Estrogen dominance is a common hormonal imbalance in industrialized countries that plays a role in PMS, endometriosis, polycystic ovary syndrome (PCOS), cystic breast disease, uterine fibroids, and breast cancer in women. In men, it contributes to larger hips, male breasts, crying, low testosterone, and more.
Estrogen clearance is the body’s ability to break down estrogens and remove them from the body. Estrogen clearance is critically important as estrogens that are not properly metabolized and cleared by the liver remain in the body and become highly toxic.
The good news is estrogen levels in our bodies can be reduced by following a protocol that supports proper hormone levels and clearance of excess estrogen from the body.
Signs and symptoms of estrogen dominance
Estrogen dominance can be determined by elevated levels of estrogen, by an imbalanced progesterone/estrogen ratio in women, or by imbalanced testosterone/estrogen ratios in men.
Common symptoms of estrogen dominance include:
- Thyroid dysfunction
- Decreased sex drive
- Irregular or abnormal menstrual periods
- Breast swelling and tenderness
- Fibrocystic breasts
- Brain fog
- Weight and/or fat gain (particularly around the abdomen and hips)
- Irritability and depression
- Headaches (especially with PMS)
- Sluggish metabolism
Men may experience some of the above symptoms, as well as:
- Larger hips
- Male breasts
- Crying fits
- Low testosterone
Factors that contribute to estrogen dominance
In the modern western lifestyle, many factors exist that contribute to both estrogen dominance and impaired estrogen clearance.
Common causes of estrogen dominance include:
- Chronic stress
- Poor diet and digestive function
- Lack of exercise
- Birth control pills
- Inappropriate hormone replacement therapy
- Environmental estrogens
Stress plays a role in estrogen dominance in both women and men. The adrenal glands are fundamental to our ability to handle stress. Prolonged, elevated cortisol (typically caused by chronic stress) runs down the liver’s ability to detoxify discarded estrogens.
Chronic stress can also lead to a depletion of progesterone via a process called “pregnenolone steal,” in which the precursor hormone pregnenolone is shunted from sex hormone production to make more stress hormone. This particularly affects progesterone in women, causing symptoms of estrogen dominance. Supporting the body’s stress handling mechanisms can help reverse pregnenolone steal.
Balancing excessive estrogen requires removing and reducing sources of stress, which includes chronic inflammation, undiagnosed autoimmunity, leaky gut, chronic infection. The most common cause of stress we see in people are blood sugar imbalances. You can read more here about how to support your adrenals’ response to stress.
Body fat and estrogen
Estrogen is stored in body fat. If you lose weight, it’s important to make sure your body can clear estrogen — the fat loss will release stored estrogen into the bloodstream, causing temporary estrogen dominance.
When it comes to estrogen dominance, excess body fat is of particular concern to men as aromatase, an enzyme stored in body fat called, turns testosterone into estrogen. Excess fat raises aromatase levels and conversion of testosterone to estrogen.
Estrogen dominance symptoms in men appear as larger hips, male breasts, crying, and drops in testosterone levels. As with women, fat loss releases stored estrogen into his bloodstream, exacerbating symptoms of male estrogen dominance.
Men with inflammation who are on testosterone therapy may see an increase in estrogen levels if these mechanisms are activated.
Poor diet and digestive function
The Standard American Diet (SAD) consists of unhealthy fats, and too many sugars, refined carbohydrates, and caffeine, paired with not enough healthy fats, protein and plant-based foods. In addition, standard dietary habits of skipping breakfast, having sugar and caffeine-laden snacks, and bad meal timing affect blood sugar balance, which profoundly affects the adrenals’ ability to cope with stress. This creates a perfect recipe for estrogen dominance.
When imbalances in the gut biome and poor digestion prevent the body from successfully eliminating unnecessary estrogen, toxic levels of this powerful hormone build. An anti-inflammatory diet that promotes gut health is key for improving estrogen clearance.
Lack of exercise
Regular exercise aids in estrogen clearance in multiple ways; it improves the body’s metabolism and storage of fats, it helps to balance blood sugar levels (assisting the adrenals’ ability to cope with stress), and in studies has been shown to lower risk of breast cancer. Additional benefits abound, including reduction of depression, weight loss, improved digestion, increased energy, and more.
