Estrogen

Estrogen is a powerful hormone that helps prevent chronic inflammatory conditions such as immune disorders and brain fog.

It is necessary throughout each stage of life,

Puberty –>Fertility –>Menopause

Although its balance fluctuates during each stage; an imbalance can cause problems.

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OVERVIEW

Estrogen is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. Three major endogenous estrogens have estrogenic hormonal activity: estrone, estradiol, and estriol.

- - - Estrone (E1) is the primary form of estrogen that your body makes after menopause.
    - Estradiol (E2) is the primary form of estrogen in your body during your reproductive years. It’s the most potent form of estrogen.
    - Estriol (E3) is the primary form of estrogen during pregnancy.

It is associated with people assigned female at birth (AFAB), including cisgender women, transgender men, and nonbinary people with vaginas.

Estrogen levels naturally fluctuate during your menstrual cycle and decline during menopause. Consistently high or low levels of estrogen may signal a condition that requires your provider’s attention.

The woman’s ovaries make most estrogen hormones, although the adrenal glands and fat cells also make small amounts of the hormones.

Function

Estrogen, like all hormones, is a chemical messenger. It tells your body when to start and stop processes affecting your sexual and reproductive health. These processes cause important changes in your body.

Puberty

Estrogen levels rise during puberty. The increase leads to secondary sex characteristics like breasts and changes in overall body composition (like curves).

Menstrual cycle

Along with hormones made in your brain (FSH and LH) and progesterone, estrogen plays an important part in your menstrual cycle. These hormones coexist in a delicate balance to keep your periods regular. Estrogen plays a role in ovulation (when your ovaries release an egg) and thickens the lining of your uterus (endometrium) to prepare it for pregnancy.

Pregnancy & Fertility

Estrogen peaks in the days leading up to ovulation. This is your most fertile period. At the same time, estrogen thins your cervical mucus, a fluid sperm has to swim through to reach and fertilize an egg. These estrogen-induced changes make it easier for you to become pregnant if you have intercourse.

Regardless of where you are in your menstrual cycle, the presence of estrogen makes it more comfortable to have intercourse. It keeps your vaginal walls thick, elastic, and lubricated, reducing pain associated with penetrative sex.

Menopause

Estrogen levels drop during perimenopause, the time right before menopause. Perimenopause may last several years before menopause. Menopause officially begins when you don’t have a period for 12 months. It usually happens around age 51. With menopause, your estrogen levels drop and you no longer ovulate. The decrease in estrogen may lead to symptoms like vaginal dryness, mood changes, night sweats, and hot flashes.

The primary estrogen in your body changes from estradiol (E2) to estrone (E1) during menopause.

Estrogen affects the reproductive health of people who are assigned male at birth (AMAB), too. In cisgender men, transgender women, and nonbinary people with penises, estrogen impacts sex drive and the ability to get an erection and make sperm.

Too little estrogen can lead to a low sex drive. Too much of it can cause infertility and erectile dysfunction. Excessive estrogen can cause gynecomastia or enlarged breasts.

If you’re assigned male at birth and concerned about your estrogen levels, speak with an endocrinologist or a functional medicine specialist for help.

Estrogen regulates non-reproductive processes such as your skeletal, cardiovascular, and central nervous systems that impact your overall health. Estrogen affects:

- - - Cholesterol levels.
    - Blood sugar levels.
    - Bone and muscle mass.
    - Circulation and blood flow.
    - Collagen production and moisture in your skin.
    - Brain function, including your ability to focus.

Advice from Dr. Kathleen Mahanna,

I often explain to my patients that feeling truly balanced and optimized hormones requires that we address the Pillars of Hormone Health:

Nutrition
Digestion
Stress Resilience
Thyroid & Metabolism
Liver Detox
Lifestyle & Environment

Almost always, women have one or more pillars that require attention to address their hormone concerns.

