“Estrogen dominance” is a term used to describe the symptoms of high estrogen levels and low progesterone levels. This is the second most common hormone imbalance I see in women in my practice.
In this article, I’ll break down why estrogen is a great hormone (but why you need progesterone to control it), the most common symptoms of “estrogen dominance,” and some of the reasons why it occurs.
What does estrogen do to you?
Despite the negative reputation of “estrogen dominance,” estrogen is an amazing hormone. You actually have 3 types of estrogen, but the main one we’re going to focus on is estradiol (for simplicity, I’ll call it “estrogen” in the article).
Estrogen performs the following functions:
Helps promote egg development
Supports the growth of the uterine lining
Contributes to ovulation (together with other hormones)
Helps you feel happy and energetic
Supports healthy libido
Protects your bones
Good for your brain function, cognition and mental acuity
Supports healthy, supple skin and hair
Protects your heart and cardiovascular system
Supports your metabolism
I describe estrogen as the “yang” hormone of the first half of your cycle. At healthy levels, estrogen can help you feel energetic, confident, sexy, mentally sharp, and productive, especially during the follicular phase.
As we know from traditional Chinese medicine, “yang” energy must be balanced with “yin”. In this case, it is progesterone. Progesterone is a calming, cooling, grounding and “yin” balancing hormone.
Progesterone balances out estrogen and we need to ovulate regularly to prevent “estrogen dominance”. Ovulation is the key event in bringing progesterone levels back to normal. If we don’t ovulate, it makes us progesterone deficient…which means we have an excess of estrogen compared to progesterone (i.e. “estrogen dominance”).
What you need to know about “estrogen dominance”?
I put “estrogen dominance” in quotes because it’s not actually a medical term. If you ask your doctor about estrogen dominance, they will give you a blank stare. More accurately, “estrogen dominance” is a general term for high levels of estrogen and low levels of progesterone. The difference between these two hormones can cause unpleasant symptoms.
Estrogen dominance usually occurs during adolescence, when the brain and ovaries learn how to regularly regulate ovulation. “Skip” ovulation is quite common in post-menarche teenagers (first period), when progesterone is low and estrogen is relatively high.
It’s a recipe for – you guessed it – estrogen dominance. Remember the heavy periods, cramps, acne, and crazy mood swings you had as a teenager? It was estrogen dominance.
This hormonal pattern can also occur later in life. Hormonal imbalances that cause anovulation, such as polycystic ovary syndrome, are characterized by high levels of estrogen and low levels of progesterone.
In addition, around the 40s of perimenopause, hormones begin to change, leading to a drop in estrogen and progesterone. If you’re in your 40s and your periods are suddenly heavier or your PMS is getting worse, it could be an “estrogen dominance” pattern.
You may be more likely to have high levels of estrogen and low levels of progesterone in the following situations.
You have PCOS
You don’t ovulate regularly
You’re in your 40s and going through menopause
You have symptoms of low progesterone
10 Signs You May Be Estrogen Dominant
These are some of the common symptoms that I study in women with elevated estrogen levels. Some of these symptoms may overlap with other hormonal issues, such as thyroid problems, so it’s important to seek help from a hormone-trained naturopathic doctor to evaluate your symptoms and rule out other concerns.
- Cyclic breast tenderness, pain or fibrocystic breast.
Some women experience increased breast engorgement and tenderness after ovulation or before menstruation. This is a response to changes in estrogen levels throughout the menstrual cycle. “Fibrocystic changes in the breast” means dense breast tissue and/or breast tenderness, diagnosed by ultrasound. Women with breast fibrosis may notice breast tenderness every month. Women with these breast symptoms have increased estrogen levels or increased sensitivity of breast tissue to estrogen.
- Uterine fibroma.
Hormone headaches or “menstrual migraines” tend to occur in the days before or during the period. Often it is the sharp decline in estrogen and/or progesterone that seems to trigger the headaches. These may be worsened in women who have higher estrogen, for example, in women going through perimenopause (see below).
