The 3-Step Process to Address Estrogen Dominance | Estrogen Metabolism

Dr. Stengler: In this video, you're going to learn about estrogen detoxification and how it ties into estrogen dominance, a very common condition that women experience. You're going to learn how your liver and your gut work together to process estrogens, the crucial nutrients involved, and why this process is so essential for your hormonal health. I'm Dr. Mark Stengler, and I've researched and written 20 books on nutrition and functional medicine.

Let's talk about estrogen dominance. Maybe you've heard the term but you don't know exactly what it means. Likely your gynecologist or family doctor have never talked to you about what estrogen dominance is, but if you're having the following signs and symptoms, you should be concerned. When you have estrogen dominance, it can accelerate aging, and it can contribute to things like allergies, bloating, breast tenderness (especially around different parts of your cycle), depression, fatigue, and foggy thinking. It can predispose you to gallbladder disease, headaches, scalp hair loss, blood sugar problems like hypoglycemia, increased blood clotting, insomnia, irregular menses, and irritability around your cycle. You can get lighter or heavy bleeding, low sex drive, memory loss, water retention, and weight gain, especially in the midsection of the body like your waist, hips, and thighs.

So what exactly is estrogen dominance? As the name tells you, estrogen is dominant — but dominant compared to what? The idea behind estrogen dominance is that there's an excess of estrogen in relationship to its partner balancing hormone, progesterone. The term estrogen dominance was created in 1996 by a very well-known gynecologist by the name of John R. Lee, a medical doctor, Harvard-trained, who had a book called What Your Doctor May Not Tell You About Menopause. Estrogen dominance in women happens from one of three primary causes. First, estrogen levels are too high in the body relative to the counterbalancing hormone partner, progesterone. This might happen because of environmental estrogens such as synthetic hormones — a classic example would be birth control pills — but also estrogens from the environment such as xenoestrogens like pesticides and the ones you get from plastics. You can also get excess estrogen from fat tissue, so if you're overweight and have too much fat, your fat cells make excess estrogen. As well, poor detoxification and elimination of estrogen in the body are big causes. Another major cause is low progesterone production by the ovaries — so estrogen levels could be high, but the progesterone production is low. And a third reason could be when your estrogen levels are too high and then your progesterone levels are too low.

When you have estrogen dominance, you're more prone to autoimmunity, breast tenderness, and fibrocystic breast disease. You can be more prone to cervical dysplasia, which is a precancerous condition of the cervix, endometrial thickening or endometrial cancer. It contributes to endometriosis, infertility and miscarriages, osteoporosis, and polycystic ovarian syndrome, which definitely has estrogen dominance as one of its issues. It contributes to PMS, premenstrual tension syndrome, can contribute to thyroid suppression like hypothyroidism, and contributes to uterine fibroids. So you can see how important it is.

Let's talk about these environmental chemicals, called endocrine-disrupting chemicals, or EDCs. These mimic estrogen at the cell receptors — pesticides, fungicides, plastics, plasticizers, industrial solvents, heavy metals, and certain pharmaceuticals. The majority of these environmental disrupting chemicals are man-made, but some occur naturally in the environment, and they get into the womb through the placenta and a growing baby. As of 2017, the Endocrine Disruption Exchange database noted there are almost 1,500 of these chemicals in the environment. At the cellular level, what they do is interfere with the body's hormone production, interfere with the release of hormones, and affect estrogen transportation, metabolism, binding action, or elimination. So you can see it's so key that we try to avoid these environmental chemicals as best we can, but because we can't get away from them totally, we need to be able to detoxify them.

Let's talk about how to best understand estrogen detoxification, because if you get this down, you're really going to maintain a better estrogen balance. But first, remember estrogen is a very vital hormone for not only women but men as well. When estrogen levels become too high, or when it's metabolized down harmful pathways, it contributes to the conditions I talked about: PMS, endometriosis, uterine fibroids, certain cancers, and even mood disorders. But the good news is that the body has a sophisticated system for breaking down and eliminating excess or problematic estrogens. This process primarily happens in your liver and is completed with the help of your gut. We can think of it as a three-phase cleanup operation.

Phase one is the first breakdown. The liver takes estrogens and begins to break them down into smaller intermediate metabolites — this is like taking a large piece of furniture and breaking it into smaller parts. The process is carried out by a family of enzymes known as cytochrome P450 enzymes, which add a hydroxyl group to the estrogen molecule, making it more reactive. However, some of these intermediate metabolites can be more toxic or damaging than the original estrogen if they aren't quickly processed in phases two and three, and this is where certain nutrients become critical. Key nutrients involved in phase one include vitamins B2, B3, B6, B9 (known as folate), and B12, which are essential cofactors for the enzymes involved. We also need antioxidants to protect against the reactive byproducts of estrogen metabolism — vitamins C and E are very important, and minerals like selenium, which is an antioxidant. In addition, magnesium is a vital cofactor for many of the enzymatic reactions involved in phase one detoxification of estrogen.

In phase two, our liver makes estrogen more water-soluble, helping the intermediate metabolites that need to be excreted out. There are what we call conjugation pathways, where your body attaches a water-soluble molecule to the estrogen metabolite — this is kind of like putting all those furniture pieces into clearly labeled, sealed boxes ready for transport. This phase ensures the estrogens become less toxic and can be easily flushed out. Key nutrients or foods for phase two include the cruciferous vegetables — broccoli, cauliflower, kale, Brussels sprouts — which contain powerful compounds like indole-3-carbinol and its metabolite diindolylmethane, also known as DIM, which help promote healthy estrogen metabolism. You also need sulfur compounds, involved in sulfation, as you get in garlic and onions and again in cruciferous vegetables; amino acids like glycine, taurine, and methionine to help in these conjugation pathways; and glucuronic acid, a major component for estrogen elimination, which you can get in a diet rich in plant foods.

