3 types of estrogen

Contents

Estrogen May Be Culprit Behind Morning Sickness

So many theories have been proposed on the cause of morning sickness that it’s sometimes called the “disease of theories,” says Dr. Jeffrey Ecker, a San Diego obstetrician.

Some of the widely circulated myths suggest that morning sickness is more common with female fetuses or that it’s related to which ovary (the right is blamed) releases the egg that becomes fertilized.

Neither is true.

What is true is that women carrying twins or multiple fetuses, those in first pregnancies, and younger women tend to have a higher incidence of morning sickness. But, Ecker says, “I think you have to view this with a grain of salt.”

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Besides the popular–but false–belief that morning sickness is psychological, some experts have proposed thyroid malfunction as a cause. But this has not been proven, Ecker says. Changes in the gastrointestinal tract that cause digestive processes to slow to a crawl during pregnancy have also been suggested but remain unproven.

Zinc, copper and Vitamin B6 deficiencies have also been blamed. But, says Ecker: “There is no reason to think that Vitamin B6 would be deficient in 70% of women”–the proportion of pregnant women who have nausea.

Ecker and other experts believe the hormone estrogen may be the most likely cause. But studies attempting to show that nausea and vomiting occur when estrogen levels are extremely high have been unconvincing, Ecker notes. “The hormone levels just don’t correlate well with the symptoms.”

Nausea and headaches can be extremely unpleasant at any time in your life. Many women come to expect these symptoms during their period or with pregnancy. However, they’re less commonly thought of as symptoms of menopause.

Just like with pregnancy, nausea during menopause tends to be worse in the morning. It can also be associated with symptoms of premenstrual syndrome (PMS) during the perimenopausal phase. To alleviate nausea or prevent it from occurring entirely, try to avoid foods that are spicy, fatty, or greasy.

You can also try removing things from your bedroom that can cause strong odors and adjust the temperature to a comfortable setting for better sleep. If necessary, open a window for a few minutes to remove any stuffiness or stale air. Fatigue can make nausea worse.

You might try some natural remedies for nausea that are believed to be effective during menopause and pregnancy. Upon awakening, take your time getting out of bed. Herbal teas, ginger, and plain crackers or toast might help alleviate nausea, particularly first thing in the morning. However, there’s no scientific evidence of their effectiveness.

Remedies for headaches during menopause are similar to those for nausea. You will need to avoid certain triggers that can cause your headaches or make them worse. These can include strong smells, particular foods, lack of sleep, and stress. Studies have shown that women experiencing menopausal headaches should incorporate certain things into their daily routine. Some of these include:

  • A healthy diet — Fresh foods are less likely to have additives and preservatives that can lead to increased headaches.
  • Hydration — Water flushes out toxins and waste products from your body.
  • Regular exercise can alleviate the pain associated with headaches.
  • Get at least six to eight hours of sleep each night.
  • Find ways to reduce or eliminate stress. Exercises such as yoga and tai chi can help clear your head, elevate your mood, and reduce stress.

What Is Estrogen?

There Are Three Main Types of Estrogen

Estrone, estradiol, and estriol are the three main types of estrogen.

Estrogen helps initiate physical changes that happen to girls during puberty, such as the start of their menstrual cycles and developing secondary sex characteristics, including breasts and body hair. (2)

Estrogen helps regulate the menstrual cycle during a woman’s childbearing years and controls the growth of the uterine lining.

Estradiol is most common in women of childbearing age. During pregnancy, estriol is produced by the placenta, and estrone is the only hormone your body produces after menopause (when you no longer get your period). (3)

In men, estrogen is important to the growth of healthy bones and the development of the male reproductive system. However, not much more is known about estrogen’s role in men. (3)

Estrogen Replacement Therapies

As women reach menopause (when they stop menstruating), the ovaries begin to produce less estrogen. (3)

When this happens, your doctor may recommend taking prescription estrogen to help with severe menopausal symptoms, such as:

  • Hot flashes
  • Excessive sweating, night sweats
  • Chills
  • Faintness
  • Dizziness

Your doctor may also prescribe estrogen if:

  • Your body isn’t producing enough estrogen during puberty.
  • You have vulvar atrophy (a genital skin condition).
  • You have atrophic vaginitis (inflammation of the vagina).
  • You have female hypogonadism (ovaries don’t produce enough hormones).
  • You have Turner syndrome (a genetic condition that affects physical development).
  • Your ovaries have been removed.
  • You’re at risk for or have osteoporosis (weak, porous bones) after menopause.
  • You’re being treated for prostate cancer.
  • You’re transitioning or have transitioned from male to female.

When men don’t have enough estrogen, they can carry excess belly fat and experience low sexual desire.

Taking Prescription Estrogen

Estrogen usually comes as a tablet that you’ll take by mouth, with or without food.

Your dose and how often you take it will depend on your reason for taking it.

Talk with your doctor or pharmacist if you have any questions about how you should take your estrogen.

