Dr. Nicole Sundene
Estrogen dominance symptoms caused by high estrogen and/or low progesterone are various and therefore often missed in women’s health. Women with high estrogen are commonly treated with a medication to suppress each individual symptom without addressing the "Root Cause." Many doctors often fail to identify and properly diagnose the estrogen dominance. A skilled women’s health doctor can identify the cluster of symptoms relating to estrogen dominance and order the proper hormone testing to diagnose the estrogen dominance.
ESTROGEN DOMINANCE SYMPTOMS
High estrogen symptoms include weight gain, bloating, fatigue, anger, agitation, rage, moodiness, dark mood, mood swings, anxiety, depression, panic attacks, acne, cystic acne, oily skin, constipation, nausea, PMS, fluid retention, swelling, headaches, and a generalized feeling of unwellness.
Women struggling with high estrogen levels often have heavy periods, painful menstrual cramps, light or absent periods, irregular periods, decreased sex drive, endometriosis, endometriosis pain, uterine polyps, adenomysosis, uterine fibroids, breast cysts, fibrocystic breasts, dense breasts, breast pain, and insulin resistance. Women with heavy bleeding from estrogen dominance often end up with anemia which worsens the fatigue and weight gain from high estrogen.
High estrogen levels tend to worsen if not cause many of these common women’s health conditions. Insulin resistance results from estrogen dominance and estrogen dominance then further worsens insulin resistance creating a vicious cycle of weight gain for PCOS and diabetic women with high estrogen levels. It is nearly impossible for these women to lose weight when they are battling estrogen dominance and insulin resistance with herbal medicine and dietary changes.
With this many common women’s health conditions being adversely impacted by high estrogen levels it is imperative that women are educated about estrogen dominance for prevention and proper treatment.
HIGH ESTROGEN LEVELS: LONG TERM DANGER
High estrogen symptoms or “estrogen dominance” when left untreated can result in high blood pressure, increased risk of stroke, heart attack, blood clots, ovarian cancer, and breast cancer. High estrogen levels will worsen patients prone to these conditions and increase their risk of developing them. Alternatively, having low estrogen can also increase a woman’s cardiac risk. So estrogen can be the hero or the villain in women’s health. It is all about the levels being at optimal levels and in proper balance with the other female hormones.
HIGH ESTROGEN VS LOW ESTROGEN
Neither extreme high estrogen nor low estrogen is healthy for women. Low estrogen such as in menopause can cause a whole host of problems such as Osteoporosis, Hot Flashes, Insomnia, Anxiety, and Depression. We need to think of estrogen as if its water. Too much water can be just as dangerous as too little water. Just like with estrogen, women also need an individualized level of water as they metabolize it uniquely. Just like with water we need to hit “the sweet spot” with estrogen where the levels are not too high nor too low. Menopausal women suffer without any estrogen just as much as my estrogen dominant patients. Both high estrogen and low estrogen states cause insulin resistance causing weight gain so it is imperative women increase the fiber, good fat, and protein in their diets as otherwise the will gain weight when their estrogen level is not optimal.
ESTROGEN DOMINANCE DIAGNOSIS
Estrogen dominance diagnosis involves proper Hormone Testing with emphasis on the estradiol, progesterone, and total estrogen to determine if the estrogen to progesterone ratio is healthy. A healthy estrogen to progesterone ratio is under <60-100. When women have an estrogen ratio higher than this they are at high risk for disorders and diseases caused by estrogen dominance.
When the estrogen to progesterone ratio is above >60-100 women have estrogen dominance. This can be caused by a few different scenarios I will explain with the math I use to calculate the "E:P Ratio" or Estrogen to Progesterone Ratio:
Total Estrogen 600/ Progesterone 20= 30 Normal
Total Estrogen 600/Progesterone 10=60 Normal
Total Estrogen 600/Progesterone 0.5=1200 High
Total Estrogen 300/Progesterone 0.5= 600 High
So we can see in the last calculation that the estrogen can be in the normal range yet if the progesterone is deficient then we can still have estrogen dominance despite a “normal estrogen level.” The first scenario is generally the progesterone level of a woman in their teens or twenties and as the progesterone level progressively deteriorates the high estrogen begins to cause symptoms. The last two calculations I commonly see in women in their 40's and 50's. Women that are overweight will maintain a high estrogen level at menopause produced by their body fat yet have very little progesterone to balance it out.
