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Estrogen Dominance: What is It and How to Address It

Saturday, June 4th 2022 10:00am 16 min read
Dr. Jessica Peatross dr.jess.md @drjessmd

Hospitalist & top functional MD who gets to the root cause. Stealth infection & environmental toxicity keynote speaker.

Estrogen dominance is a term for many common – and sometimes serious – hormone-related issues. It’s a complex condition that needs an appropriate approach to treatment. Let’s take a deeper look at estrogen dominance, what it is, and why it’s crucial to identify and understand it. Then let’s take a look at how to address common symptoms from menstrual migraines, heavy periods, hot flashes to breast tenderness, and more. If you are experiencing estrogen dominance, you need to protect yourself from chronic excess estrogen exposure.

The importance of estrogen

Estrogen plays a truly crucial role in our health and wellbeing. In addition to helping regulate our monthly hormonal cycle, estrogen also:

  • Prepares the uterus for pregnancy
  • Maintains healthy blood sugar levels
  • Helps regulate our stress response
  • Maintains bone health
  • Maintains skin tone and hair health
  • Supports vaginal and urinary tract health
  • Supports cognitive health, memory, and executive function
  • Stimulates cells growth
  • Controls cholesterol levels
  • Helps produce neurotransmitters like serotonin
  • Assists in the production of our sleep hormone, melatonin
  • Plays a role in empathy and facial expression recognition during our menstrual cycle
  • Supports cardiovascular health
  • Keeps inflammation controlled
  • Influences the development of the female body shape and physical female characteristics

With this knowledge, it should be obvious that estrogen levels that are unbalanced – either too low or too high – have been linked to common hormonally-related symptoms and more serious conditions like endometriosis, uterine and breast cancers, and serious gynecologic conditions.

Estrogen and estrogen receptors

Estrogen is produced in the ovaries. However, estrogen receptors are found throughout the body, in the bones, brain, and even in the immune system. Estrogen has a major influence on our metabolism and heart health. It has a profound role during menopause as overall estrogen levels decline. All other health factors can be altered as well due to that decline.

In fact, estrogen is actually three hormones: estrone or E1, estradiol or E2, and estriol or E3. They are produced in the ovaries, fat cells, and to some extent, in the skin.

  • Estrone: E1 is the weakest form of estrogen. Some E1 is produced by the ovaries but most of it is produced by the fat cells through something called peripheral conversion (meaning the estrogen production doesn’t happen in a central location like the ovaries). Estrone is the reason some overweight women experience fewer symptoms during menopause and why some body types lead to higher levels of circulating estrogen.
  • Estradiol: E2 is the most dominant and strongest form of estrogen. It is prominent from menarche through perimenopause. It is produced in the ovarian follicles and drives the activity of the first half of the menstrual cycle.
  • Estriol: E3 becomes dominant during pregnancy. Towards the end of pregnancy, it promotes the growth of milk ducts within the breasts and enhances the effect of prolactin, the hormone responsible for lactation.

Shifts in the balance between these three types of estrogen over our life cycle determine the beginning of puberty, our fertility, and the transition to menopause. Some fluctuations are quite normal and can affect issues like our sex drive, vaginal lubrication, moodiness, mild bloating, and breast tenderness.

While some fluctuation is normal, our modern world can contribute to higher-than-normal estrogen levels. When this happens, the healthy balance becomes unhealthy and can cause many irritating symptoms from heavy periods, mood swings, hormonal chaos, and estrogen-driven gynecologic condition.

High estrogen: symptoms and risks

If you have higher than normal levels of estrogen, the symptoms can turn into something concerning that deserves attention. In fact, they can get so intense that they interfere with your ability to function at certain times in your cycle or throughout the whole month.

If your estrogen levels are too high, symptoms/conditions you might experience include:

  • Heavy periods
  • Uterine fibroids
  • Endometriosis
  • Water retention
  • Mood swings
  • Depression, anxiety
  • Cyclic breast tenderness, breast cysts, breast fullness
  • Short menstrual cycles (< 21 days)
  • Hormonal migraines and headaches (as estrogen drops)
  • Irregular vaginal bleeding
  • Weight gain or weight loss resistance
  • Cervical dysplasia

The side effects of estrogen dominance may seem confusing until you remember that estrogen receptors are located throughout the body. When estrogen levels are too high, it can impact our entire body. If estrogen levels remain elevated for too long, it can increase your risk of serious long-term issues including:

  • Breast, ovarian, and endometrial cancers: Years of research have shown that unhealthy changes in estrogen can be linked to the progression of certain cancers, including breast cancer and ovarian and endometrial cancers.
  • Heart disease, stroke, and clotting problems: Changes in estrogen levels have been linked to different forms of cardiovascular disease.
  • Hypothyroidism: There’s a link between estrogen and thyroid health; If your estrogen levels are too high, it leads to a decrease in the amount of thyroid hormone circulating in your body, which can give your symptoms of a slow thyroid even if your thyroid is “technically” healthy.
  • Worsened endometriosis: Elevated estrogen can trigger the growth of endometrial lesions that can contribute to and worsen your endometriosis.
  • Endometrial hyperplasia: High estrogen can lead to an overgrowth of the uterine lining called endometrial hyperplasia, which can lead to abnormal uterine bleeding.