- Acne breakouts.
If you tend to break out in the first half of your menstrual cycle or around ovulation, this may be connected to estrogen. Check out this article for more information.
- Heavy and/or irregular periods.
As mentioned earlier, one of estrogen’s main jobs is to build up the uterine lining. If we have excess estrogen, this can further build the lining and contribute to really heavy periods. If your period is very heavy, or your period is irregular and hard to predict, this can be associated with both elevated estrogen and low progesterone.
- Weight gain around the hips and buttocks.
Estrogen is the hormone that promotes the body composition and shape that is classically associated with the female form: wider hips, larger buttocks, and breasts. Estrogen “encourages” fat deposition in these areas. This is not inherently a bad thing. Women need a higher body fat percentage compared to men for optimal hormone health. If you have noticed an increase in your weight, especially in these areas, estrogen might be one contributing factor.
- You have signs of low progesterone, such as difficulty sleeping, short cycles (every 21-24 days), spotting, or PMS problems.
As described above, “estrogen dominance” involves a discrepancy between estrogen and progesterone. If you are estrogen dominant, that means you are ALSO relatively low in progesterone! Check out this article to learn more about the signs of low progesterone.
- You have been diagnosed with Polycystic Ovarian Syndrome (PCOS).
PCOS is a hormone balance involving anovulation, elevated testosterone, elevated insulin and blood sugar. The skipped or infrequent ovulation means the body isn’t producing enough progesterone to balance estrogen. Because of this, other signs of elevated estrogen may develop. For more information on treating PCOS, check out this article.
- You are in your 40’s and experiencing worsened PMS, heavier periods or flooding, weight gain, hot flashes and/or night sweats.
These are signs of perimenopause. During perimenopause, progesterone is the first hormone to decline, resulting in low progesterone symptoms.
It was previously believed that estrogen slowly declines during this phase of a woman’s life, causing the classic perimenopause symptoms of hot flashes and night sweats. It is now understood that rather than declining slowly, estrogen production becomes erratic and unreliable. The more frequent fluctuations in estrogen, along with low progesterone are what produce estrogen dominance symptoms: heavy periods, worsened PMS, sleep problems and hot flashes. Overall, perimenopause is a time of low progesterone and high estrogen.
What is the root cause of “estrogen dominance”?
When I am working with patients on balancing their hormones, we first need to identify their hormone pattern. This can be accomplished in a detailed initial consultation, using my hormone assessment method, and in some cases, hormone testing.
After identifying your hormone pattern, the next most important question to ask is WHY? Why is there a pattern of “estrogen dominance” occurring?
So far in this article I’ve discussed the imbalance between estrogen and progesterone that contributes to estrogen dominance patterns. I explained that ovulation is a key event that is required to produce progesterone and keep estrogen balanced. Anovulation and low progesterone is an important hormone imbalance to understand if you have estrogen dominance symptoms (read more here).
There is another important contributing factor to estrogen dominance besides high estrogen and low progesterone. We’ve covered what happens when your body is producing excess estrogen, we haven’t yet covered how your body gets rid of estrogen.
Did you know that once estrogen is used, it goes to your liver to be processed, broken down and “tagged,” then sent to your intestines to be excreted from your body?
Furthermore, did you know that your gut bacteria play a role in your ability to excrete (or reabsorb) estrogens from your gut?
That’s right. If you’re not pooping regularly (once or more a day), and if you have certain gut bacteria, you may actually be reabsorbing estrogen back into your blood stream. This is why focusing on gut health is one of the most important pillars of hormone health.
Addressing your hormone concerns using natural medicine
If you identify with the hormone imbalance described, know that there are LOTS of ways to help balance your hormones using natural medicine! Once we identify your hormone pattern, and the cause of your hormone pattern, we can go to work
on balancing your hormones. In my practice, this involves a combination of foods, herbs, nutrients, acupuncture, or sometimes bioidentical hormone therapy. Each woman receives a treatment plan that is based on her unique pattern and needs.