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Estrogen Dominance: How can you recognize it? (Plus Ovulation 101!)
How do you recognize an imbalance in your female sex hormones? And what do people mean by ‘estrogen dominance‘? This ‘tip’ explains it all! If in the future we refer to estrogen dominance (and we will!) this is what we’re talking about!Common Signs & Symptoms of Estrogen Dominance
This list below is not a complete list, but it’s a list of common signs & symptoms. If you experience just one… just ONE symptom of this list below, you might have an imbalance in your female hormones:- Pre-menstrual syndrome (PMS)
- Heavy periods/clots(Menorrhagia)
- Cramps (dysmenorrhea)
- Tender breasts/fribrocystic breasts
- Increased anxiety
- Worse endometriosis symptoms
- Bloating/water retention
- PCOS
- Fertility issues
- Fibroid/polyp growth
- Poor Sleep
- High histamine symptoms
Who ‘Invented’ Estrogen Dominance?
The term estrogen dominance was first introduced by Dr. John Lee in his book ‘What Your Doctor May Not Tell You About Menopause’. To understand what it means I want to take a step back and explain to you how the female reproductive cycle works.It is divided into 4 phases:
Phase 1: Menstruation
This might be the only phase men know, so let’s start here. It might not need much explanation. When you menstruate, your uterus lining sheds and flows out of your vagina. In an attempt to bring men and women closer together I always say this to my clients:- Men: please educate yourself about this topic. Hormonal changes can impact man-woman relations a lot. Understanding the female challenges can improve your relationships with women. They will not talk about it, so you could help them by starting the conversation. It’s enlightening!
- Women: please educate men! Don’t hide this. Sit down and have ‘the talk’ with them! Get this topic out in the open and make the world a better place!
But I digress…After menstruation comes the next phase:
Phase 2: Follicular Phase
The follicular phase (see the picture below) starts on day 1 and usually ends on day 13-14.
The brain (pituitary gland) releases a hormone called Follicle Stimulating Hormone – or FSH for short – to stimulate the production of follicles on the surface of the ovaries. Usually, one follicle will ripen into an egg. The eggs produce estrogen to prepare the lining of the uterus called the endometrium.
Phase 3: Ovulation
Ovulation happens when an egg is mature and released from an ovary.In layman’s terms: the follicle with its containing egg tells the brain with a peak of estrogen it’s ready to go. The brain talks back with LH (or Luteinizing Hormone) and prepares the body for the implantation of the egg.
Usually, this phase takes 16 to 32 hours.
Phase 4: The Luteal Phase
After ovulation, LH and estrogen levels drop. The dominant follicle transforms into the ‘corpus luteum’, which means yellow body… I know… scientists and their difficult names…But the corpus luteum is a sort of temporary organ that predominantly secretes progesterone to prepare the uterine lining for the implantation of a fertilized egg.
This phase lasts for 14 days for most people.- If a fertilised egg implants in the lining of the uterus, the corpus luteum continues to produce progesterone, which maintains the thickened lining of the uterus.
- If pregnancy does not occur, the corpus luteum dies, progesterone levels drop, the uterus lining sheds and the cycle starts from the beginning.
Now you have the background to understand estrogen dominance… well almost anyway.How much progesterone, and estrogen does a cycling woman make?
Let’s start with progesterone. In this document, they mention that a woman makes 0.418 mg per day in the follicular phase (phase 2) while in the luteal phase (phase 4) a woman can make up to 50 mg per day! This is more than 100 times more!Compare this with estrogen:
- Progesterone: 2830 – 64000 pmol/l (Higher numbers are in the luteal phase)
- Estradiol (the most abundant estrogen): 275-1650 pmol/l (The peak is just before ovulation)
There is much more progesterone!What do we mean by estrogen dominance?
Here are 3 different variations of estrogen dominance.Progesterone insufficiency
Due to reasons (which will be my next article) progesterone can drop, causing progesterone insufficiency in the luteal phase (phase 3). We call this estrogen dominance, although estrogen might behave completely normally here. Progesterone insufficiency won’t happen in the follicular phase (phase 2)Elevations in estrogen
Estrogen might be elevated. This could be because of lots of reasons (the liver doesn’t breakdown estrogen well, or your body reabsorbs estrogen from the stool)One of the estrogens is high compared to the others
Wait… women have multiple estrogens? Yes, estrogen refers to a group of hormones. There are 3- Estrone
- Estradiol (which is the most abundant estrogen in cycling women who aren’t pregnant)
- Estriol.
There you have it: ovulation and estrogen dominance in a nutshell! -
7 Replies
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Excellent write-up
– thank you for sharing -
Thank you, super interesting.
Would non hormonal contraceptives like copper coil would still effect natural balance of hormone?
What is ideal scenario what are we striving for?
