In Part 1 of this series we covered cortisol, progesterone, and their relationship. Though the vast majority of hormones are made of protein, both of these are steroid hormones made of cholesterol. Estrogen is another steroid hormone. It is the main female sex hormone, but it also plays an important role in male bodies.

Estrogen: The Breakdown

Estrogen is responsible for most of the physical changes in the female body related to reproduction. It stores fat in certain areas leading to ‘curviness’, plumps skin, and grows the breasts and pubic hair in females. It also has other important functions such as improving immunity and memory, strengthening bones, controlling cholesterol levels, and maintaining a balanced mood. 

The body makes three different types of estrogen:

1. Estrone (E1) = the only estrogen produced after menopause
2. Estradiol (E2) = main estrogen in females of reproductive age
3. Estriol (E3) = produced during pregnancy

The two main sex hormones (hormones involved in reproduction) in females are progesterone and estrogen. As we discussed before, progesterone dominates the second half of the menstrual cycle, maintaining the thick uterine lining to prepare for pregnancy. That thick uterine lining exists thanks to estrogen, who dominates the first half of the cycle. Here is that visual again to refresh your memory:

A Finicky Relationship

One of the most common hormonal imbalances seen in females is between progesterone and estrogen. This imbalance is known as estrogen dominance. In males, this presents as an imbalance between testosterone and estrogen. Even though estrogen does important things like keeping bones strong, the key to balanced health is balanced hormones! One of progesterone’s most important roles is to balance out estrogen after it gets ramped up during the first half of the menstrual cycle. When estrogen levels in the body are too high, you risk developing estrogen-related cancers and experience a range of symptoms.

Because estrogen dominance describes the relationship between estrogen and progesterone, there are a few ways it can present. Estrogen levels could be normal, but if progesterone levels are low, you have estrogen dominance. The opposite can result in the same: If progesterone levels are normal, but estrogen levels are high, you have estrogen dominance.

Symptoms of Estrogen Dominance

If you menstruate, you may have experienced some (or all) of these symptoms. Though they are common in our society, they are likely the result of a hormone imbalance that you can get under control with proper nutrition and supplementation and the help of a functional medicine practitioner.

Females:

• Heavy or irregular periods
• Water retention and swelling
• Breast tenderness and breast changes
• Headaches or migraines
• Weight gain
• Mood swings  
• Painful periods
• PMS symptoms
• Fertility challenges
• Hypothyroidism
• Sugar cravings
• Uterine fibroids (benign growths around or in the uterus)
• Changes in memory and brain function
• Cold hands and feet

Males:

• Erectile dysfunction
• Infertility
• Enlarged breasts
• Depression

Estrogen is created in the ovaries/testes, adrenal glands, and fat tissue. In normal amounts, it keeps our bodies well balanced. However, high amounts of fat tissue can result in extra production of estrogen, which in turn encourages more fat storage. This cycle can lead to unwanted weight gain. On top of that, estrogen has been shown to discourage the breakdown of fat cells, especially in the midsection (hips and waist).

Estrogen dominance over time can lead to more serious health issues, such as heart attacks, breast or ovarian cancer, blood clots, and stroke.

Estrogen and autoimmunity

Estrogen is known to be an immune-enhancer, whereas androgens and progesterone are immune-suppressors. This is an important piece of information for people living with autoimmune diseases such as Hashimoto’s thyroiditis, rheumatoid arthritis, and multiple sclerosis. Autoimmune diseases manifest when one’s immune system is overactive and starts to attack the body’s own tissue. In this case, having estrogen continue to ramp up your immune system is going to cause further damage. This is the reason that about 78% of people with autoimmune diseases are women.

What causes estrogen dominance?

High estrogen levels can be partially hereditary, but it can also be caused (or triggered) by external sources such as hormonal contraceptives, some antibiotics, and other medications, including the popular hormone replacement therapy used to ‘treat’ menopause symptoms. Other factors that contribute are gut dysbiosis, a low fiber diet, and alcohol consumption.  The most common mechanism we see in clinical practice is estrogen dominance due to insulin resistance.  When insulin is spiking to control blood sugar this creates fat cells and fat cells secrete more estrogen.  This in turn alters the ratios of hormones and can increase inflammation which impacts all areas of the body.  As this continues it’s almost like a train gaining steam without brakes.  The estrogen dominance then facilitates inflammation which in turn causes more insulin resistance (and on and on…).

Another cause of estrogen dominance can be polycystic ovary syndrome (PCOS), which we mentioned in Part 1 as a cause of low progesterone levels. PCOS can be caused by high levels of androgens (male hormones). Symptoms can include acne, facial hair or male pattern baldness in females. PCOS may be manageable through proper nutrition. One group of researchers studied women with PCOS and found that by decreasing the amount of refined carbohydrates in their diets, insulin sensitivity could be induced. Insulin sensitivity, being the opposite of insulin resistance, can help increase levels of progesterone and therefore decrease levels of estrogen.

Insulin resistance promotes the enzyme aromatase, which converts androgens to estrogen. It also inhibits sex-hormone-binding globulin, resulting in more free estrogen. We’ll talk more extensively about insulin resistance in part 3 of this series.

Excess fat, stress, impaired digestion and detoxification pathways, and external estrogen copy-cats such as xeno- and phytoestrogens can also lead to increased levels of estrogen. The body metabolizes hormones and gets rid of them through detoxification pathways. When these processes aren’t functioning properly (or genetic alterations are present), estrogen will remain in the body for long periods of time.

Xenoestrogens are synthetic, man-made chemicals that resemble estrogen and act on estrogen receptors in the body. They are found in things like plastics, cosmetics (we absorb up to 60% of what we put on our skin!), and birth control pills. Phytoestrogens on the other hand, come from plants and have less of an impact (though still an impact!) on the body’s natural estrogen levels. Soy is the most common culprit in this family of estrogen disruptors.

What’s next?

The functional medicine approach to all hormone imbalances is represented in the pneumonic “PTSD”. Let’s apply it to estrogen!

1. Production: 
   1. Estrogen is made in multiple places, but we can have the most control over our fat tissue. This does not mean that you need to eat less. Our bodies need to be nourished! Exercise and proper nutrition will help us control excess fat buildup.
   2. We can limit our exposure to external estrogen-like chemicals. Choosing clean cosmetics and organic foods is one way to reduce our intake of xenoestrogens. Avoiding foods like soy can reduce our intake of phytoestrogens.
2. Transport
   1. More available estrogen as a result of dysregulated transportation pathways can lead to estrogen dominance.
3. Sensitivity
   1. A cell’s sensitivity to a hormone may have an impact. For instance, a cell with a rigid membrane may not allow for estrogen to enter. When estrogen receptors are defective, it can result in an estrogen resistance condition and therefore more free estrogen.
4. Detoxification
   1. If detoxification pathways are not functioning optimally and estrogen isn’t being excreted at a normal rate, that leaves more of it to cause an imbalance. We can provide our bodies with nutrients that support healthy digestion and a healthy liver for detoxing.

If you suspect you may have estrogen dominance, you should consider meeting with a practitioner who understands how to identify root causes and will work with you to create a personalized plan for balancing your hormones. Contact us using the form below to get started!

Stay tuned for Part 3 of our hormone series, where we will dive deeper into another very common hormone imbalance: insulin resistance.

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