Nutrition is one of those critical foundational pieces. I cover this in greater detail inside Heal Your Hormones Mini-Training.

Did you know that estrogen and progesterone are built from cholesterol, some of which we obtain from the diet?

Did you know that the production of these hormones, as well as our “feel good” neurotransmitters, requires the vitamins and minerals we obtain from fruits and vegetables?

For this reason, this hormone-balancing smoothie recipe is one of my most common nutrition prescriptions for patients.

A hormone-supporting diet is a key piece of hormone balance. Here are some of the common myths I break down with patients:

“Carbs are bad for you.”

The healthy complex carbohydrates from sweet potatoes, whole grains, vegetables, and fruits can improve PMS symptoms. I see time and time again in practice that women’s hormones do not respond well to low-carbohydrate diets in the long run.

“Eating fat will make you fat.”

An entire generation of women have unfortunately been raised to be afraid of fat. Healthy fats such as those from avocados, nuts, seeds, coconut, and olive oil will not make you fat; they are essential for every aspect of your health.

“You should intermittent fast to help with weight loss.”

In several different hormone patterns, restricting nutrition or intense intermittent fasting can exacerbate hormone concerns.

It can be challenging to cut through the “noise” on the internet when it comes to nutrition. Everyone has an opinion, and it seems like every study conflicts with the next one. This is why it is important to have PERSONALIZED, TAILORED nutrition guidance that will address your specific needs and goals. More importantly, it has to be realistic for YOU, in the context of your day-to-day life.

I am a big fan of small sustainable changes over time, rather than huge dietary overhauls or restrictive diets (they rarely work in the long run, anyway).

I address this with patients in the context of reviewing their blood work and nutrient status, as well as helping them audit their nutrition habits.

Nutrition needs change over a woman’s lifetime depending on many, many factors. If it feels like your nutrition habits aren’t getting you the results the way they may have previously, that may be because something has shifted or changed. That doesn’t necessarily mean there is something “wrong” with your metabolism… it may mean that it is time to review and update how you nourish yourself and support your hormones for this stage of your life.

A proper assessment will help to elucidate what your next steps are to support yourself as optimally as possible.

Just know that I am here for you if you’d like to take that next step together.

Yours in Hormone Health,

PS. Here is the link again to my hormone-balancing smoothie recipe!

Anatomy

Where is estrogen located in the body?

Your ovaries make most of your estrogen during your reproductive years. Your adrenal glands (the glands on your kidneys) and adipose tissue (body fat) secrete estrogen, too. The placenta (the organ that allows nutrient-sharing between parent and fetus) secretes estrogen during pregnancy.

Once it’s released, estrogen travels through the bloodstream until it reaches the part of your body that needs to be spurred into action. There, estrogen binds to a protein, called an estrogen receptor, that gets the process moving. Estrogen receptors are located throughout your body.

Conditions and Disorders

What are the common conditions and disorders associated with estrogen?

Estrogen plays a role in most conditions that fall under the umbrella of women’s health. Some of the most common include