I have heavy periods since putting copper coil and really sore left breast every other periods and periods that that last longer (effecting my iron levels). I didn’t want to go for adding hormones (took enough pills unfortunately in my youth) but I still don’t fully understand how I could find out the optimal way for my body? With hormone tests?
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Hey ,
The ideal scenario we are striving for is personal. It is balancing the reasons for taking them versus are you happy with the costs. Reasons, why women take birth control, can be because of several reasons: preventing pregnancy, heavy & irregular cycles, cramps, acne, excessive body hair growth, PCOS, PMS, Anemia, etc
Unfortunately, people don’t get educated enough about the possible costs. Besides preventing pregnancy, all the other ‘reasons’ do have to a certain degree natural solutions, which in general aren’t taught to people.But let me give you an example from my practice in which it wasn’t so clear cut: one of my female clients was struggling with PMS so bad she became physically violent once a year. If you asked her why she couldn’t explain why. When she uses birth control pills, her PMS symptoms are gone. To her the benefits of the pills outway the costs even after we talked about different solutions extensively. Do I believe natural remedies could have helped her and would be better for her body? Yes, definitely. But it probably would take some time to find the right balance. To her, it isn’t worth the risk if she hurts the people she loves.
I guess I believe that the first achievable ideal scenario is that women are educated about natural solutions for other symptoms and educated about the risks of long-term contraceptives use.
Copper IUDsLet’s talk about IUDs now. Although copper IUDs don’t use hormones, I wouldn’t categorise them as naturally.I personally look at it this way: Any form of birth control is designed to interfere with a natural process in the body.
How do copper IUDs work?
The copper IUD isn’t using hormones for this, but it works differently. The copper IUD is a plastic T-shaped device wrapped in coiled copper. The copper layer will start an inflammatory process that will kill the sperm. It will also inflame the endometrium so that the implementation of the ovum(egg) becomes hard. This is why some women experience heavier periods when they start with a copper IUD.Heavy bleeding & how to asses risks.
I attached a document from Washington University in St Louise that reflects general advice about copper IUDs. Usually, these heavy periods become less after a while. The document says 3-6 months but may last longer.I do have some doubts about this general type of advice. This research is a little older (2009) but followed almost 2000 first time copper IUD users a year long. From them
• 177 (9.1%) experienced more pain than before copper IUD use in the first 9 weeks. This number decreased to 68 (4.7%) after a year
• 106 women (5.4%) experienced an increase in menstrual bleeding after 9 weeks. This number dropped to 44 women (3.1 %) after a year.This risk assessment is helpful before you place an IUD. Once you have a copper IUD and you have complaints, we have to make a new calculation to asses risks. We have to look at the change in the group of women who experience pain/menstrual at the beginning of the IUD placement and after a year. This means calculated from these numbers (and please realize that this is an ‘on the back at an envelope calculation’):
• If you experience an increase in pain after placing a copper IUD there is a 38% chance you still have increased feelings of pain after a year.
• If you experience an increase in menstrual bleeding after placing a copper IUD there is a 41.5% chance you still have increased feelings of pain after a year.Now I do believe these numbers calculated from this study need more research behind them. Still, I just wanted to give you a rough idea of what it means when general advice says: after 3-6 months heavy periods usually disappear.
Does reducing inflammation help?
The first mode of action of IUDs is by creating inflammation. There is some limited evidence that stopping the formation of prostaglandins (with ibuprofen – see this study) helps with reducing the blood loss. Therefore anti-inflammatory supplements might help.
• Try for example high dose omega 3’s (dosages between 2000-4000 mg of EPA+DHA) which actually helps to resolve the inflammation faster
• Curcumin (the Meriva form – for example, this supplement from Thorne) can reduce inflammation as well.Estrogen dominanceHowever, copper & estrogen are related (see this video here from the mineral balance course). Elevations in copper could lead to elevated levels of estrogen for example. The natural hormonal cycle with the use of copper IUDs is still present unlike with the use of hormonal contraceptives which actually disrupt the communication between the brain & the ovaries.
Testing & Things you can do right now
If you are in your reproductive years a DUTCH complete test can give you insight into what type of estrogen imbalance you are dealing with and how you are detoxifying your hormones. With this type of information, you can do much more targeted interventions. That doesn’t mean you couldn’t do anything right now. These are things you can do:
• Make sure you aren’t constipated. By that I mean you need 1 bowel movement per day. If you are experiencing problems with that, focus on movement, eat the right types of fats (Olive oil & Avocados help in particular). Make sure you eat enough fiber, drink water, get enough Magnesium. In the presence of constipation magnesium citrate is the best choice for a magnesium supplement.
• With bloating, diarhea, cramping or other gut issues: the gut health masterclass is full of helpful tips. Estrogen leaves via the stool your body, but gets reabsorbed after staying 24 hours in the gut.