Estrogen and Potential Side Effects

Tell your doctor if you experience any of the following side effects: (1)

  • Upset stomach
  • Vomiting
  • Symptoms of a common cold
  • Heartburn
  • Gas
  • Diarrhea
  • Constipation
  • Weight changes
  • Leg cramps
  • Burning or tingling in the arms or legs
  • Muscle tightness
  • Dizziness
  • Hair loss
  • Unusual hair growth
  • Darkening of skin on face
  • Irritation from wearing contact lenses
  • Breast pain or tenderness
  • Swelling, redness, burning, itching, or irritation of the vagina
  • Vaginal discharge
  • Change in sexual desire
  • Nervousness
  • Depression

Call your doctor immediately if you experience any of the following serious side effects:

  • Bulging eyes
  • Yellowing of the skin or eyes (jaundice)
  • Stomach pain, swelling, or tenderness
  • Loss of appetite
  • Sore throat, fever, chills, cough, or other signs of infection
  • Weakness
  • Joint pain
  • Uncontrollable movements
  • Rash or blisters
  • Severe allergic reaction (anaphylaxis) which is often accompanied by hives, difficulty breathing, feeling faint, and nausea or vomiting
  • Hives
  • Itching
  • Swelling of the eyes, face, tongue, throat, hands, arms, feet, ankles, or lower legs
  • Hoarseness
  • Difficulty breathing or swallowing

Concerns About Hormone Replacement Therapy

Concerns about hormone therapy began in the early 2000s when the Women’s Health Initiative (WHI) study reported a link between combined estrogen and progestin and an increased risk of breast cancer and cardiovascular disease. The study also stated that hormone therapy caused more harm than good in postmenopausal women, showing that estrogen alone appeared to be related to an increased risk of stroke and was not beneficial for coronary artery disease. (4)

WHI alarmed the medical community in 2002 with study results in the Journal of the American Medical Association (JAMA) reporting that, after following participants for a mean of five years, the researchers had stopped the estrogen-plus-progestin portion of their study prematurely because the excess risk of breast cancer facing the women taking the drugs made it unethical to continue. (5)

Then, two years later, the estrogen-only study was also stopped ahead of time, because it also uncovered an increased risk of blood clots. For these women, though, there was no significant increase in breast cancer risk. (6)

More current analyses do not show these risks to be associated (or present) with hormone therapy, including a follow-up study published in September 2017 in JAMA. The study found that neither estrogen-plus-progestin taken for a median of 5.6 years, nor estrogen alone taken for a median of 7.2 years, was associated with increased risk of all-cause, cardiovascular, or cancer mortality during a cumulative follow-up of 18 years. (7)

Given the concerns and past controversy surrounding hormone therapy, talk with your doctor about whether this treatment is a good option for you.

When You Have Too Much Estrogen

Women can have too much estrogen (often referred to as estrogen dominance). When this happens, the following can occur: (3)

  • Weight gain, typically in your waist, hips, and thighs
  • Light or heavy bleeding during your periods
  • Intensified premenstrual syndrome (PMS) symptoms
  • Fibrocystic breasts (noncancerous breast lumps)
  • Fibroids (noncancerous tumors) in the uterus
  • Tiredness and fatigue
  • Loss of sexual desire
  • Feeling depressed or anxious

When men’s estrogen levels are too high, they can have enlarged breasts (gynecomastia), infertility, and difficulty maintaining an erection. (3)

Based on what your doctor determines is causing your high estrogen levels, he or she may prescribe a medication, suggest surgery, or recommend dietary changes to help lower your estrogen levels.

Health Benefits From the Estrogen in Hormonal Birth Control

In addition to oral contraception for birth control, your doctor may prescribe one made with estrogen to help relieve menstrual cramps and some perimenopausal symptoms or to regulate periods if you have polycystic ovarian syndrome (PCOS). Additionally, there is some research that reports birth control pills may reduce the risk of ovarian, uterine, and colorectal cancer. (8)

Forms of birth control with estrogen protect you from getting pregnant by doing the following:

  • Thickening the mucus in your cervix, making it hard for sperm to get to the uterus and fertilize an egg
  • Stopping your body from ovulating
  • Thinning the lining of your uterus

Birth control pills contain estrogen in combination with a form of progesterone. Depending on the brand of oral contraceptive, the medications and dose may vary, and may be taken differently. They also may have different risks and benefits. (8)

The vaginal ring (NuvaRing) contains estrogen and progestin and is inserted inside your vagina. The ring needs to be replaced monthly. Take note that not having the ring inside your vagina for more than 48 hours during the weeks you should be wearing it means you are not fully protected from getting pregnant. (9)

The ring may not be as effective if you take any of the following:

  • Antibiotics such as rifampin, rifampicin, and rifamate
  • Antifungal griseofulvin
  • Some HIV medications
  • Some antiseizure and mental health medications
  • St John’s wort

The ring can cause the following side effects:

  • Back and jaw pain
  • Stomach pain
  • Nausea, sweating, and breathing difficulties
  • Chest pain or discomfort
  • Intense headache
  • Vision problems, such as seeing flashes
  • Yellowing of the skin or eyes

The birth control skin patch works like the other forms of birth control in that it contains estrogen and progestin.

The patch is worn on your belly, upper arm, butt, or back, and is replaced every week for three weeks. Then you don’t wear the patch for a week, and repeat the cycle.

If you take any of the medications or supplements listed above under the vaginal ring, the patch may be less effective.

Additionally, using the patch may cause the same side effects as the ring. (10)

Hormones are so much more interesting than what we’re taught in health class. So we’ve created a guide to aaaall of the hormones. Here’s everything you need to know about estrogen, progesterone, androgens, progestins, synthetic estrogen, and sex hormone binding globulin (SHBG).

What is estrogen?

Estrogen is the most famous sex hormone in women and people who menstruate. It is made from cholesterol (a type of fat molecule) within the body.

Hormones facilitate communication between cells around the entire body. Cells that have receptors for estrogen have functions which are activated or deactivated by it. Think of estrogen as a key, and estrogen receptors as a lock—together they make your body systems work.

