Never heard of it? You're not alone.
Estrogen dominance is a common hormonal imbalance which affects many women and can significantly impact health. Functional medicine offers effective strategies to address this issue comprehensively.
Sometimes referred to as unopposed estrogen or progesterone deficiency, estrogen dominance occurs when estrogen levels are high in relation to progesterone. This imbalance can arise from elevated estrogen levels, insufficient progesterone production or a combination of both. It is particularly common in perimenopause, when progesterone is tapering off and estrogen is fluctuating.
Functional medicine views estrogen dominance as a systemic issue influenced by factors like diet, lifestyle, environmental exposures and genetics.
Common symptoms of estrogen dominance
Estrogen stimulates the thickening of the uterine lining, while progesterone works to thin it. When estrogen levels dominate or progesterone levels are insufficient, this imbalance can lead to conditions such heavy periods and fibroids.
This hormonal disruption also contributes to other symptoms of estrogen dominance, including PMS (bloating, mood swings and breast tenderness), weight gain around the hips and abdomen, fatigue, hormonal acne, fibrocystic breasts, decreased libido, anxiety and brain fog.
Identifying estrogen dominance
Estrogen dominance can often be identified by symptoms, but testing can provide additional insights. Conventional blood tests measure oestrogen and progesterone levels, while the DUTCH (dried urine) test offers a detailed analysis of hormone metabolites, revealing how well estrogen is being metabolised and eliminated. Testing can confirm imbalances and guide tailored strategies.
Risk factors for estrogen dominance
Various factors can contribute to estrogen dominance, including lifestyle habits, environmental exposures and underlying health conditions that affect hormone metabolism.
Metabolism and detoxification issues
Poor liver detoxification: Inefficient phase 1 and phase 2 detox pathways may lead to the accumulation of harmful estrogen metabolites.
Poor methylation, often from deficiencint folate, B12 and B6, reduces phase 2 detoxification, causing harmful metabolite accumulation.
Gut dysbiosis: Imbalances in gut bacteria, particularly the estrobolome, can lead to the recirculation of estrogen in the body.
Hormonal and physiological imbalances
Insulin resistance: Estrone, primarily produced in fat tissue and dominant after menopause, increases with insulin resistance and may worsen PCOS or raise post-menopausal uterine cancer risk.
High histamine: Estrogen stimulates histamine production and reduces histamine clearance, creating a cycle of increased histamine and estrogen.
Hypothyroidism: An underactive thyroid impairs estrogen clearance.
Chronic inflammation: Inflammatory cytokines and aromatase activity drive harmful estrogen metabolite production.
Excess weight: A large amount of estrogen is produced in fat tissue.
Lifestyle and external influences
Chronic stress: Elevated cortisol levels suppress progesterone production.
Sleep deprivation disrupts hormonal rhythms, increases cortisol and reduces melatonin, affecting estrogen metabolism.
Toxins: Xenoestrogens from plastics, pesticides and personal care products mimic estrogen, while pollution and alcohol overburden the liver.
Hormonal medications: Birth control pills and HRT may elevate estrogen levels. Ethinylestradiol, a synthetic estrogen in birth control, is more potent than natural estradiol and disrupts gut microbiome and metabolism.
Eliminating excess estrogen: detoxification
Estrogen performs its functions when bound to specific receptors, but unbound estrogen must be efficiently eliminated from the body through liver detoxification to prevent overstimulating cells. Efficient detoxification reduces the risk of symptoms like fibroids or cancers and is essential for hormonal balance.
The liver processes estrogen through two key phases:
Phase 1 converts estrogen into metabolites, some of which are harmful if not neutralised in the next phase.
Phase 2, where methylation, glucuronidation or sulphation make these metabolites water-soluble for excretion.
The efficiency of each detoxification phase relies on adequate nutrient availability - as without them, the process can become inefficient or blocked. Digestive health also plays a role, as gut imbalances can lead to the reabsorption of estrogen into the bloodstream.
Potential strategies to manage estrogen dominance
As each woman’s health profile, underlying drivers and needs are unique, an effective approach should be tailored to these individual factors. A personalised strategy to estrogen dominance may include a combination of conventional treatments, targeted dietary changes, supplementation and lifestyle modifications.
Food-based strategies
Supporting hormonal health through diet involves key food choices that aid estrogen metabolism and promote overall balance.
