Estrogen Dominance - What is it & What are the Signs?

What is estrogen dominance? 

Estrogen dominance, although not an official medical diagnosis, is one of the most common hormone imbalances that reproductive-aged (aka premenopausal) women experience. It is specifically an imbalance between estrogen and progesterone levels, when estrogen is too high relative to progesterone in the luteal phase (or second half) of the cycle. 

Estrogen dominance is an umbrella term for several different possible lab patterns (and symptom presentations) of estrogen and progesterone levels:

• High estrogen and low progesterone

• Normal estrogen and low progesterone

• High estrogen and normal progesterone 

• Normal estrogen/progesterone but low estrogen:progesterone ratio 

Generally, estrogen dominance is considered to be when estrogen is too high and/or progesterone is too low. While this is true, you can see that estrogen doesn’t necessarily always need to be high nor does progesterone necessarily always need to be low, in order to be in a state of estrogen dominance (or for it to be causing problems). When estrogen dominance is due to low progesterone, it's known as luteal phase defect/deficiency (LPD).

What is the importance of estrogen and progesterone? 

Estrogen and progesterone are primary hormones in the female body and each plays its own incredibly profound role throughout our fertile years. In this blog we will focus on their role as co-stars in the elaborate production of the menstrual cycle. Progesterone and estrogen are like yin and yang, respectively, as they work synergistically with one another and have opposing yet complementary actions. Sufficient estrogen levels in the follicular phase (or first half) of the cycle promote sufficient levels of progesterone in the luteal phase (or second half of the cycle) – because progesterone only rises if ovulation occurs, and peak estrogen is what triggers ovulation. Therefore, estrogen levels fluctuate throughout the entire menstrual cycle, whereas progesterone levels rise only in the luteal phase (or second half) of the cycle. 

The purpose of the menstrual cycle is to prepare the body for pregnancy each month by perfecting the uterine lining for fertilization – simply put, estrogen builds the uterine lining in the first half of the cycle and progesterone sustains it in the second half of the cycle. It’s often described as estrogen being the bricks and progesterone being the mortar. Estrogen stimulates growth of tissues, like the breasts and uterus, while progesterone downregulates estrogen’s effects, protecting these tissues from overgrowth. There should always be enough progesterone to buffer and balance estrogen in the luteal phase (or second half) of the cycle. Thus, healthy estrogen and progesterone levels are essential in protecting against the development of estrogen-dominant related symptoms as well as conditions and complications (listed below).

What are the signs and symptoms of estrogen dominance?

Estrogen dominant related signs & symptoms 

• Acne

• Bloating

• Weight gain

• Mood swings

• Irregular cycles

• Heavy/painful periods 

• Migraines/headaches

• Gallbladder problems 

• Diarrhea/constipation

• Low stress resilience 

• Depression/anxiety

• Breast tenderness

• Fatigue/brain fog

• Fertility problems 

• Varicose veins

• Food cravings

• Low libido 

• Insomnia

• These signs and symptoms typically occur cyclically in and around the luteal phase (or second half) of the cycle.

Estrogen dominant related conditions & complications 

• Premenstrual syndrome (PMS) / premenstrual dysphoric disorder (PMDD) 

• Polycystic ovary syndrome (PCOS)

• Endometriosis

• Uterine fibroids

• Ovarian cysts

• Fibrocystic breasts

• Estrogen dependent cancers of the breast, ovaries, and uterus

• These conditions and complications occur overtime and usually involve other causative or contributing factors. 

As you can see, estrogen dominance doesn't just affect the way you feel in the short-term but can increase the risk of developing serious diseases in the long-term, and therefore should not be underestimated. None of these signs, symptoms, conditions, or complications are normal, even though you may have become used to them or they may have been brushed off by the doctors you’ve seen. They should always be evaluated and treated by a specialist who is well-versed in this area of hormone imbalance.

What is the workup for estrogen dominance?

The workup for estrogen dominance includes a medical history (identifying likely causes and symptoms of estrogen dominance) and lab testing (testing hormones at a specific time in the menstrual cycle). 

Gynecological screenings, including PAP smears, pelvic exams, breast exams, and mammograms/transvaginal ultrasounds (if indicated), are vital to stay up to date with for early screening and prevention of estrogen dominant related conditions and complications.

Functional lab testing is an amazing tool for looking deeper – for example, a comprehensive stool analysis can assess how your gut function may be potentiating excess estrogen levels, an adrenal stress test can assess how adrenal function may be depleting progesterone levels, and a urinary hormone test can assess how your liver function is breaking down estrogen (into either healthy or harmful metabolites). 

Treatment should always be individualized to every woman based on all of the information from the above workups as well as on the underlying cause(s) of estrogen dominance.

Summary

Estrogen dominance is a very common hormone imbalance in cycling women that can have profoundly negative effects on quality of life and disease risk. It can be evaluated simply with a consultation and lab testing and it can be managed successfully with non-invasive interventions that target the underlying causes. ANAMARIA Natural Medicine is a functional and naturopathic clinic dedicated to helping women blossom into abundant health by addressing health and hormone imbalances at their root using natural, evidence-based, and wholistic approaches. For personalized care, get started by scheduling a free discovery call.

Written by Dr. Jordan Valdez, ND, RD

Contact Information: (Telemedicine Only)

Social: @anamaria.naturalmedicine

Email: connect@anamarianaturalmedicine.com 

Website: www.anamarianaturalmedicine.com

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