Estrogen is not exclusive to women and people who menstruate. Men, trans-women, children, and post-menopausal women also have estrogen in their bodies. Since these people don’t have ovaries that are actively releasing eggs every month, their estrogen is made in other areas of the body, like in fat tissues, bones, skin, liver, and adrenal gland (1). In adult men, estrogen is produced in the testes (2).

What does estrogen do for the body?

You might already know that estrogen powers the menstrual cycle and the development of secondary sex characteristics (breast development, pubic hair growth) starting at puberty. But that’s not all: estrogen also plays a role in many other functions, from bone health (3) to cognitive function (4,5), and so much more.

Types of estrogen

In women and people who menstruate, there are potentially four major types of estrogen.

These types have different functions across the body over different life stages. For example, during pregnancy, different types of estrogen are produced to help support the development of the baby.

Weak estrogens can bind to estrogen receptors, but their impact on the body is not very dramatic.

  • Estrone (E1): Produced mostly in body fat, but also in the ovaries and placenta. This is a weak estrogen (6).

  • Estradiol (E2): This is the most active type of estrogen, which is the type involved in the menstrual cycle (6). This type of estrogen binds very strongly to estrogen receptors. In Clue, when we refer to “estrogen” we are almost exclusively referring to this type of estrogen.

  • Estriol (E3): This is the main estrogen of pregnancy. This type of estrogen is primarily made and secreted from the placenta (with help from the fetus) about five weeks after implantation. This is also a weak estrogen (6).

  • Estetrol (E4): This type of estrogen is only produced during pregnancy from the liver of the fetus (7).

Most of the estrogen in your body is estradiol, and is made in the ovaries. However, estrogens are also produced in other areas of the body, including fat tissues, bones, skin, liver, and adrenal glands (1). As people enter menopause, these other sources increase estrogen synthesis and become more influential in the body (8).

How does estrogen (estradiol) change during the menstrual cycle?

Remember how the menstrual cycle works? Like a relay race, many different hormones play a part in trying to fertilize and implant an egg. Estradiol is one of these main players.

Stage 1: Follicular phase = increasing estrogen

Estradiol is mostly made within the ovaries. In the first part of the cycle—the follicular phase, from the start of your period until ovulation—estradiol is produced from sacs that contain your eggs, called follicles. Estradiol stimulates the growth and thickening of the endometrium (the lining of the uterus) (6).

Near the end of the first phase, estradiol levels peak, triggering the brain to release two hormones: a large surge of luteinizing hormone (LH), and a smaller surge of follicle stimulating hormone (FSH). This then triggers ovulation. Just before ovulation, the follicle stops producing estradiol and its levels drop (6).

During the follicular phase of the cycle—from the start of your period until ovulation—estrogen levels are high. You may notice some changes throughout your body.

  • Just before ovulation, some people may notice that their skin and hair are less oily, though we don’t know for sure that the increase in estrogen causes these changes (9).

  • Your cervical fluid changes throughout the follicular phase:

  • Early-to mid follicular: dry/sticky

  • Mid-to-late follicular: thick/sticky/creamy

  • Late follicular to ovulation: wet and slippery, like an egg white (6,10)

  • Some people notice an increase in their sex drive around ovulation (11-13)

Stage 2: Luteal phase = lower estrogen

In the second part of the cycle, the luteal phase, when the follicle has ruptured and the egg has been released—ovulation has occurred. In the place where the follicle was, a new hormone producing structure forms from the walls of the follicle and is called the corpus luteum. The main function of the corpus luteum is to produce lots of progesterone, another sex hormone, but also some estradiol too (6).

If an egg is not fertilized and implanted, about four days before the start of the period, the corpus luteum stops producing progesterone and estradiol, and the levels of both hormones in the blood fall again. This triggers your period to start (6).

When estrogen is lower during the late luteal phase and the start of the period, you may notice some changes.

  • Your overall body temperature will increase slightly during this phase.

  • One study found that 2 out of 5 women report more sensitive skin, which researchers suspect could be due to low levels of estrogen during this time (14).

  • Premenstrual symptoms also show up during this time before the period starts, when estrogen (and progesterone) are low.

  • Some people may even get migraine headaches that are related to the drop in estrogen levels (15,16).

What are “normal” levels of estrogen? And what are normal levels during pregnancy? Perimenopause?

Since estrogen levels fluctuate greatly throughout the cycle, a “normal level” of estrogen changes every day (if you’re not on hormonal birth control).

But if you’re experiencing unexpected symptoms and suspect your estrogen is high or low, you might ask your healthcare provider to run tests. These levels may differ. Differences in laboratory procedures, population served by the laboratory, and testing technique can also impact results—so lab results should always be interpreted using the laboratories reference values (17).

Estrogen levels for people with regular cycles, not using hormonal birth control

Estradiol levels in the blood can range considerably across the cycle. What’s “normal” can vary based on the lab you go to, where you live, your ancestry, and the testing technique. So you should always interpret your lab results with this in mind, but you can use these reference points below.

People under 15 years old and people who are postmenopausal generally have lower levels (18).

Estrogen levels can differ dramatically from cycle to cycle, but also be very different from person to person (17,19).

Estrogen levels during pregnancy

Hormone production is really high during pregnancy. Estradiol skyrockets, along with other hormones like progesterone, testosterone, and prolactin (20). These hormones, plus many more, work together to support the development of a baby.

  • First trimester estradiol: 188–2497 pg/mL

  • Second trimester estradiol: 1278–7192 pg/mL

  • Third trimester estradiol: 3460–6137 pg/mL (20)

Perimenopause and menopause estrogen levels

After menopause, estrogen levels drop dramatically, as there are few follicles in your ovaries. Additionally, these follicles are no longer growing and producing the estradiol spikes that occur during the menstrual cycle (6). The laboratory estradiol levels of postmenopausal women are generally less than 20 pg/mL (73 pmol/L) (18).