Anorexia nervosa: Conditions like anorexia nervosa are associated with low estrogen levels. Too little estrogen can cause irregular and missed periods (amenorrhea). People with very little body fat (models, athletes) or who engage in disordered eating may also have low estrogen.
Breast cancer: Studies have shown that increased exposure to estrogen does not increase breast cancer risk, but it may worsen breast cancer once it’s formed.
Endometriosis: Estrogen doesn’t cause endometriosis, but estrogen may worsen endometriosis pain.
Female sexual dysfunction (FSD): Falling estrogen levels can cause physical and emotional changes that make sex less enjoyable. However, estrogen is not considered for hormone replacement until you’re menopausal.
Fibrocystic breasts: Fluctuating estrogen levels during your menstrual cycle may make your breast tissue feel lumpy, tender, or uncomfortable.
Infertility: Low and high estrogen can disrupt your menstrual cycle. Underlying causes that can lead to low and high estrogen may be associated with infertility.
Obesity: Estrogen levels are often higher among people with more body fat.
Osteoporosis: Low estrogen levels can weaken your bones so that they fracture and break more easily.
Polycystic ovary syndrome (PCOS): PCOS is a condition that occurs when the ovaries produce too many androgens (hormones associated with being assigned male at birth). Sometimes with PCOS, estrogen levels are too high in relation to progesterone levels.
Primary ovarian insufficiency (also known as premature menopause): With this condition, the ovaries prematurely stop producing eggs (before age 40). As a result, your ovaries don’t secrete the estrogen your body needs.
Premenstrual syndrome (PMS) and Premenstrual dysphoric disorder (PMDD): The cyclical hormone changes associated with menstruation can lead to unpleasant physical symptoms and mood changes. Dips in estrogen following ovulation are a potential cause of PMS and PMDD.
Turner Syndrome: Ovaries are often underdeveloped in Turner syndrome, resulting in low estrogen. As a result, people with this condition may not develop breasts or get their periods.
Uterine cancer (endometrial cancer): High estrogen levels may cause the lining of your uterus to build up. Eventually, cancer cells may start to grow.
Uterine fibroids and polyps: Too much estrogen may be associated with noncancerous tumors called fibroids or polyps that grow in your uterus.
Vaginal atrophy (atrophic vaginitis): Too little estrogen may cause the lining of your vagina to thin and become dry. Vaginal atrophy is most common during menopause and postmenopause.

Research is ongoing about estrogen’s role in conditions affecting other body systems. For instance, estrogen has been linked to some endocrine disorders and gastrointestinal diseases.

What are normal estrogen levels?

Estrogen levels rise and fall throughout life. The fluctuation is normal. For instance, it’s normal for estrogen levels to rise during puberty and decline as you approach menopause. It’s normal for estrogen levels to rise during ovulation so that your body can prepare itself for pregnancy. It’s normal for levels to dip during your period when the pregnancy changes aren’t needed.

Levels that are consistently low or high may signal an underlying condition that requires your provider’s attention.

What happens when estrogen levels are consistently low?

Low estrogen is often a tell-tale sign that you’re approaching menopause. Low estrogen may also signify a fertility problem, a nutritional deficiency, a condition like Turner syndrome, etc.

Symptoms may include:

Breast tenderness.
Weak or brittle bones.
Hot flashes and night sweats.
Irregular periods or no periods.
Headaches, trouble concentrating.
Fatigue, drowsiness, trouble sleeping.
Mood changes, irritability, and depression.
Vaginal dryness leads to painful intercourse (dyspareunia).

What happens when estrogen levels are consistently high?

Excess estrogen in your body can be associated with multiple conditions: polyps, fibroids, PCOS, endometriosis pain, ovarian tumors, etc.). Your levels may be high because you have too much estrogen in relation to your other sex hormone, progesterone. Medications you’re taking that contain estrogen may cause you to have too much of it in your body.

Symptoms may include:

Decreased sex drive.
Weight gain, especially in your waist and hips.
Irregular periods (unpredictable timing, light or heavy bleeding).
Worsening symptoms associated with PMS or PMDD.

How do I know my estrogen level?

An estrogen test can measure your levels of estrone (E1), estradiol (E2) or estriol (E3). Your provider will do a simple blood draw and send it to a lab for analysis.

What are common treatments for estrogen-related conditions?

Hormone replacement therapy (HT) is a common treatment for low estrogen, especially for people experiencing menopause. With HT, your provider prescribes small doses of estrogen to boost your level or a combination of estrogen and progesterone (or the synthetic version of progesterone, progestin). HT comes with risks, though, and isn’t for everyone. Talk to your provider about whether you’re a good candidate for HT.

Care

How can I maintain healthy estrogen levels?

You can’t always prevent the conditions associated with hormone imbalances. Still, you can put good practices into place to help maintain your overall health.