In phase three, we have the final elimination. After being conjugated in phase two, these water-soluble estrogen metabolites are secreted in your bile and urine to be excreted out of the body. For efficient elimination, a healthy digestive system is absolutely critical. The processed estrogens are primarily eliminated through your stool, and this is where the health of your gut plays a final crucial role. You need fiber, both soluble and insoluble, from foods like flaxseeds, chia seeds, fruits, vegetables, and whole grains, because the fiber binds the excess estrogen in your digestive tract and prevents it from being reabsorbed, ensuring it leaves your body through the stool. If not, it gets reabsorbed in the large intestine back into the bloodstream. Your gut microbiome is also very important: your gut bacteria produce an enzyme called beta-glucuronidase, and if you have an imbalance in your gut flora, this enzyme can become overactive, breaking the bond on those conjugated estrogens and releasing them back into your body to be reabsorbed, which undermines all the hard work your liver did in phases one and two. But eating fermented foods like yogurt, kefir, and kimchi, or taking a probiotic supplement, can help maintain a healthy gut balance and keep the beta-glucuronidase enzyme levels in check.

So understanding these three phases shows just how interconnected your diet, liver health, and gut health are to maintaining optimal estrogen balance. By supporting these pathways with the right foods and nutrients, you can significantly improve your hormonal health and help to prevent or alleviate estrogen dominance. There's another factor I want to talk about, and it goes back to digestion and detoxification — that's bile production and flow. We use herbs that increase bile production and flow. Choleretic herbs are those that stimulate the liver to produce more bile, which is essential for digesting fats and eliminating waste products like the estrogen metabolites. A good example is artichoke leaf, one of the most well-researched choleretics; the active compound cynarin has been shown to significantly increase bile output from the liver. Turmeric is also very effective — it's anti-inflammatory and a choleretic, stimulating the liver cells to produce more bile. Dandelion root is another one, commonly found in teas or supplements, traditionally used as a liver tonic that gently stimulates bile production, and has been used in European and naturopathic medicine for estrogen dominance.

Then we have the herbs which stimulate bile flow, known as cholagogue herbs, which stimulate the gallbladder to contract and release stored bile into the small intestine. Many herbs, especially bitter herbs, have this effect. Milk thistle is one of the more well-studied ones — not only liver-protective thanks to its compounds known as silymarin, but it can also act as a cholagogue, helping to release that bile and get rid of those estrogen metabolites. Now, another factor, which is very simple in helping to improve estrogen dominance, is just plain old exercise. Exercise is a powerful tool for improving estrogen balance through several interconnected mechanisms. Number one, it reduces estrogen-producing body fat. Fat tissue, also known as adipose tissue, is not just inert storage — the cells actively produce estrogen, because an enzyme in fat cells called aromatase converts androgens into estrogen. The more body fat a person has, the more aromatase activity, leading to higher overall estrogen levels, which is a primary driver of estrogen dominance, and this is what happens in overweight women. Besides using cardiovascular and strength training to reduce body fat, exercise also enhances liver detoxification — the liver is the primary organ for breaking down estrogens, and regular physical activity increases blood flow throughout the body, including the liver, which enhances liver function and its ability to metabolize estrogen.

There's another factor with exercise: it improves insulin sensitivity. Insulin resistance and high blood sugar levels are closely linked to hormonal imbalances, including estrogen dominance, because high insulin levels can lead to increased fat storage and lower levels of sex hormone-binding globulin, the protein that binds up estrogen in your bloodstream. Exercise, especially resistance training and high-intensity interval training, makes your cells more sensitive to insulin, which helps lower circulating blood sugar and insulin levels, and in turn helps increase sex hormone-binding globulin, supporting a healthier estrogen-to-progesterone ratio. Exercise also promotes regular bowel elimination, so you're not going to have the constipation which leads to estrogens being reabsorbed back into the bloodstream from the gut. Physical activity, especially moderate aerobic exercise like brisk walking or jogging, stimulates peristalsis, the muscular contractions of your intestines, which promotes regular bowel movements and ensures that harmful estrogen metabolites are efficiently moved from the body.

I mentioned sex hormone-binding globulin, which is a protein that binds the hormones, including estrogen, in the blood. When estrogen is bound to sex hormone-binding globulin, it becomes inactive, so low levels mean more free or active estrogen is available to exert its effect on your body tissues, which can contribute to estrogen dominance. The nice thing about exercise is that it's been shown to consistently increase your levels of sex hormone-binding globulin, which effectively manages your estrogen supply by ensuring less of it is free and active at any given time. So by addressing these five key areas with a regular exercise routine, you're going to have much better-balanced hormones. Now, are there some women whose body weight is good and who have good detoxification, but for other reasons their progesterone levels are too low, leading to estrogen dominance? Yes — and you can naturally boost progesterone levels with the herb vitex in premenopausal women, and we can always use bioidentical progesterone as a hormone if need be for really severe cases of estrogen dominance, which does work well. I hope you found this information helpful. If you did, hit the like button and subscribe for more evidence-based health information. Thanks for watching.

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