During perimenopause, people may notice that their body changes in response to these lower levels of estrogen.

Symptoms of low estrogen during perimenopause and menopause

  • Vaginal dryness (known as atrophic vaginitis or vulvovaginal atrophy) is common. Without enough estrogen, the walls of the vagina are not able to maintain their thickness and are no longer as moist (21).

  • Hot flashes are associated with decreasing levels of estrogen, and can be treated using estrogen therapy (22). Phytoestrogens, or estrogens from food, may be moderately beneficial, but more research is needed (23).

  • Osteoporosis is a risk for post-menopausal people as estrogen levels decrease (24).

How do I know if my estrogen levels are normal?

There are many physical symptoms that can give you a clue to whether your hormone levels are within normal ranges. A lack of “normal” development during puberty, an irregular menstrual cycle, or difficulty becoming pregnant can all indicate a potential underlying hormonal problem.

Estrogen levels (along with all the other sex hormones) fluctuate and change a lot throughout the cycle and throughout life—for most people, these changes are normal and part of aging. Perimenopause in particular can be a wild hormonal ride for some people, filled with unexpected symptoms at inconvenient times (like hot flashes, insomnia, unexpected periods). Some people choose to use hormonal therapy to help control these symptoms (24).

Estrogen dominance

You may have heard about “estrogen excess” or “estrogen dominance” and how these conditions may affect the cycle. Some healthcare practitioners, bloggers, and companies have written about this topic.

Estrogen levels can be too high. For example, there is a condition that can affect estrogen levels called aromatase excess syndrome. People with this condition have higher estrogen because they convert androgens to estrogens at a much higher rate. This condition is caused by a genetic shift in the CYP19A1 gene, and the symptoms are usually present around the time of puberty (25).

It is also possible for some cancers, such as cancer of the adrenal gland, to cause high estrogen levels (26).

That being said, health bloggers are usually not talking about estrogen imbalance caused by atypical genetics or cancer. Often, these writers are discussing hormonal imbalances caused by diet, current or former use of hormonal contraception, and body fat.

In the context of online bloggers and some alternative health providers, there are different causes of “estrogen excess” or “estrogen dominance”.

  • One proposed cause is an imbalance between estrogen and progesterone. It’s thought that estrogen levels can stay too high as progesterone decreases, causing a hormonal imbalance.

  • Another proposed cause is when the estrogens E1 and/or E2 are too high in comparison to E3. Sometimes this is called an unfavorable “Estrogen Quotient”.

  • Sometimes the imbalance is thought to be caused by issues in estrogen metabolism.

Although these imbalances and issues may be real, they are often not diagnosed as a standalone condition in general medicine. Rather, some elements of the above imbalances are thought to be symptoms of another condition.

For example, high E2 and E1 levels may be a sign of polycystic ovary syndrome (PCOS) (27), which can cause irregular periods. Whether or not this estrogen ratio in PCOS is a cause or a symptom of the condition is unclear.

In contrast to mainstream medicine, some alternative healthcare providers may “diagnose” someone with these imbalances. There is little research on whether these “diagnoses” are valid as standalone conditions and not just signs of other conditions or normal fluctuations in hormones with age.

It’s also common to hear about how estrogens from the foods we eat, the products we use, and estrogens being released into the environment on our hormonal levels. Environmental exposure to endocrine disruptors, such as bisphenol-A, are recognized as having a (usually harmful) effect on the body by many medical organizations (28,29). These endocrine disruptors can interfere with hormone function.

Often bloggers will recommend changing your diet to address “estrogen excess/dominance”, usually suggesting eating diets high in (organic) vegetables and fruits, low in meat and dairy, and very little processed food (though different people have different opinions). Although eating a healthy diet is a great idea, it’s not known whether these dietary changes actually address “estrogen excess” or if people begin to feel better simply because they are eating better. Also, what is a “healthy diet” for one person may be as healthy for another person, so it’s good to listen to your body and find a diet that works for you.

If you suspect there is a problem with your hormone levels, speak to your healthcare provider about measuring the levels your sex hormone levels, including estrogen. Estrogen is usually assessed through blood testing, though estrogen tests through urine, saliva, and even amniotic fluid are also possible (18).

Be sure to track your cycle in Clue before you go, so that you can provide your healthcare provider with information about your previous cycles so that they can best interpret your lab results.

How does hormonal birth control affect estrogen?

Combined hormonal contraception (the pill, the patch, the ring) and estrogen

These types of contraception contain both estrogen and progestin, in different amounts and ratios. Many combined oral contraceptives contain ethinyl estradiol, a synthetic estrogen. In the United States, ethinyl estradiol doses do not exceed 50mcg (30), and are often lower, even 10 mcg (10). When the contraceptive pill is taken as prescribed, it works by disrupting the normal communication between the brain and the ovaries, so that:

  • hormonal fluctuations of the menstrual cycle do not happen

  • follicles are less likely to mature to their final stage, meaning less natural estrogen is produced (31)

  • ovulation does not occur (10,32)

Because follicle growth and ovulation is stopped, the natural production of estrogen (and other hormones) is affected, and may be responsible for any side effects or changes you may experience after starting the pill.

The vaginal ring supplies a much lower dose od ethinyl estradiol of 15 mcg per day (33), and the patch supplies 20 mcg (34).

