For as long as I have been in private practice helping women balance their hormones has been a very important focus of mine. Looking at the stats on my blog my estrogen dominance posts like Estrogen Dominance Examined, Taming Estrogen Dominance and Evolution and My Estrogen Dominance Protocol are the most requested Google search and those posts have the most questions and comments.
The long and short of it is, hormonal imbalance affects a great number of women. In fact, at some point in every woman’s lifetime they will experience some sort of “imbalance” whether it is puberty, PMS, premenopause or perimenopause. Not only estrogen but progesterone, DHEA and even testosterone are in a constant state of flux and, at times can be a delicate balancing act.
How does estrogen work and what exactly is estrogen dominance?
First let me say, estrogen in and of itself is not a “bad” hormone. Now that we got that out of the way, both estrogen and progesterone are the primary “sex” hormones for women. During the menstrual cycle estrogen is the “dominant” the first half of your cycle with progesterone being the “dominant” hormone in the last half the cycle. Estrogen peaks at ovulation and progesterone is released at the rupture of the follicle during ovulation.
Now here’s where it gets good. As the follicle ruptures there is a burst of testosterone that happens (around the time progesterone is released). This might be because Mother Nature needs to increase our libido (our desire for sex) so that we are exposed to sperm that can fertilize the follicle to, you guessed it, make a baby. Testosterone also increases right before menses which drives down the progesterone levels so that menses can occur if there is no pregnancy. (There is no such surge of testosterone if pregnancy occurs.)
This is a a delicate symphony that makes beautiful music when it is working well. Each hormone and the amount created works on a delicate feedback system with the hypothalamus and the pituitary in the brain which releases Follicle Stimulating Hormone (FSH) and Lutenizing Hormone (LH) the ovaries, and the adrenal glands. When something happens to disrupt that biofeedback loop (diet and lifestyle, prescription drugs, exposure to chemicals and, above all, stress) hormonal imbalance can occur.
Think about it this way. Estrogen is tissue building and progesterone encourages it to slough off by “opposing” estrogen’s effects, helping break down the metabolites in the second half of the cycle and encouraging estrogen to be eliminated from the system.
For the purpose of this article, estrogen levels do remain high during pregnancy which is a naturally estrogen dominant state.
With the advent of birth control pills, hormone replacement therapy, an ever increasing reliance on pesticides, plastics and stronger and stronger personal and home care along with the manufacturing by-products that go with them, our exposure to xenoestrogens have become problematic for both men and women in the last 30-40 years as well. Xenoestrogens are manmade chemicals that mimic hormones and disrupt endocrine function even with very minute concentrations.
Men and women are both exposed the xenoestrogens not only through the active exposure to these compounds but the passive exposure through our waterways and in our municipalities. Water treatment facilities were never equipped and still are not to filter the hormonal pollutants caused by the excretion of used hormones through our own elimination process. This has caused a buildup in our water supplies and an overflow into our lakes, streams and, inevitably, oceans.
Not so fun factoid: Women in underdeveloped countries have far lower levels of estrogen than women of developed nations (US, Canada and Europe, mainly though Japan, China and Korea are catching up slowly!). The argument as to whether or not the rise of breast, ovarian and uterine cancers, autoimmune disorders and infertility directly correlates with exposures to xenoestrogens is still debated hotly within the WHO, the NHS (in the UK), NIH (in the US) and the FDA (which are supported by the lobby groups of the manufacturers and pharmaceutical companies).
So where does that leave premenopause, perimenopause and menopause?
This one isn’t a one size fits all answer. Somewhere in premenopause, it is quite common for progesterone levels to fall and, sometimes estrogen levels fall with it. In perimenopause, going on that assumption, it is when doctors start to blanket HRT across the land.
Oh sorry, I went off on a tangent, didn’t I?
Now, here’s where it gets good. In the women where progesterone falls below that of estrogen levels (even if estrogen is low, progesterone would be lower still in these women) then the woman is in an estrogen dominant state and the simple answer would be to supplement with progesterone.
