What causes Estrogen Dominance?

When asking what causes estrogen dominance, the most common answer you may hear is that it is because of much estrogen or not enough progesterone. If you read Part 1 , that description really only describes what the condition is, not what actually causes a bad estrogen to progesterone ratio.

In other conditions, I see this all the time; people say they have diabetes, rheumatoid arthritis or attention deficit disorder. While the diagnosis is correct, the diagnosis should be just the beginning of the process. The question that you should ask next is WHY.

I would estimate that 98% of all conditions have a known why. The hard part about the why is that it usually includes more than a single cause as you will see is true in estrogen dominance.

Liver

A proper functioning liver is the hallmark of health. In a healthy state, the liver detoxifies excess estrogen through two phases commonly referred to as phase 1 and phase 2 detoxification.

Phase 1 is responsible for converting estrogens into a form that Phase 2 can then process. When Phase 1 isn’t working optimally estrogen is improperly converted into carcinogenic (bad) estrogen which may lead to breast cancer, endometrial or cervical cancer in women and prostate cancer in men.

Things that create problems with Phase 1 and you can take action on yourself are caffeine, alcohol, pesticides and most off-gases or fumes. One of the easiest ways to know if you have a liver Phase 1 detoxification problem is if you can drink coffee or an energy drink without feeling a boost of energy from the caffeine. This is an old liver test that has been used for many years. If you drink your coffee and go to bed, you usually have a problem.

Phase 2 is responsible for binding the estrogen produced in Phase 1 and helping you to excrete it. If Phase 2 is impaired, you will only excrete or eliminate a portion of the estrogen that you would optimally. The excess hormones then get to go back into circulation and cab wreak havoc creating all the symptoms associated with estrogen dominance.

Gut (Intestines)

Your gut or digestive tract contains what I like to call “bugs.”

They are microorganisms that live in the digestive tract and help with the breakdown and digestion of food. We are discovering new roles for the gut flora (aka bugs) all the time. To make a long story short, there are good bugs and bad bugs. The good bugs and the bad bugs help with various different processes, but it’s important that they stay in a healthy ratio. When the ratio of good bugs to bad bugs is altered in a bad way, we call this dysbiosis.

Bad bugs are one of the top causes of estrogen dominance.

Let’s imagine you have a perfectly healthy liver and everything is working well. Your liver properly detoxifies some estrogen molecules and send it back out to your digestive tract, properly bound and ready to go into your stool and down the drain. If you have a high level of bad bugs in your gut, then these bugs are able to unconjugate or unbind (aka reverse) all the hard work that your liver did to detoxify estrogens.  While these old and excess estrogens should have been excreted from your body, instead they end up getting freed and released into circulation.

So your liver may have to repeatedly detox the SAME estrogen molecule.  Kind of like when you clean the house and one of your kids or husband comes and puts something right where you just cleaned. Your liver feels the same way!

Xenoestrogens
Xenoestrogens are any chemical we are exposed to in the environment that has an estrogen like effect, or promotes more estrogenic activity. The big ones that people hear about are BPAs and phthalates, but unfortunately they are many more found in our drinking water, shampoo, deodorant, dryer sheets, laundry detergents, and all plastics, even the BPA free ones. Besides having an estrogenic effect, xenoestrogens also have to be detoxified by the liver and compete with the same pathways to get out of the body.

Even worse, these xenoestrogens get caught in the fat cells of our body and even weave themselves into the cellular matrix which makes many other body systems start to work suboptimally.

Adrenals
The adrenals play a huge role in proper estrogen maintenance as the adrenals can make the same hormones as the ovaries.

In peri- and post-monpause, the adrenals play a significant role in production of the sex hormones like estrogen and progesterone. Good adrenal health is critical for passing through menopausal phases without fear and discomfort. Eating too many carbohydrates, drinking too much caffeine or simply having too much stress in your life can lead to subpar performance from your adrenals.