Progestin-only (IUDs, the shot, mini-pill, etc.) birth control and estrogen

There is no estrogen in progestin-only contraceptives, which include the progestin-only pill (the mini-pill), the shot, the implant, and hormonal IUDs.

Using progestin-only contraceptives may influence the fine balance and complicated interactions of some or all of the hormones involved in the menstrual cycle. Often when one hormone level is changed, a ripple occurs and others are also impacted, including estrogen. These hormonal changes may cause changes in your symptoms or menstrual cycle. Each contraceptive may impact you and your symptoms differently, and some of these changes could be the result of different estrogen levels.

The mini-pill and estrogen

Depending on the type of progestin used and the dose in the pill, ovulation is not consistently stopped (10,35). How the mini-pill impacts natural estrogen levels is not well understood, and more research is needed.

The hormonal IUD and estrogen

Hormonal IUDs are available in different progestin-doses, and usually do not stop ovulation. Whether ovulation (and thus estrogen production) stops depends on the progestin dose in the IUD and also the amount of time that IUD has been worn for (10). Ovulation is not suppressed in most cases (10,36,37).

The contraceptive injection (shot) and estrogen

The contraceptive injection works by preventing ovulation and suppressing the communication between the brain and the ovaries. Estradiol levels are much lower for people using the shot, about 15 pg/mL, though this can vary by person (38).

The implant and estrogen

The implant does not dramatically change estradiol levels (39,40). After insertion, there may be a moderate decrease in estradiol levels, but these levels slowly rose to the pre-insertion estradiol levels (or close to those levels) over two to three years (39,40).

Non-hormonal birth control and estrogen

Non-hormonal contraceptives like condoms and the copper-IUD will not impact your natural hormonal fluctuations and estrogen levels.

To learn more about estrogen’s impacts on the cycle, check out these articles:

  • Vaginal dryness

  • Skin and the menstrual cycle

  • Hair and the menstrual cycle

  • Migraines and the menstrual cycle

  • Changes in cervical discharge and the cycle

  • Basal body temperature and the cycle

What Does Estrogen Do?

Estrogen is one of two main sex hormones that women have. The other one is progesterone. Estrogen is responsible for female physical features and reproduction. Men have estrogen, too, but in smaller amounts.

Why is estrogen important?

Estrogen helps bring about the physical changes that turn a girl into a woman. This time of life is called puberty. These changes include:

  • • 

    Growth of the breasts

  • • 

    Growth of pubic and underarm hair

  • • 

    Start of menstrual cycles

Estrogen helps control the menstrual cycle and is important for childbearing. This hormone has other functions:

  • • 

    Keeps cholesterol in control

  • • 

    Protects bone health for both women and men

  • • 

    Affects your brain (including mood), bones, heart, skin, and other tissues

How does estrogen work?

The ovaries, which produce a woman’s eggs, are the main source of estrogen from your body. Your adrenal glands, located at the top of each kidney, make small amounts of this hormone. So does fat tissue. Estrogen moves through your blood and acts everywhere in your body.

What can go wrong with estrogen levels?

For many reasons, your body can make too little or too much estrogen. Or, you can take in too much estrogen, such as through birth control pills or estrogen replacement therapy.

You might want to keep track of your symptoms (changes you feel) by writing them down each day. Bring this symptom journal to your doctor.

Your body makes three main types of estrogen:

Your estrogen levels change throughout the month. They are highest in the middle of your menstrual cycle and lowest during your period. Estrogen levels drop at menopause.

Words to know

endocrinologist (EN-doh-krih-NOLL-uh-jist): a doctor who treats people who have hormone problems, such as low estrogen.

hormone (HOR-mohn): a chemical made in a gland in one part of the body. The hormone travels through the blood to another part of the body, where it helps other cells do their job.

sex hormone: a hormone that affects and is made by the reproductive (sex) organs. It is responsible for secondary sex traits, such as breasts in women.

Where to learn more

Hormone Health Network estrogen information:

National Institutes of Health information:

  • • 

    Estradiol test: nlm.nih.gov/medlineplus/ency/article/003711.htm

To find an endocrinologist near you:

hormone.org or call 1.800.HORMONE (1.800.467.6663)

Patients have questions. We have answers.

The Hormone Health Network is your trusted source for endocrine patient education. Our free, online resources are available at hormone.org

Copyright © 2014 by The Endocrine Society

Signs of Estrogen Dominance — and How to Fix It

  • Estrogen dominance is essentially too much estrogen. There’s no set number that indicates estrogen dominance. It’s the amount of estrogen you have relative to your other sex hormones.
  • Estrogen is crucial for day-to-day functioning. Without it, you end up with vaginal changes that lead to painful sex and urination, hot flashes, moodiness, wonky periods, brain fog, and more.
  • Too much estrogen can wreak absolute havoc on your whole body. It can cause things ranging from fatigue and anxiety to fibroids, endometriosis, abnormal menstruation, and breast cancer.
  • Conventional medicine tends to prescribe hormonal birth control to alleviate symptoms of estrogen dominance, which can have a lot of side effects and make the problem worse in the long run.
  • There are things you can do that not just alleviate symptoms, but get rid of the problem at its core.

It seems like female problems come in groups. Patients will learn they have fibrocystic breasts, then get treated for endometriosis or fibroids. A woman with a lifetime of heavy periods will end up at the fertility clinic. A man with a more womanly shape up top may find himself with sexual dysfunction down the road.

It all points to estrogen dominance, which is high estrogen levels. There’s no set number that indicates estrogen dominance. It’s the amount of estrogen you have relative to your other sex hormones (progesterone in women and testosterone in men).

