Estrogen Dominance

Estrogen dominance is a very common condition with women, and may include symptoms such as PMS, anxiety, irritability, insomnia, breast tenderness, water retention, mid-cycle bleeding or heavy painful menstrual cycles.  Conditions such as uterine fibroids, endometriosis and fibrocystic breasts are also encouraged and aggravated by estrogen dominance.

These situation are caused by an imbalance of estrogen and progesterone.  Simply put, estrogen stimulates and progesterone puts the breaks on estrogen.  Excess estrogen or deficient progesterone will lead to estrogen dominance.

Estrogen is normally made by the body, does it’s job, then needs be metabolized and eliminated.   This process starts with a healthy gut as do most all detox processes, then requires the right nutrients to support the liver’s metabolic detox pathways.

Lowering Excess Estrogen

Step 1 in dealing with estrogen dominance is to insure a clean diet, with plenty of methyl donor foods for liver support including:

  • Cauliflower, eggs, flax seeds, lentils, liver, peanuts, soybeans and wheat germ (choline)
  • Leafy greens, asparagus, citrus fruits, cheese, eggs, legumes, peanuts (folate)
  • Dairy products, eggs, fish, meat, poultry and rice (methionine)
  • Cheese, eggs, meat and milk (vitamin B2/riboflavin)
  • Bananas, fish, grains, legumes, liver, meat, potatoes and poultry (vitamin B6/pyridoxine)
  • Eggs, fish, meat, poultry, dairy products (vitamin B12/cobalamin)

Note if you are following a whole-food plant-based diet, which I highly recommend, such as a Mediterranean diet, then you will need to consider alternate sources of B12 in particular.  A simple B12 or B-Complex with Metafolin supplement will address this just fine.

Step 2 is to address possible gut inflammation that will impair elimination of estrogen and detox in general.  Conditions such as delayed food allergies, leaky gut, or imbalances of the gut microbiome can cause inflammation and impaired detox.

Step 3 is to avoid foreign estrogens called Xenoestrogens.

Beyond this, adding a few natural supplements is often very helpful in lowering excess estrogen and/or blocking the impact of excess estrogen.

DIM and Myomin

DIM, or Diindolylmethane, is a food based supplement that is naturally found in cruciferous vegetables such as broccoli, cabbage, cauliflower, brussel sprouts, collard and mustard greens, and kale.  DIM helps the liver to metabolize estrogen not only better, but safer, leading to less cancer promoting byproducts such as estrone.

Myomin is an herbal supplement that helps estrogen dominance in two ways.  First, it inhibits the breakdown of testosterone to estradiol, thus lowering estrogen levels.  Second, it selectively blocks estrogen receptors, which means it will bind to an estrogen receptor but not stimulate it meanwhile blocking stronger estrogens from binding and really activating estrogen receptors.

We generally recommend DIM as directed.  Myomin dosage varies from 1 to 3 capsules 3x/day, typically starting a the full dose and lowering after symptoms are under better control.

Alongside the above considerations, check for causes of low progesterone including:

  • Low thyroid
  • High insulin such as with prediabetes or PCOS
  • High cortisol from stress or inflammation (think gut health again)
  • High prolactin
  • Inadequate nutrition or excess sugar

Sometimes when all of the above is not solving the problem of estrogen dominance we’ll prescribe progesterone to help balance the excess estrogen.  The progesterone is typically “cycled” and taken for 2-3 weeks when estrogen is high, then basically held during menses when estrogen is low and so much progesterone isn’t really needed.

Premenopause Estrogen Dominance

Take note that as women get closer and closer to menopause they seem to naturally just quit making as much progesterone.  We see this all the time in our clinic and are quicker to add progesterone cycling as the issue is not necessarily an underlying problem as much as the natural course of declining ovarian output.  It seems progesterone is the first to go for many women, even 5-10 years before menopause.  Taking progesterone will usually quickly control the estrogen dominant symptoms while lowering the risk of uterine fibroids, breast cysts and other estrogen dominant conditions.

One more tidbit…  Many of these women are also deficient in testosterone.  If supplementing testosterone it’s critical to get the estrogen dominance well under control first!  If you add testosterone too soon it will make everything worse.

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