Estrogen Dominance: Signs and Symptoms

Estrogen plays many important roles in the body, including regulating female reproductive organs and supporting cognitive function, the nervous system, and more. Estrogen dominance is a condition in which estrogen levels in the body are increased. Signs and symptoms can include but are not limited to, full and tender breasts, irregular periods, increased premenstrual symptoms, insomnia, mood changes, and more. Estrogen dominance can be identified by a blood test. 

What Is Estrogen Dominance? 

Estrogen is a group of sex hormones responsible for the development and regulation of the female reproductive system, including the menstrual cycle and pregnancy. Estrogen plays many roles in the body and is important for cognitive health, bone health, cardiovascular (heart) health, and many other essential processes. The ovaries produce most of the body’s estrogen, but the adrenal glands and fat cells produce small amounts as well. 

The three main forms of Estrogen include: 

• Estrone: Also known as E1, estrone is the main form of estrogen the body makes after menopause. 
• Estradiol: Estradiol, or E2, is the main form of estrogen the body makes during the reproductive years. 
• Estriol: Also known as E3, estriol is the main form of estrogen during pregnancy. 

Estrogen dominance can occur when there is an increased level of estrogen in relation to progesterone in the body. Progesterone is also a sex hormone that occurs naturally in the body and is mainly responsible for supporting pregnancy. 

The most common signs of estrogen dominance include: 

• Full and tender breasts
• Dense breast tissue
• Irregular and unpredictable periods
• Light or heavy periods
• Increased PMS symptoms like bloating
• Decreased sex drive
• Insomnia
• Mood changes
• Hot flashes

What Causes High Estrogen Levels?

High estrogen levels can result from the body making too much estrogen due to a medical condition, from taking certain medications, long-term exposure to Xenoestrogens, or inefficient breakdown and removal of estrogen from the body. Hormonal imbalances may also occur due to in vitro fertilization (IVF), hormone replacement therapy (HRT), menopause, ovarian cancer, and polycystic ovary syndrome (PCOS). The most common reasons for high levels of estrogen are related to inefficient estrogen detoxification or low progesterone levels.

Making Too Much Estrogen

For those with polycystic ovary syndrome (PCOS), the body may be making an excess amount of estrogen. 

Medication, Hormone Replacement Therapy, IVF

Certain medications, as well as IVF, may alter the body’s natural hormonal balance. Working with a doctor to monitor hormone levels and adjust HRT or medications as needed is essential to achieving optimal hormone balance.  

Xenoestrogens

Xenoestrogens are estrogen-mimicking compounds primarily found in some plastics, including those containing Bisphenol A (BPA), phthalates, pesticides, chemicals, and water systems. Xenoestrogens are classified as endocrine-disrupting chemicals (EDCs). According to the World Health Organization (WHO), they are “associated with altered reproductive function in males and females, increased incidence of breast cancer, abnormal growth patterns and neurodevelopmental delays in children, as well as changes in immune function”.¹ 

Estrogen Detoxification

The body metabolizes estrogen mainly via the liver in a process called biotransformation. In this process, the liver breaks down estrogen into metabolites. The body then excretes these metabolites, typically through stool or urine. 

Symptoms of Estrogen Dominance

The following is a list of common symptoms of estrogen dominance. However, keep in mind that every person is biologically different, and peoples’ symptoms vary. A person who has estrogen dominance may experience one, all, or even none of these systems. Keeping a wellness journal to track symptoms can help identify hormonal- and menstrual-related patterns as well as the duration and severity of symptoms. 

Increased PMS Symptoms

Premenstrual syndrome, or PMS, is the name for a variety of symptoms that some women experience in the weeks prior to their period, known as the luteal phase. PMS symptoms can include, but are not limited to: 

• Bloating 
• Constipation 
• Breast tenderness 
• Fatigue 
• Mood swings 
• Enhanced feelings of anxiety 
• Sadness or irritability 
• Headaches 
• Acne 
• Changes in appetite 
• Changes in sex drive 

Estrogen dominance can worsen PMS symptoms. Natural remedies for PMS include exercise, eating well, reducing stress, acupuncture, and some herbs and supplements like magnesium, chaste tree berry, evening primrose oil, and DIM. 

