Estrogen Dominance
For a client with estrogen dominance, their hormones are balanced in favor of estrogen with progesterone sitting at little to none. Excess estrogen overloads estrogen receptors (ERα and ERβ), causing harm to tissues, autoimmune conditions, and abnormal tissue growth, either benign or cancerous. This imbalance can disrupt the flow of reproductive endocrine hormones.
Estrogen dominance can contribute to
Irregular menses & heavy bleeding
Weight gain (especially hips, thighs, and midsection)
Fibroids/endometriosis
PCOS
Fibrocystic breasts and gynecomastia in men (man boobs)
Breast cancer
Infertility
Insomnia
Depression/anxiety/irritability
Fatigue
Low libido
There has been an unusual rise in polycystic ovary syndrome (PCOS), breast cancer, ovarian cancer, gynecomastia (man boobs), & infertility, suggesting estrogen dominance is becoming widespread, and I feel more people need to be aware of this (Patel et al., 2018).
Estrogen dominance can occur at any time ⏰, especially since progesterone declines 📉 with age, thus symptoms of estrogen dominance become noticeable during middle adulthood 👩🏻 ➡️ 👵🏼.
To remedy this, we want to shift the balance towards decreasing estrogen, or increasing progesterone, and can do so through:
DIET
Heart-healthy diets
Examples are the Mediterranean Diet, DASH diet, IFM’s Cardiometabolic Diet. These emphasize whole fresh foods, low glycemic carbs, moderate amounts of healthy fats and protein, little to no added sugar and salts, and are high in high in anti-inflammatory & antioxidant-rich foods to balance hormone levels.
Focus on healthy fats such as omega 3s (fish, nuts, seeds) and less on omega 6 fatty acids (fried/process foods, animal fats, dairy), which tend to be more pro-inflammatory and can convert testosterone into estrogen via an enzyme called aromatase (Patel et al, 2018)
Detoxification diets is one way to eat clean with organic foods to reduce food triggers and toxic burden while eating foods meant to support the function of our detox organs such as the liver, kidneys, lymph, digestive system, skin, and lungs.
Increase intake of cruciferous vegetables.
Cruciferous vegetables such as kale, broccoli, cabbage “are rich unique sources of glucosinolates, whose hydrolytic products, primarily isothiocyanates (ITCs) and indoles [like Indole-3-carbinol (I3C)] have been found to prevent or inhibit breast cancer development through the following mechanisms: modulating the activity of phase I and phase II enzymes [in liver detoxification], inhibiting cell proliferation, regulating the expression of estrogen receptor, altering the metabolism of estrogen, or suppressing cyclooxygenase 2 (COX-2)” (Lin et al., 21017). COX-2 is expressed by inflammatory cells and is upregulated by estrogen.
Cruciferous vegetables also contain diindolylmethane (DIM), which is a product of I3C and some data suggests that DIM enhances the breakdown of estrogen and “can potentially serve as an antiestrogenic dietary supplement” (Rajoria et al., 2011). Increased water intake is advised with increased fiber intake from the cruciferous vegetables. This allows for bowel movement regularity, which also helps eliminate excess estrogens. Excessive estrogen slows transit time, leading to constipation, which allows for reabsorption of estrogen, leading to increased estrogen dominance. Digestive enzymes, hydration, and juicing should help eliminate constipation. However, if constipation is chronic, this allows for reabsorption of estrogen eliminated by the liver into the bloodstream, thus, increasing or maintaining estrogen dominance since estrogen receptors have been found in the gastric and small intestinal mucosa (Oh et al., 2013).
For those with estrogen dominance and hypothyroidism
It may seem contraindicative to have cruciferous vegetables which are known for being high in goitrogens that are not good for hypothyroidism, but high in I3C and DIM that are good at reducing estrogen dominance. However, most of the foods in the Cruciferous/Brassica family are heat-sensitive, and boiling the vegetables lowers the availability of goitrogenic compounds. Loss of nutrients also occurs when boiling so it's usually best to briefly steam the vegetables and consume them in modest amounts. Numerous other methods to support thyroid as well including Iodine, zinc, vitamins A, E, B6, and Selenium. Both I3C and DIM can be supplemental options for these cases.
