A Naturopathic Guide to Estrogen Dominance: Take Our Estrogen Dominance Quiz
Estrogen dominance is a common cause of hormone imbalance that’s widely overlooked or misdiagnosed. Many women are given a prescription for birth control for their hormonal concerns but, unfortunately, not given any further answers.
For more answers, this article will offer a deep dive into the hormone imbalance called estrogen dominance, including an estrogen dominance quiz.
What is Estrogen Dominance
Estrogen Dominance Quiz
Types of Estrogen: Estrone, Estradiol and Estriol
Estrogen and Progesterone Balance
What Causes Estrogen Dominance
Case Study: Avoiding Surgery - Estrogen Dominance and Endometriosis
Diagnosing Estrogen Dominance with DUTCH Hormone Testing
BBT Cycle Tracking
How to Reduce Excess Estrogen
How to Treat Estrogen Dominance
What is Estrogen Dominance
Elevated estrogen levels in the body can cause estrogen dominance, but you can also have estrogen dominance with normal estrogen levels when you don’t have enough progesterone to balance the amount of estrogen. When it comes to women’s hormones and reproductive health, we are rarely talking about individual hormones in a vacuum, but rather in relation to each other. Neither estrogen or progesterone are bad on their own. They both serve very important roles in our reproductive and overall health. But like all things in the body, we feel our best when they are in balance.
Left unaddressed, long-term effects of excess estrogen can also lead to more serious health issues including cancer. The naturopathic doctors at Be Well Natural Medicine understand estrogen dominance well and use cutting-edge hormone testing and research-based natural methods to identify and treat various types of estrogen dominance. Working with a naturopathic doctor to balance hormones may not only improve how you feel overall from month to month but also prevent chronic disease.
Want to find out if your symptoms might be related to estrogen dominance? Take our Estrogen Dominance Quiz and then read on to learn more about causes and natural treatments for estrogen dominance using a naturopathic approach.
Estrogen Dominance Quiz
Count the total number of symptoms that apply to you currently:
Allergies or Histamine Intolerance
Bloating
Breast tenderness or Fibrocystic (Lumpy) Breasts
Endometriosis or Fibroids
Gallbladder Problems
Headaches or Migraines (worse before your period or mid-cycle)
Heavy Bleeding or Postmenopausal Bleeding
Infertility
Insomnia
Irregular Periods
Irritability, Mood Swings or Anxiety (worse before your period or mid-cycle)
Low Sex Drive
Painful Periods
Ovarian Cysts or Polycystic Ovarian Syndrome (PCOS)
Spider or Varicose Veins
Weight gain or difficulty losing weight, especially around hips, butt, and thighs
Estrogen Dominance Quiz Answer Key:
0 or 1 symptoms = Estrogen dominance is unlikely to be a an issue for you.
2 to 4 symptoms = Moderate estrogen dominance may be an issue for you.
5+ symptoms = Severe estrogen dominance may be an issue for you.
Disclaimer: The Estrogen Dominance Quiz is not intended to treat, diagnose, cure or prevent any disease. All information is for educational purposes only. Always seek the advice of your doctor or another qualified healthcare provider.
Types of Estrogen: E1, E2, and E3
So let’s get into the nitty gritty. We often talk about estrogen as one hormone, but estrogens are actually a group of hormones that include estrone (E1), estradiol (E2), and estriol (E3). Of these, conventional testing methods typically only test estradiol (E2), however, the doctors at Be Well Natural Medicine prefer to test all three to get a more comprehensive assessment of hormones. Each type of estrogen is normally found in different concentrations depending on the phase of life.
Estradiol (E2) is the most dominant form of estrogen during the reproductive phase of life and is also thought of as the strongest form of estrogen.
Estriol (E3) is in highest concentrations during pregnancy.
Estrone (E1) continues to be made after menopause, after the body has stopped making estradiol and estriol. It is referred to as the weakest type of estrogen and can convert to estradiol when our body needs more estrogenic activity.
Estrogen and Progesterone Balance
Estrogen is most prominent in the first half of our menstrual cycle, also known as the follicular phase. This starts with the first day of menstrual bleeding (day 1) until we ovulate (for many people this is around day 14). During this time, estrogen works to mature the egg that will be ovulated that month. It also thickens the uterine lining in preparation for a fertilized egg.