Low estrogen symptoms (i.e., why you need estrogen)

Estrogen is crucial for day-to-day functioning. It regulates menstruation, hunger and satiety, insulin sensitivity, it helps you metabolize cholesterol, it contributes to bone density, and more. Without it, you end up with symptoms of menopause, like vaginal changes that lead to painful sex and urination, hot flashes, moodiness, wonky periods, brain fog, and more.

But, too much of a good thing causes biological chaos, in the case of high estrogen.

Symptoms of estrogen dominance:

Women:

  • PMS
  • Weight gain (particularly in hips, midsection, thighs)
  • Fibrocystic breasts
  • Fibroids
  • Endometriosis
  • Abnormal menstruation
  • Fatigue
  • Reduced sex drive
  • Depression
  • Anxiety
  • Bloating
  • Breast tenderness
  • Mood swings
  • Brain fog
  • Insomnia

Men:

  • Enlarged breasts (gynecomastia or man boobs)
  • Sexual dysfunction
  • Infertility

If you have a few high estrogen symptoms going on, you might want to open up a conversation with your functional medicine doctor about estrogen dominance. Read on to find out where these symptoms are coming from and what to do about them.

Hormonal birth control

One of the main reasons there has been a noticeable rise in estrogen dominance is because hormonal birth control is so popular. It’s a common scenario that doctors prescribe the pill to young women to regulate periods or to control heavy bleeding, and these women will stay on hormonal birth control for years without fully understanding long-term effects.

Hormonal birth control creates the perfect storm of hormone imbalance. Erratic periods and heavy bleeding are likely a result of estrogen dominance to begin with. Prescribing the pill to treat it just stacks more estrogen on top of excess estrogen. Second, hormonal birth control releases synthetic progesterone, which suppresses your natural progesterone production. Progesterone balances the effects of estrogen, and without enough, you end up with symptoms of estrogen dominance.

You don’t even have to be a lifetime Pill user to end up with hormone balance problems. If you used hormonal birth control and have symptoms of estrogen dominance after only a few cycles, the culprit could still be the exogenous hormones.

Personal care products

Thousands of man-made products contain xenoestrogens, which means they mimic estrogen and disrupt your hormone balance. There’s a long list of chemicals that mimic estrogen. Here’s the short list of the more common ones you’ll see:

  • Parabens. Manufacturers use this well-known xenoestrogen as a preservative.
  • Phthalates. You’ll find phthalates in plastics and as an emulsifier and stabilizer in topical products.
  • Benzophenones. This additive alters estrogen and testosterone production. Most often, you’ll find it in sunscreens.
    Triclosan. Manufacturers use triclosan as an antibacterial agent. Researchers found that it measurably acts on estrogen receptors. For example, it increased the size of uteri and grew breast cancer cells in rats.

Another rule of thumb is that if it has a strong chemical or perfume smell, there’s a good chance it’s messing with your hormones. The exception is products fragranced with essential oils, which can smell strong but won’t disrupt your hormones. It’s best to avoid products with “fragrance” on the ingredients list.

You absorb a substantial portion of the things that come into contact with your skin, so it makes sense to be conscious about what’s in the products you use. Whether you switch out your products as you run out, swap one thing a month, or go nuclear on your shelves, you’ll need to pay attention to your personal care products to reduce your estrogen load.

Related: Natural Beauty Products That Won’t Wreck Your Hormones

Estrogen in the food you eat

Whether the food you eat comes from plants or animals, it has an effect on your estrogen levels. The pesticides most widely used in large-scale farming contains endocrine disruptors, and researchers associated the most common herbicide in the world, glyphosate, with female cancers which point to estrogenic and endocrine-disrupting effects. In one example, glyphosate caused human breast cancer cells to grow in vitro.

It’s common practice for factory farmers to administer hormones to animals for faster growth, which end up in your meat (particularly the fat) and dairy.

Carefully sourcing your food matters. Small-scale, naturally-minded farmers do not pump animals full of hormones for quick turnaround, and they do not have hundreds of acres of crop-dust with dangerous herbicides. Choose organic for high-residue foods when you can.

Related: The Sneaky Place Glyphosate Is Hiding in Your Food

Estrogen in water

The Environmental Working Group identified 45 hormone-disrupting chemicals in public drinking water.

As a consumer, that presents a problem. You can decide to forgo certain types of foods or check ingredients on your personal care products, but you can’t skip water. If you’re drinking water from a public source, you’re probably dosing yourself with things that mimic estrogen and disrupt your hormones. Bottled water is equally problematic. Estrogenic chemicals in plastic bottles leaches out into the water. Canned drinks lined with BPA are no better.

The cleanest water you’ll get is regularly tested well water that’s not close to factory farms, mines, or any sort of industrial complex that will contaminate it. Obviously, that’s not accessible for everyone. For the rest of us, the combination of a public water source with a high-quality filter will give you clean water that won’t change your bra size. Look for a triple-stage filter: a sediment filter, a ceramic filter (to block viruses), and an activated charcoal filter.

Slow digestion

What does the way you digest your food have to do with how much estrogen you have pumping through your system? Since your digestion points to how efficiently you get rid of waste that hangs around in your intestines, it has everything to do with how much estrogen is in your bloodstream.

One major way your body eliminates estrogen is through pooping. If you have slow elimination, you don’t get rid of estrogen through the digestive tract. If estrogen hangs around your intestines and moves inefficiently, it has plenty of opportunity to be reabsorbed into the bloodstream. Stack that on top of the normal estrogen your body releases at ovulation and around period time, and your estrogen levels will climb month over month.

