Physician Assistant Elizabeth Hedlund continues her series of posts on hormone imbalances in women.

We know that hormones are chemical messengers in the body produced by various glands and organs that work intimately together to create optimal functioning and homeostasis – more simply, balance. This balance helps us to feel well, sleep well, think well, and function well. When something is out of balance, our body tells us with symptoms.  

In women, our primary reproductive hormones are estrogen and progesterone. These are the hormones that give us female characteristics, cause breast development and menstrual cycles, and support healthy pregnancies. These hormones change most during eventful times in our lives such as puberty, pregnancy and post-partum, and then perimenopause into menopause. Estrogen and progesterone are primarily made by the ovaries, along with a small amount of testosterone. Most of the testosterone produced by a woman’s body is converted into estrogen.

Usually when estrogen and progesterone are out of balance it is due to higher levels of estrogen. A number of possibilities can occur: too much estrogen is produced by the body (often due to excess fat tissue which makes estrogen), too much toxic estrogen is in the body from outside sources (birth control pills, HRT, xenoestrogens), poor metabolism of estrogen through the gut and liver, and then unbalanced estrogen due to low progesterone levels (PCOS, birth control pills, chronic stress and cortisol production). This creates a complicated puzzle!

Symptoms of Estrogen Dominance

Imbalanced and high estrogen levels can affect many functions of the body, thereby causing a variety of symptoms. Some of these symptoms include: menstrual changes (often heavier bleeding with cramps), increased PMS symptoms, mood changes including depression and anxiety, breast tenderness and dense breasts, hot flashes, fatigue, headaches, bloating, weight gain (mainly waist, hips, and thighs), fluid retention, and decreased sex drive. Conditions associated with high estrogen levels or estrogen-progesterone imbalance include endometriosis, fibroids, thyroid disorders, infertility, autoimmune conditions, and even female cancers.

Strategies to Balance Hormones

Correcting an imbalance and reducing high estrogen levels depends on the cause. In my experience, traditional western medicine practice is not familiar with this concept. Using the resources given along with the providers at our HELPcare Clinic as a guide to navigate this process, you can identify, test, treat and change lifestyle behaviors to restore balance!

1. Identify xenoestrogens and reduce or eliminate them. These include plastics used mainly for food storage and beverages (water bottles, soda/juice containers), herbicides/pesticides, flame retardants (common in children’s pajamas), synthetic fragrances, household cleaning products with chemicals. Some of the culprits here are PCBs, BPAs, phthalates, DDT, sulfates, and parabens, essentially petrochemical toxins. Even cosmetics and skin care products can contain these chemicals. Other xenoestrogens include hormones found in pork, beef, and dairy cows. Chickens can be given antibiotics which are then passed on to humans.  All of these xenoestrogens can also be called endocrine disruptors.
2. Reduce stress and manage stress in a healthy way. Chronic high stress leads to increased cortisol production. The body uses progesterone to make cortisol, so as cortisol levels remain high, progesterone levels will be low resulting in imbalance.
3. Improve sleep. Most adults need 7-9 hours of good sleep every night. Melatonin, the sleep hormone, reduces the conversion of testosterone to estrogen. Since melatonin production increases in the dark at night, minimizing light exposure and allowing for adequate sleep time will reduce excess conversion of testosterone to estrogen. 
4. Engage in daily movement and activity that you enjoy. Our bodies need to move for so many reasons. One of them is for improved sleep (see #3), another is for reducing stress (see #2).  Activity also promotes a preferred form of estrogen metabolism by the desired pathways. Another primary benefit is for improving insulin sensitivity.  Insulin resistance (elevated blood sugars, prediabetes, type 2 diabetes) is a significant problem for many Americans and causes increased estrogen levels. If you really want to know… the science behind this is that insulin resistance increases aromatase activity which then increases testosterone conversion to estrogen. It also decreases sex-hormone-binding-globulin which means that more estrogen is left free and unbound to this protein. Plus, insulin resistance increases inflammatory mediators. 
5. Eat balanced nutrition to include healthy fats, proteins and carbohydrates with adequate fiber and fluids. Cruciferous vegetables such as broccoli, cauliflower, brussel sprouts, cabbage, collard greens, rutabagas, and turnips, along with green tea and nonGMO soy and flax will promote favorable estrogen metabolism and excretion. Regular bowel movements will also improve estrogen metabolism and excretion. Minimize or avoid processed foods that tend to be high in sugar. Avoid highly processed vegetable oils (corn, canola, soybean), Crisco, and trans fats (hydrogenated oils) which cause damage and inflammation in the body, disrupting our hormone balance. Whole foods, fiber, and fluids will promote overall gut health which is crucial.
6. Avoid tobacco products, even secondhand smoke. Minimize alcohol consumption. Identify heavy metal exposure and toxicity if needed (lead paint, amalgam tooth fillings, etc). These are all considered endocrine disruptors.
7. Consider supplementation. Iodine, magnesium, selenium, vitamin D, and omega-3 fatty acids can be lacking in our diets but are necessary for hormone balance. B vitamins tend to be depleted with high levels of estrogen so some women may benefit from adding these in the form of a methylated B complex vitamin. Digestive enzymes, prebiotics/probiotics, and glutamine may be needed for gut healing and optimal digestion.
8. Consider hormone testing and bioidentical hormone therapy (bHRT). Hormones are best tested through saliva or blood spot (fingerstick) and can be tested at home. Anyone can order these tests through ZRT Labs. Results can be brought to your health care provider for review. Then a determination can be made whether an Rx would be helpful. These prescription treatments need to made through a compounding pharmacy such as The Apothecary, Bloomington Drug or Pure Scripts, all of which are in Minnesota. If you have symptoms of estrogen dominance and want to try bioidentical progesterone cream, this can be purchased over-the-counter and used very safely.  The Women’s Health Network and Vitacost have good products to purchase online.

Wow, this is a lot of information to sort through and think about! You may want to start by taking a hormone-health quiz on one of the resource websites given. Or make an appointment with the HELPcare Clinic and we can help you get started. Keep in mind that while this information is geared for women, men have signs of estrogen dominance as well and should consider applying the above guidelines too!

Resources: 

About Estrogen Metabolites (zrtlab.com)

High Estrogen: Causes, Symptoms, Dominance & Treatment (clevelandclinic.org)

Estrogen Dominance: Symptoms, Causes & Solutions | Amy Myers MD

Estrogen Dominance - Whole Health Library (va.gov)

https://www.weightandwellness.com/resources/articles-and-videos/signs-estrogen-dominance-what-means-how-fix-it

https://www.weightandwellness.com/resources/articles-and-videos/understanding-estrogen-dominance

https://www.womenshealthnetwork.com/hormonal-imbalance/best-supplements-and-vitamins-to-balance-hormones/