Seed cycling
While this approach needs more research behind its effectiveness, the increase in healthy fats and lignans may be of benefit to general health. Seed cycling requires the woman to consume one tablespoon of each seed every day for a few months to promote hormone production during different stages of the menstrual cycle. During the follicular phase (days 1-14, at the start of menses to ovulation) eat pumpkin and flax seeds to increase estrogen. Flax seeds are high in lignans, which are structurally similar to estradiol (E2) – the most potent form of estrogen. Conversely, during the luteal phase (days 14-28, ovulation to next menstrual cycle), women can eat sunflower and sesame seeds to enhance progesterone production and counteract estrogen dominance.
SUPPLEMENTS
Calcium-D-Glucarate
Calcium-D-glucarate is also known as glucaric acid and “is found in many fruits and vegetables, with the highest concentrations found in oranges, apples, grapefruit, and cruciferous vegetables.” Oral supplementation of calcium-D-glucarate has been shown to inhibit beta-glucuronidase, which is an enzyme made by gut bacteria that deconjugates estrogens into their active unbound forms during Phase II liver detoxification” and allows the estrogens to recirculate through the body. Thus, clinical applications of oral calcium-D-glucarate may regulate estrogen metabolism and act as a lipid-lowering agent (Calcium-D-glucarate, 2002).
Vitex Agnus-Castus
Also known as chaste berry, this is a hypothalamic-pituitary-ovarian modulator. Studies show that vitex has progestogenic activity, which increases progesterone and reduces estrogen dominance (Vitex Agnus-Castus - an Overview | ScienceDirect Topics, n.d.).
LIFESTYLE
Remove estrogen mimics
Phytoestrogens - first of all, let’s clear up the issue with soy.
While phytoestrogens are listed as a common exposure, not all phytoestrogens function in the same way!
Phytoestrogens are estrogen-like compounds derived from plants, which are structurally similar to 17β-estradiol. Four phenolic compounds classified as phytoestrogens are isoflavones, stilbene, coumestan, and lignin.
Phytoestrogens can be found in nuts, seeds, some vegetables (garlic, celery, carrots, potatoes, rice, wheat, red clover, sweet potatoes, some fruits (apples, pomegranates and chaste berries) and coffee. Isoflavones are found in legumes, especially soybeans (Desmawati & Sulastri, 2019).
Phytoestrogens have been shown to have both estrogenic and antiestrogenic effects. This means that, while some phytoestrogens have estrogen-like effects and increase estrogen levels in your body, others block its effects and decrease estrogen levels (Al-Anazi et al., 2011; Bilal et al., 2014; Patisaul & Jefferson, 2010).VERDICT ON PHYTOESTROGENS?
In the scientific review article by Patisaul & Jefferson (2010) they best concluded with the following:
As with many other compounds, like alcohol or caffeine, there are many pros and cons associated with moderate soy intake. Consumers should be aware that soy contains endocrine-disrupting compounds and make dietary choices accordingly. For a typical consumer, alarm over soy products is likely unnecessary but so is the belief that a soy-rich diet will alleviate all ills. Women who are pregnant, nursing, or attempting to become pregnant should use soy foods with caution and be aware that soy formula may not be the best option for their babies. Older individuals, especially those with high cholesterol, may experience modest benefits including improved bone and cardiovascular health, and perhaps a decreased risk of carcinogenesis. Moderation is likely key and the incorporation of real foods, as opposed to supplements or processed foods to which soy protein is added, is probably essential for maximizing health benefits
Bisphenols:
Global production of BPA has steadily grown in recent years on account of its multiple applications in the plastic and manufacturing industries, in food packaging and toys, causing a constant and permanent poisoning of food, water, and the environment.