Get enough sleep. Getting adequate, uninterrupted sleep each night helps your body maintain the healthy hormone levels needed to carry out important functions.
Manage your stress.High stress can cause your body to produce too much of the stress hormones cortisol and adrenaline. Excess stress hormones can cause a hormone imbalance that negatively impacts your estrogen levels.
Get the right amount of exercise.A healthy amount of exercise can help you regulate how much you eat and how much body fat you have. It can help you sleep better, too.
Limit your alcohol intake. Alcohol can raise your estrogen levels. Over time, too much exposure to estrogen may raise your cancer risk.
Practice good eating habits.Monitor your food intake to help balance your hormones. Reducing foods with sugar and eating foods high in fiber and healthy fats (fats found in olive oil, nuts, seeds, and fish) can help with hormone balance.

A note from Cleveland Clinic

Estrogen is an essential part of your reproductive health — and your overall health for that matter. It’s natural for estrogen levels to vary depending on your age and menstrual cycle. If they’re consistently high or low, you may experience unpleasant symptoms worth discussing with your provider. Treatments are available that can help, most often in the form of contraception, lifestyle modifications, or hormonal therapies after menopause.

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What does estrogen do for you?

Despite its negative reputation in “estrogen dominance,” estrogen is an incredible hormone. You have 3 types of estrogens, but the main one we will focus on is estradiol (for simplicity, I’ll refer to it simply as “estrogen” in the article).

Estrogen has the following functions:

- - - Helps to promote the development of an egg
    - Promotes the growth of the uterine lining
    - Contributes to ovulation (in tandem with other hormones)
    - It helps you feel happy and energized
    - Promotes a healthy libido
    - Protects your bones
    - Benefits your brain function, cognition, and mental sharpness
    - Supports healthy, supple skin and hair
    - Protects your heart and cardiovascular system
    - Supports your metabolism
    - I describe estrogen as the “yang” hormone of the first half of your cycle. When present in healthy levels, estrogen helps you feel energized, confident, sexy, mentally sharp, and productive, particularly in your follicular phase.

As we know from Traditional Chinese Medicine, “yang” energy must always be balanced with “yin.” In this case, that would be progesterone. Progesterone is the calming, cooling, grounding, “yin” balancing hormone.

In order for progesterone to balance estrogen and prevent “estrogen dominance,” we need to ovulate regularly. Ovulation is the key event to allow for healthy progesterone levels to be produced. If ovulation doesn’t occur, this sets us up for progesterone deficiency… and this means that estrogen is elevated relative to progesterone (i.e. “estrogen dominance”).

What you need to know about “Estrogen Dominance”

I put “estrogen dominance” in quotations because this is actually not a medical term. If you ask your medical doctor about estrogen dominance, they will probably give you a blank stare. More correctly, “estrogen dominance” is an umbrella term that describes a pattern of elevated estrogen and low progesterone, occurring together. It is the discrepancy between these two hormones that can create bothersome symptoms.

Estrogen dominance is most commonly known to occur in adolescence when the brain and ovaries are figuring out how to regularly coordinate ovulation. During the teen years soon after menarche (the onset of the first period), it’s quite common to “skip” ovulation, which results in low progesterone, and relatively high estrogen.

This is a recipe for – you guessed it – estrogen dominance. Remember those heavy periods, cramps, acne, and crazy mood swings as a teen? That was estrogen dominance.

This hormonal pattern can occur later in life as well. Hormone imbalances that cause anovulation (skipped ovulation), such as Polycystic Ovarian Syndrome, also have patterns of elevated estrogen and low progesterone.

Additionally, hormones start to shift in the 40s during perimenopause time, leading to fluctuating estrogen and low progesterone. If you’re in your 40’s and your period is suddenly very heavy, or your PMS is worsening, this could be the “estrogen dominance” pattern emerging.