There are hundreds of things that might affect your intestinal motility, but two you can take control of are low stomach acid and gut bacteria imbalance.

  • Low stomach acid. If you don’t have enough stomach acid, your food doesn’t break down enough for a smooth move through the intestines. When food moves slowly, bacteria have the chance to feast and reproduce, which throws off the balance of your gut microbes.
  • Gut bacteria imbalance. When your gut bacteria is off, owing to low stomach acid, antibiotics, heavy metal exposure, or a million other causes, it can affect the nerves that tell your intestines to contract and relax and move things along. So, an imbalanced gut both causes things like IBS and SIBO, and makes them worse.

Finding the root cause of these things can be frustrating, but if you suspect you have acid or microbiome imbalances, ask your functional medicine doctor about supplementing with betaine HCl or digestive enzymes.

Toxic load

Whether it’s heavy metals, a moldy house, or eating processed packaged foods, toxic load contributes to estrogen dominance by burdening your detoxification and elimination systems. Your detox systems — particularly your liver and kidneys — can only handle so much over the course of a day. If your body is constantly dealing with heavy metals, mold toxins, plastics, cleaning products, fragrances…all of those things and more compete with estrogen for its place in the elimination line.

Toxin-free environments do not exist. Even digestion releases by-products that your body has to neutralize and excrete. The key here is to minimize toxins when you can, which leaves room for your body to deal with the toxins that you can’t control.

Being overweight and high estrogen

Your body produces estrogen in the adrenal glands, brain, and in your ovaries or testes, depending on your equipment. Another place both men and women produce estrogen is in adipose (fat) tissues.

As expected, the more fat cells you have, the more estrogen you will make. The more estrogen you make, the more fat you store. And then you make even more estrogen, and store more fat, and so on until you have more estrogen and fat than you know what to do with.

Does stress cause estrogen dominance?

If you have a handful of symptoms of estrogen dominance, evaluate your stress levels before you do anything else. Stress has a massive impact on the production of your sex hormones, and chronic stress will throw off your hormone balance and contribute to estrogen dominance if you don’t get a handle on it.

The reason for this is because we have a multi-tasking hormone, pregnenolone, that is a precursor to both stress hormones and sex hormones, and it will go wherever the demand is.

When everything is fine, pregnenolone helps make progesterone and just enough cortisol. When you’re stressed, your body snaps up the pregnenolone that it would otherwise use to make progesterone, and instead makes a substantially more stress hormones like cortisol. That means progesterone comes up short.

Progesterone keeps estrogen in check, so if you don’t have enough of it, estrogen can go haywire. That’s when you end up with weight gain, PMS, and the other symptoms of estrogen dominance.

A stressful event here and there is fine, and your body can handle that. It’s chronic stress that causes problems with your hormones and frankly, your whole body.

What to do about too much estrogen

  • Quit birth control. Talk to your functional medicine doctor about non-hormonal birth control options.
  • Swap out your personal care products. There are non-toxic versions of just about everything nowadays, and they perform just as well or better than the nasty stuff.
  • Choose organic. It might be tough to go all organic, all the time, but you can at least opt for organic meats and choose organic of the most high-residue foods.
  • Filter your water. Obviously, you can’t forgo water. A high-quality filter is an expense up-front but will pay for itself if you were buying bottled water, not to mention medical costs down the road.
  • Talk to your doc about stomach acid. Functional or integrative medicine doctors do stomach acid better. Conventional medicine doctors will prescribe you things that will make problems worse if your acid is too low.
  • Reduce toxic load and support detox pathways. Natural herbs and supplements like milk thistle, dandelion root tea, dandelion greens, glutathione, and calcium d-glucarate support the liver and help get rid of excess estrogen and all the other day-to-day yuck we run into. Here’s a fascinating article on why calcium d-glucarate is an amazing detoxifier. (Spoiler: it metabolizes estrogen as well as tamoxifen, a prescription medication for excess estrogen).
  • Lose weight. You know who you are. You can start by using our 30 Day Upgrade guide to clean up your diet while crushing cravings.
  • Meditation, yoga, gratitude. Start a de-stressing practice that will free up that pregnenolone for progesterone.

When people try to get help from a doctor or other practitioner, they are often told this is genetics, it’s just the way you are, that you have to deal with it. It’s simply not true. Just because there’s no magic pill (or there is a pill but it has awful side effects) doesn’t mean you’re at a loss. There are things you can do that not just alleviate symptoms, but get rid of the problem at its core.

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A few weeks ago, I had a blood test run at a wellness boutique in Los Angeles to get a basic idea of my hormonal and metabolic health. I’d never had a blood test like this done before, and even though I generally feel like I’m in pretty good health, I was deeply curious to see what the numbers had to say. I went to a facility called Next Health, a high-tech health optimization center that offers services ranging from cryotherapy to genetic testing. They ran their baseline blood test on me, which costs $199, and a couple weeks later, I went back to go over my results. Everything checked out pretty much as I expected (including my low B12 #veganproblems), except for one surprising piece of information: My estrogen levels were slightly high.

“Do you remember where you were during your menstrual cycle when you had the test done?” the Next Health nurse asked. As it turns out, your estrogen levels are naturally lowest when you’re on your period and highest when you’re ovulating a few weeks later, exactly in between periods. At the time of the test, mine had just ended. “Have you noticed any weight gain?” she continued. “Excess fat behind your upper arms?” This question really got me: Evidently, women with slightly high estrogen levels often complain of a mysteriously flabby tricep area, which just so happens to be my one profound body insecurity. This insight was truly enlightening. My estrogen was undoubtedly a little bit high, and I needed to do something about it.