If you are experiencing symptoms of estrogen dominance, it is crucial to check with your doctor. But rather than just using progesterone therapy to increase progesterone levels as many experts suggest, the key to reducing elevated estrogen is addressing the factors causing high estrogen in the first place.

Is estrogen dominance a recognized health condition?

Estrogen dominance is a term used commonly in functional medicine, natural medicine, and alternative health practices. In general, it can be a blanket term that describes a variety of hormone-related issues.

Originally, estrogen dominance was a hypothesis about a metabolic state in which estrogen levels outweigh progesterone levels. First proposed by John R. Lee and Virginia Hopkins in their 1996 book, “What Your Doctor May Not Tell You About Menopause: The Breakthrough Book on Natural Progesterone,” the authors suggested that estrogen dominance occurred when progesterone decreased without a subsequent decrease in estrogen. The authors criticized estrogen replacement therapy and instead proposed the use of “natural progesterone” as a better way to alleviate symptoms for menopausal women. Unfortunately, Lee’s theories have been criticized for being based on anecdotal evidence rather than peer-reviewed research.

So the term, estrogen dominance, can’t really be called a recognized medical condition. Instead, it indicates an imbalance between estrogen and progesterone. Hormones fluctuate continually, not only daily but as we age. We naturally have more estrogen in the first half of our menstrual cycles, for example, but that does not mean we have a hormone imbalance called estrogen dominance.

Still, our modern world can contribute to estrogen problems, in particular chronic, abnormally high levels of estrogen. Estrogen levels can be negatively impacted by both underlying conditions and lifestyle factors. If you have too much estrogen circulating in your system, you most likely have some uncomfortable symptoms. Thus, even though estrogen dominance isn’t a recognized medical condition, it does have legitimate health complications. And these complications are affecting an increasing number of women with issues like precocious puberty, hormone-related cancers, endometriosis, infertility, and fibroids, among other conditions.

What causes elevated estrogen levels?

There is no simple answer to that question. Many of the causes of elevated estrogen levels overlap, and some aren’t recognized by traditional western medicine. Each person is unique with an individual hormone ecosystem. It’s important to look at the overall picture instead of trying to zoom in on one single cause – though making sure you have no underlying medical condition is essential. Here are the common root causes of high estrogen that conventional medicine rarely recognizes or addresses:

Overwhelmed or undersupported hormone detoxification

In this sense, detoxification refers to metabolic detoxification, which is the process of eliminating hormones from your body. This is an inherent physiological process that works on a daily basis without our help, but it’s also a process that can get overloaded by the many estrogen-mimicking chemicals we face on a daily basis. This can be compounded by genetic changes that can make us slower at detoxifying estrogen and increase our vulnerability to elevated estrogen.


Obesity or even carrying significantly extra weight increases your likelihood of producing more estrogen because our bodies create estrogen in our adipose tissue. More adipose tissue means more estrogen production. Further, we store environmental toxins that act as endocrine disruptors in our adipose tissue.

Research suggests that if you are significantly ‘overweight’ or obese, losing some weight can help reduce your estrogen levels. And considering that fat cells can produce estrogen, it makes sense that reducing body fat percentage can help lower estrogen levels in the body. In one study on overweight and obese women, losing an average of 7.7 kilograms (about 16 pounds) led to 13.4% decrease in average concentrations of free estradiol.

In addition to addressing weight, focus on reducing endocrine disruptor exposure and supporting your microbiome, which can help reduce your overall estrogen body burden and xenoestrogens and dysbiosis as obesogenic factors. Address hormone health, gut health, and weight health for the best results.

Estrogen-mimicking hormones in your food or environment

Probably the biggest contributing factor to high estrogen levels is exposure to endocrine-disrupting chemicals (EDCs). These chemicals interfere with the body’s hormone system because they can actually mimic the hormones we produce naturally. The result can be higher concentrations in human tissue than normal, which can block, disrupt, or overstimulate the body’s natural hormonal processes. This includes how your body metabolizes and excretes hormones.