Premenstrual dysphoric disorder (PMDD) is a condition in which a woman may experience severe PMS, including cognitive, emotional, and physical distress, prior to menstruation. From a holistic and functional medicine perspective, high estrogen levels may be associated with PMDD. Balancing hormones can be multi-faceted; therefore, it’s important to work with a doctor to help get to the root cause of any health imbalance. 

Irregular Periods

The average menstrual cycle is 28 days. The first day of a menstrual cycle occurs on day one of a period and continues until the next period begins. A period is considered irregular if menstruation arrives in less than 21 days or more than 35 days. This means that a woman’s cycle is still regarded as normal if it occurs anywhere from 22 to 34 days after the first day of the last period. 

A period may be temporarily irregular due to stress or illness, such as the cold or flu. Periods that are consistently irregular may be due to a hormonal imbalance, including estrogen dominance. 

Decreased Sex Drive

A woman's sex drive naturally fluctuates throughout her menstrual cycle. Many women find their sex drive is highest around ovulation. This is because oxytocin, also known as the “love hormone,” peaks around ovulation or mid-cycle, which could be anywhere from day 10 to day 17 of a woman’s cycle. 

A woman's sex drive may be the lowest after ovulation and during the luteal phase of a cycle, days 15 to 28. This is because, during the luteal phase, a hormone known as progesterone can naturally reduce sex drive. 

Despite its name, estrogen dominance can interfere not only with estrogen levels but also with progesterone levels, resulting in mood swings, low energy, weight gain, anxiety, and more. These can all impact sex drive. 

While balancing estrogen levels can help improve sex drive naturally, additional herbs and supplements that can naturally support sex drive include Tongkat Ali, maca, ashwagandha, ginseng, and chocolate. Regular exercise, effective stress management, and getting plenty of sleep are also essential for a healthy sex drive.

Depression

Depression is a group of conditions that result in a person feeling constant sadness and loss of interest in daily and normal activities. Estrogen dominance has been associated with an increased risk of anxiety, depression, and sleep disturbances.² Balancing hormones may help lessen depression symptoms. The following habits and supplements may also offer natural support for depression: 

• Exercise 
• Time in nature 
• Talk therapy 
• Reducing stress 
• Getting enough sleep
• Omega-3 fats
• Vitamin D
• Ashwagandha
• Lemon balm
• St. John’s Wort
• Lion’s mane³ 

Bloating

Bloating is a physical response to gas and a feeling of fullness in the stomach. Bloating can occur for numerous reasons, including gut dysbiosis, small intestinal bacterial overgrowth (SIBO), food allergens, lactose intolerance, constipation, gastroesophageal reflux disease (GERD), and overeating. Estrogen dominance can increase water retention, resulting in bloating. 

In addition to focusing on balancing hormones and supporting gut health, these natural remedies may help reduce bloating: 

• Mild movement after a meal, like walking
• Reducing salt intake
• Digestive enzymes 
• Apple cider vinegar
• Magnesium
• Peppermint tea
• Ginger tea 
• Chamomile tea 
• Epsom salt bath 

Hot Flashes

When a person experiences a hot flash, they suddenly feel warm and flushed and may begin sweating. Hot flashes can occur during the day or while asleep. Estrogen dominance can increase the likelihood of hot flashes, especially for women who are in perimenopause or menopause. Natural remedies for hot flashes include: 

• Black cohosh 
• Vitex (aka Chaste Berry or Chaste Tree)
• Evening primrose oil 
• Red clover
• Maca
• Ginseng 

Breast Tenderness

Breasts can naturally become tender during ovulation, the luteal phase, and menstruation due to fluctuating hormones. High estrogen levels can impact breast health and lead to breast cysts and bumps, known as fibrocystic breast lumps. High estrogen levels can hyperstimulate breast tissues and cause swelling, pain, nipple tenderness, and general discomfort. 

Natural ways to support healthy breasts include: 

• Reducing high estrogen levels with a DIM supplement 
• Increasing one's intake of cruciferous vegetables (a natural source of DIM) 
• Vitamin E
• Evening primrose oil during the luteal phase of the cycle
• Lymphatic breast massage
• Rebounding for lymphatic flow
• Avoiding a bra with wires or that is too tight
• Reducing one's intake of caffeine and chocolate 

Weight Gain

Weight can fluctuate within a day as well as daily based on natural hormone fluctuations, water retention, sodium intake, and more. Estrogen dominance mainly causes weight gain due to water retention. Managing estrogen levels, monitoring thyroid levels, and engaging in daily habits for a healthy weight, like staying hydrated, exercising, eating a diet rich in whole fresh foods, and reducing stress, can help manage weight. 