Most common bisphenols: Bisphenol S, F, B, and AF.
Bisphenol A (BPA) = low estrogen effect with an affinity for the nuclear estrogen receptor
BPA can easily accumulate in adipose (fat) tissue
Effects depend on the dosage, targeted tissue, and tissue development on the site where it acts
Pthalates
Frequently used in the plastic, coating, cosmetic, and toy industries, including the manufacturing of medical equipment such as syringes and blood bags.
Among the phthalates, three ester types are considered endocrine disruptors with estrogenic effects: DHEP (diethyl-hexyl phthalate), BBP (benzyl-butyl phthalate), and DBP (dibutyl phthalate).
Esters of Polychlorinated & Polybrominated bisphenols (PCBs and PBBs)
Used in the rubber, resin, adhesives, paint industries, flame retardants and in mattresses and blankets
Build up both in the environment (contaminated schools and construction sites) and in adipose tissue, and are considered endocrine disruptors affecting the thyroid hormone with estrogenic and anti-androgenic activity
Five esters top the list of toxicity: tetra BDE-47, penta-BDE99 -100, -153 and deca-BDE-209 or PBDE= Polybrominated diphenyl ethers
Diethylstilbestrol (DES)
Powerful synthetic non-steroidal estrogen was used in the USA from 1940 to 1975 to prevent miscarriage and/or its complications
Later on, was proven to be an ineffective treatment due to the correlation between the use of DES and reproductive system disorders in the male and female children of mothers treated with DES
Disorders included the appearance of clear cell vaginal adenocarcinoma, cryptorchidism, uterine abnormalities such as T-shaped uterus, and some types of hormone-dependent cancers.
(Piazza & Urbanetz, 2019).
Be Balanced Centers (2021) summarized perfectly how stress, weight, and birth control can affect your estrogen levels:
Reduce excess stress
Chronic stress is one of the main reasons women become estrogen dominant. When you are stressed, or overly busy, your cortisol levels go sky high and your body must use up its progesterone to keep up, which will ultimately deplete your “oh so helpful” hormone, progesterone. As more progesterone is used for cortisol production, less is available to balance estrogen – leading to increased estrogen levels. Also, excess estrogen will cause the pancreas to overproduce insulin, so you can’t burn fat efficiently, no matter what you are eating! Practice relaxation techniques such as meditation, yoga, and gratitude. Start a de-stressing practice that will free up that pregnenolone for progesterone. It is also important that you make sure you’re getting adequate sleep at night to let your body detox and recover from the stresses of the day. Hypercortisolism and prolonged activation of the HPA axis have been demonstrated in excessive exercising so even movement needs to be done in moderation because overworking your body is another form of stress.
Being Overweight
Excess body fat is one of the main causes of estrogen dominance. Not only does fat tissue absorb and store estrogen in your bloodstream, but it also synthesizes estrogen from your other hormones. As expected, the more fat cells you have, the more estrogen you will make. The more estrogen you make, the more fat you store, and the cycle continues. Exercise can speed up the liver’s detox processes, sharpen insulin sensitivity, boost weight loss, help mitigate mood swing problems associated with estrogen dominance, and reduce levels of stress hormones in the body. Choose lower impact exercises as opposed to high impact, which can raise cortisol levels.
Alternatively, you can try moderate impact exercises by doing a little bit of each (low and high impact) as tolerated.
Low Impact: movement that is gentle on the joints + muscles and puts little strain on them or fluid motions such a
walking, step stairs, swimming, cycling, yoga, pilates, spinning, rowing, elliptical cardio
Moderate impact: movement that includes weight training, or endurance exercise — things like jogging, cycling, or lap swimming.