Why Estrogen is Needed

In females, estrogen is the primary hormone associated with sexual development and health. During puberty, physical characteristics such as breasts and pubic hair are developed. In the reproductive years, both estrogen and progesterone work together to regulate ovulation and the menstrual cycle. Estrogen is also necessary for cognitive and bone health, as well as optimal cardiovascular function.

Estrogen dominance affects many women throughout life in both the reproductive years and in menopause. This common hormonal imbalance can be detected through saliva testing.

Healthy levels of estrogen and progesterone are necessary for both physical and emotional well-being. Sometimes, however, the body produces too much estrogen or too little progesterone causing the ratio between sex steroid hormones to change. This is known as estrogen dominance.

Symptoms of Estrogen Dominance include:

- - - Brain fog
    - Fatigue
    - Anxiety
    - Depression
    - Nausea
    - Bloating
    - Breast sensitivity
    - Menstrual discomfort
    - Weight gain
    - Tender breasts
    - Uterine fibroids
    - Excessively heavy menstrual flow
    - Irritability
    - Thyroid issues
    - Mood swings
    - Cold hands/feet
    - Sleepiness
    - Memory difficulties
    - Hair loss
    - Insomnia
    - Low libido
    - Increased PMS symptoms
    - Headaches
    - Vasomotor symptoms (hot flashes, night sweats)

Excessive estrogen levels can put women at risk for other serious medical conditions including blood clots, stroke, thyroid dysfunction, breast cancer, ovarian cancer, and according to the American Cancer Society, endometrial cancer.

Natural Estrogen Imbalance

Premenopause: This marks the period of less ovulatory activity and progesterone production.

Perimenopause: (40s-mid-50s): Fluctuating progesterone levels and erratic ovulation cycles cause fluctuating estrogen levels at this time.

Postmenopause: The estrogen to progesterone ratio becomes imbalanced as ovarian production of estrogen significantly declines (by as much as 60%) and progesterone levels drop to nearly zero. At this time ovulation has ceased completely.

Additional Causes of Estrogen Dominance

Estrogen dominance can occur as the result of exposure to synthetic estrogen or the body’s inability to metabolize estrogens properly. Some hormone-based medications for use in hormone replacement therapy can cause or contribute to excessive estrogen in the system as well.

Balancing Estrogen, Testing is Key

The Estrogen Dominance Test measures:

- - - Progesterone (Pg)
    - Estradiol (E2)
    - Estrogen to progesterone ratio

Normal Estrogen Levels

Estrone/Estradiol

Prepubescent female: Undetectable–29 pg/mL/Undetectable–20 pg/ml

Pubescent female: 10–200 pg/mL/Undetectable–350 pg/ml

Premenopausal adult female: 17–200 pg/mL/15–350 pg/ml

Postmenopausal adult female: 7–40 pg/mL/<10 pg/ml

How Estrogen Dominance is Treated

Medication—Doctors may treat estrogen dominance in women with several medications depending on the primary cause of the hormone imbalance. Changes to hormone replacement therapy (HRT) regimens are common.

Some cancers are also sensitive to high levels of estrogen and may become worse if estrogen levels are not reduced. Medications such as Tamoxifen may be prescribed to block the binding of cancer cells to estrogen. Other medications known as aromatase inhibitors stop the enzyme aromatase in its conversion process from androgens to estrogen. Other pharmaceuticals can inhibit estrogen production from ovaries as well.

Surgery—In some cases radiation or a surgical procedure is necessary to render ovaries inactive. An oophorectomy, also referred to as surgical menopause, removes ovaries altogether.

Diet—Depending on the severity of estrogen dominance a physician may prescribe a diet lower in fat and higher in fiber. Weight loss may also help reduce estrogen production from excess fat cells.

Balanced hormones are important at any age and life stage of a woman. Testing at home, or through a healthcare practitioner is the first step to long-term hormone health and wellness.

Source(s) HRT.org, Dr. Kathleen Mahanna ND,

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