To sum up what estrogen dominance feels like I want to tell you about my patient, Denise.  Denise was a 36-year-old mom of 2, married SAHM. She came to see me because she was feeling awful and was tired of trying multiple birth control pills for her symptoms.  Especially considering her husband had a vasectomy, they didn’t need a form of birth control. Denise was puffy all the time. She had multiple sizes in her closet and wore lots of skirts because of her daily weight changes.  

She told me, ‘I have never had a stomach, and now I have a gut!’  Diane had long heavy periods, and she would plan her vacations around her periods.  She always felt melancholy and nostalgic, but in an instant get mad over nothing. Denise could not sleep through the night.  She would keep a notebook by her bed to write the worried-middle-of-the-night thoughts in. And she often could be found watching TV at 2:30 am.  She said her mom had a hysterectomy at her age and her old sister just had a total hysterectomy recently.

Her gynecologist tried her on multiple birth control pills.  Denise had also tried a hormonal IUD, which made her symptoms worse and she had to have it removed. At his wit’s end, her gynecologist wanted to do a hysterectomy and suggested she see a psychiatrist.  She said her doctor never tested her hormones and she felt like they were way off. I had Denise do a blood test for me on day 21 of her cycle. Day 21 is when the progesterone should be the highest in a 28-day menstrual cycle.  Denise had high levels of estrogen and non-existent levels of progesterone. Denise had estrogen dominance.

Symptoms of Estrogen Dominance:

• Weight gain/belly fat: I get this question all the time. “Does estrogen dominance cause belly fat?”.  Absolutely!
• Puffy water weight:  Weight changes on a daily basis.  
• Moody:  Estrogen dominance women are more weepy and nostalgic.  They worry a lot about things they cannot control. Denise described it as, “ I am sad and worried all the time.”
• Easily irritable:  While women with estrogen dominance are more sad and worried, they can get cranky for no reason.  Then they feel sad and guilty for being so irritated.
• Breast tenderness:  Women with estrogen dominance will have full, tender breasts 7-14 days before their period.  Some women cannot even wear a bra at this time. Estrogen causes a lot of water weight. This is why you see weight changes, puffiness, and breast tenderness.
• Heavy periods:  Estrogen loves to ‘grow things.’  If you have estrogen dominance, then the uterine lining will thicken up so much that there is heavy, long periods with a lot of clots.
• Fibroids, polyps:  As mentioned above, estrogen likes to ‘grow things.’  Polyps and fibroids are exacerbated and grow larger in the presence of high levels of estrogen.
• Fatigue: Estrogen itself does not make you tired.  But the symptoms of estrogen dominance can cause fatigue.  Such as sugar cravings, sleep issues, low iron from heavy periods, water weight and mood swings.
• Hungry/Cravings:  Estrogen does increase cravings for sugar, salt, and refined carbohydrates.  Estrogen dominance can make your appetite increase and increase cravings.
• Sleep issues: Estrogen dominance can cause trouble staying asleep and waking multiple times in the night.
     

Who does estrogen dominance happen to? 

Estrogen dominance can happen to women of all ages, but you mainly see it in females 35 to 45 years old.    

Teenage girls: When a girl first gets her period, she is not producing much progesterone.  This creates an imbalance of lower progesterone to higher estrogen ratio. It usually takes 2-5 years for the estrogen and progesterone to balance each other.   

Perimenopause: During perimenopause, the hormones start to decline.  In some females, their estrogen does not decline, but their progesterone drops considerably.  This drop in progesterone creates estrogen dominance symptoms. Note: it is not possible to be estrogen dominant when in menopause. 

Men: Estrogen dominance is not common in men.  But you do see it in men receiving testosterone replacement therapy.  The testosterone molecule is almost identical structure to estradiol. In testosterone replacement therapy, you can see testosterone converting to high levels of estrogen in some men depending on lifestyle habits and dose and type of testosterone being replaced.  It is common to give a man an estrogen-blocker to stop this conversion of testosterone to estrogen in Low-T replacement. Other medications and drugs can cause estrogen dominance in men.

What Causes Estrogen Dominance? 

Processed Food: High glycemic foods will cause estrogen dominance.  When your blood sugar goes up, it causes your insulin to soar.  I don’t want to bore you here with the biology. So try not to yawn too much here, but higher levels of insulin will raise your estrogen. In nature, animals would get carbohydrates during the summer when food is growing plentiful with long hours of light.  This signals reproduction, which is why animals mate in fall. This is why males have more testosterone in the late summer, early fall.  Now in our “nature,” we live in a perpetual state of “summer.” Long hours of light (thank you, Thomas Edison!) and lots of high glycemic foods (hello refined carbs!).  While in our bodies this doesn’t increase our fertility. But this does make our bellies grow and increase the likelihood of estrogen dominance.

Stress and Cortisol: High levels of stress raise our cortisol. The job of cortisol is to mobilize glucose, which in turn makes our insulin rise.  High levels of stress can also inhibit ovulation and drop progesterone, Pushing us further toward a state of estrogen dominance.  

Genetics: Some women are more prone to estrogen dominance.  They genetically inherit the ability to make more estrogen.  Which is not a ‘bad thing.’ Estrogen is the best hormone in the world.  But not properly balanced or letting estrogen lead the show will cause symptoms of estrogen dominance.  Adding in high glycemic foods, stress (physical and mental) and a burdened liver can exacerbate the probability of estrogen dominance.   