I hear every day from women how their doctor tested their hormones and said they were “normal,” yet often I receive incomplete labs that are not properly ordered. Many important hormone tests are missing, and there is a 99.99% failure rate their previous doctor calculated the ratios of the hormones to each other to ensure they are all in balance with each other.
ESTROGEN DOMINANCE TREATMENT
Treating estrogen dominance involves a multifactorial approach between eliminating xenoestrogens from beauty products, plastic water bottles, and environmental sources as well as helping the liver detoxify estrogen, in addition to understanding why the estrogen levels are so high in the first place.
Often in a woman's 40's this is somewhat "normal" as women that are Perimenopausal are experiencing often permanent PMS symptoms from constant estrogen dominance. Rather than having a few days each month that they feel "PMSy" they are now feeling PMS symptoms every day of the month with a few breaks from it as their hormones begin to shift towards menopause. Around 35 years of age a woman's progesterone and testosterone levels begin to decline while estrogen remains high or becomes even more elevated.
Estrogen dominance can be corrected with a solid long term nutrition and herbal medicine approach. The good news with estrogen dominance is that it can be easily treated naturally by a women's health Naturopathic Doctor that specializes in bioidentical hormone therapy, nutrition, and herbal medicine. While bioidentical hormones are not always required to correct the estrogen dominance, they can be helpful for correcting a scenario of low progesterone that is out of balance with a high or normal estrogen level.
WHY DO WOMEN HAVE ESTROGEN DOMINANCE?
When women are in their teens and twenties their progesterone levels are generally around 20. Around 35 these levels begin to dwindle down to zero causing the symptoms of estrogen dominance to become more unbearable each year. The impact of this hormone imbalance can significantly impair the mental health of women and cause their psychiatric issues to worsen. Some women develop depression or anxiety during this time of severe hormone imbalance.
When women suddenly develop mental health disorders in their 40's or 50's it is more likely related to their hormones impacting their neurotransmitter levels. Did you know that estrogen dominance, estrogen deficiency, testosterone deficiency, and progesterone deficiency can all impair a woman’s mental health? Around 35 most women begin to notice this decline in their natural hormones with various odd new symptoms they never experienced before.
WHAT DISEASES ARE CAUSED BY ESTROGEN DOMINANCE?
Many women's health conditions cause high estrogen such as hypothyroidism, Hashimotos thyroiditis, obesity, perimenopause, oral birth control, synthetic hormones, and bioidentical hormones. When bioidentical hormones are not properly tested to match a woman’s individual hormone metabolism they can also cause estrogen dominance. On rare occasions, tumors secreting estrogen on the ovaries and adrenal glands can also cause estrogen dominance.
Alcoholism causes estrogen to pool in the system as the liver fails to detoxify both the estrogen and the alcohol. PCOS, excess body fat, liver problems and even stress all cause estrogen dominance. Stress lowers progesterone levels referred to as “The Progesterone Steal” in biochemistry, causing estrogen dominance symptoms to worsen when there is not sufficient progesterone to balance the high estrogen levels.
Some women do not excrete or metabolize estrogen due to genetic mutations such as COMT, MAO, and MTHFR, and therefore will need estrogen metabolizers and liver support in addition to bioidentical hormones. Bioidentical hormones such as progesterone and testosterone can be helpful in balancing high estrogen levels. When women are younger all three hormones are high. With the aging process, the progesterone and testosterone decline and the estrogen remains high until menopause officially sets in.