Progesterone is most prominent in the second half of the cycle, also known as the luteal phase. This extends from ovulation until we start bleeding again. Progesterone is responsible for maintaining the uterine lining and if pregnancy occurs, it will sustain the pregnancy until a placenta is fully formed.
When estrogen and progesterone are in a balance, we should experience healthy menstrual cycles that are regular and free of pain, heavy bleeding, and mid-cycle spotting. When these hormones become unbalanced and estrogen is more dominant, symptoms can arise that are seemingly unrelated to the menstrual cycle. These can include mood swings, insomnia, acne, and migraines.
What Causes Estrogen Dominance
So, why are so many people suffering from estrogen dominance? Great question - there are many reasons! Things that can contribute to estrogen dominance include:
Genetics
Stress
Poor sleep
Poor diet
Ineffiecient liver detoxification
Gastrointestinal imbalances
Endocrine disruptors in the environment (more on this later)
As you can imagine, the cause will differ from person to person which is why naturopathic doctors spend a good deal of time with each patient to collect an extensive health history and develop an individualized treatment plan for each person. We are in tune with the fact that a prescription for birth control is not the answer for everyone.
Case Study:
Avoiding Surgery - Estrogen Dominance and Endometriosis
Mandy is a 32 year old female with a history of endometriosis which caused painful, heavy periods as well as pain throughout her cycle. She had surgery to address the endometriosis but it only resolved her symptoms for a few years.
When she began naturopathic care with me her pain was, yet again, quite severe. Her OBGYN was recommending another surgery which she wanted desperately to avoid. I ordered comprehensive hormone testing via the DUTCH Complete test which not only revealed estrogen dominance but also uncovered poor estrogen detoxification - something I would not have been able to detect with standard blood tests. Her estrogen metabolism was going down an unfavorable pathway in the liver creating an excess of “the bad” estrogen metabolite known as 16-OH estrogen (more about “the good, the bad and the ugly” estrogen metabolites below). The result was that she was not able to detoxify excess estrogen and she required specific support to help her eliminate excess estrogen from the body.
I developed a naturopathic treatment plan specifically targeted to address her specific lab results. We addressed the following core issues through diet and supplements:
1) send her estrogen down the more favorable 2-OH estrogen pathway
2) support the liver so it could detoxify her estrogen more effectively
3) lower inflammation which is an underlying factor with pain
Her pain improved in just a few months and she was able to avoid another surgery!
Diagnosing Estrogen Dominance with DUTCH Hormone Testing
We can test hormones through blood, urine and saliva. Different physicians will favor different methods and we get slightly different information from each. I, personally, lean towards testing through urine metabolites. More specifically, I use something called DUTCH testing. This stands for Dried Urine Testing for Comprehensive Hormones. The test is conveniently collected at home with a urine sample and as the name implies, it offers a comprehensive look at sex and adrenal hormones. This gives us an understanding of how the patient both produces and metabolizes hormones and allows me to design a highly specific and individualized treatment plan by intervening exactly where we see dysfunction.
The limitations I find with blood tests is that we only see what the hormones are doing in a moment in time, we do not learn anything about how we break down the hormones and we only test for estradiol but not the other two forms. In other words, by looking at a person’s blood results we may wrongly assume they do or do not have estrogen dominance simply based on their estradiol levels, but their other two forms of estrogen may tell a very different story! The DUTCH test also collects samples over the course of a day so we get data about what is going on over time rather than just one snapshot. This is important because so much can affect hormone levels from moment to moment.
Testing hormones through blood tests also requires that the blood draw is done on certain days of the cycle. When someone’s cycles are very irregular, this can be difficult. The DUTCH test has the option to run a test specifically for these folks to account for the irregularity so that we can determine exactly how to address the issue at hand.
BBT cycle tracking
Along with DUTCH testing, I also encourage my patients to track their basal body temperatures (BBT) so we can monitor what hormones are doing from day to day and cycle to cycle. Our temperatures shift slightly throughout our cycle based on which hormones are more dominant. These shifts can tell us a lot including when ovulation is occurring and how long the follicular and luteal phases are. It can even give us clues about the balance of our sex hormones and our thyroid function. We also see how things like stress, poor sleep, and dietary factors affect the cycle. BBT tracking involves taking your temperature with a basal body thermometer every morning before getting out of bed. We then plot those values on a graph over the course of the month and extrapolate information by observing trends in temperatures.