Sulphur-rich foods to aid liver detox sulphation. Good sources include cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, kale), alliums (garlic, onions, leeks), protein sources (eggs, meat, fish), legumes and asparagus.
Adequate fibre: It binds excess estrogen in the gut and promotes its excretion. Aim for 25-35 g/day from whole foods including vegetables, fruits and flaxseeds.
Phytoestrogens: Flaxseeds (crushed) and fermented soy (miso, tempeh) contain natural plant compounds (isoflavones) that can balance estrogen activity by competing for receptor sites.
Omega-3 reduces inflammation and support hormone balance. It is found primarily in oily fish.
Balance blood sugar: Replace refined carbs with whole grains, add protein to each meal and choose healthier alternatives to sweets and snacks.
Reduce inflammation by limiting processed foods, gluten, dairy, sugar and alcohol.
Stay hydrated: Estrogen and progesterone influence fluid balance, making hydration important post-ovulation and during heavy periods. It also supports bowel movements and estrogen elimination. Aim for 2 litres daily.
Targeted nutrients
Certain nutrients are essential for supporting estrogen metabolism and detoxification. These nutrients can be obtained through food, or in higher concentrations through supplementation. Before starting any supplement, it’s important to consult a qualified health care professional, particularly if you are taking medication.
Magnesium helps reduce PMS symptoms, supports insulin sensitivity and promotes hormone balance by influencing SHBG levels. It can be found in nuts, seeds, leafy greens like spinach and whole grains.
Vitamin B6 regulates oestrogen activity at the cellular level and alleviates PMS symptoms, especially when combined with magnesium. It also supports methylation, a process critical for oestrogen detoxification. Food sources include poultry, fish, fortified cereals, bananas and avocado.
Methylated folate and B12 play a key role in methylation processes that assist in oestrogen detoxification while supporting energy, mood and stress management. Naturally methylated forms are found in food. Folate is abundant in leafy greens, legumes, vegetables and fruits, while B12 is found in meat, fish, dairy and eggs.
Indole-3-carbinol (I-3-C) and diindolylmethane (DIM) promote the conversion of estrogen into protective metabolites. These compounds are found in cruciferous vegetables and are especially abundant in broccoli sprouts. Common food sources include broccoli, cauliflower, kale and broccoli sprouts.
Calcium D-glucarate inhibits the bacterial enzyme beta-glucuronidase, reducing oestrogen reabsorption in the gut, particularly when gut health is compromised. It can be found in foods such as oranges, apples, broccoli and Brussels sprouts.
Isoflavones, a type of phytoestrogen, help reduce inflammatory estrogen activity and improve blood sugar regulation. These are commonly found in fermented soy products such as miso and tempeh, as well as in crushed flaxseeds.
Herbs such as milk thistle, rosemary and Vitex agnus-castus (chasteberry) may support hormone balance and detoxification. As a reminder: herbs can interact with medications and may not be suitable for everyone. Always consult a practitioner before use.
Lifestyle practices
Practical lifestyle adjustments can play a significant role in supporting hormonal balance and managing estrogen dominance.
Reduce exposure to xenoestrogens by avoiding plastics and using natural personal care products.
Limit alcohol and stimulants, which place additional toxic burden on the liver.
Exercise regularly: Focus on resistance and strength training to reduce excess fat tissue and support hormone balance.
Manage stress through practices like yoga or mindfulness to reduce cortisol, which can disrupt hormone balance.
Prioritise sleep to regulate hormones and engage in regular exercise to reduce body fat and improve insulin sensitivity.
What to do now?
Managing estrogen dominance with functional medicine involves personalised strategies that address root causes and promote hormonal health. At Investigative Health in Geneva, tailored care focuses on supporting liver detoxification with nutrient-rich foods, maintaining gut health and optimising lifestyle choices.
Targeted supplementation, guided by a qualified practitioner, can enhance these efforts to restore balance and alleviate symptoms. By addressing your unique needs, functional medicine can help reduce symptoms, improve well-being and support optimal hormonal health.
Ready to take the next step?
If you’re experiencing symptoms like heavy or irregular periods and want to uncover the root causes, let's talk. Hormonal health may feel complex, but with the right support, you can regain balance and vitality.
Book your consultation today to begin your journey to better health with Investigative Health in Geneva. Learn more and take control of your hormonal health.
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