meat burger, antibiotics, NSAIDs, low fat or restrictive diets, low fiber intake, overtraining or sedentary lifestyles (note: excessive exercise can obstruct the normal flow of bile).
If you can’t move bile, excess hormones accumulate inside and get tossed to your small intestine where more havoc can occur (excess estrogens in the gut invite bacterial overgrowth).
Keep bile moving by implementing these steps:
- Eat cholagogue-rich foods.
Cholagogues are substances found in certain foods and herbs that work by stimulating the flow of bile from the liver and causing the gallbladder to contract, squeezing the bile into the intestinal tract. Turmeric, celery (juice, raw), beets, dandelion, fennel, artichokes, apples, carrots, bitter greens (dandelion, collards, bok choy), ginger and peppermint (tea, herbs) are super stars.
- Try a liver-gallbladder flush.
A gallbladder flush is an alternative, holistic home remedy for cleansing a sluggish gallbladder. Check out how to do it here.
- Poop daily.
If you are not pooping daily, this is a problem. If you struggle with constipation, try one (or multiple remedies.
-
- Hydration (drinking at least half your bodyweight in ounces of water)
- Take digestive bitters (like these or these) and digestive enzymes with meals
- Sip Smooth Move Tea as needed
- Coffee enemas
- Mineral drops (added to water) (like these ; use code PJ03HABY to place your order)
- Magnesium (my favorite is the Upgraded Magnesium here)
Essential #4: Balance Blood Sugar
Your blood sugar is a code for “your body’s energy stores.”
When your blood sugar is balanced, so is everything else. If your blood sugar is out of whack, so is everything else (gut health, nervous system, hormones, energy, mood).Blood sugar imbalance and hormone imbalance (estrogen dominance and cortisol imbalance included) go hand in hand.
To promote more balanced hormones, your body wants to know it’s safe and not in threat of being in “survival mode” (ie. Not enough fuel). Cortisol (your stress hormone) is actually glucocorticoid itself (a hormone that feasts on glucose—blood sugar).
If blood sugar goes down, cortisol and adrenaline go up to keep you from “crashing” or prevent you from becoming bear meat (in the wild).
Likewise, your body doesn’t know what to do with intake or blood sugar overload either. Whenever there’s an increase in sugar or glucose in the body, it decreases the free testosterone levels in particular, which can lead to estrogen dominance and blood sugar imbalance issues.
Common signs of blood sugar imbalance include: feeling hangry or lightheaded if meals are missed or delayed, feeling energetic after eating meals, nausea (especially in the morning), not hungry in the morning and often skipping breakfast, binging or overeating at night time, thoughts about food, headaches, fatigue despite sleeping, insomnia or nighttime waking, poor appetite and under-eating.
Here are some tactics to balance blood sugar:
- Balance your plate. Eat a quality protein, fiber and 1-2 healthy fats with each meal.
- Eat a protein within the first 1-2 hours of waking (sets the tone for blood sugar all day long)
- Try to stick to 3 meals per day; If you need a snack, reach for a protein or healthy fat based snack, like hardboiled eggs, grass-fed beef or turkey jerky, lettuce wrap with turkey or chicken, handful raw macadamia nuts
- Eat your starchier carbs in the evenings or around workouts. Starchy carbs are essential for prebiotic fiber as well as carbohydrate intake; however, they can sometimes make you sleepy unless they are utilized.
- Cut back on caffeine. Consume 1 cup of quality coffee per day or less
- Replace sugar with 1 “keto” friendly treat/day ( Avocado chocolate pudding; 100% dark chocolate square; berries w/ coconut whip)
Essential #5: Detox Xenoestrogens
Xenoestrogens are are estrogen mimicking compounds that are not produced by our body. These compounds, found in:
- plastics (water bottles, disposable cups, plastic wrap, food containers, hand sanitizers)
- receipt paper
- pesticides and insecticides (on non-organic fruits and vegetables)
- tap water (chlorine and other chemical treatments, runoff byproducts)
- chemicals in cosmetics, lotions, shampoos, and other body care products
- birth control pills, antibiotics, NSAIDs
- furniture (mattresses, couches, etc.) and toxic cookware (plastic spatula, aluminum, teflon)
- mycotoxins (toxic mold spores) in HVAC systems, bathrooms or other humid/water damaged spots
Xenoestrogens bind to natural estrogen receptors and create excess estrogen in the body. Clean up your body care, cleaning products, and environmental toxin exposure.
