The female reproductive hormones tend to be extremely complicated with a lot of factors contributing to relative imbalances within the body. Relative imbalances, described by functional medicine practitioners as either estrogen dominance or progesterone dominance, can lead to a whole host of uncomfortable symptoms women will present to their doctor to discuss. Understanding the difference between the two states is essential for medical practitioners to recognize, leading to appropriate testing, diagnosis, and therapeutic support aimed at bringing harmony to the cycling hormones.
Recognizing these states of imbalance start with understanding the roles of estrogen and progesterone in the female body. Both are reproductive hormones that cycle month to month and are responsible for the development and function of the breast tissue, ovaries, uterus, and vagina with additional effects on the bones and cardiovascular system. More specifically during the first half of the menstrual cycle, estrogen promotes the proliferation of the endometrial lining to prepare the fertilization as well as lubricates the vaginal tissue; in addition, it also has some action in enhancing mood. Progesterone, produced by the ovaries during the second half of the cycle further supports the endometrial lining and prepares the body for pregnancy.
In many cases, a determination of the body being in an estrogen dominant or progesterone dominant state can be teased out by examining signs and symptoms, but confirmation can be done via lab work. This can be done via the progesterone/estradiol (Pg/E2) ratio. A finger prick blood spot or salivary sample is taken five days post ovulation (average day 21 of the cycle) and the ratio is calculated. In general, an “optimal” ratio is considered anywhere between 100-500. A low ratio would indicate estrogen dominance; a high ratio would indicate progesterone dominance.
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Estrogen Dominance:
Estrogen dominance gets a lot more attention in the integrative medical world as it tends to be much more common compared to progesterone dominance. This is a state in which estrogen is high relative to progesterone, indicating a relative progesterone deficiency. Common complaints frequently associated with estrogen dominance include: dysmenorrhea (painful periods), menorrhagia (heavy periods), premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD), breast tenderness, migraines, and structural issues such as fibroids and endometriosis.
A few things can contribute to an estrogen dominant state. For one, age related hormonal fluctuations can cause temporary and sometimes intermittent months of estrogen dominance; this is especially true during the fluctuations associated with puberty and perimenopause. Another contributor can be exogenous sources of estrogen adding to the total burden in the body; this includes exposure to foods containing pesticides, antibiotics, growth hormone or environmental exposures to things like BPA, phthalates, or birth control. Excess weight can also contribute to the overall burden on the body as fat cells can produce estrogen as well. Finally, another avenue to examine in this situation is how estrogen is metabolized by the body; for example, inadequacies in liver detoxification systems or a dysbiosis of the microbiome can all affect how estrogen is cycled and eliminated.
When it comes to treatment, understanding the possible contributors is essential. Recommendations to patients by functional medicine practitioners can include lifestyle changes, diet changes, environmental exposure adjustments, and supplemental support depending on each person’s unique presentation and concurrent issues.
Progesterone Dominance:
Progesterone dominance tends to be less discussed as it frequently is related to issues with bio-identical progesterone prescribing. This is a state of the physiology in which progesterone is high relative to estrogen, resulting in a relative estrogen deficiency. Symptoms associated include fatigue, abdominal bloating, water retention, low libido, and sometimes increased appetite.
A common cause of this state is over prescribing progesterone. For example, a woman who has been using progesterone successfully could end up with excess progesterone relative to estrogen as perimenopause begins, causing fluctuations month to month in estrogen levels (ie. Month of low estrogen production while taking prescribed progesterone). Progesterone is prescribed by healthcare practitioners for a number of complaints, including amenorrhea, fertility issues, endometriosis, PMS, PMDD, in IV cycles, or for the prevention of miscarriage. Overall, treatment generally involves an adjustment or discontinuation of progesterone dosing. An alternative option depending on the patients situation would also be the addition or adjustment of bio-identical estradiol dosing, therefore balancing the two hormones.
Overall, when practitioners and patients discuss hormone imbalance they’re referring to a state of estrogen dominance; however, as estrogen dominance is managed, progesterone dominance can occur. Hormone balancing treatments aren’t always straight forward and require a lot of care and attention to each patients’ unique situation for the long term. Recognizing the signs of each can be essential in keeping women healthy and happy throughout their hormonal journey. Hormone levels can be evaluated using saliva-based tests that are highly precise and painless. 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.