ESTROGEN DOMINANCE CAUSES WEIGHT GAIN WHICH ELEVATES ESTROGEN
Estrogen dominance causes weight gain and weight gain then ironically causes more estrogen dominance as the higher a woman’s body fat level the higher their estrogen level. Body fat constantly secretes estrogen independently of the ovaries.
Conversely, the less body fat a woman has the lower their estrogen. When women are estrogen dominant and they are losing weight even more estrogen is being released from the fat cells and this can actually slow if not stop weight loss completely until properly addressed with the appropriate estrogen detox measures.
Women with estrogen dominance often end up stuck in a vicious weight loss cycle where they cannot lose the weight because when they start to lose weight their estrogen dominance worsens and causes more weight gain. High estrogen levels also smother thyroid function and therefore lower and suppress the metabolism even further. It is important to work with a skilled hormone doctor that understands all the other hormones that need to be tested for to properly identify and treat the high estrogen levels, and treat the thyroid and estrogen.
Just treating one hormone in the “web” will not be effective when we do not address the other imbalanced hormones in the web impacted by estrogen.
ESTROGEN DOMINANCE AND LIVER DETOX
The liver is important in breaking estrogen down into an almost totally impotent form. It also converts estrogen into compounds that can be excreted from the body through urine and bile. The purpose of an estrogen lowering diet is to support the liver, to reduce sources of estrogen found in foods, and to support other glands such as the adrenal glands and the thyroid gland that influence estrogen.
Women with Hashimotos Thyroiditis, Thyroid Disease, and Hypothyroidism will suffer from estrogen dominance until the thyroid levels are properly regulated. The thyroid is the "Mother of the Endocrine System," and in this case the estrogen dominance is caused by thyroid disease. A holistic women's health Naturopathic approach can work to balance the estrogen levels over time.
HOW LONG DOES IT TAKE TO LOWER HIGH ESTROGEN LEVELS?
Estrogen dominance requires patience and reasonable expectations. It generally can take three to six months for menstruating women to correct their estrogen dominance as the eggs that are being made today have not yet undergone Naturopathic hormone balancing treatment and will be released in three months. These unhealthy eggs will also then secrete imbalanced hormones along with them.
Therefore it is important for women to understand this takes time, and it is important we never ignore estrogen dominance. Many of my estrogen-dominant patients that were unable to follow their estrogen lowering program and remember to take their supplements have ended up with breast cancer, uterine cancer, and ovarian cancer due to the high uncontrolled estrogen levels in their systems. Therefore working on your high estrogen levels for mood or weight loss now may save your life someday in the future!
The following estrogen dominance diet and lifestyle recommendations should be implemented as soon as possible to prevent stroke, blood clots, breast cancer, uterine, and ovarian cancer in estrogen-dominant women.
ESTROGEN DOMINANCE DIET
• Eliminate sugar, white flour, and refined foods. Sugar increases estrogen. Having insulin resistance or diabetes also increases estrogen. Body fat makes estrogen, therefore losing weight will also naturally lower estrogen levels. Keep in mind that while losing weight your estrogen levels may suddenly shoot up as I discussed above. However, over the long term fat loss will lower high estrogen naturally.
• Eliminate alcohol and methyl xanthines that increase estrogen such as coffee, tea, chocolate, colas, and other foods or beverages that contain caffeine. The liver is too busy metabolizing these chemicals to eliminate high estrogen levels.
• Eliminate red meat, lamb and pork. Organic chicken, turkey, and safe seafood such as Alaskan wild salmon, shrimp, and scallops (not Tuna or Swordfish) are acceptable alternatives. Many women eat Vegan to reduce estrogen consumption from meat. Most animal protein naturally contains some hormones. Non-organic meats are injected with estrogen to help increase the sale per pound of meat in the meat industry. If you suffer with estrogen dominance the first most important diet change you should make is to invest in high quality organic meats that are low fat. The saturated fat content in animal fats should be counted daily and women with estrogen dominance should be under <10g of saturated fat daily. This is why many Naturopathic Doctors recommend a Vegan diet for estrogen dominance. But eating low-fat meat choices free of hormones can also be helpful, especially for those with insulin resistance that need to be on a higher protein diet.
