Estrogen dominance is a hot topic for practitioners of functional and integrative medicine.
A number of different ailments that are presented to doctors by reproductive age women, and in some cases even menopausal women, can be attributed to this state, where estrogen is high relative to progesterone levels in the body. Assessing whether this is occurring generally requires a combination of both presenting symptoms/conditions, along with supporting lab values. If an imbalance is found, the approach to care is multi-faceted, integrating nutrition, lifestyle, nutraceuticals, and in some cases pharmaceuticals.
Women’s health practitioners frequently hear from patients about difficult symptoms related to their periods. These symptoms can be related to PMS (premenstrual syndrome) which include bloating, mood changes, insomnia, breast tenderness, etc in the week leading up to their menses; or they can be related more to the period itself, such as painful cramping, heavy bleeding, or irregular cycles. In addition to these uncomfortable symptoms, certain conditions are also brought to integrative practitioners frequently due to their complexity, including endometriosis, fibroids, and breast cancer. All of these symptoms and conditions can potentially be linked to a state of estrogen dominance and should be assessed.
In combination with the presentation of the above symptoms, estrogen dominance can be confirmed via standard labs or via more specific functional labs. When it comes to standard testing, a measurement of estradiol (the dominant ovarian estrogen) and progesterone levels can be taken five days post ovulation (around day 21 of the cycle). Then once the units are converted, the progesterone/estradiol ratio can be calculated. A low value indicates estrogen dominance, representing a state of high estrogen relative to progesterone, even if levels are within the standard normal range.
If further labs are desired for a more comprehensive evaluation, it is also within reason to look at more thorough hormone testing including FSH, LH, DHEA-S, testosterone, and their metabolites. Functional medicine practitioners likely will also look at liver function testing, nutrient levels, stool testing, thyroid testing, adrenal hormone levels, and environmental exposures. A thorough physical exam with PAP testing should also not be discredited, with some conditions requiring surgical or pharmaceutical intervention prior to the functional approach.
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If estrogen dominance is established as a contributing factor to a woman’s symptomatology, a number of interventions can be implemented to bring these hormones back into balance. In integrative medicine, practitioners generally start with lifestyle intervention. For one, a systematic review of studies in 2023 showed a significant correlation between sleep disturbance and exacerbation of menstrual irregularities (1). In addition, lifestyle intervention can include recommending the proper exercise, avoiding exposure to endocrine disrupting chemicals, and stress management techniques.
Another aspect of intervention that is essential in these patients is a thorough nutritional evaluation. Ensuring adequate caloric and macronutrient intake, adequate fiber, and minimal processed foods all can contribute to an improved state of health promoting hormone balance. In some situations, specific nutritional recommendations can even be made; for example, seed cycling is a popular intervention incorporated into any hormone balancing treatment plan.
The next tier of approach usually includes supplements or herbs that promote progesterone production or proper estrogen metabolism. This can be nutraceuticals like DIM, Calcium-D-Glucarate, Vitex, Black Cohosh, Omega-3-Fatty Acids, Magnesium, etc. The specific recommendations would depend on the patient and what their specific needs are. From there, in certain situations, pharmaceuticals may also be used, but generally the goal would be to use minimal dosing for the shortest time period for adequate results.
Estrogen Dominance is a complicated and occasionally tricky state to be in when it comes to treatment. Its becoming more and more prevalent, likely related to diet patterns, chemical exposures, and way of life in the modern world. However, the symptoms and conditions associated with it can be incredibly detrimental to quality of life for women. Understanding when to evaluate for estrogen dominance and forming a complete and comprehensive approach to treatment is essential for the success and improvement of these patients. Female hormone levels can be evaluated using saliva-based tests that are highly precise and painless. Saliva testing accurately measures the bioavailable/ free fraction of the hormones that are available to the tissues. Extensive published research has supported the accuracy of saliva testing in determining the hormone levels. AYUMETRIX is a world leader providing hormone testing in saliva, which is simple and convenient. The samples can be self-collected at home and mailed to the laboratory for analysis. To learn more about hormone testing in saliva, please visit www.ayumetrix.com.
- Mary Hall, ND, LAc
References:
1. Jeon, Bomin and Baek, Jihyun. 2023. Menstrual disturbances and its association with sleep disturbances: a systematic review. BMC Women’s Health. 23(1): 470.