Estrogen hormone given in hormone replacement therapy
The conventional medical model tends to skip directly to estrogen-only hormone supplementation, without adding in progesterone, and without considering any of the causative factors. This is rarely the proper path to take, and commonly leads to excess estrogen. If you are considering estrogen replacement, please consult with a healthcare practitioner who is up to date on the use of bioidentical hormone replacement therapies.
A note on hormone replacement therapy:
I am very reluctant to use bioidentical hormone replacement for hormonal deficiencies without first investigating underlying mechanisms. I prefer to discover the cause for the deficiency, such as poor adrenal function, and address that.
However, due to the importance of estrogen for brain function, if a perimenopausal or postmenopausal woman is unable to resolve her estrogen deficiencies through functional medicine, I feel bioidentical hormone replacement is warranted. In this case, it’s important to use natural, bioidentical hormones instead of synthetic, because the bioidentical hormones show up on lab tests (synthetic do not) so they can be monitored.
Excessive environmental estrogens
Our world is full of estrogens and chemicals that mimic their behavior in our bodies.
Constant exposure to these estrogenic compounds in the air, water, and surfaces we touch has a profound effect on the body’s ability to and clear estrogen properly.
Regardless of whether you have estrogen dominance, it’s important to minimize your exposure to environmental estrogens. This is especially important for children.
Common sources of environmental estrogens to avoid:
- Plastics, especially when exposed to heat or acid (i.e., hot food in plastic containers and acidic soda and juice in plastic bottles).
- Nail polish and polish removers (solvents)
- Fabric softeners (petrochemicals)
- Most perfumes (petrochemicals)
- Surfactants found in many condoms and contraceptive gels
- Exposure to new carpet and certain flooring and fiberboard (noxious fumes)
- Noxious gases from copiers and printers
- Home use of all pesticides, herbicides, and fungicides
Estrogen and thyroid function: a two-way street
Too much estrogen creates excess thyroid binding globulin proteins (TBG), the transport protein that carries thyroid hormones through the bloodstream. Thyroid hormone in the bloodstream binds to excess TBG. As a result, not enough thyroid hormone is available for the body’s cells, resulting in hypothyroid symptoms.
Thyroid dysfunction also affects the body’s ability to produce proper amounts of estrogen and progesterone. In my thyroid book I talk at length about this relationship.
Liver detox is critical for estrogen clearance
Estrogen must first be made water soluble to be eliminated from the body via sweat, urine, or feces. This happens via the Phase I and Phase II pathways in the liver.
Phase I pathway
A fat-soluble compound enters the liver, and the Phase I pathway changes its structure in order to prepare it for removal from the body.
Phase II pathway
In Phase II, molecules are added to the compound so it can be eliminated from the body safely.
Inefficient Phase I and Phase II detox pathways in the liver result in compounds remaining in the body. As a result, estrogen circulates back into the bloodstream in a more toxic form, and becomes overly abundant.
Liver support for estrogen clearance
Nutritional compounds to improve Phase I and II liver detoxification include molybdenum chelate, milk thistle extract seed, dandelion root, gotu kola nut, panax ginseng, L-glutathione, glycine, N-acetyl-L-cysteine, and DL-methionine.
Nutritional compounds to support healthy bile formation, secretion, and flow include dandelion root, milk thistle seed, ginger, taurine, beet concentrate, vitamin C, and phosphatidylcholine.
Nutritional compounds to support healthy methylation reactions include choline, trimethylglycine, MSM, beetroot, and betaine HCl. Please work with a qualified healthcare practitioner to safely and correctly use these nutrients in the right amounts.
Nutritional compounds to optimize estrogen metabolism and receptor site response
These nutrients are recommended for healthy estrogen balance in both women and men. In my thyroid book I write at length about these compounds and how they interact with the body:
- Pyridoxal-5-Phosphate (the most active for of vitamin B6)
- Black Cohosh (Cimicifuga racemosa)
- Dong Quai (Angelica sinensis)
- Methylation cofactors
- Glycyrrhizin and lignins