How To Tell If You Have An Estrogen Imbalance

Estrogen is a key hormone that plays a role in female reproduction, fat distribution, cardiovascular health, bone turnover, and memory. A functional medicine approach to estrogen balance may involve assessing and addressing gut bacteria involved with hormone metabolism, lifestyle, and environmental exposures.

Three main forms of estrogen are needed in appropriate proportions at various life stages.

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Estrone (E1)

This less potent estrogen is mainly made in the ovaries before menopause. It can be converted into estradiol (and vice versa). Although total estrogens decline overall around menopause, estrone becomes the dominant circulating estrogen and is principally made in fat tissue postmenopausally.

Estradiol (E2)

Estradiol is the most potent estrogen during reproductive years in terms of absolute levels and impacts. It is the primary form produced in the ovaries before menopause and produced in smaller amounts by the adrenals and placenta.

Estradiol influences the development of female secondary sexual characteristics such as breasts, and fat distribution helps maintain reproductive tissues like the ovaries and lining of the uterus. It may impact conditions like endometriosis and fibroid development. It also supports bone growth, heart health, and memory.

Estriol (E3)

This is the least potent and dominant estrogen during pregnancy since it is manufactured in high quantities by the placenta.

Estrogen is not just a female hormone and plays essential roles in men's health, such as sperm maturation and libido.

Estrogen Imbalance Signs & Symptoms

Different forms of estrogen interact, so overall balance determines impacts. Hormone levels and proper metabolism and excretion may influence the risk of inflammatory, autoimmune, and chronic conditions.

Some common signs that may suggest imbalanced estrogen include:

• Bloating and digestive upset,
• Acne
• Low libido
• Irregular periods
• Tender, swollen, or fibrocystic breasts
• Headaches
• Weight gain
• Hot flashes
• Endometriosis
• Fibroids
• Mood swings
• Polycystic ovarian syndrome (PCOS).

Estrogen Imbalance Possible Causes

In addition to being made in the ovaries, adrenals, placenta, and fat tissue, estrogens are influenced by gut bacteria and environmental exposures. Liver health and genetics can also impact estrogen levels.

Poor Gut Health

The estrobolome is a collection of bacteria in the gut capable of metabolizing and modulating the body's circulating estrogen. Some of these bacteria produce beta-glucuronidase, an enzyme that helps reabsorb estrogen into the blood instead of being eliminated in the stool. Generally, the more beta-glucuronidase gut microbes produce, the less estrogen gets removed from the body, so more remains to exert influence.

Imbalances in gut bacteria may lead to imbalances between the forms of estrogen that could contribute to estrogen-related symptoms. For example, women with endometriosis commonly have more beta-glucuronidase-producing bacteria, which may lead to higher estrogen levels in the blood, potentially influencing the growth of uterine tissue outside the uterus.

The balance of the estrobolome also influences PCOS. Imbalanced gut microbiota may alter how bacteria process hormones, contributing to the hormonal imbalances seen in women with PCOS.

Xenoestrogens

Xenoestrogens are estrogen-mimicking compounds. These naturally-occurring plant compounds are similar to human estrogens. Some fiber-rich foods, such as seeds (particularly flaxseeds), grains, nuts, and soy, can act as phytoestrogens. Depending on the source and quantity, phytoestrogens may have health benefits, including supporting bone and heart health and reducing menopausal symptoms, but others can contribute to imbalanced hormones.

Synthetic xenoestrogens in household products, including fragrances, pesticides, personal care products, and plastics, are absorbed by the body and stored in the liver and fat. They may act additively with internal estrogens to influence hormonal balance.

Mineral Deficiencies

Micronutrients are essential for sex hormone synthesis and metabolism, particularly during the age-related decline in the endocrine system. Previous research found that certain micronutrients, including vitamin D, vitamin E, vitamin A, lycopene, iron, magnesium, selenium, and zinc, are associated with androgen metabolism. Associations between estrogen and vitamins C, D, E, A, and carotenoids have also been found.

