Is Estrogen Dominance affecting your health? Learn how to identify and treat this common disorder

Introduction

Hormones are the body’s most important regulators of cell function. Hormones regulate every function in our body. These chemicals travel through our bloodstream, and bind to cells across the body, regulating their function.

A key aspect of optimal hormonal function is balance. When your hormones are out of balance, some are produced in excess while others are lacking. Hormonal imbalances can lead to a broad range of problems, including abnormal weight gain, insomnia, painful periods, low libido, or constantly feeling tired. For a full list of symptoms related to hormonal disbalance, see this article from AUSCFM.

Among hormones, those involved with sex and sexual development have a prominent role in our health. Alteration to the normal levels of sex hormones like estrogen and testosterone can influence conditions like obesity, inflammation, and type 2 diabetes, among others, particular through the role of estrogen dominance.

Estrogen Dominance Basics

Estrogen and testosterone are hormones involved with sexual function and development. While both hormones are present in both men and women, estrogen is commonly known as a ‘female hormone’, whereas testosterone is mainly associated with males. In reality, both hormones are present in men and women, but estrogen is, on average, present at higher levels in women than men. Likewise, with testosterone, on average, men have higher levels of this hormone.

Estrogen helps with the initial stages of sexual development alongside another hormone: progesterone. These hormones have important roles in women’s menstrual cycles and reproductive system. However, estrogen is also involved with multiple other functions, being fundamentally involved with the physiology of the cardiovascular, skeletal, and central nervous systems¹.

Alterations to the optimal estrogen levels can influence multiple conditions, including obesity, inflammation, type 2 diabetes, and more (Figure 1).

Figure 1. Summary of estrogen actions in glucose homeostasis and energy metabolism in physiology and menopause. Figure taken from Ref 1.

The reason estrogen is so important and involved with different functions is also reflected by the large and diverse number of estrogen receptors found across the body². Estrogen receptors, ERα (NR3A1) and ERβ (NR3A2), proteins found inside the cells that bind to estrogen, followed by a cell-specific transcriptional response to estrogen, which greatly depends on the location of the receptor.

Estrogen receptors are found in:

Key functions of Estrogen 3

Sexual development
- In women, estrogen:
  - Increases breast size during puberty and pregnancy
  - Influences libido
  - Increases uterine growth
  - Increases vaginal lubrication
  - Promotes sexual receptivity
  - Stimulates endometrial growth
  - Thickens the vaginal wall
- In men, estrogen:
  - Promotes a healthy libido
  - Regulates healthy production of sperm
  - Regulates pregnancy and menstrual cycles
Involved with brain development and cognitive function and may influence the development of mental health conditions, like ASD, ADHD, and others.
Regulates homeostasis of the mitochondria.
Can protect the brain and spine through different mechanisms.
Influence metabolic function, influencing glucose metabolism. It can also affect cholecystokinin (CCK), which suppresses food intake.
Affects our circadian function⁴.

Additional functions of estrogen involve roles in Muscles, Bones and Wound Healing, aging, the immune system, gut function, the vascular system, cancer, and mood disorders⁴.

What is Estrogen Dominance?

As with all hormones in the body, alterations to the normal levels of estrogen can lead to altered functions across the body. Excluding alterations to estrogen levels caused by medications or treatments, some people may ‘naturally’ develop low testosterone or low progesterone levels, which can alter the optimal balance of these hormones.

When estrogen levels are abnormally high, relative to levels of progesterone, the condition is sometimes referred to as estrogen dominance.

Estrogen Dominance and associated problems

Conditions associated with high levels of estrogen in women, or estrogen dominance include⁵:

Conditions associated with high levels of estrogen in men, or estrogen dominance include⁵:

Key symptoms associated with Estrogen Dominance

Among men and women, estrogen dominance can exacerbate different health problems and influence others. For example,

Heavy Periods and PMS

Symptoms typically associated with PMS can be worsened by hormonal alterations like those found in estrogen dominance. Some PMS-associated symptoms include anxiety, mood swings and irritability, appetite changes, insomnia, or poor concentration, among others. The role of estrogen dominance on these symptoms may be associated with changes in levels of chemicals associated with the brain, like serotonin.

