Being a woman is hard. The last thing we all want to deal with is estrogen dominance. This imbalance in hormones may explain why some women experience irregular periods, bloating and unexplained weight gain, all of which are not normal. Our hormones are always fluctuating, but having an imbalance in our sex hormones can cause some of these issues. To make things worse, if you have an autoimmune disease, keeping your hormones in balance can help prevent flares and keep inflammation away.
What is estrogen dominance?
The two major female sex hormones are estrogen and progesterone. There needs to be a delicate balance between these hormones for the female reproductive system to work. Estrogen dominance is when there is an elevated estrogen level as compared to progesterone. There can be a few reasons why this happens:
The body overproduces estrogen
Hormone replacement therapy or birth control may cause excess estrogen production. Additionally, having excess body fat can increase estrogen production.
Inefficient estrogen excretion
Estrogen excretion is complicated. It relies on several body systems to work properly. First, estrogen is broken into 2 major metabolites: 2-hydroxyestrone and 16-hydroxyestrone. The preferred pathway is 2-hydroxyestrone. The metabolites help block cancer and abnormal cell growth. On the other hand, high 16-hydroxyestrone metabolites have been linked to inflammation, obesity, and hypothyroidism.
Second, estrogen breakdown is a two step process that happens in the liver. The first phase changes the structure of estrogen and phase 2 attaches molecules to it to remove it from the body. Phase 1 is usually very efficient. Phase 2 can be slower, especially if the liver is overloaded. If this happens, partially metabolized estrogen is reabsorbed and recirculated in the body.
Lastly, estrogen metabolites are carried to the large intestine for removal. However, estrogen will be reabsorbed if the gut is compromised or has bacterial overgrowth.
Progesterone levels are too low
It is not always about estrogen. Progesterone levels also need to be robust to prevent estrogen dominance. This hormone has anti-inflammatory properties, so it is important that the body is producing enough. Stress affects progesterone levels. Chronic stress forces the body to constantly produce cortisol. Progesterone needs cortisol for creation. Therefore, progesterone levels will drop if all of the cortisol is being directed to support the stress response.
What are the symptoms?
Estrogen dominance can rear its ugly head in a variety of ways. Below are the most common symptoms of this imbalance.
- Mood swings
- Decreased sex drive
- Exaggerated PMS symptoms
- Irregular periods
- Bloating and/or water retention
- Unexplained weight gain
- Hair loss
- Insomnia and/or trouble sleeping
- Fertility issues
- Brain fog
- Hot flashes and night sweats
How do we know if we have estrogen dominance?
Testing estrogen and progesterone levels is the best way to be sure that you have estrogen dominance. Blood, urine or saliva tests are used to measure these hormones. It’s important to note that the timing of the test is very important to accurately measure the hormone ratio. The best time to capture this ratio is 5-7 days after ovulation. For women with a “normal” 28-day cycle, this is around day 19-22 of your cycle (counting from your period beginning on day 1). Also, progesterone levels typically peak during this time frame.
Many functional practitioners use a DUTCH test which is an at-home saliva and urine test. This test also measures other hormones such as cortisol, testosterone and DHEA which can give you a more complete picture of the underlying issue.
How is it related to autoimmune disease?
Estrogen levels can either be protective or inflammatory when it comes to autoimmune conditions. Different diseases are affected by either an increase or drop in estrogen levels, depending on the underlying inflammatory mechanism. In fact, it comes down to which immune response is dominant in the disease.
When it comes to adaptive immunity (or acquired immunity), helper T cells are the most important. There are two different types of helper T cells, Th1 and Th2. Each of these helper T cells secrete different cytokines to stimulate antibodies to attack the invading antigen (1). Under normal conditions, both Th1 and Th2 help in an immune response.
However, in autoimmune disease, there is an imbalance between the Th1 and Th2 response. Conditions like multiple sclerosis, inflammatory bowel disease and rheumatoid arthritis are Th1 dominant, whereas systemic lupus erythematosus (SLE) and Sjogren’s syndrome are Th2 dominant (2,3).
Estrogen and progesterone levels affect these diseases differently based on which T helper cell is dominant. You can read more about how these diseases are affected by hormones in my recent blog post.
What can we do to reverse estrogen dominance?
There are a number of strategies that use both diet and lifestyle to help rebalance these hormones. It really comes down to getting the body more balanced on a system-wide level that includes specific organs and the endocrine system. However, there is no one specific fix to estrogen dominance. Treating estrogen dominance requires a full body assessment to get your hormone levels back on track.
Switch to an anti-inflammatory diet
Removing inflammatory foods is key for balancing out hormones. Inflammation exacerbates hormone imbalance. The best place to start is removing added sugars and processed foods. From there, you can see if other common inflammatory foods affect you. Some of these include gluten, dairy, nightshades, grains, eggs, soy and even nuts and seeds.
Include foods to support your liver
The liver is the main organ for estrogen metabolism. If your liver is overloaded or sluggish, estrogen will not be efficiently removed from your body. One of the best foods to support your liver are cruciferous vegetables. Cruciferous vegetables include cabbage, broccoli, cauliflower and brussel sprouts contain glucosinolates which have been shown to increase phase 2 metabolism in the liver (4).
Increase your fiber consumption
Fiber helps excrete estrogen from your body. Eating a high fiber diet can actually help lower circulating estrogen (5). In fact, switching to an anti-inflammatory diet, fiber intake will naturally increase. This is because fiber is found in whole foods like vegetables, fruits, and whole grains. Adding flaxseeds or chia seeds to salads, yogurt, smoothies or breakfast cereal is an easy way to sneak in more fiber. Also, remember to increase your water intake as you are increasing fiber. Too much fiber blocks up your colon if you are not adequately hydrated.
Cut out alcohol
The last dietary tip is cutting back on alcohol. Alcohol metabolism mainly occurs in the liver. And based on the above, the liver is essential for removing estrogen from the body. When you drink alcohol, every metabolic process in your body stops and focuses its attention on getting alcohol out of your body. So, the less alcohol you drink, the more estrogen your liver can process.
Moving your body is essential for reducing inflammation. Moderate exercise can help reduce stress, which lowers cortisol. Also, progesterone production relies on cortisol. So, less stress can redirect cortisol to progesterone production. In addition, lowering excess body fat can also help lower estrogen production.
Get your stress under control
More stress equals more cortisol. Less progesterone is made when your body has higher cortisol needs. Additionally, cortisol also raises your blood sugar and can lead to insulin resistance. Insulin resistance encourages your body to store more energy as fat. Also, excess fat increases estrogen production. This entire chain of events can be rebalanced to stabilize hormones when less stress is present.
Clean up your life by avoiding xenoestrogens
Xenoestrogens are a type of endocrine disrupting chemical. They mimic estrogen and bind to estrogen receptors. This blocks estrogen from doing its job and increases circulating estrogen in your body. We find xenoestrogens in plastics, pesticides, tap water and beauty products. Specifically, common xenoestrogens are parabens, phthalates and triclosan. Check your product labels and use the Environmental Working Group’s Health Living App to see how safe your products are and what products might be better for you to use.
Please reach out to a qualified health professional if you think you may have estrogen dominance. You can also contact me if you need help implementing any of these dietary or lifestyle changes. Being a women is a privilege and we should not have to live with these unpleasant effects of hormonal imbalance.