“Estrogen dominance” is a term that describes a pattern of elevated estrogen and low progesterone symptoms. It is the second most common hormone imbalance that I see in women in my practice.
In this article, I will break down why estrogen is an amazing hormone (but why you need progesterone to keep it in check), the most common signs of “estrogen dominance,” and some of the reasons why it occurs.
What does estrogen do for you?
Despite its negative reputation in “estrogen dominance,” estrogen is an incredible hormone. You actually have 3 types of estrogens, but the main one we will focus on is called estradiol (for simplicity I’ll refer to it simply as “estrogen” in the article).
Estrogen has the following functions:
Helps to promote the development of an egg
Promotes the growth of the uterine lining
Contributes to ovulation (in tandem with other hormones)
Helps you feel happy and energized
Promotes a healthy libido
Protects your bones
Benefits your brain function, cognition, and mental sharpness
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. When present in healthy levels, estrogen helps you feel energized, confident, sexy, mentally sharp and productive, particularly in your follicular phase.
As we know from Traditional Chinese Medicine, “yang” energy must always be balanced with “yin.” In this case, that would be progesterone. Progesterone is the calming, cooling, grounding, “yin” balancing hormone.
In order for progesterone to balance estrogen and prevent “estrogen dominance,” we need to ovulate regularly. Ovulation is the key event to allow for healthy progesterone levels to be produced. If ovulation doesn’t occur, this sets us up for progesterone deficiency… and this means that estrogen is elevated relative to progesterone (i.e. “estrogen dominance”).
What you need to know about “Estrogen Dominance”
I put “estrogen dominance” in quotations because this is actually not a medical term. If you ask your medical doctor about estrogen dominance, they will probably give you a blank stare. More correctly, “estrogen dominance” is an umbrella term that describes a pattern of elevated estrogen and low progesterone, occurring together. It is the discrepancy between these two hormones that can create bothersome symptoms.
Estrogen dominance is most commonly known to occur in adolescence, when the brain and ovaries are figuring out how to regularly coordinate ovulation. During the teen years soon after menarche (the onset of the first period), it’s quite common to “skip” ovulation, which results in low progesterone, and relatively high estrogen.
This is a recipe for – you guessed it – estrogen dominance. Remember those heavy periods, cramps, acne, and crazy mood swings as a teen? That was estrogen dominance.
This hormonal pattern can occur later in life as well. Hormone imbalances that cause anovulation (skipped ovulation), such as Polycystic Ovarian Syndrome, also have patterns of elevated estrogen and low progesterone.
Additionally, hormones start to shift in the 40’s during the perimenopause time, leading to fluctuating estrogen and low progesterone. If you’re in your 40’s and your period is suddenly very heavy, or your PMS is worsening, this could be the “estrogen dominance” pattern emerging.
You may be more likely to have elevated estrogen and low progesterone if:
You have PCOS
You aren’t ovulating regularly
You’re in your 40’s and are going through perimenopause
You have signs of low progesterone
10 Signs You May Have Estrogen Dominance
These are some of the common signs I examine for in women concerned about elevated estrogen. Some of these symptoms can overlap with other hormone concerns, such as thyroid problems, so it is important to get support from a Naturopathic Physician trained in hormones to evaluate your symptoms and rule out other concerns.
1. Cyclic breast tenderness, pain or fibrocystic breasts.
Some women experience an increase in breast fullness or tenderness around ovulation or before the period. This is a response to fluctuating estrogen levels throughout the menstrual cycle. “Fibrocystic breast changes” basically means dense breast tissue and/or breast tenderness, and is diagnosed via ultrasound. Women with fibrocystic breasts notice monthly breast tenderness. Women with these breast symptoms may have elevated estrogen, or an increased sensitivity to estrogen in the breast tissue.
2. Uterine fibroids.
Uterine fibroids grow in response to elevated estrogen levels. They are more common in women in their 30’s and 40’s and during perimenopause. Once menopause occurs, estrogen levels in the body drop, and fibroids often shrink on their own.
3. PMS moodiness, especially with irritability, tearfulness, or mood swings.
When estrogen and progesterone are out of balance, this can worsen PMS symptoms.
4. PMS-related headaches.
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).
5. 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.
6. 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.
7. 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.
8. 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 your are ALSO relatively low in progesterone! Check out this article to learn more about the signs of low progesterone.
9. 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.
10. 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 is 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 is 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.