How to Reduce Excess Estrogen
So what do we do with all this information? Here’s a hint: it’s all about pathways and metabolites.
All hormones need to be broken down and cleared from the body though processes of metabolism and detoxification. We rely on our liver and GI tract to carry out these processes. In the liver, they undergo two phases of detoxification which makes them less reactive and more water soluble. Then, the metabolites are sent to the GI tract where they are excreted as waste. If we have digestive issues, especially an imbalance in the types of bacteria in our gut, we can run into issues with eliminating our hormones and can actually reabsorb them, causing even more harm. For these reasons, it is important to have healthy liver function, GI function, and regular bowel movements to ensure hormone balance.
It is very important when treating an estrogen dominant patient that we understand how much they are using each pathway and the metabolites they are producing as a result, because some are less favorable than others. The DUTCH test is a panel that gives us this information, allowing us to be more targeted in our treatment approach, and help the patient metabolize estrogen in the healthiest ways possible. Below, we will discuss each pathway and its metabolites in more detail. You can think of them as “the good, the bad, and the ugly.”
1) The Good: the CYPA1A enzyme and the 2-OH metabolite
The most favorable pathway uses the CYP1A1 enzyme and it produces the most favorable metabolite, called 2-OH. We can think of this as the cleanest or safest way to detoxify estrogens and ideally 60-80% of our estrogen is being processed via this pathway.
2) The Bad: the CYP3A4 enzyme and the 16-OH metabolite
The pathway that uses the CYP3A4 enzyme and produces the 16-OH metabolite is less favorable and more “proliferative.” In other words, rather than helping us clear estrogen from the body, it creates more. So, for someone who is already estrogen dominant, it’s important to make sure they are not using this pathway in excess. If patients are using this pathway in excess they can develop swollen, painful breasts, and a thickened endometrial lining which can lead to heavy bleeding. Ideally, we are using the 16-OH pathway about 13-30% of the time.
3) The Ugly: the CYP1B1 enzyme and the 4-OH metabolite
Finally, the pathway that uses the CYP1B1 enzyme and produces the 4-OH metabolite is the least favorable option. Downstream, it can produce what is called quinones- harmful substances that can lead to DNA damage and even cancer.
How to Treat Estrogen Dominance
OK so now that you know what estrogen dominance is, why we develop it, and how to test for it, you’re likely wondering what the heck we do about it!
Below are a few of the ways I support all patients with estrogen dominance by working on the pathways responsible for metabolizing and eliminating excess estrogen. Remember, these are foundational steps that are useful for most people. More targeted approaches are important, and I work with patients to individualize treatment based on their unique hormone patterns using a variety of naturopathic tools.
1) Support Detoxification:
As we discussed above, all hormones are sent to the liver to be metabolized, or broken down into smaller components, then sent off to the GI tract where they can be excreted. Liver detoxification is divided into two phases and depending on the patient, they may need phase I support, phase II support, or both. The DUTCH test is key in helping us identify which phase requires more support.
Phase I: The first phase breaks hormones down into smaller metabolites. To support phase I detodification we may use nutrients such as DIM (diindolylmethane) IC3 (indole-3-carbinol) and glutathione as well as dietary recommendations like increasing our intake of vegetables in the brassica family like broccoli, cabbage, and Brussel sprouts.
Phase II: The second phase attaches an additional molecule to make the metabolites more water soluble so that they can be excreted as waste. To support phase 2 detoxification we may use nutrients such as magnesium, B vitamins, choline, methionine, and SAMe.
2) Support the GI tract:
The GI tract and a healthy microbiome are extremely important in maintaining a healthy hormone balance. As mentioned above, after hormones are broken down by the liver, the GI tract is responsible for eliminating them from the body. To do this efficiently, we must have the correct balance of good bacteria and be having regular and complete bowel movements. If not, we can reabsorb estrogen metabolites which can contribute even further to estrogen dominance. For this reason, it’s common to see GI and hormonal issues going hand in hand, even in patients that do not have overt GI symptoms. I often rely on the GI-Map by Diagnostic Solutions to get a more comprehensive understanding of a patient’s GI health and microflora when they are struggling with hormonal issues. The GI-Map uses a stool sample to identify the presence of pathogenic bacteria, fungi, parasites and worms; the balance of healthy bacteria; and the balance of “opportunistic” bacteria, or bacteria that can be common in the correct amounts but can be pathogenic if they overgrow. It also tests for several markers of digestive health and inflammation.