The Truth Behind Estrogen Dominance

The most common signs and symptoms of estrogen dominance include fatigue, mood changes, hot flashes, low libido, bloating and difficulty concentrating.

When the levels of estrogen, the primary female sex hormone are increased reative to the levels of progesterone circulating in the blood, women are said to be experiencing estrogen dominance. Men may also be diagnosed with estrogen dominance if estrogen levels become very high.

Let’s take a look at the symptoms of estrogen dominance and whether it might be time to take a test for it.

Contents

  • The Truth Behind Estrogen Dominance
  • Signs and Symptoms of Estrogen Dominance
  • How To Test Your Estrogen Levels

The term originated from the late Dr. John Lee, who claimed that the cause of premenopausal and menopause symptoms is a fluctuation in the hormone: estrogen, particularly in young women .

The term has led to a lot of back and forth in the health industry, and there is some uncertainty around the term.

Ultimately, ‘estrogen dominance’ refers to a fluctuation and imbalance of the hormone, estrogen, relative to other hormones. Symptoms resulting from high levels of estrogen usually don’t last very long.

Signs and symptoms of Estrogen Dominance

Common symptoms of high estrogen levels include:

  • Decreased sex drive
  • Increased PMS symptoms
  • Irregular periods
  • Depression
  • Mood swings
  • Headaches
  • Bloating
  • Hot flashes
  • Breast tenderness
  • Weight gain
  • Fatigue
  • Difficulty concentrating
  • Insomnia

Symptoms of high estrogen levels vary from person to person and depend largely on the severity of your hormone imbalance.

Remember, while these are all symptoms of a fluctuation in estrogen levels, they may also signal other health problems.

Read on for more information about the signs and symptoms associated with fluctuating levels of estrogen:

Decreased sex drive
While optimal levels of estrogen stimulate vaginal lubrication and increased sexual desire; higher estrogen levels may cause mood swings, worsened PMS symptoms and fatigue – each of which naturally have an effect on your sex drive.

Increased PMS
High levels of estrogen may leave women feeling that their PMS symptoms have increased in severity – severe bloating, feeling especially emotional and bad back pain in the days leading up to your period may be a result of significant fluctuations in estrogen.

Irregular periods
Women experiencing a fluctuation in estrogen levels are more likely to experience irregular periods. Mayo Clinic suggests that a significant change in your period may suggest that your hormone levels have shifted .

Depression/ Mood swings
For those living with increased levels of estrogen, you may experience extreme emotions. This can happen in the lead up to and/or the aftermath of your period.

Headaches/Difficulty concentrating
Headaches and difficulty concentrating have been linked to estrogen when it exists in the body in either too high or too low a volume. It’s been found that more than half of women who experience migraines believe it to be linked to their menstrual cycle .

Bloating
Bloating is usually caused by water retention or disruption in the water-salt balance in females. An increase in estrogen levels and fluctuation of your hormones may cause water retention, which can cause bloating .

Hot flashes
Hot flashes are one of the trademark symptoms of menopause. They can indicate increasing estrogen levels if you’re experiencing them well before your periods are expected to come to an end .

Tenderness in the breasts
If your breasts feel lumpy, swollen or sore, it can often be attributed to your hormones.

During the menstrual cycle, tenderness in the breasts can often be attributed to the decreased volume of progesterone in relation to estrogen – this is generally a natural occurrence.

With that said, recurring sensitivity in the breasts may also be attributed to higher levels of estrogen.

Weight gain
A tell-tale sign that you may be having issues with your estrogen levels is weight gain – particularly around your middle.

This weight gain is most likely to take place during menopause which may be confusing for people to hear due to the fact that both estrogen and progesterone are believed to drop during this period. What is often misunderstood is that progesterone drops more dramatically than estrogen which gradually leads to weight gain.

Fatigue
Low progesterone, in comparison to levels of estrogen is said to lead to feelings of fatigue .

Insomnia
It’s unsurprising that some of the above symptoms would keep you up at night. Though, another reason that you may be struggling to fall asleep is your hormone levels – estrogen and progesterone are sleep promoting hormones and fluctuations may lead to sleep disruptions.

The only way to know if too much estrogen is to blame for your symptoms is to test your hormones. The most accurate way to test your hormones is via a blood sample.

It’s always informative to do a baseline test and have an idea of where your hormones are before seeking out treatment.

How Do I Know If I Have Estrogen Dominance?

The signs and symptoms of an estrogen imbalance aren’t always obvious and they can be attributed to different things that affect our everyday lives.

If you do notice some of the above signs and symptoms, begin to take note of when they started and what they feel like – this will make it easier for you to pinpoint exactly when it began and the severity of each symptom.

If you’re feeling very unwell, you should visit your physician for a check up..

If your symptoms aren’t severe but you would still like to have an understanding of what might be going on, you have the option to take a female hormone test from the comfort of your own home!

The Female Hormone test measures a number of key hormones, providing you with an overview of your reproductive health status

This test is beneficial for anyone who wants a comprehensive overview of their current fertility status and hormonal health.

It will offer insight into your estrogen levels as well as other hormonal imbalances such as:

  • Polycystic Ovary Syndrome (PCOS)

  • Ovarian failure

  • Low ovarian reserve

  • Early menopause

  • Menopause

  • Thyroid Issues

  • Ovulation function issues

LetsGetChecked tests are convenient options that make it possible for you to better know your health. Whatever the reason, you may not want to visit the physician’s office, have a face to face consultation or take time off work.

Written by Hannah Kingston | Approved by Medical Director, Dr. Dominic Rowley

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