Functional Medicine Labs to Test for Estrogen Imbalance

Sex Hormone Panels

Saliva, serum, and urine tests can measure estrogens and other sex hormones. The DUTCH Complete dried urine test, Complete Hormones Panel, and Estrogen Elite Profile measure estrogen, progesterone, and androgen metabolites. ‍

Urine testing measures the primary forms of estrogen and downstream estrogen metabolites, which are not routinely measured in blood or saliva. Urine metabolite concentrations measured by several spot tests show the same pattern as serum, offering an at-home collection option.

Liver Function Tests

Unused estrogen is primarily metabolized by the liver in processes that require vitamins and minerals to function. B vitamins, vitamin D, and Magnesium may influence the production and processing of estrogen.

Liver function should be assessed along with a nutrient panel to evaluate imbalances in vitamins and minerals.

Comprehensive Stool Test

Once the liver processes estrogen, it moves into the gut for further modification and elimination. When there is a healthier mix of bacteria in the GI tract, excess estrogen may be more easily eliminated from the body via stool, so it does not lead to problems.

Genomics

Several genes that impact the processing of estrogen can be assessed with a functional medicine genomic lab test.

Estrogen is metabolized in the liver to prepare it for elimination out of the body when it is no longer needed. This process involves enzymes known as cytochromes like CY1B1 (Cytochrome P450 1B1) and a cycle known as methylation that involves many processing steps involving MTHFR (Methylenetetrahydrofolate Reductase) and COMT that require vitamins B6, B12, and folate to metabolize estrogen. When all of these steps work well, unneeded estrogen can be safely excreted into the gut to be removed from the body.

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Functional Medicine Approaches for Estrogen Balance

Estrogen balance may be influenced by genetics, diet, alcohol, environmental exposures, lifestyle, and medications, especially antibiotics and hormonal contraceptives—most of these may impact the estrobolome.

An individualized combination of diet, detoxification, and movement may encourage the restoration of a balanced estrobolome and estrogen levels.

Consider a Hormone-Supportive Diet

Eating a more high-fiber whole foods diet may create greater bacterial diversity in the gut and a balanced estrobolome.

Including fermented foods like sauerkraut, kimchee, and kvass may help rebalance and increase bacterial diversity.

Prebiotic-rich foods containing fructooligosaccharides or inulin like chicory, asparagus, garlic, unpeeled raw carrots, and Jerusalem artichokes may promote the growth of beneficial bacteria.

Probiotic strains, including Lactobacillus Plantarum and bifidobacteria species, may decrease bacteria that produce beta-glucuronidase to help keep estrogen balanced.

High-fiber plant-based foods like nuts, seeds, legumes, beans, and various vegetables may support healthy bacteria and lead to more balanced estrogen by keeping the bowels moving regularly to excrete extra estrogen.

Adequate quality protein is also essential for optimal liver detoxification.

Reducing alcohol and caffeine may also support hormone balance since these can burden the liver and disrupt estrogen metabolism.

Supplements

Calcium-d-glucarate supplementation may also help support the excretion of excess estrogen since it inhibits beta-glucuronidase and allows more estrogen to leave the body in the stool.

Reduce Xenoestrogens

Since manufactured xenoestrogens mimic natural estrogens and may alter the microbiome, reducing exposure may help restore balanced hormones.

• Minimize plastic use, especially when heated
• Opt for non-chemical plant-based laundry and household cleaning products without synthetic fragrances
• Avoid phthalates, stearalkonium chloride, and parabens in personal care products
• Opt for organic food whenever possible

Balance Exercise

Regular moderate-intensity exercise may help keep estrogen levels balanced.

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Summary

Estrogen is a crucial hormone for bones, mood, female characteristics, and sexual and reproductive function, but it must remain balanced.

The ratio of the three forms of estrogen – estrone (E1), estradiol (E2), estriol (E3), and their metabolites – may influence impacts.

A full urine female hormone panel, including all forms of estrogen and other sex hormones, may help determine hormone balance. In addition, assessing liver function, levels of vitamins and minerals, relevant genomics, and gut health may help figure out why estrogen is out of balance.

A functional medicine approach to estrogen balance encourages a nutritious diet, balanced movement, targeted supplementation, and reduced toxicity to allow the body to support the balance of gut bacteria in the estrobolome and estrogens in the body.