Specific to hormone imbalance, the GI-Map tests for an enzyme called beta glucoronidase. In high levels, it can essentially allow estrogen that has already been metabolized by the liver to be reabsorbed into circulation. If beta glucoronidase is elevated and not addressed, then we will be fighting an uphill battle in treating estrogen dominance.
3) Lower Inflammation:
Estrogen dominance in itself can be associated with higher levels of inflammation which in turn can exacerbate painful, heavy periods. That’s why I take a whole body approach to lowering inflammation through diet, supplements, and stress management.
4) Manage Stress:
Our body has two major branches of the nervous system- the sympathetic (often referred to as fight or flight) and the parasympathetic (often referred to as rest and digest). As you can imagine, the sympathetic nervous system is more dominant during times of stress. It is engaged when there is a threat and we need to think on our toes and conserve resources. We respond by speeding up the heart and sending energy to the muscles so that we can run from danger if we need it. The parasympathetic nervous system is engaged when we are relaxed. Our breath gets deeper and slower, our heart rate slows down. This is the part of the nervous system that likes to focus on digesting and reproducing. Even if our goal is not to become pregnant, our reproductive tract is preparing for a possible pregnancy every month. If we are stressed, our body will not prioritize reproducing. The more time we spend in the fight or flight, the less time is spent focusing on healthy hormones and healthy gut function.
5) Avoid Endocrine Disruptors:
Endocrine disruptors are chemicals found in our environment that can resemble and mimic our own natural hormones. More specifically, xenoestrogens are compounds that resemble estrogen and can bind to our body’s estrogen receptors. Most women are exposed to hormone-disrupting chemicals every day in their own homes without even knowing it. I love to chat with my patients about this topic because there are some very easy changes you can make to start reducing your exposure.
6) Avoid Storing Food and Drink in Plastic Containers:
You have probably heard of BPA or bisphenol-A which is a type of plastic that was found to have negative effects on hormones many years ago. For this reason, you will see many plastic products labeled as “BPA free.” Unfortunately, many of the compounds used in place of BPA are also endocrine disruptors. When in doubt, it’s best to switch from plastic water bottles to a reusable stainless steel bottle; avoid storing food in plastic bags and containers, especially hot food. To go a step further, you can also switch out your plastic coffee maker for a French press.
7) Eat Organic:
Certain pesticides found in non-organic foods can disrupt hormone balance. If you cannot eat organic 100% of the, check out the Environmental Working Groups “Dirty Dozen and Clean 15” which lists off the foods with highest and lowest pesticide levels so that you can shop smartly and also maintain your budget.
8) Avoid Fragrances in Beauty and Household Products:
Fragrances are a HUGE source of endocrine disruptors. Avoiding perfumes and transitioning to fragrance free soap, lotion, body wash, shampoo and conditioner, dish and laundry detergent, fabric softeners, air fresheners, household cleaners can go a very long way.
9) Get Good at Reading Labels in your Beauty Products:
When you can, try to avoid things like parabens, formaldehyde, and synthetic fragrances.
In summary, estrogen dominance may be the cause of many hormone-related symptoms but often times goes undetected. You can talk to your doctor about comprehensive hormone testing via the DUTCH Test to help get a clearer picture of what’s really going on with your hormones. A personalized and holistic and approach is often required because of the many factors that influence hormones - estrogen detox pathways, gut health, liver function, inflammation, stress, diet, toxins in the environment and more. The doctors at Be Well Natural Medicine are experienced and passionate about women’s health and correcting underlying hormone imbalances.
Learn More About Be Well Hormone Balancing Programs:
Healthy Period Program
Vibrant Menopause Program
Natural Fertility Program
Natural Acne and Skincare Program
ABOUT THE AUTHOR
Dr. Liz Orchard is a Naturopathic Medical Doctor (NMD) and founder of Be Well Natural Medicine. After graduating magna cum laude with a B.A. in pre-medical studies from the University of St. Thomas (2001), Dr. Orchard earned her Doctorate in Naturopathic Medicine (2008), with honors, from the oldest fully accredited Naturopathic medical school, National College of Natural Medicine, in Portland, Oregon.