Hormone levels are dictated by a delicate balance of internal and external factors that work to maintain health in both men and women. Estrogen is a hormone that is present in both genders, but women have higher levels. It is a chemical messenger that maintains the menstrual cycle, promotes bone mass, and aids in the process of puberty. The levels of estrogen, progesterone, and testosterone fluctuate and can become imbalanced. Estrogen dominance is a condition of increased estrogen relative to progesterone that can occur in females.

This article aims to describe the causes and symptoms of estrogen dominance as well as provide practical guidance for hormone rebalancing. 

[signup]

Understanding Estrogen Dominance

When estrogen levels become too high, the balance of progesterone is altered. This imbalance ratio can contribute to conditions such as cancer, endometriosis, fibroids, and polycystic ovarian syndrome (PCOS). High estrogen levels in males can cause changes to fertility, gynecomastia, and be a causal factor behind erectile dysfunction. 

There are three subtypes of estrogen, estrone (E1), estradiol (E2), and estriol (E3). Estradiol is present in the childbearing years, and estrone becomes the primary estrogen after menopause. Estriol levels are highest when a woman is pregnant. The body has two types of estrogen receptors, alpha, and beta, that have different roles and locations. Estrogen is metabolized (broken down) via two separate hydroxyesterone pathways. The pathway 2-hydroxyesterone promotes overall health and is associated with balanced estrogen and progesterone.

Estrogen dominance can be caused by several factors, including inadequate progesterone production. This leads to estrogen being unopposed in the body. High estrogen levels can also occur from medication (contraception), PCOS, and obesity. Adipose (fat) cells produce estrogen, which can cause a hormone imbalance. When high levels of stress are present, your body produces a hormone called cortisol. When high cortisol levels persist the body may produce less progesterone, leading to estrogen dominance.

The liver is the primary location of estrogen breakdown in the body. When it is not functioning properly estrogen breakdown is reduced, resulting in higher circulating estrogen levels. Alcohol intake can impair the metabolism of estrogen as well, increasing the risk for estrogen dominance. Environmental chemicals called xenoestrogens act as synthetic estrogen and cause a hormonal imbalance. These xenoestrogens include bisphenol A (BPA) and phthalates. 

Symptoms and Complications

Estrogen dominance can manifest in several ways, these are symptoms to be aware of if an imbalance is suspected:

• Irregular menstruation (timing and flow changes)
• Worsening premenstrual syndrome (PMS)
• Weight gain
• Sex drive decrease
• Dense breast tissue
• Acne
• Trouble sleeping
• Headaches

High estrogen levels are also associated with uterine fibroids, PCOS, endometriosis, tumors of the ovary, and endometrial polyps. 

If estrogen dominance is left untreated, it can contribute to the progression of uterine cancer, ovarian or adrenal tumors, insulin resistance, endometriosis, breast cancer, and ovarian cancer. Persistently high estrogen levels can contribute to infertility, weight gain, and the worsening of PMS.  

Diagnosis of Estrogen Dominance

Balanced estrogen levels can promote a healthy reproductive system and contribute to overall well-being. When symptoms of estrogen dominance are present and interfering with daily life, seeking a provider for testing and assessment is recommended. 

The three types of estrogen can be measured via a blood, urine, or saliva test. Testing can allow a provider to measure estrone (E1), estradiol (E2), and estriol (E3). 

Here are lab options for ordering on Rupa:

1. Serum (Blood) Testing:

• Estrone (E1) Serum Test - Access Med Labs
• Estradiol (E2) Serum Test - Access Med Labs
• Estrol (E3) Serum Test - Access Med Labs

2. Saliva Testing:

• Estradiol (E2) Saliva Test - ZRT Laboratory
• Saliva Hormone Opendx Supreme - Access Med Labs

3. Urine Testing:

• Essential Estrogens™ - 24 hr - Genova Diagnostics
• DUTCH Complete (Dried Urine) - Precision Analytical (DUTCH)

Progesterone and other hormone levels can also be measured via a blood test like Female Serum Hormones Advanced Profile by ZRT Laboratory to check for an imbalance. This test also includes markers for thyroid hormones, which may be indicated to test for depending on symptoms. 

[signup]

Treatment Options for Estrogen Dominance

A well-rounded treatment plan consists of nutritional changes, supplementations, and medical interventions, when necessary.