Obesity
Obesity is usually just seen as being overweight, but it is important to note that the extra adipose tissue (fat cells) are functioning cells too. So while many people only consider being overweight a bad thing for appearance, the truth is obesity is not only a sign of poor health but a cause of poor health.

In estrogen dominance the fat cells actually make estrogen. They do this by converting precursor hormones into estrogen. So not only is weight gain caused by estrogen, the added weight actually perpetuates the cycle and makes things worse. Adipose tissue is also a huge factor in creating inflammation in the body which leads to pain, immune problems and almost every medical condition.

Statistics show that women that gain over 20 lbs. from age 18 to mid-life have DOUBLE the risk of developing breast cancer post-menopause. The lifetime risk for a woman is currently close to 1 in 8. I recommend using the BMI scale to determine your optimal weight. A range from 21 to 25 should be the goal. While being in the range doesn’t guarantee health, being outside the range almost guarantees a decrease in health.

Side note: I realize that many women and men are not in their optimal BMI range. In our office we don’t exclusively focus on weight loss but rather on being healthy and in return we notice that we get closer to our optimal body weight, whatever that may be.

Diet, Lifestyle, Exercise, Sleep, Toxins
To start this section the easiest one to address is sleep. Melatonin is produced from the pineal gland in the brain when it is dark. The darker your room while you sleep and the more sleep you get, the healthier your melatonin levels will be. Melatonin stops your excess estrogen from connecting with receptors and worsening your condition, so while trying to recover from estrogen dominance, proper sleep will speed up your results.

Nutritional deficiencies occur in almost all people to some extent. While it is possible that you aren’t getting adequate nutrients in your diet, most non-vegetarian (or vegan) Americans meet their daily requirements. But, when you have too much estrogen for too long your body uses the same vitamins, minerals and nutrients to try and break it down and can induce a nutritional deficiency.

In a healthy balanced hormonal state, you would have enough of nutrients for your body to to keep up, but with excess estrogen for too long, your diet may not be enough to support these processes and you end up with low nutrient levels. Many times temporary supplementation is necessary to get back to a state of homeostasis (balance). I will cover supplementation in part 3.

In addition to nutritional deficiencies contamination with toxic metals will drain nutrients and even replace them, rendering critical processes inoperable. It specifically can inhibit your body’s energy cycle making you feel fatigued, have brain fog and continue to gain weight.

Aerobic exercise is important in developing a healthy heart and healthy estrogen levels. Properly done, aerobic exercise promotes the ratio of “good” to “bad” estrogen. The bad estrogen is responsible for increased risk of breast and ovarian cancers. With the new trend of HIIT (high intensity interval training) many people are not building adequate bases of aerobic conditioning.

Conclusion
If you think you have fallen down the slippery slope of estrogen dominance, then dietary and lifestyle changes can definitely help. How deep you are into the pattern of estrogen dominance determines how much help you need to get back on track, but it is important to know that no single pill, oil or remedy can fix the problem.

The most prevalent idea in estrogen dominance is to supplement with progesterone. If you refer back to the list of causes, I didn’t put lack of progesterone as a cause for a reason. It is usually a symptom rather than a cause. If your liver detoxification is a problem, adding more hormones like progesterone won’t fix the liver, but will rather bog it down even more. If you have developed a nutritional deficiency, then supplementation of the specific nutrient required is needed, not a magical herb, oil, acupuncture needle or hormonal injection.

Part 3 will cover supplementation and the estrogen dominance test.

REFERENCES :

1. Barbieri R.L. (2014) The Endocrinology of the Menstrual Cycle. In: Rosenwaks Z., Wassarman P. (eds) Human Fertility. Methods in Molecular Biology (Methods and Protocols), vol 1154. Humana Press, New York, NY PMID: 24782009
2. Grodin, J.M., et al.(1973). Source of estrogen production in postmenopausal women. J. Clin. Endocrinol. Metab. 36(2): 207-14.
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3138025/
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4063249/