Slow gut elimination of estrogens/gut microbiome dysbiosis

One of the key regulators of circulating estrogens is the gut microbiome. Estrogen is produced in your ovaries, and then it circulates in your bloodstream and throughout your body. Then it is broken down in the liver to be eliminated through the GI tract. When estrogen is in your GI tract, it interacts with a special subset of your microbiome called your estrobolome which has the important job of regulating estrogen levels for excretion. When your gut bacteria become imbalanced, it impairs the estrobolome and your body reabsorbs the estrogen.

A low-fiber diet

Fiber is critical for regular bowel movements, which helps remove estrogen from the body after it has been metabolized by the liver. Research has even linked a high fiber diet to a decreased risk of estrogen-positive breast cancer. Unfortunately, most Americans are only getting about 15 grams of fiber a day when our bodies were designed to have nearly 100. This can lead to constipation, which allows estrogen to re-enter circulation and cause problems.

Estrogen-containing pharmaceuticals (the Pill, HRT)

The pill interferes with our body’s natural hormone production and hormonal communication channels and acts as a daily dose of excess estrogen that the body has to contend with. There are some situations where the pill is still the best treatment approach, but for many, it’s worth a second look if you have a problem with high estrogen. Similarly, hormone replacement therapy (HRT) used for perimenopausal and menopausal symptoms can cause high estrogen levels.

These factors are the primary contributors to elevated estrogen levels, although other factors exist. These include a sedentary lifestyle, underlying conditions like endometriosis or PCOS, lack of sleep, processed red meat consumption, stress, and deficiencies in specific nutrients. All of these factors are connected and tend to overlap to cause the bigger picture of high estrogen. For example, a sedentary lifestyle continues to obesity; a lack of fiber typically means more meat consumption, and nutrient deficiencies can lead to impaired detoxification.

Restoring healthy estrogen levels

What steps can you take to restore healthy estrogen levels? These steps can help address the contributing factors of our modern lifestyle and help restore balance to your estrogen levels.

Reduce your xenoestrogen burden

An important first step toward improving estrogen levels is to reduce exposure to endocrine-disrupting chemicals in your environment called xenoestrogens. These are found in cosmetics, cleaning products, food storage containers, and likely the foods you’re putting in your cart at the grocery store, unless they’re organic, as a result of herbicide and pesticide contamination.

To minimize your exposure to environmental disruptors, follow these tips:

  • Eat organic and “hormone-free” foods, especially animal-based products like meat.
  • Wash hands well after handling paper receipts (these are coated with BPA).
  • Choose glass containers for heating and storing food.
  • If you’re buying something canned or in glass, make sure it’s marked “BPA-free.”
  • Check ingredients in skin and hair care products and buy ones labeled paraben-free” instead.

Change your diet for healthier estrogen levels

Another important step is to focus on a diet rich in fiber and plant-based nutrients, which prevent you from having elevated estrogen levels, and can help you to eliminate excess estrogen:

Add more of these to your diet:

Greens (especially Brassicaceae vegetables)

Leafy greens, particularly those in the Brassicaceae family – which includes broccoli, cabbages, kale, Brussels sprouts, cauliflower, and collards – are especially important allies for hormone health. Leafy greens are rich in antioxidants and plant chemicals needed for detoxification of hormones and environmental chemicals. They contain the best type of fiber to feed your estrobolome to eliminate estrogen properly. Many studies have shown that a diet high in plant foods like leafy greens can increase estrogen excretion and decrease concentrations of bioavailable estrogen in the body.

Fiber and Flaxseeds

Flaxseeds are a great source of fiber and a great source of dietary lignans, which are phytochemicals that are precursors to phytoestrogen. Lignans have been shown to increase levels of sex-hormone-binding globulin (SHBG), which decreases the amount of available active estrogen, as estrogen bound to SHBG is rendered inactive. Experimental studies suggest that lignans may exert breast cancer-preventive effects through hormonal mechanisms; one study on 48 women who consumed flaxseeds every day for 12 weeks noted a decline in estrone and estradiol levels and these reductions were more pronounced in overweight or obese participants. This means that flaxseeds can help you improve bowel health and regularity.

Use hormone balancing herbs

Use herbs like Cyperus Rotundus which is a known selective estrogen receptor modulator that can help block xenoestrogens from interacting in your body. Studies have shown that it can help decrease ovarian cysts and fibroids, as well as help with urinary tract infections. Check out my Hormone Hero I formulated with Get Soul which is great for hormoe imbalance but specficily for anyone dealing with estrogen dominance! Use code DRJESS to save money!

