Estrogen is a key hormone influencing female reproduction, fat, cardiovascular health, bone turnover, and memory. A functional medicine approach to estrogen imbalance assesses and addresses gut bacteria involved with hormone metabolism, lifestyle and environmental exposures.
Three main forms of estrogen are needed in appropriate proportions at various life stages.
This less potent estrogen is mainly made in the ovaries before menopause. It can be converted into estradiol (and vice versa). Although total estrogens decline overall around menopause, estrone becomes the dominant circulating estrogen and is principally made in fat tissue postmenopausally.
Estradiol is the most potent estrogen during reproductive years in terms of absolute levels and impacts. It is the primary form produced in the ovaries before menopause and produced in smaller amounts by the adrenals and placenta.
Estradiol influences the development of female secondary sexual characteristics such as breasts, and fat distribution helps maintain reproductive tissues like the ovaries and lining of the uterus. It impacts endometriosis and fibroid development. It also supports bone growth, heart health, and memory.
This is the least potent and dominant estrogen during pregnancy since it is manufactured in high quantities by the placenta.
Estrogen Imbalance Signs & Symptoms
Different forms of estrogen interact, so overall balance determines impacts. (1) Hormone levels and proper metabolism and excretion modulate the risk of inflammatory, autoimmune, and chronic conditions.
The most common signs of imbalanced estrogen include:
- Bloating and digestive upset,
- Low libido
- Irregular periods
- Tender, swollen, or fibrocystic breasts
- Weight gain
- Hot flashes
- Mood swings
- Polycystic ovarian syndrome (PCOS).
Estrogen Imbalance Possible Causes
In addition to being made in the ovaries, adrenals, placenta, and fat tissue, estrogens are regulated by gut bacteria and obtained from environmental exposures. Liver health and genetics can also impact estrogen levels.
Poor Gut Health
The estrobolome is a collection of bacteria in the gut capable of metabolizing and modulating the body's circulating estrogen. Some of these bacteria produce beta-glucuronidase, an enzyme that helps reabsorb estrogen into the blood instead of being eliminated in the stool. Generally, the more beta-glucuronidase gut microbes produce, the less estrogen gets removed from the body, so more remains to exert influence.
Imbalances in gut bacteria lead to imbalances between the forms of estrogen that may promote estrogen-related symptoms. For example, women with endometriosis commonly have more beta-glucuronidase-producing bacteria, leading to higher estrogen levels in the blood, driving the growth of uterine tissue outside the uterus.
The balance of the estrobolome also influences PCOS. Imbalanced gut microbiota (5) alters how bacteria process hormones, contributing to the hormonal imbalances seen in women with PCOS.
Xenoestrogens are estrogen-mimicking compounds. These naturally-occurring plant compounds are similar to human estrogens. Some fiber-rich foods, such as seeds (particularly flaxseeds), grains, nuts, and soy, can act as phytoestrogens. Depending on the source and quantity, phytoestrogens can have health benefits, including improved bone and heart health and reduced menopausal symptoms, but others can contribute to imbalanced hormones.
Synthetic xenoestrogens in household products, including fragrances, pesticides, personal care products, and plastics, are absorbed by the body and stored in the liver and fat. They act additively with internal estrogens to disrupt hormonal balance.
Micronutrients are essential for sex hormone synthesis and metabolism, particularly during the age-related decline in the endocrine system. Previous research found that certain micronutrients, including vitamin D, vitamin E, vitamin A, lycopene, iron, magnesium, selenium, and zinc, are associated with androgen metabolism. Associations between estrogen and vitamins C, D, E, A, and carotenoids have also been found.
Functional Medicine Labs to Test for Estrogen Imbalance
Sex Hormone Panels
Saliva, serum, and urine tests can measure estrogens and other sex hormones. The DUTCH Complete dried urine test, Complete Hormones Panel, and Estrogen Elite Profile measure estrogen, progesterone, and androgen metabolites.
Urine testing measures the primary forms of estrogen and downstream estrogen metabolites, which are not routinely measured in blood or saliva. Urine metabolite concentrations measured by several spot tests show the same pattern as serum, offering an at-home collection option.
Liver Function Tests
Unused estrogen is primarily metabolized by the liver in processes that require vitamins and minerals to function. B vitamins (6), vitamin D, Magnesium influence the production and processing of estrogen.
Comprehensive Stool Test
Once the liver processes estrogen, it moves into the gut for further modification and elimination. When there is a healthier mix of bacteria in the gi tract, excess estrogen is more easily eliminated from the body via stool, so it does not lead to problems.
Several genes that impact the processing of estrogen can be assessed with a functional medicine genomic lab test.
Estrogen is metabolized in the liver to prepare it for elimination out of the body when it is no longer needed. This process involves enzymes known as cytochromes like CY1B1 (Cytochrome P450 1B1) and a cycle known as methylation that involves many processing steps involving MTHFR (Methylenetetrahydrofolate Reductase) and COMT that require vitamins B6, B12, and folate to metabolize estrogen. When all of these steps work well, unneeded estrogen can be safely excreted into the gut to be removed from the body.
Functional Medicine Treatment for Estrogen Imbalance
Estrogen balance is influenced by genetics, diet, alcohol, environmental exposures, lifestyle, and medications, especially antibiotics and hormonal contraceptives—most of these impact the estrobolome.
An individualized combination of diet, detoxification, and movement can encourage the restoration of a balanced estrobolome and estrogen levels.
Eat a Hormone Balancing Diet
Eating a more high-fiber whole foods diet creates greater bacterial diversity in the gut and a balanced estrobolome.
Including fermented foods like sauerkraut, kimchee, and kvass rebalances and increases bacterial diversity.
Prebiotic-rich foods containing fructooligosaccharides or inulin like chicory, asparagus, garlic, unpeeled raw carrots, and Jerusalem artichokes promote the growth of beneficial bacteria.
Probiotic strains, including Lactobacillus Plantarum and bifidobacteria species, decrease bacteria that produce beta-glucuronidase to help keep estrogen balanced.
High-fiber plant-based foods like nuts, seeds, legumes, beans, and various vegetables support healthy bacteria and lead to more balanced estrogen by keeping the bowels moving regularly to excrete extra estrogen.
Adequate quality protein is also essential for optimal liver detoxification.
Reducing alcohol and caffeine also balances hormones since these can burden the liver and disrupt estrogen metabolism.
Calcium-d-glucarate supplementation can also help support the excretion of excess estrogen since it inhibits beta-glucuronidase and allows more estrogen to leave the body in the stool.
Since manufactured xenoestrogens mimic natural estrogens and alter the microbiome, reducing exposure helps restore balanced hormones.
- Minimize plastic use, especially when heated
- Opt for non-chemical plant-based laundry and household cleaning products without synthetic fragrances
- Avoid phthalates, stearalkonium chloride, and parabens in personal care products
- Opt for organic food whenever possible
Regular moderate-intensity exercise helps keep estrogen levels balanced.
Estrogen is a crucial hormone for bones, mood, female characteristics, and sexual and reproductive function, but it must remain balanced.
The ratio of the three forms of estrogen – estrone (E1), estradiol (E2), estriol (E3), and their metabolites – determines impacts.
A full urine female hormone panel, including all forms of estrogen and other sex hormones, helps determine hormone balance. In addition, assessing liver function, levels of vitamins and minerals, relevant genomics, and gut health can help figure out why estrogen is out of balance.
A functional medicine approach to estrogen imbalance encourages a nutritious diet, balanced movement, targeted supplementation, and reduced toxicity to allow the body to restore the balance of gut bacteria in the estrobolome and estrogens in the body.