Liver Function: The liver detoxifies and metabolizes every chemical we come into contact with in our environment.  If there is a burden on the liver from the environment or what we put in our mouths, then it is distracted and cannot properly metabolize estrogen, which causes higher levels of 2OH-estrone, 4OH estrone and 16 alpha OH estrone.  Elevated levels of 4-OH estrone and 16 alpha OH estrone are unhealthy and increase the risk for breast and reproductive cancers.

Obesity: We always hear about hormones that are secreted by the endocrine system.  The system involving the thyroid, pancreas, adrenals and testes/ovaries. But did you know that our fat cells (adipose tissue) secretes hormones and proteins too?  One of the hormones our fat cells secrete is estrogen, in particular, estrone. Therefore, having a large number of fat cells means more estrone, contributing to estrogen dominance.  

Hormone Therapies: Hormone replacement, hormone treatments, birth control pills can contribute to estrogen dominance.  If the dosing has a higher estrogen to progesterone ratio (a high dose of estrogen), this can cause estrogen dominance.  Also, removal of hormonal IUDs can cause a crash in progesterone. There is a common term referred to as the ‘Mirena Crash.’  After removal of a hormonal IUD, the ovaries will start making estrogen. But in some women, there is a delay in the production of progesterone creating estrogen dominance and a lot of symptoms of low progesterone.  

How to Overcome Estrogen Dominance? 

Improve Liver Function: Let’s love our liver and help it process better. I like to use a liver supplement meant to help the liver detoxify and process metabolites better: Liver GI Detox: take two capsules a day for at least a year to help with estrogen dominance.

Reduce and Balance Estrogen Metabolites: Remember yawning when I was talking about estrogen metabolites above?  Stay with me here. One of the best ways to overcome estrogen dominance is to reduce 16 alpha OH-estrone and 4-OH estrone.  While at the same time, increasing 2-OH estrone, which is a very unhealthy estrogen metabolite. Having high levels of 4-OH estrone causes estrogen dominance symptoms and also puts you at a higher risk of developing breast cancer.  16-OH estrone is not as bad as 4-OH estrone, but it is better to have lower levels of this metabolite to minimize estrogen dominance. 2-OH estrone is the more beneficial estrogen metabolite. So the goal here is to keep higher levels of 2-OH-estrone and lower levels of 4 OH estrone and low levels of 16 alpha OH estrone. The best way to do this is to take diindolylmethane/indole-3-carbinol.  I could not pronounce this if my life depending on it, so we call it DIM.  Taking DIM can help estrogen dominance. Not all DIM products are the same dose, ingredients, and quality.  I like EstroDim by Ortho Molecular Products. 

Diet / Lifestyle: We all know that diet is important. We all know that we need to lose weight, eat healthier foods and overall less sugar.  But sometimes it is hard to do this without help. That is why we developed the KCCP (keto-carb-cycling-program).  It is free to download. And it helps estrogen dominance by:

• Reducing/balancing insulin
• Reducing/balancing cortisol
• Balancing glucose
• Lose belly fat
• Reduce cravings
• Supports the liver detoxification process

Progesterone: Raising levels of progesterone will help estrogen dominance.  Progesterone can rein in the negative effects of estrogen. Progesterone can help with hormonal weight gain, mood (especially irritability), cravings, heavy periods and sleep.  How do we raise progesterone levels? Well, you can take micronized bioidentical progesterone. This is a prescription from your naturopathic or functional medicine doctor.  Perhaps you do not have excess to a doctor that can prescribe bioidentical progesterone or you are not a candidate.  Then you can raise progesterone by taking vitex. Vitex is a herb that raises luteinizing hormone, which increases your bodies ability to make progesterone.  

Sleep: Sleep is not only crucial to for our well being, but it is necessary to our overall health.  I do not advocate sleeping pills because they are addictive and cause next day grogginess. Not to mention, we might get an important phone call, your kids need you, or you have to drive a car in the middle of the night.  You cannot do this on a sleeping pill. Estrogen dominance can cause cortisol to rise at night. This causes waking in the middle of the night. I find by raising levels of GABA naturally helps reduce the cortisol at night for sleep.  GABA is a large molecule and not easily absorbed. I like to use the precursor to GABA called 4-amino-3-phenyl butyric acid before bed. 4-amino-3-phenyl butyric acid is easily absorbed and will cross the blood-brain barrier to help you stay asleep.  But if you needed to wake up in the middle of the night, that is not a problem. And it will not make you tired in the morning. I like the product Kavinace, 1-3 capsules before bed. 

Remember Denise and her symptoms of estrogen dominance? This tendency toward estrogen dominance ran in Denise’s family. But her diet, which was low fat, high carbohydrate exacerbated her symptoms. Denise spent a lot of time worried and stressing about things in her life that she could not control.  This raised her cortisol which further exacerbated her estrogen dominance.

Denise changed her diet by incorporating our KCCP and lost 15 pounds. She started sleeping better and worked on her liver function.  Denise was a good candidate for progesterone. Taking progesterone day 14 of her cycle to her period helped balance her estrogen. This also helped her mood and her tendency to worry. Her periods lightened up after four months, and she did not need a hysterectomy.           

There is so much more I could go into on estrogen dominance, but I hope this was helpful to you.  If you have any questions, please feel free to leave a comment below or send an email to [email protected]