High IMPACT vs high intensity (HIIT)
High impact is the amount of force that is used in a certain exercise. These exercises tend to put more stress on the joints when being performed: running, jumping, tennis, skiing, gymnastics, hiking, cross-fit
High-intensity exercises mean kicking up the intensity of your cardio. Pushing yourself to the maximum effort for a short amount of time (i.e. 20 seconds – 90 seconds). High intensity could be bodyweight training (e.g. squats and push-ups), weighted exercises (e.g. kettlebell, dumbbell, or medicine ball).
Birth control pills and hormone replacement therapy (HRT)
Erratic periods and heavy bleeding are often a result of estrogen dominance. Hormone replacement therapy medications and most oral contraceptives only add more estrogen on top of excess estrogen, without the balance of progesterone. Progesterone balances the effects of estrogen, and without enough, you end up with symptoms of estrogen dominance.
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Al-Anazi, A. F., Qureshi, V. F., Javaid, K., & Qureshi, S. (2011). Preventive effects of phytoestrogens against postmenopausal osteoporosis as compared to the available therapeutic choices: An overview. Journal Of Natural Science, Biology, and Medicine, 2(2), 154–163. https://doi.org/10.4103/0976-9668.92322
Be Balanced Center. (2021). What is Estrogen Dominance and how can it affect you https://bebalancedcenters.com/blog/estrogen-dominance-can-effect/
Bilal, I., Chowdhury, A., Davidson, J., & Whitehead, S. (2014). Phytoestrogens and prevention of breast cancer: The contentious debate. World Journal of Clinical Oncology, 5(4), 705–712. https://doi.org/10.5306/wjco.v5.i4.705
Calcium-D-glucarate. (2002). Alternative Medicine Review: a journal of clinical therapeutic, 7(4), 336–339.
Desmawati, D., & Sulastri, D. (2019). Phytoestrogens and Their Health Effect. Open access Macedonian Journal of Medical Sciences, 7(3), 495–499. https://doi.org/10.3889/oamjms.2019.044
Lin, T., Zirpoli, G. R., McCann, S. E., Moysich, K. B., Ambrosone, C. B., & Tang, L. (2017). Trends in Cruciferous Vegetable Consumption and Associations with Breast Cancer Risk: A Case-Control Study. Current developments in nutrition, 1(8), e000448. https://doi.org/10.3945/cdn.117.000448
Oh, J.-E., Kim, Y.-W., Park, S.-Y., & Kim, J.-Y. (2013). Estrogen Rather Than Progesterone Cause Constipation in Both Female and Male Mice. The Korean Journal of Physiology & Pharmacology : Official Journal of the Korean Physiological Society and the Korean Society of Pharmacology, 17(5), 423–426. https://doi.org/10.4196/kjpp.2013.17.5.423
Patel, S., Homaei, A., Raju, A. B., & Meher, B. R. (2018). Estrogen: The necessary evil for human health and ways to tame it. Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie, 102, 403–411. https://doi.org/10.1016/j.biopha.2018.03.078
Patisaul, H. B., & Jefferson, W. (2010). The pros and cons of phytoestrogens. Frontiers in Neuroendocrinology, 31(4), 400–419. https://doi.org/10.1016/j.yfrne.2010.03.003
Piazza, M. J., & Urbanetz, A. A. (2019). Environmental toxins and the impact of other endocrine disrupting chemicals in women's reproductive health. JBRA Assisted Reproduction, 23(2), 154–164. https://doi.org/10.5935/1518-0557.20190016
Rajoria, S., Suriano, R., Parmar, P. S., Wilson, Y. L., Megwalu, U., Moscatello, A., Bradlow, H. L., Sepkovic, D. W., Geliebter, J., Schantz, S. P., & Tiwari, R. K. (2011). 3,3'-diindolylmethane modulates estrogen metabolism in patients with thyroid proliferative disease: a pilot study. Thyroid : official journal of the American Thyroid Association, 21(3), 299–304. https://doi.org/10.1089/thy.2010.024
Vitex Agnus-Castus—An overview | ScienceDirect Topics. (n.d.). https://www.sciencedirect.com/topics/medicine-and-dentistry/vitex-agnus-castus
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