What is Estrogen Dominance?
Irregular bleeding, mood swings and depression, water retention/bloating, painful breasts, hot flashes, heavy periods, painful periods, fatigue, brain fog, sleep disturbance…. sound familiar? These can all be caused by a relative excess of estrogen compared to progesterone. In Functional Medicine we often refer to the relationship between estrogen and progesterone as the “dance of the hormones” or the “hormone orchestra.” Although that makes it sound so serene and lovely, what women experience each month with PMS, menstrual cramps and heavy periods can often feel quite the opposite! So what’s going on? The answer could be Estrogen Dominance. What I hope to do is shed light on this hormonal imbalance and explain my approach to treating it.
First we have to understand the hormonal changes that take place during a typical menstrual cycle, the first half of the month progesterone is relatively low and estrogen levels steadily rise. This is the estrogen dominant phase. Then around day 14, ovulation occurs and the ovary starts producing progesterone. During this second half of the menstrual cycle, estrogen levels fall somewhat and progesterone levels go up. This is when progesterone takes the lead in our hormone tango.
What can disrupt this cycle and lead to estrogen dominance?
- One root cause of estrogen dominance is if ovulation doesn’t occur and progesterone doesn’t have the opportunity to rise. We see this type of problem in young girls who haven’t started ovulating regularly, and in peri-menopausal women who are close to the end of their ovarian reserve.
- Stress is another root cause of low progesterone and skipped ovulation. Cortisol, the stress hormone, is made from progesterone. If you are in a chronically stressed out state, you end up using a lot of your progesterone to make cortisol, leaving you with an imbalance between estrogen and progesterone. Many women can attest to the fact that an episode of high stress can cause them to miss a period.
- Xenoestrogens are another important factor that contribute to estrogen excess. I’m talking about chemicals found in plastics, food containers, pesticides, furniture, make up, fragrances, you name it! These toxic chemicals can act like weak estrogens in our bodies. Women are potentially very vulnerable considering how many bath, haircare, cosmetic, nail, feminine hygiene products we use daily. These just add to our total estrogen “load” that our body sees on a regular basis and that our liver has to metabolize and detoxify. It turns out that optimal liver function is very important in estrogen metabolism and clearance.
- Hormones found in food make their way into our bodies too. When cows are fed hormones, antibiotics, and pesticide laden feed, all of those chemicals make it into the meat and milk products that we eat. This is why eating organic, grass fed meat, and dairy products whenever possible is extremely important.
- The gut microbiome and our gastrointestinal function is another major player in this hormonal dance. Bacteria that live within our intestines play a large part in estrogen metabolism. If we have too many of the “bad bacteria” that inhibit estrogen metabolism, we end up recirculating the same toxic estrogen metabolites over and over. To make matters worse, if you have constipation, that prolonged elimination phase just increases the chances for the bad bacteria to have a negative impact.
- Lastly, obesity itself is a problem since estrogen is stored in fat cells. The fact that 2/3 of Americans are overweight or obese points to how prevalent this form of estrogen exposures is.
So now that I have outlined some of the root causes for your PMS, fibrocystic breasts, fibroids, endometriosis, irregular periods, the question is, “how do we treat it”? As a traditionally trained Ob/Gyn, I can tell you that I was taught to offer birth control pills. You guessed it: more estrogen! That doesn’t make much sense, but it does help symptoms because most combined hormonal methods (pill, patch, ring) have both estrogenic and progestogenic compounds mimicking your normal cycle. Unfortunately, birth control pills don’t address the underlying problem and they come with some risks. I am more than happy to prescribe birth control for women who want it, but it is not my first choice for someone who doesn’t need contraception.
My approach to Estrogen Dominance:
In my practice, we start with an in-depth history to figure out what triggers are contributing to your state of health right now. We consider your entire medical history, genetic background, nutrition, environmental exposures, stress, sleep. We do traditional and functional testing to assess hormones, hormone metabolism, gut microbiome. The truth is we have so many ways to help women feel better. We can, and should, use food as medicine, weight loss, mind body modalities for stress management, herbal medicines and supplements. I believe that women can actually heal themselves in many instances without the need for risky medicine and surgery.
If you are interested in learning more, contact me for a free 15 minute consultation to see if an Integrative Gynecology visit is right for you.
Best in health,