Lifestyle and Dietary Changes

Nutrition is an important aspect of balancing estrogen levels and preventing associated conditions. Some dietary interventions allow the body to break down estrogen and prevent high levels. It is important to promote the 2-hydroxyestrone pathway of estrogen metabolism through diet. Food and drink choices that help with appropriate estrogen metabolism are whole soy foods, flaxseed (these contain isoflavones), omega-3 fatty acids (fish, algae supplements, nuts, seeds), green tea, and cruciferous vegetables.

Broccoli, kale, cauliflower, and cabbage are examples of cruciferous vegetables that promote healthy hormone levels. An anti-inflammatory, plant-focused diet rich in fiber promotes a healthy microbiome and increases estrogen excretion in the feces. Reducing animal products and adopting a vegetarian diet can increase estrogen excretion. Avoiding excess sugar and processed foods that contain little fiber can help promote balance. 

Engaging in regular physical activity can help promote a healthy weight and reduce stress. Stress reduction improves overall well-being and prevents multiple types of hormone imbalances, including cortisol and estrogen. Because adipose tissue makes estrogen, reducing body weight to a healthy level through diet and exercise can promote balanced hormones. 

Reducing alcohol consumption can promote estrogen metabolism and a healthy liver. Limiting exposure to xenoestrogens in plastics and hormones can also assist in optimal estrogen levels. 

Supplements and Natural Remedies

There are several supplements available that can promote the balance of estrogen.

Chaste berry in supplement form is called Vitex and has been shown to rebalance estrogen and progesterone levels.

If the dietary intake of cruciferous vegetables is inadequate, indole-3-carbinol can be supplemented.

‍Ginger and turmeric can be helpful supplements as well as omega-3 fatty acids if intake is not meeting the recommended amounts.

Prebiotics and probiotics can address gut dysbiosis if present.

Additionally, calcium-d-glucarate increases the fecal excretion of estrogen. It is important to consult with a provider before starting any supplement regimen to ensure correct dosages and product choices. 

Medical Treatments

Treatment for hormone imbalances may include contraception if pregnancy is not desired. While hormonal birth control can help balance hormones, it is important to consult a provider about the best approach.

Adjustments to current medications may also be necessary if they are promoting a hormone imbalance. It is important to identify the root cause of estrogen dominance when possible. If necessary, a provider may recommend healthy weight loss to treat estrogen dominance. 

Preventing Estrogen Dominance

Preventing imbalanced estrogen is a holistic approach that encompasses nutrition, stress relief, sleep, and physical activity. Adopting a healthy diet that promotes healthy fats, vegetables, fruits, whole grains, and whole soy products, and limits alcohol, sugar, and animal products is a vital aspect of preventing estrogen dominance. Supplements can be used when necessary and should be used in conjunction with nutrition. Sleep, physical activity, and mindfulness all reduce stress and promote balance throughout the body. All of these interventions can help prevent estrogen dominance.

Routine preventative care with a medical provider is important for many reasons, including taking a proactive approach to hormone health. Regular check-ups can help monitor for symptoms of estrogen dominance before the condition progresses. 

Frequently Asked Questions (FAQs)

#1. What impact does elevated estrogen have on behavior? 

Estrogen dominance can impact mood, especially related to fluctuations in the menstrual cycle. Increased irritability and severe premenstrual syndrome can occur, causing mood swings and behavior changes.

#2. What indications are there of excess estrogen in males? 

Males can experience high levels of estrogen and there are several symptoms of an imbalance. Infertility can occur, as well as erectile dysfunction and gynecomastia. Gynecomastia is a condition where males develop excess breast tissue.  

#3. What are the signs of too much estrogen in females?

Clinical manifestations of excess estrogen in women can include changes to the menstrual cycle, weight gain, low libido, migraines, insomnia, and dense breast tissue.

#4. Is elevated estrogen a sign of pregnancy? 

Higher levels of estrogen can indicate pregnancy, but not always. It is important to consult a provider for pregnancy testing and to discuss a possible hormone imbalance.

[signup]

Key Takeaways

Estrogen is vital for the reproductive function of both men and women and promotes fertility, bone density, and overall well-being.

Keeping estrogen balanced involves a holistic approach to diet, exercise, supplementation, microbiome balance, and mental well-being.

‍Prevention is important for hormone health: if an imbalance is suspected consulting a provider can help identify a cause and provide customized treatment.