Depression, Anger and Anxiety

Estrogen dominance can lead to altered levels of neurotransmitters, such as dopamine and serotonin, which has been associated with anxiety and depression. Research studies have shown, for example, that people with personality disorders that have a lifetime history of aggressiveness also have low levels of certain serotonin metabolites⁶.

Poor sleep and fatigue

Estrogen dominance is tightly linked to the optimal function of our hypothalamic–pituitary–adrenal (HPA) axis. The HPA axis describes the interaction between the hypothalamus, pituitary gland, and adrenal glands, which work in concert to create the body’s response to stress. Overactivation of the HPA axis can lead to excessive production of certain hormones, like cortisol, which increases blood pressure and cardiac output. Having an overactive HPA axis can lead to multiple health problems. Read more about the HPA axis here.

Hypothyroidism (Low Thyroid)

Estrogen dominance can affect thyroid hormone levels, potentially leading to hypothyroidism through its effect on thyroid receptors⁷. Some reported symptoms of hypothyroidism include:

Fatigue
Weakness
Weight gain or increased difficulty losing weight
Coarse, dry hair
Dry, rough pale skin
Hair loss
Cold intolerance
Muscle cramps and frequent muscle aches
Constipation
Depression
Irritability
Memory loss
Abnormal menstrual cycles
Decreased libido

Infertility

In women, estrogen dominance can influence multiple aspects of sexual development, including breast growth and the start of menstrual cycles. During the menstrual cycle, estradiol (a type of estrogen) acts as a growth hormone for female reproductive organs, including the vaginal lining, cervical glands, lining of the fallopian tubes, the endometrium, and the myometrium, among other functions. Hormone therapy to correct estrogen levels is a common approach to treating infertility.

Autoimmune diseases

Studies have identified a link between the development of autoimmune diseases (AD) and estrogen dominance. AD are thought to occur through multiple factors that cause inflammation and abnormal immune function in specific organs and tissues. Estrogen may play an important role in this context through its extensive network of action, which include the immune system, cardiovascular system, skeletal system, central nervous system, and gastrointestinal system⁸.

Cancer

Different lines of research support the notion that estrogen and estrogen dominance can influence the risk of certain cancers, like breast, uterus, cervix, and ovarian, by helping cancerous cells to multiply and spread. For example,

Breast cancer and estrogen dominance – for some types of breast cancer, estrogen and progesterone help cancerous cells to grow.
Ovarian cancer and estrogen dominance – major forms of ovarian cancer, such as HGSOC, LGSOC, endometrioid ovarian carcinoma and adult-type GCTs, are sensitive to estrogen and respond to strategies that either inhibit the production of estrogen or directly compete with its action at estrogen receptors⁹
Uterine or endometrial cancer and estrogen dominance – estrogen and progesterone can “fuel” some forms of these cancers, primarily through estrogen signalling involving estrogen receptor α (ER), which acts as an oncogenic signal¹⁰. In fact, the most common cause of endometrial cancer is having too much estrogen, relative to progesterone.

Headaches and estrogen dominance

Estrogen has receptors in cells throughout our body, including blood vessels. Altered estrogen levels may lead to poor circulation, which can influence migraines. A recent review on this topic found that “estrogen is very likely to play a key role in migraine pathogenesis, but seems to affect patients in different ways depending on their medical history, age, and use of hormonal therapy¹¹.”

Uterine Fibroids and estrogen dominance

These noncancerous growths of the uterus commonly occur in women during their childbearing years. Uterine fibroids develop from the muscle tissue of the uterus, but they can also grow in the fallopian tubes, cervix, or tissues near the uterus. They can vary in size, from being invisible to the naked eye to being the size of a melon. Risk factors for their development include a family history of fibroids, obesity or early onset of puberty. Symptoms associated with this condition include heavy menstrual bleeding, prolonged periods, and pelvic pain. However, in some cases, there are no symptoms. While the pathogenesis of uterine fibroids is not fully understood, estrogen has been linked to the growth of fibroids. For example, one study found that patients with this condition had higher levels of messenger RNA expression of estrogen receptors α and β compared to patients without this condition¹².