Reduce or eliminate:


If you’re trying to reduce estrogen and get your hormones back in balance, alcohol – including beer, wine, liquor, and alcoholic kombucha or zero-sugar seltzers hurt that process. After drinking alcohol, your estradiol levels go up and lead to persistently high levels in the luteal phase, which can lead to uncomfortable symptoms like breast tenderness and heavy bleeding. Alcohol is a known hormone disruptor and can contribute to estrogen imbalances.


Dairy isn’t necessarily bad. However, if your estrogen levels are elevated, you should consider reducing or eliminating dairy for a period. Dairy is one of the most significant sources of human exposure to estrogen. Unlike the pasture-fed animals of the past, modern dairy cows are usually kept pregnant or lactating year-round to raise their milk yield, and they continue to lactate during the latter half of each subsequent pregnancy, when the concentration of estrogens in milk is the highest. Plus, endocrine-disrupting environmental chemicals are also known to bioaccumulate in animal fat, making dairy products a kind of repository for hormone-disrupting toxins.


A study published in the American Journal of Clinical Nutrition revealed that the caffeine from just a few cups of coffee can increase our risk of hormonal conditions, though the study was inconclusive and showed variations based on ethnic background. If you’re resistant to decreasing your caffeine consumption, you can at least switch to decaf or green tea. The antioxidants and phytochemicals in green tea boost liver detoxification which may support hormone health.

Red Meat

There’s an established link between meat consumption and breast cancer and also red meat and increased estrogen levels. And while the estrogen levels in meat are much lower than those in contraceptive pills or other sources, it contributes to your overall burden of estrogen, allowing it to accumulate.

What about phytoestrogens?

If you stay informed about the latest health issues, you are likely aware of estrogen-mimicking compounds such as soy. These are called “phytoestrogens” and they have a structure similar to estradiol. However, phytoestrogens contain a weaker form of estrogen that can bind to estrogen receptors and help prevent them from getting overloaded with xenoestrogens, which are much more damaging. Moderate soy intake in women does not cause harm to hormonal health. To avoid excess phytoestrogen consumption, limit soy consumption to twice weekly and make sure all soy products are organic and non-GMO.

Support gut health

Nourish your microbiome

Nourishing your microbiome is a key ingredient for healthy estrogen levels. This means eating plenty of vegetables and greens, getting beneficial fiber, and even more importantly, eating plenty of fermented foods. Fermented foods are not only tasty, they’ve been an integral part of just about every traditional diet around the world. Naturally fermented foods like coconut yogurt, sauerkraut, pickled veggies, kimchi, and chickpea and rice miso are important for a healthy estrobolome and proper detoxification and elimination of estrogen. You can also supplement with a probiotic containing at least 10 billion colony-forming units (CFUs) of a variety of Lactobacillus and Bifidobacterium species to help restore the normal balance of flora in your gut.

Take care of your liver

Your liver is also a part of your digestive system. More than 50% of all estrogen metabolism and conjugation occurs in the liver, so it’s critical to support liver detoxification pathways if you want to balance estrogen levels. The good news is that focusing on steps one through three above will help support your liver’s ability to complete metabolic detoxification quickly and efficiently, without getting overloaded with endocrine disruptors or estrogen that’s been reabsorbed. You can learn more about metabolic detoxification here.

Maintain regularity

When you are irregular, estrogen gets reabsorbed into the bloodstream and increases your circulating levels. To make matters more complicated, estrogen also delays gastric emptying, so high estrogen and constipation can become a vicious cycle. To make sure you’re having regular bowel movements, increase your fiber intake and move your body daily since exercise can help keep things moving.

What about hormone testing?

It can be helpful to get your hormone levels tested, although the test results may not show you a direct link between hormones and symptoms. Typically, they will indicate if there’s a hormonal imbalance. The most common hormone tests are:

  • Estradiol
  • FSH and LH (best tested on day 3 of your menstrual cycle)
  • Progesterone (best tested on day 19–22 of your menstrual cycle)
  • Sex-hormone-binding globulin
  • Free testosterone
  • Prolactin

Running these tests can help identify whether you do have a specific hormone imbalance, and your doctor can help you understand what the results mean.

Unfortunately, this still doesn’t tell you why your hormone levels are off. There are different types of estrogen that all come from many different sources. In addition, you may have high estrogen levels caused by excess estrogen exposure, but you might also have too much estrogen because of an issue metabolizing or eliminating it. Imbalances in estrogen can affect virtually every aspect of your life. Hopefully, you have a better understanding of how to obtain healthier estrogen levels.

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Learn To Treat Yourself

Access Dr. Jess personally curated holistic medicine guides and protocols.