Relative Estrogen Dominance
Intro
Relative estrogen dominance is a common hormone imbalance syndrome when there is relatively higher levels of estrogen compared to progesterone, leading to higher levels of active, unopposed estrogens in the system. Relative estrogen dominance is mainly a functional diagnosis, meaning that those who practice functional medicine and/or naturopathic medicine would be able to identify this syndrome after completing a clinical intake and completing labs.
This March, I am focusing on relative estrogen dominance, and through a series of 4 blog posts, you will learn what estrogen dominance is, how it’s tested and investigated, and naturopathic management options. In this blog post you will learn about the symptoms of relatively high levels of unopposed estrogens, the root causes of relative estrogen dominance, & what testing with a licensed ND looks like.
Before we dive into symptoms, let’s speak a little biochemistry & Physiology:
First, how is estrogen made? The ovaries get signals for the brain, then the ovaries transform testosterone into estrogen, specifically estrone. Once testosterone turns into estrone, it can be covered into different forms of estrogen, such as estradiol and estriol. Estrogen are usually made in the first half of the cycle, called the follicular phase. So, levels of estrogen, testosterone, precursors of testosterone, and these brain signals are important to consider when trying to identify causes of relative estrogen dominance.
Second, when does progesterone come into play? Progesterone comes into play in the second half of the cycle (called the luteal phase), which occurs after ovulation. Ovulation is the period at which the ovaries release an egg, and ovulation will take place because of certain brain signals that ovaries get. The luteal phase is when menstrual bleeding takes place, and this is the phase when people can experience symptoms of relative estrogen dominance since this is when the balance of progesterone and estrogen come into play. So, levels of progesterone & these brain signals are important to known when trying to identify causes of relative estrogen dominance.
So, after completing labs, relative estrogen dominance can look like one of the following 4 types:
High estrogen + normal progesterone
Normal estrogen + low progesterone
High estrogen + low progesterone
Low estrogen + low progesterone, but estrogen is relatively higher than progesterone
Symptoms
Symptoms of high levels of unopposed estrogens:
Heavy cycles & irregular bleeding: Literature reveals that thickening of the endometrium (definition of endometrium) can occur when there is unopposed estrogenic stimulation of the endometrial tissue. Symptoms of endometrial thickening can include: heavy menstrual bleeding & irregular menstrual bleeding. Complications of unopposed estrogenic stimulation of endometrial tissue can include endometrial cancer.
Breast changes: Elevated levels of estrogens have been shown to cause breast pain, most likely due to stimulation of breast tissue by estrogen.
symptoms of low levels of progesterone:
Menstrual cramping: It has been hypothesized that low levels of progesterone may play a role in menstrual cramping.
Irregular bleeding: Literature shows that low levels of progesterone can play a role in anovulatory cycles, leading to irregular menstrual bleeding.
Emotional changes: Changes in progesterone levels relative to estrogen levels appear to play a role in the development of pre-menstrual emotional changes, such as PMDD. Animal research indicates that optimal levels of progesterone reduces anxiety-like behaviors, and that progesterone changed animal gut microbiome populations to cause these effects.
Symptoms of high testosterone:
Cystic acne
Coarse facial hair
Hair thinning
And with relative estrogen dominance, a person can experience a combination of the symptoms above. So, it makes it worth while to understand the root cause of a person’s symptoms to understand how to address these symptoms.
Causes
Looking for the root cause of high levels of estrogens means understanding the whole lifecycle of a hormone: 1) how and where the hormone is made, 2) how the hormone is used, 3) how and where the hormone is metabolized/detoxified, and 4) how and where the hormone is eliminated out of the body. A licensed ND usually asks a set of questions and completes pertinent physical exams to understand which of the 4 levels above may need to be investigated. Some causes of relative estrogen dominance (but not all) are:
Estrogen production:
Environmental factors & medications: The environment & medications can be a source of estrogens, which could contribute to relative estrogen dominance.
Excess body fat: Literature reveals that fat tissue (called adipose tissue) has higher levels of aromatase, which is an enzyme that converts testosterone into estrogen.
& more
Progesterone production:
Age: Progesterone levels naturally decline as people age
Prolactinoma: A prolactinoma is a small, benign pituitary mass that secretes high levels of prolactin. High levels of prolactin suppress LH and FSH, which can lead to low levels of progesterone.
Thyroid dysfunction: In a study completed on 150 females, it was seen that those with hypothyroidism had higher levels of prolactin. And, as mentioned above, higher levels of prolactin can reduce levels of progesterone.
& more
Estrogen metabolism/detoxification:
Iron deficiency: Iron is a necessary co-factor in the healthy function of cytochrome enzymes, which are involved phase I detoxification of estrogen.
Methylation dysfunction: Methylation is a detoxification process involved in phase II detoxification of estrogen. And, folate, B12, and magnesium are necessary nutrients for optimal methylation.
& more
Estrogen elimination:
Constipation
Diet
& more
Testing & Work-up
Work-up options depends on the root causes that your trusted doctor suspects. The following testing & work-up options may be considered by your doctor:
Estrogen production & sex hormone levels:
Complete blood count (CBC), comprehensive metabolic panel (CMP), lipid panel, thyroid panel (TSH, Free T3, Free T4, Anti-TPO, & Anti-TG), & vitamin D3
Luteinizing hormone (LH), follicle stimulating hormone (FSH), & prolactin
Hemoglobin A1c & fasting insulin
DHEA-S, free testosterone, total testosterone, DHT, estrone, estradiol, estriol, & progesterone
17-OH-progesterone
Sex hormone binding globulin
Sedimentation rate & C-reactive protein
DUTCH Test
& more
Estrogen metabolism/detoxification:
Homocysteine, B12, & methylmalonic acid
Iron/TIBC & Ferritin
DUTCH Test
& more
Estrogen elimination:
Comprehensive stool analysis to check for gut dysbiosis and beta-glucuronidase (I will speak about this in a blog post about the estrobolome next week).
Summary & Takeaways
In this first part of the 4-part series on relative estrogen dominance, you learned about:
What relative estrogen dominance is
How relative estrogen dominance looks like
What the root causes of relative estrogen dominance can be and how to test for them
The 4 different types of relative estrogen dominance
As we continue through this month, expect blog posts every Friday on relative estrogen dominance. Next week’s post will focus on the gut microbiome-hormone connection, called the estrobolome.
If you found this blog post educational & insightful, make sure to share it with your wellness community so that more people can learn about relative estrogen dominance and naturopathic medicine. Also, make sure to sign up for my email list to stay up-to-date with new blog posts, news about my upcoming podcast on naturopathic skin health & beauty, and more! Click here to sign up for my email list.
And as always, I hope that this blog post helps you feel more confident about speaking to your doctor about your options so that you can get the best treatment course as possible.