“Estrogen dominance” is a term used to describe the symptoms of high estrogen levels and low progesterone levels. This is the second most common hormone imbalance I see in women in my practice.
In this article, I’ll break down why estrogen is a great hormone (but why you need progesterone to control it), the most common symptoms of “estrogen dominance,” and some of the reasons why it occurs.
What does estrogen do to you?
Despite the negative reputation of “estrogen dominance,” estrogen is an amazing hormone. You actually have 3 types of estrogen, but the main one we’re going to focus on is estradiol (for simplicity, I’ll call it “estrogen” in the article).
Estrogen performs the following functions:
Helps promote egg development
Supports the growth of the uterine lining
Contributes to ovulation (together with other hormones)
Helps you to be happy and energetic
Supports healthy libido
Protects your bones
Good for your brain function, cognition and mental acuity
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. Estrogen at healthy levels can help you feel energetic, confident, sexy, mentally sharp, and productive, especially during the follicular phase.
As we know from traditional Chinese medicine, “yang” energy must be balanced with “yin”. In this case, it is progesterone. Progesterone is a calming, cooling, grounding and “yin” balancing hormone.
Progesterone balances out estrogen and we need to ovulate regularly to prevent ‘estrogen dominance’. Ovulation is the key event in bringing progesterone levels back to normal. If ovulation doesn’t occur, it leaves us progesterone deficient…which means we have an excess of estrogen compared to progesterone (aka “estrogen dominance”).
What you need to know about “estrogen dominance”?
I put “estrogen dominance” in quotes because it’s not actually a medical term. If you ask your doctor about estrogen dominance, they will give you a blank stare. More accurately, “estrogen dominance” is a general term for the combination of high levels of estrogen and low levels of progesterone. The difference between these two hormones can cause unpleasant symptoms.
Estrogen dominates during adolescence as the brain and ovaries figure out how to regulate ovulation. Ovulation “skipping” is quite common in post-menarche (first period) teenagers, when progesterone is low and estrogen is relatively high.
It’s a recipe for – you guessed it – estrogen dominance. Remember the heavy periods, cramps, acne, and crazy mood swings you had as a teenager? It was estrogen dominance.
This hormonal pattern can also occur later in life. Hormonal imbalances that cause anovulation, such as polycystic ovary syndrome, are characterized by high levels of estrogen and low levels of progesterone.
In addition, around the 40s, around menopause, hormones begin to change, leading to a drop in estrogen and progesterone. If you’re in your 40s and your periods are suddenly heavier or your PMS is getting worse, it could be an “estrogen dominance” pattern.
You may be more likely to have high levels of estrogen and low levels of progesterone in the following situations.
You have PCOS
You don’t ovulate regularly
You’re in your 40s and going through menopause
You have symptoms of low progesterone
10 Signs You May Be Estrogen Dominant
These are some of the common symptoms that I study in women with elevated estrogen levels. Some of these symptoms may overlap with other hormonal issues, such as thyroid problems, so it’s important to seek help from a hormone-trained naturopathic doctor to evaluate your symptoms and rule out other concerns.
- Cyclic breast tenderness, pain or fibrocystic breast.
Some women experience increased breast engorgement and tenderness after ovulation or before menstruation. This is a response to changes in estrogen levels throughout the menstrual cycle. “Fibrocystic changes in the breast” means dense breast tissue and/or breast tenderness, diagnosed by ultrasound. Women with breast fibrosis may notice breast tenderness every month. Women with these breast symptoms have increased estrogen levels or increased sensitivity of breast tissue to estrogen.
- Uterine fibroma.
Uterine fibroids grow in response to increased estrogen levels.
Hormonal headaches or “menstrual migraines” occur before or during menstruation. A sudden drop in estrogen and/or progesterone often causes headaches. These can worsen in women with high levels of estrogen, such as pre-menopausal women (see below).
If you tend to spot during the first half of your menstrual cycle or around the time you ovulate, it may be due to estrogen. See this article for more information.
- Heavy and/or irregular periods.
As mentioned earlier, one of the primary jobs of estrogen is to build the lining of the uterus. If we have an excess of estrogen, it increases the lining and makes periods really difficult. If your periods are very heavy, or if your periods are irregular and difficult to predict, it may be due to high estrogen and low progesterone levels.
- The weight around the thighs and buttocks will increase.
Estrogen is a hormone that promotes body structure and shape, and it is associated with the classic female shape: wide hips, large buttocks, and breasts. Estrogen “triggers” the accumulation of fat in these areas. This is not inherently bad. Women need more fat than men to maintain hormonal health. If you notice weight gain, especially in these areas, estrogen may be a factor.
- You have low progesterone symptoms such as trouble sleeping, short cycles (every 21-24 days), spotting, and PMS-related problems.
As mentioned above, “estrogen dominance” refers to the difference between estrogen and progesterone. If you are estrogen dominant, your progesterone is relatively low! Read this article to learn more about symptoms of low progesterone.
- You have been diagnosed with polycystic ovary syndrome (PCOS).
PCOS is a hormone imbalance with anovulation, elevated testosterone levels, insulin levels, and blood sugar levels. Skipped or infrequent ovulation means the body is not producing enough progesterone to balance the estrogen. Because of this, other symptoms of increased estrogen may appear. Read this article for more information on how to treat PCOS.
- You’re in your 40s and experiencing worsening PMS, heavy periods, flooding, weight gain, hot flashes, and/or night sweats.
These are the symptoms of perimenopause. Progesterone levels drop during perimenopause, resulting in low progesterone symptoms.
It was previously thought that during this phase of a woman’s life, estrogen gradually declines, causing classic perimenopause symptoms such as hot flashes and night sweats. It is now understood that instead of a gradual decline, estrogen production becomes erratic and unreliable. More frequent fluctuations in estrogen and less progesterone can lead to symptoms of estrogen dominance: heavier periods, worse PMS, sleep problems, and hot flashes. In general, perimenopause is a time of low progesterone and high estrogen.
What is the root cause of “estrogen dominance”?
When I work with patients to balance their hormones, I first need to determine their hormonal patterns. This can be done through a detailed initial consultation using my hormone assessment method and in some cases hormone testing.
After determining your hormonal pattern, the next most important question is WHY? Why the “estrogen dominance” model?
In this article, I discuss estrogen and progesterone imbalances that contribute to estrogen dominance. I explained that ovulation is a key event necessary to produce progesterone and maintain estrogen balance. Anovulation and low progesterone are important hormonal imbalances to understand if there are signs of estrogen dominance (read more here).
In addition to high estrogen and low progesterone, there is another important factor in estrogen dominance. We’ve covered what happens when your body produces excess estrogen, and we haven’t yet covered how your body gets rid of estrogen.
Did you know that after you consume estrogen, it is processed in the liver, broken down, “labeled” and then sent to your gut and out of your body?
Furthermore, did you know that your gut bacteria play a role in your ability to release (or reabsorb) estrogen from your gut?
That’s right. If you’re not pooping regularly (one or more times a day), and you have certain gut bacteria, you’re probably reabsorbing estrogen back into your bloodstream. That’s why