Estrogen Dominance at AUSCFM

At AUSCFM, we follow a modern and evidence-based approach to diagnosing and treating pathologies associated with hormonal imbalances. We are on top of current research on hormones’ role in human health. We employ leading diagnostic testing technologies to hormonal imbalances, as well as other markers of health. Our DUTCH hormone test, for example, provides a comprehensive assessment of key hormones and metabolites, including hormones like cortisol and DHEA, melatonin, key estrogens (estrogen: estradiol, estriol, estrone), as well as progesterone and testosterone. Our testing informs clinicians about key physiological aspects of your body, such as cortisol and melatonin function, levels of dehydroepiandrosterone, cortisol metabolites, six organic acids and levels of sex hormones. To learn more about the DUTCH hormone test, see our article.

Based on our DUTCH hormone test results, we can identify evidence of hormonal imbalances that may be driving your symptoms. The results of this test, for example, can reveal altered function of the HPA axis. The Hypothalamic-pituitary-adrenal (HPA) axis is part of the endocrine system and a key regulator of homeostatic processes, influencing immune function and our stress response. To learn more about the HPA axis, see our recent article.

In addition to hormone health, we employ advanced testing that targets six additional gut pathologies. Taken together, the results of these seven tests will give us a comprehensive view of the factors influencing a patient’s health and will help us design personalised treatment strategies.

In parallel, getting an in-depth understanding of your current health and lifestyle, including the diet you follow, can help clinicians identify the root of your problems. Working closely with your practitioner and health coach, you can resolve the underlying cause of hormone imbalance with a personalised plan, including changes to your nutrition, lifestyle, and stress management practices.

If you are experiencing health problems that could be explained by hormonal imbalances, start by registering to

References

Mauvais-Jarvis, F., Clegg, D. J., & Hevener, A. L. (2013). The role of estrogens in control of energy balance and glucose homeostasis. Endocrine reviews, 34(3), 309–338. https://academic.oup.com/edrv/article-abstract/34/3/309/2354631
Hilder, T. A., & Hodgkiss, J. M. (2017). Molecular mechanism of binding between 17β-estradiol and DNA. Computational and structural biotechnology journal, 15, 91-97. https://doi.org/10.1016/j.csbj.2016.12.001
Estrogen Receptors, Estrogenics, And The Rise of Western Disease (Part 1) — MyBioHack | Unlock Your Maximus Potential
Hatcher, K. M., Royston, S. E., & Mahoney, M. M. (2020). Modulation of circadian rhythms through estrogen receptor signaling. European Journal of Neuroscience, 51(1), 217-228. https://doi.org/10.1111/ejn.14184
Signs and Symptoms of High Estrogen: Diagnosis, Treatment, and More (healthline.com)
Trifu, S. C., Tudor, A., & Radulescu, I. (2020). Aggressive behavior in psychiatric patients in relation to hormonal imbalance. Experimental and therapeutic medicine, 20(4), 3483-3487. https://www.spandidos-publications.com/10.3892/etm.2020.8974
Santin, A. P., & Furlanetto, T. W. (2011). Role of estrogen in thyroid function and growth regulation. Journal of thyroid research, 2011, 875125. https://doi.org/10.4061/2011/875125
Merrheim, J., Villegas, J., Van Wassenhove, J., Khansa, R., Berrih-Aknin, S., Le Panse, R., & Dragin, N. (2020). Estrogen, estrogen-like molecules and autoimmune diseases. Autoimmunity reviews, 19(3), 102468. https://doi.org/10.1016/j.autrev.2020.102468
Langdon, S. P., Herrington, C. S., Hollis, R. L., & Gourley, C. (2020). Estrogen signaling and its potential as a target for therapy in ovarian cancer. Cancers, 12(6), 1647. https://doi.org/10.3390/cancers12061647
Rodriguez, A.C., Blanchard, Z., Maurer, K.A. et al. Estrogen Signaling in Endometrial Cancer: a Key Oncogenic Pathway with Several Open Questions. HORM CANC 10, 51–63 (2019). https://doi.org/10.1007/s12672-019-0358-9
Reddy, N., Desai, M.N., Schoenbrunner, A. et al. The complex relationship between estrogen and migraines: a scoping review. Syst Rev 10, 72 (2021). https://doi.org/10.1186/s13643-021-01618-4
Bakas, P., Liapis, A., Vlahopoulos, S., Giner, M., Logotheti, S., Creatsas, G., … & Zoumpourlis, V. (2008). Estrogen receptor α and β in uterine fibroids: a basis for altered estrogen responsiveness. Fertility and sterility, 90(5), 1878-1885. https://doi.org/10.1016/j.fertnstert.2007.09.019