• Decrease fats, especially animal fats and trans fats from fried foods. Use instead unsaturated fats such as those in cold-pressed vegetable oils raw nuts like walnuts, and flax or fish oil. Total fat consumption should be <50g of fat for estrogen-dominant women as fats increase estrogen in biochemistry pathways.
• Increase foods found in the cabbage family such as cabbage, Brussels sprouts, cauliflower, etc. As the sulforaphane and Indole-3 Carbinole helps aid in the detoxification of estrogen to a less active form. Increase fruits and veggies that aid liver support and liver detoxification in my Liver Foods blog.
• Decrease dairy products such as milk, cheese, cream, etc. Saturated fat from dairy is a top contributor to female hormone imbalance. Only consume organic low-fat dairy if any.
• Increase fiber from vegetables to naturally detoxify estrogen. Fiber binds estrogen for elimination in the digestive tract. Without sufficient fiber the estrogen continue to circulate and worsen the estrogen dominance. Women with estrogen dominance should consume at least 30g of fiber daily. I recommend using a macro tracker such as Myfitness pal to understand where the excess fat and carbs are coming from and to reach dietary fiber intake goals.
• Increase garlic and onions as sulfur is needed to detoxify estrogen.
• Be sure you are taking adequate amounts of selenium, iodine, beta-carotene, and vitamins A, C and E. Consult your Naturopathic Doctor to determine this.
ESTROGEN DOMINANCE LIFESTYLE FACTORS
Chemicals and Xenoestrogen or “estrogen mimickers” increase estrogen levels. Chemicals like pesticides and insecticides impede liver detox pathways causing elevated estrogen. Plastic and other chemicals such as BPA, phthalates, and parabens also contribute to high estrogen.
#1 MOST IMPORTANT THING FOR WOMEN WITH HIGH ESTROGEN: BPA from plastic water bottles, and lining aluminum cans are a significant source of xenoestrogens or estrogen mimickers that contribute to the estrogen dominance when seen in the total estrogen pool. Do not eat canned food, do not use plastic water bottles, do not cook or freeze anything in plastic and work to eliminate as much plastic from your world as possible as it is the #1 issue causing hormone imbalance for women.
There is no point in me prescribing expensive herbs and supplements to detoxify high estrogen when we are not paying attention to the front loading of synthetic estrogen poison entering a woman’s body in the form of plastics and BPA. This is why I buy food in glass jars and support companies that also are willing to pay a little extra for glass jars to save our environment from the loads of plastic poisoning women, sea creatures, and wildlife. This is not only a better choice for our health as women, but also the environment.
#2 Eliminate all beauty products with parabens, fragrance and phthalates. Switch to clean beauty products as your beauty products run out. This is especially important for lotions, creams and moisturizers you regularly use as well as makeup that is regularly used. Most makeup is complete poison for women and causing their estrogen dominance. Any “natural fragrance” should be listed with the source, or should be assumed as toxic otherwise. Perfume is 100% hormone poison and should be thrown straight into the garbage can if you have been diagnosed with estrogen dominance.
#3 Decrease stress as it depletes progesterone. Stress causes cortisol our main stress hormone to be made from progesterone. This lowers our progesterone and raises our estrogen to progesterone ratio. Stress also tells the body it is “Running From a Bear” and it is not a good time to reproduce and hence less progesterone that is needed to maintain a pregnancy is produced under stress. The body does not care about making a baby when it is running from a bear. Women with high estrogen and also low progesterone will feel the worst with their estrogen dominance symptoms. Read my blog on tips for Anxiety to learn more about managing your stress naturally.
If you need my help with diagnosing your estrogen dominance or treating high estrogen levels or the conditions related to estrogen dominance simply pop over to my SCHEDULE page to treat yourself to a Naturopathic visit.
Dr. Nicole Sundene
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology, Acne, Psoriasis, Eczema, and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 23 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease.
She has been an Herbalist for over 28 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan (not Medicaid) and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!