• Magnesium glycinate (my favourite brand of magnesium glycinate comes from Designs for health). This is magnesium bound to glycine, which is an amino acid necessary for bile & glutathione production. These are both important for estrogen detoxification as well. Magnesium helps with something we call phase 2 detoxification of estrogen.
• Zinc will help with female hormone balance (see this study) and could bring balance to a possible copper dominance that might be present. More targeted recommendations could be done by testing copper and zinc status as well. This is something I would recommend you do.
• B vitamins help with all kinds of liver detoxification.
• Broccoli sprouts contain Sulforaphane which helps to reduce the metabolites causing DNA damage. You will need 2 to 5 grams of Sulforaphane powder daily for that.
• Reducing estrogen-like substances from plastics, makeup and pesticides, herbicides and insecticides in your life.
• Reduce alcohol intake since alcohol and estrogen compete for the same enzymes that will break them down.
• Make sure you can produce enough progesterone by reducing stress, reduce inflammation in the ovaries, insulin resistance, PCOS, Hypothyroidism, low cholesterol, too much or aggressive exercising, and age… Ok, the last one can’t be helped, but in the 10 years before menopause, we often see progesterone slowly decreasing.As I said: with testing there are many more targeted interventions you could do. If you like to explore that option, we can help you with the interpretation of for example the DUTCH test, which in my opinion gives you a lot of insight.
I hope this gives you some answers you can work with!
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Wow, thank you so much. Super informative! I’ll get digging and expiring.
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Sorry, I forgot to attach the document I talked about yesterday evening!
Here it is:[Copper-IUD-Fact-Sheet.pdf]
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what an effort! Thank you!
I have 3 questions of you don’t mind so o can understand this whole thing better.1- Women with estrogen dominance and COMT how they have to manage during perimenopause and menopause??
2- what is the good ratio between progesterone and estradiol via regular blood test on day 21 of the cycle to know if there is estrogen dominance?
3- can you help with these results on day 21 of cycle for 50 years old lady and regular cycle.
Estradiol 112.6 (literal phase: 43.8-211 pg/ml)
Progesterone: 1 (1.7-27 ng/ml)
Testosterone: 1.58 H (0.1-1.4 nmol/ L)She’s taking 20mg natural progesterone cream from NOW supplement as she has no access to compounding pharmacy)
And what’s the reason of elevated testosterone? Is the cream has some ingredients that can elevate it?
Thank you
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Hey ,
Thank you for the compliment! It’s much appreciated! I hope I can answer your questions, but I might need some additional information here and there.
1. If someone has a variation on the COMT gene that makes the COMT enzyme less effective, it becomes a balancing act. Having enough magnesium will help the enzyme to become more effective. Besides estrogen, COMT breaks down catecholamines like (nor)adrenaline and dopamine. This is why stress reduction can help. More COMT enzyme is needed to break down adrenaline if more adrenaline is made. This can influence how women break down estrogen and contribute to higher estrogen concentrations, however…COMT determines the speed at which estrogen gets broken down, but the most impact you can make on high estrogen states often is by focusing on what elevates estrogen. Here are some sources of what can elevate estrogen
– Bodyfat produces estrogen
– Histamine release can elevate estrogen
– Constipation can cause estrogen to be reabsorbed in the gut
– Sources of estrogen outside her body can cause elevations of estrogen
– Alcohol
– Sluggish liver function
2. Determining the ratio can be helpful when estrogen and progesterone are within the reference ranges, but estrogen dominance symptoms are still present.In women with a healthy hormonal balance, the progesterone-to-estradiol ratio in blood (and not in saliva) typically falls between 100 to 500 (based on this research – which was done with women who became pregnant as a reference of a healthy hormone ratio). If the ratio exceeds 500, it may suggest progesterone dominance, while a percentage lower than 100 may indicate estrogen dominance.
When women go through perimenopause I honestly don’t like to guide myself too much by this ratio. Estrogen levels can go up and down in an irregular pattern. This means the ratio can change and give you a false sense of what might be going on.
3. I can’t help you based on numbers only, but I can give you some guidance. Using the ratio here wouldn’t make sense since she is 50. She is in perimenopause, close to menopause.In this case, progesterone is low. For that reason, I would consider the low progesterone as a cause of her estrogen dominance symptoms. I can’t tell if the progesterone cream isn’t enough, isn’t well absorbed or isn’t well used. That’s best evaluated by a professional who sees her.
Progesterone is made in the ovaries and a little bit in the adrenals. Stress will lower her own progesterone production. You can consider adrenal support as well since her ovaries contribute less and less to her body’s progesterone production.
High testosterone
I don’t know if the progesterone cream from NOW could influence her testosterone. But taking a step back: have you checked her fasting insulin levels? Insulin resistance can cause elevations in testosterone.I hope this answers a few of your questions, without creating a lot of new ones!
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