hormonal balance

Estrogen Dominance: What It Is and Why You Can and Should Treat It

As the chief chemical messengers of your body, your hormones play a large role in how well it functions and operates. Whether it’s estrogen, progesterone, or testosterone, your sex hormones are constantly fluctuating. On top of that, your lifestyle can affect your ability to metabolize your hormones. This can lead to unwanted symptoms, like heavy or missed periods or difficulty losing weight—all of which are signs that you may have a condition known as estrogen dominance. What Is Estrogen Dominance, Exactly? Women with estrogen dominance have one of three scenarios, says Dr. Nisha Chellam, MD, a board-certified internal medicine and holistic and integrative health physician at Parsley Health. These include: normal estrogen levels but lower progesterone levels, higher estrogen levels than progesterone, or abnormally high estrogen levels Although estrogen dominance isn’t an official medical diagnosis, functional medicine and integrative health physicians, like Dr. Chellam, say it’s an under-diagnosed condition. “In conventional medicine, when we define a disease, there has to be consistent levels. The problem with estrogen is that the levels go up and down because it’s a cyclical hormone,” Dr. Chellam explains. “So that’s why estrogen dominance is not a clinically relevant condition. But we know that women who are unable to break down their estrogen, for whatever reason, tend to have more symptoms, and what drives that estrogen dominance can vary for each individual.” In women, estrogen dominance can lead to hormonally driven diseases, such as breast and uterine cancer, endometriosis, and polycystic ovary syndrome (PCOS), among others, says Bill Cole, a doctor of chiropractic, functional medicine practitioner and founder of The Cellular Health Accelerator program. For men, it puts them at higher risk for prostate cancer, infertility, and mood disorders. To make sense of what estrogen dominance is, it’s important to understand the menstrual cycle because your levels of estrogen and progesterone are dictated by what happens during your cycle, Dr. Chellam says. “In women, estrogen dominance can lead to hormonally driven diseases, such as breast and uterine cancer, endometriosis, and polycystic ovary syndrome (PCOS).” — Bill Cole, a doctor of chiropractic and functional medicine practitioner Your menstrual cycle starts on the first day of your period, and that’s when all of your hormones are at their lowest levels. Then, slowly your estrogen levels build up during the follicular phase; this is when the lining of your uterus starts to thicken and grow. Right when the egg is released during ovulation, your estrogen levels reach a peak. But when the egg doesn’t get fertilized, your estrogen levels drop while your progesterone levels pick up to support the egg, hoping it gets fertilized. When fertilization doesn’t happen, the progesterone levels drop and your estrogen levels get a small boost. “In some women, the estrogen peak [during ovulation] is so high or it’s normal, but the progesterone is not as high when the egg is released. But that’s not something that happens in isolation,” Dr. Chellam says. “When there’s a system problem, like heavy periods, missing periods, or shorter cycles, it’s a system failure. The question is where is the system failing and what’s disrupting it—is it the estrogen or progesterone level?” Estrogen dominance can happen during any point in your cycle—such as if your estrogen level stays high when it’s supposed to tank or if it rises too much when it’s supposed to surge, Dr. Chellam says. “That’s why it’s important to catch it during the cycle, so if you have a 28-day cycle, we try to look at the level around day 21,” she says. “So we can catch the estrogen and progesterone levels and see if they’re in the normal range.” Common Estrogen Dominance Symptoms Subcutaneous (under the skin) fat, which is harder to lose than visceral (in your abdominal cavity) fat, is one of the biggest indicators of estrogen dominance in women and men. Because estrogen is stored in the subcutaneous tissues, you have to adjust the estrogen levels in order to get rid of this type of fat, Dr. Chellam says. According to Dr. Chellam and Cole, women who have estrogen dominance usually experience: Unexplained weight gain Difficulty losing weight Breast tenderness Subcutaneous fat (visible fat under the skin), such as cellulite Heavy periods Missing periods Prolonged cycles (periods after 35 days) Painful periods Premenstrual dysmorphic disorder (PMDD) Infertility Mood swings Insomnia Headaches and migraines In men, Cole says the most common symptoms are: Fatigue Mood changes Infertility Lowered sex drive Erectile dysfunction Gynecomastia (increase in breast tissue in men) Keep in mind that these symptoms can be signs of other health conditions, so it’s important to see your physician to get a proper diagnosis. What Contributes to Estrogen Dominance It’s important to note that there is good and bad estrogen, Cole says. “The good estrogen should comprise about 60% to 80% of a person’s total estrogen,” he says. This is the type of estrogen that offers heart-protective benefits. “The bad estrogen should only comprise 7% to 11% of the body’s estrogen. Increased levels of this estrogen puts a person at risk for developing cancer and other diseases, particularly breast cancer. A third type of estrogen, often considered neutral estrogen, is not as harmful, as it’s bound to protein, but it should only comprise 13% to 30% of total estrogen,” he explains. There are many factors that play a role in someone being estrogen dominant. For example, it could be a change in your genes that makes the process of breaking down and getting rid of estrogen slower for some people, Dr. Chellam says. “We have to evaluate why you have a more difficult time breaking down your estrogen (why your estrogen levels are higher than your progesterone),” she explains. “It could be exposure to xenobiotics (foreign chemical substances), which disrupt your estrogen action and keep them from being metabolized, or it can be a liver or gut problem.” The detoxification pathway of the liver, which is crucial for breaking down and removing harmful estrogen that can damage DNA and cause cancer, needs