Mastering Hormone Health: A Doctor’s Guide to Managing Estrogen Dominance

Written and edited by Sarah Bonza MD, MPH, FAAFP, Dip-ABLM

As a physician specializing in both conventional and now functional medicine, I have observed an increasing trend among women in their 40s and 50s. They approach me with a set of symptoms that are both perplexing and distressing. Often, these symptoms point to a common underlying condition: estrogen dominance during the perimenopausal phase. While the term may sound daunting, understanding it can significantly empower women to reclaim their health.

Unveiling Estrogen Dominance

Many women are unaware that challenges like infertility, PMS, mood swings, difficulty losing weight, or a decreased sex drive might stem from estrogen dominance. This condition is particularly common as women approach menopause. Women who have high estrogen levels may experience the following symptoms:

If symptoms of estrogen dominance are ignored, it poses a risk for chronic illnesses and other health complications. Fortunately, knowledge and proactive measures can mitigate these risks and restore control over one’s health.

Estrogen Dominance Equals Progesterone Deficiency

When we talk about balancing hormones, we are frequently referring to maintaining optimum levels of estrogen and progesterone. As women enter perimenopause, balancing estrogen and progesterone is nearly impossible. This is why Maisie Hill refers to perimenopause as “second puberty.

Perimenopause is sometimes called “second puberty” because of the widely fluctuating estrogen levels while progesterone tapers off.

Conventional Medicine and Estrogen Dominance

Conventional medicine does not recognize estrogen dominance as an entity to be treated. This would not be a problem, but because these women are entering the age of menopause, many physicians will prescribe estrogen to these women. But Estrogen dominance affects a significant portion of the population but frequently goes unrecognized. This oversight can contribute to a rise in associated chronic illnesses and cancers. My goal is to inform and provide practical solutions, not to alarm.

Estrogen Metabolism

Estrogen needs a good way to be removed, and that’s where the process of breaking it down, called metabolism, comes in. It’s important for our bodies to properly get rid of extra estrogen to keep things balanced and avoid annoying symptoms.

The three pathways of estrogen metabolism . The 2-hydroxyestrone pathway is considered the most beneficial and protective pathway.

Our bodies use three main paths to break down estrogen: 2-hydroxyestrone, 4-hydroxyestrone, and 16-alpha hydroxyestrone. The 2-hydroxyestrone pathway is considered the most beneficial and protective pathway, while the 4-hydroxyestrone and 16-alpha hydroxyestrone pathways can be harmful if they become dominant.

The other two detoxification pathways can cause harmful estrogen by-products that might damage our DNA and increase the risk of cancer if they become too active. What we eat affects which path estrogen goes down, with some foods encouraging the safer 2-hydroxyestrone path.

Here’s how it works: First, the liver changes estrogen into three different types, known as metabolites. Among these, 2-hydroxyestrone is the least likely to cause issues, while 16α-hydroxyestrone can cause more. Next, these metabolites go through a process to make them water-soluble so our bodies can easily get rid of them via pee or poop.

Dietary Influence on Hormonal Balance

Diet is pivotal in managing estrogen dominance. Foods that support hormonal equilibrium, like cruciferous vegetables, aid in detoxifying harmful estrogen metabolites and reducing cancer risk. Lifestyle changes, such as regular exercise, stress management, and adequate sleep, further support hormonal health.

A Two-Pronged Approach to Combat Estrogen Dominance

In my practice, combating estrogen dominance involves a dual strategy: minimizing exposure to its causes and aiding the body in eliminating excess estrogen. This includes nutritional strategies for liver detoxification, alongside lifestyle modifications to tackle hormonal imbalance at its root.

Enhancing Liver Detoxification Through Diet

What you eat is really important for helping your liver work, especially when it comes to getting rid of extra estrogen. Eating lots of fiber is great because it grabs onto estrogen in your guts and helps kick it out of your body. Some foods are superstars in helping you deal with too much estrogen:

Veggies like broccoli and cauliflower have indole-3-carbinol that promotes the beneficial 2-hydroxyestrone pathway. Flaxseeds contain lignans that can bind to estrogen receptors and help regulate estrogen levels. Probiotics and dietary fiber can support gut health, which is important for proper estrogen metabolism and elimination.

Foods that are good sources of B vitamins and omega-3 fats are also beneficial in supporting these pathways. Moving your body regularly and keeping a healthy weight are also help keep your hormones in check.

Maintain Healthy Gut

Keeping your gut microbiome healthy matters a lot, too. There are special bacteria in your gut that can accidentally put estrogen back into your body instead of getting rid of it. Eating foods that are good for your gut, like those with probiotics and prebiotics, can stop this from happening and help clear estrogen away.

Cutting back on alcohol, caffeine, and junk food can also keep your estrogen levels from going too high, as these hinder your liver’s ability tp clear excess estrogen..

In short, eating right and exercising is your secret weapon against too much estrogen. Turning your diet into a tool can help you navigate through perimenopause more smoothly.

Conclusion: Empowerment Through Understanding

Navigating the challenges of perimenopause and estrogen dominance requires knowledge, patience, and proactive steps. Through dietary and lifestyle adjustments, and guided by healthcare practitioners, women can manage their symptoms and uphold their health during this pivotal life phase. Remember, your health is in your hands, and informed choices lead to a balanced and fulfilling existence.

If you are suffering from perimenopause (or even menopause) symptoms, including weight gain, and struggle with weight loss or figuring out the best fitness routine for yourself, please consider Signing up with Bonza Health in Fullscript for Dr. Bonza’s perimenopause symptom relief supplement protocol recommendations.

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