And it is, in many cases, effective. Or is it?
Where this assumption goes wrong is this. Many women don’t plummet in progesterone yet estrogen levels elevate due to external factors (or even physiological reasons like methylation pathways not being clear enough to metabolize estrogen which is made more problematic because of those external factors, or gut dysfunction which can make it difficult to properly eliminate used estrogen).
So what are the women whose progesterone levels are normal but their estrogen levels are high in relation to the ratio of estrogen to progesterone to do?
For those women I recommend focusing on changes that can normalize their estrogen or testosterone levels. The key here is having your estrogen checked in relation to progesterone. Most practitioners recommend Day 3 and Day 21 levels for estrogen and progesterone respectively. (In my practice I look at a few other key tests like DHEA levels and Prolactin along with FSH and LH ratios.)
Let me go on to say that starting in premenopause and marching into perimenopause estrogen levels do decline slightly but progesterone (which is manufactured in large amounts due to ovulation) falls rapidly because if you don’t ovulate or don’t rupture a follicle (hello PCOS!) then your progesterone levels cannot climb to oppose estrogen properly.
Unfortunately, “estrogen dominance” is an easy but oversimplified diagnosis. It sounds really good to be able to label what’s going on but what is really going on is the body is having difficulty maintaining hormonal balance. You are not simply estrogen and progesterone so to oversimplify it down to giving you progesterone, taking DIM, or Calcium D-Glucarate to lower estrogen levels is one of the major reasons women (and men) take these supplements and still have some major symptoms.
Many women I treat for PMS, and perimenopause don’t actually suffer from simple estrogen dominance but from a fundamental inability for the body to maintain hormonal balance. The factors are numerous, stemming from diet and lifestyle, chemical and pesticide exposure, and, of course, stress.
Hormonal balance is a complex issue. It’s not as simple as progesterone and and estrogen balance and, honestly, estrogen and progesterone are the tip of the iceberg when it comes to treating menopausal symptoms so many doctors and practitioners are bereft of the real knowledge of treating hormonal imbalance.
Even earlier in my career, I treated estrogen dominance very simply and time and time again I had to go back to the drawing board when I figured out that how I was treating wasn’t looking at the big picture. I was great at treating underlying symptoms but the hormonal imbalance was still present. When we started working with the whole picture of the hormonal canvas, including the biofeedback loop and working with the precursors to the hormones, looking at thyroid and adrenal health, the health of the liver and gut, and creating a complete treatment picture encompassing diet and lifestyle, supplements, and lifestyle consulting we were finally able to make quantum leaps in getting these clients on the path to real health.
Once again, the symptoms of hormonal imbalance are:
- Decreased sex drive
- Irregular or otherwise abnormal menstrual periods
- Bloating (water retention)
- Breast swelling and tenderness
- Fibrocystic breasts
- Headaches (especially premenstrually)
- Mood swings (most often irritability and depression)
- Weight and/or fat gain (particularly around the abdomen and hips)
- Cold hands and feet (a symptom of thyroid dysfunction)
- Hair loss
- Thyroid dysfunction
- Sluggish metabolism
- Foggy thinking, memory loss
- Trouble sleeping/insomnia
Hormonal imbalances including estrogen dominance have been associated with autoimmune disorders, infertility, thyroid disorders, allergies, breast, ovarian and uterine cancer, allergies, PCOS, ovarian cysts, accelerated aging, and increased risk of stroke (increased blood clotting).
Fortunately, hormonal imbalance doesn’t have to be a reality for you. Our EstroBalance E-Course begins on April 21st and in this you will learn to be the master of your hormones by getting a handle on which foods, supplements, herbs and lifestyle practices to support your health and aging and that of those you love.
If you are lucky enough to be a member of The Society, yearly, this course is my gift to you. If you desire to get quality real functional medicine and clinical nutrition information without the overhead of jumping to your doctor’s office, this course is for you!