Difficulty Concentrating

Difficulty concentrating may include easily forgetting, difficulty sitting still, difficulty thinking clearly, inability to make decisions or perform tasks, brain fog, consistent tiredness, and more. An estrogen imbalance may impair cognitive function and interfere with concentration. Natural remedies to improve focus include eating whole foods, staying hydrated, exercising, getting plenty of sleep, and adequate intake of B vitamins, and caffeine—although caffeine is not well-tolerated by everyone and may increase symptoms of anxiety rather than focus. 

Insomnia

Insomnia is a sleep disorder that makes falling or staying asleep at night difficult. High estrogen levels can impact sleep quality and duration. Women may naturally experience one or more nights of insomnia before menstruation due to fluctuating estrogen levels. Chronically high estrogen levels may increase insomnia symptoms. 

There are many ways to support the body’s natural circadian rhythm, known as the sleep-wake cycle. These include: 

• Exposure to outdoor natural light within 10 minutes of waking 
• Regular exercise
• Reducing caffeine intake, especially after 3 pm
• Chamomile
• Magnesium
• Reducing exposure to blue lights one to two hours before bed, including television and phone screens 

Symptoms of High Estrogen in Males

While estrogen is often thought of as a female hormone, males also have estrogen—though circulating in lower amounts compared to females. 

Males can also experience estrogen dominance. Symptoms of estrogen dominance in males include: 

• Gynecomastia, or breast tissue enlargement
• Erectile dysfunction (ED)
• Infertility
• Reduced sex drive
• Fatigue
• Hair loss over the entire body
• Loss of bone density
• Fluid Retention 
• Weight Gain 
• Mood Swings

Adopting healthy habits for hormone support can benefit both males and females who may be dealing with high estrogen levels. 

Estrogen Dominance Treatment

Working with a Registered Dietitian Nutritionist for personalized nutrition counseling can help you learn which foods, herbs, and supplements to eat and avoid for hormone balance support. 

In addition to working with a health professional, you can try implementing the following healthy habits for better estrogen balance: 

• Lose weight or maintain a healthy weight
• Reduce stress
• Eat a healthy diet rich in whole, high-fiber foods like fruits, vegetables, nuts, seeds, legumes, and whole grains 
• Limit alcohol intake
• Consider a DIM supplement
• Avoid plastics—switch to glass food storage containers, silicone reusable snack and sandwich bags, and a glass or stainless steel water bottle 
• Avoid tap water and drink filtered water 
• Support liver function for estrogen detoxification with dandelion tea or supplements, milk thistle, beets, and cruciferous vegetables
• Eat sulfur-rich plant-based foods like broccoli, cauliflower, kale, collard greens, Brussels sprouts, turnips, and arugula, all of which contain 3,3'-diindolylmethane (DIM). DIM supports phase 1 detoxification, helping to support excess estrogen detoxification.

How Do I Know If I Have High Estrogen? 

While estrogen dominance can be multi-faceted and complicated, the good news is that it can also be managed and reversed with dietary, herbal, lifestyle, and medicinal support.

If you suspect that you have estrogen dominance, the first step is to meet with a healthcare provider, such as a medical doctor, naturopathic doctor, or functional medicine doctor, to discuss your symptoms and run a full hormone panel blood test, like the DUTCH Complete hormone test. In addition to testing for sex hormones, it is important to test for cortisol levels and thyroid hormones, which can also impact estrogen levels. 

By completing a full hormone panel, you and your doctor can assess the potential root cause of any hormonal imbalance and address treatment where needed. 

References:

1. Paterni I, Granchi C, Minutolo F. Risks and benefits related to alimentary exposure to xenoestrogens. Crit Rev Food Sci Nutr. 2017;57(16):3384. 
2. Shors TJ, Leuner B. Estrogen-mediated effects on depression and memory formation in females. J Affect Disord. 2003;74(1):85. 
3. Chong PS, Fung ML, Wong KH, Lim LW. Therapeutic Potential of Hericium erinaceus for Depressive Disorder. Int J Mol Sci. 2020;21(1).