Some ideas:
- Buy organic, local and wild caught produce and meats
- Replace laundry detergent with a clean product like Branch Basics
- Swap out plastic tupperware for glassware or stainless steel; same thing with your water bottles
- Drink filtered (non tap) water like Berkey, reverse osmosis or spring
- Forgo the talc, formaldehyde and other carcinogens in your makeup and hair care for cleaner brans like W3ll People, Ilia and Seeds; use hygiene products approved by Think Dirty and EWG Skin Deep database
- Use non-toxic cookware like the Always Pan, glassware and Corningware baking dishes, bamboo cutting boards, stainless steel cooking utensils
- Steer clear of fake soy products (a la Tofurkey) and industrial seed oils (canola, grapeseed, sunflower, vegetable oil)
- Opt for electronic receipts, not paper
Essential #6: Supplement Smart for Estrogen Dominance
On top of your “gut love” supplements, there are a few supplemental supports you can integrate to help decrease estrogen dominance.
GUT LOVE RECOMMENDATIONS
Supplement: Probiotic/Synbiotic
Purpose: Support ecosystem of beneficial gut bacteria
Formula: Seed Synbiotic
Dose: 1 dose with breakfast
Supplement: Fiber
Purpose: Feed beneficial microbes to cultivate a balanced gut microbiome.
Formula: Soluble fiber (Paleo Fiber, Partially hydrolyzed guar gum, or Fibromin)
Dose: 1 dose in the morning
Supplement: Butyrate (short chain fatty acids)
Purpose: Boost mood and regulates progesterone and estradiol secretion.
Formula: Tributyrin
Dose: 2 capsules in morning, 2 at night
Supplement: Digestive Bitters
Purpose: Support gallbladder health, fat digestion and hormone clearance.
Formula: CarminaGest
Dose: 2 capsules in the morning, 2 at night
Supplement: Mineral drops
Purpose: Aids in hydration and sodium-potassium-calcium-magnesium balance.
Formula: Spectramin
Dose: 1 drop/10 pounds per bodyweight in 32-40 oz water for the day
HORMONE BALANCE RECOMMENDATIONS
Supplement: Mitochondria support
Purpose: Support tissue and cellular foundations of hormones.
Formula: Compounded formula powder or Mitochondrial NRG
Dose: 1 scoop in the morning
Supplement: Adrenal Adaptogen
Purpose: Boosts low cortisol levels naturally
Formula: Vital Adapt (contains licorice for low cortisol)
Dose: 1 dose in morning and mid-day
Supplement: Calcium D-Glucarate
Purpose: Supports healthy hormone metabolism. Prevent recycling of environmental toxins and hormones back into the liver, aiding in their elimination from the body.
Formula: Calcium D-Glucarate
Dose: 1 capsule at night
Supplement: DIM
Purpose: Helps balance estrogen levels in your body. Specifically, may stimulate the production of a less potent, more beneficial 2OH estrogen.
Formula: DIM-Evail
Dose: 1 capsule at night
Essential #7: Chill Out
Stress less. Stress is the anecdote to hormone balance.
I know, I know…easier said than done. Stress is inevitable. However, how we handle stress—both physical and mental—is what separates “normal stress” from “chronic hormone rocking stress.”
You can be sitting on a beach in Tahiti, seemingly no care in the world, yet still be under stress is you’re under-eating, overtraining, running on 3 cups of coffee, looking at screens for 8 to 10 hours per day and constantly comparing yourself to others. Your body sees all sources of stress the same and cannot tell a different in running from a bear versus “OMG! I can’t eat more than 20 grams of net carbs!”
“Chilling out” for the sake of hormone balance can be as simple as intentionally building in a few “breath breaks” into your daily schedule to pause, re-energize and decompress stress.
For example, I start every morning off with a phone-free morning routine (no email or social media checking). Then at noon, I take a yoga break. And in the evenings, it’s a walk, infrared sauna and/or something fun or social—like my church community group or acting class.
Another “must” to “chill out”: preserve your energy! We all get the same 24 hours in a day to spend. Use yours wisely:
- just say “no” so you can say “yes” to something else (like less stress)
- shorten your to-do list (and make a to don’t list)
- move your body (without pushing yourself over the edge and forcing yourself to overexercise).
- simplify—clear the clutter, seek to adjust and find simple solutions for “hard” challenges (ex. You like the idea of working out, but hate the gym? Take your workouts outside, do a group fitness class or pick up an activity like tennis or swimming)
- remind yourself, Rome was not built in a day—focus one one thing at a time
Say Goodbye to Estrogen Dominance
Estrogen dominance doesn’t have to be something you always struggle with. Reach out to my virtual clinic today and let’s rebalance your hormones together!