Many women that come to our office, complain of the common estrogen dominant symptoms, such as:
- Heavy and/or painful periods
- Breast tenderness and swelling
- PMS and moods swings
- Sugar cravings
- Fibroids, breast cysts, ovarian cysts, endometriosis, adenomyosis
- Bloating and water retention
- Irregular menstrual periods
- Decreased sex drive…. And more!
It’s important to first of all understand, that not all these symptoms guarantee that you actually have
too much estrogen in the system. There are several imbalances that can contribute to these symptoms,
such as normal estrogen but low progesterone, high estrogen in combination with low progesterone,
high cortisol, thyroid imbalance and others that can cause some of these symptoms.
This is why it’s important to do proper testing on all your hormones, to truly get a complete picture and know the best treatment options to avoid guesswork. In a previous blog post, we talk about The Importance of Testing you Hormone before Blindly Treating your PMS or Menopausal Symptoms.
So assuming you’ve done testing and have learned that you truly have high or high normal estrogen
levels, now what?
Why do I have high estrogen levels, to begin with?
There are several possible reasons you need to explore:
- High exposure to Xenoestrogens – these are estrogen-mimicking chemicals that can bind your natural
estrogen receptors and disrupt your endocrine system. Unfortunately, they are found in a variety of
everyday items such as our make-up and other skincare products, plastic Tupperware or bottles, in our
food in the form of preservatives, pesticides or insecticides that are sprayed on foods, hormone
containing meats and dairy products, the birth control pill and many others.
- Poor phase I or phase II detoxification pathways – discussed in detail below.
- Poor elimination and excretion of estrogen metabolites through stool or urine due to constipation and irregular bowel movements.
- Being overweight and having high percent body fat- your fat tissue is not just a blob that is annoying and hard to get rid of it, it’s actually hormonally active tissue. Estrogen gets stored in fat, so the more body fat there is, the more estrogen the body will store. This also applies to men by the way!
- Having elevated testosterone levels – testosterone gets converted to estrogen through the aromatase enzyme as seen in the diagram below. Therefore, having Polycystic Ovarian Syndrome (PCOS), over supplementing with testosterone or DHEA or generally having a high production of this hormone, can lead to more estrogen being produced as a byproduct.
How is Estrogen Detoxified in the Body and What Can You Do to Support It?
Did you even know you have 3 forms for estrogen in the body? Estrone (E1), Estradiol (E2) and Estriol (3). Most conventional tests check for only one – E2 – since it’s our predominant one. However emitting the other two leaves important information behind.
Many women simply worry about whether they have too much or too little estrogen but knowing your total quantity is NOT enough. That is why unfortunately conventional bloodwork and even saliva testing has its limitations.
Knowing what your body does with your estrogens and how it metabolizes them is crucial in order to properly address the root cause your symptoms and imbalances. Estrogen metabolism is a complex process, but luckily one you can easily test for through urine. We recommend the DUTCH urine testing to get a complete snapshot of your circulating levels of all 3 estrogens, as well as whether your body is metabolizing them and excreting them in a healthy and cancer-protective way.
So let’s start…this may get a little complex but we need to review what is called phase I and phase II detoxification that occurs in the liver.
In this phase, the body breaks down your estrogens to 3 metabolites:
1. 2-OH-E1 – the protective pathway which 60-80% of estrogens should be metabolized through
2. 4-OH-E1 – the dangerous pathway that can promote breast cancer and should be limited to 7.5-11% use
3. 16-OH-E1-the proliferative pathway, where too much of this metabolite can also promote cancer growth, but too little has been associated with accelerated bone loss. You should have no more than 13-30% of your estrogen metabolites in this form.
If this comes up as your issue, some vital nutrients that support this phase include DIM or I3C (indole-3-carbinol) which come from cruciferous vegetables and support the better use of the protective 2-OH pathway, while reducing the use of the dangerous 4-OH pathway.
Keep in mind DIM should only be taken if you have both high total estrogens levels and poor phase I metabolism, otherwise, you risk lowering your estrogen too much.
Once phase I is done with, your body then needs to transfer these metabolites to the next step in the factory line, called phase II. Phase II makes the estrogen metabolites water-soluble go they can get out through urine or feces and do not recirculate in the body to cause those estrogen dominant symptoms.
This phase uses the COMT and Methylation pathways and if this is your weak spot (like for the patient in the case below) – some nutrients that help increase this pathway include activated and methylated B vitamins, such as methylcobolamin (B12), methylfolate (activated folic acid) or P-5-P (the active form of vitamin B6), along with things like magnesium, tri-methyl glycine, choline, methionine and SAMe.
It’s important however not to rush to supplement with all of these or just one of the nutrients listed above but to do proper testing to assess whether the issue is elevated estrogen levels only, poor phase I, poor phase II or all of the above!
Supporting the system only partly, or supporting only phase I when phase II may be sluggish, may only exacerbate your symptoms or not be nearly as effective.
Other general interventions to keep in mind that can be beneficial for everyone if you don’t know the status of your hormones includes:
- Avoiding xenoestrogen exposure. Here is a great link to the top endocrine disruptors to avoid your environment:
- Eat more cruciferous vegetables from the Brassica family- broccoli, kale, Brussels sprouts, cauliflower, cabbage, kale, etc.
- Support your liver on-goingly – from the basic lemon water to increasing consumption of dandelion or dandelion tea, doing a liver cleanse twice a year and reducing consumption of sugar and alcohol.
- Make sure your bowels are going – lots of fluids and high fiber in your diet will help regulate your bowel movements and make sure your hormones are properly detoxified rather than sitting in your body and recirculating back in the system.
The bottom line is that there are many interventions that may help relieve your symptoms and support your body is doing its job right, but the best results will come with proper testing and a comprehensive plan to support all hormone which may be out of balance for you.
Some women may not experience severe symptoms but still have poor detoxification of hormones which may put them at risk for health problems down the road, including breast cancer.
If you are interested in learning more about testing, please contact us! Make sure to speak to a qualified healthcare practitioner before starting any supplements on your own.
Wishing you healthy estrogen metabolism!