A Root Cause Medicine Approach to Estrogen Excess: Testing, Diagnosis, & Treatment

Estrogen is an important hormone for reproductive function, as well as optimal function in many other body systems. When estrogen levels are too high, however, it can lead to disruption in reproductive processes and other health concerns.

Conditions associated with elevated estrogen levels, such as breast and ovarian health issues, infertility, and polycystic ovary syndrome (PCOS), are rising. This highlights the need for awareness of the related causes and symptoms to support overall health.

This article will shed light on estrogen excess, including causes, symptoms, the difference between excess and estrogen dominance, functional laboratory testing to identify potential contributing factors, and which conventional and functional medicine approaches can support a return to hormone balance.

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What is Estrogen?

You likely know estrogen by the role it plays in the female hormone system. But did you know that men also produce estrogen? Did you know estrogen plays a role in brain function, skeletal growth, bone metabolism, and glucose and lipid balance? Estrogen does so much more than just regulate the menstrual cycle. Healthy levels of estrogen are vital for optimal health.  

Estrogen is a steroid hormone produced primarily in the ovaries in women and in the testes in men; however, small amounts are also made in the liver, skin, heart, brain, breasts, adipose tissue, and adrenal glands. Estrogen is produced by converting androgen hormones into estrogen by an enzyme called aromatase.

There are three forms of estrogen: estrone, estradiol, and estriol. Estriol plays a more significant role during pregnancy, estrone plays a larger role after menopause, and estradiol is the most prominent and potent form of estrogen.

In women, estrogen is indeed involved in regulating the female menstrual cycle. It is one of the primary female sex hormones. It plays a key role in developing and maintaining the female reproductive system and secondary sex characteristics, such as the growth of breasts and the widening of hips. Estrogen is also involved in many other physiological processes throughout the body, including bone health, cardiovascular health, and brain function. In women, estrogen levels fluctuate during the menstrual cycle and decrease during menopause. In men, estrogen levels also play a role in maintaining bone density and overall health.

What is Estrogen Excess?

As with most aspects of health, when it comes to estrogen, too little can pose risks such as osteoporosis and brain degeneration, and too much may also pose health risks.

Estrogen excess occurs when estrogen levels rise above normal laboratory reference ranges. Elevated estrogen levels are associated with various health concerns, including cancer, dementia, cardiovascular issues, insulin resistance, PCOS, fibroids, and adrenal tumors.

How is Estrogen Excess Different From Estrogen Dominance?

Estrogen and another steroid hormone, progesterone, fluctuate during the different phases of the menstrual cycle. During the first part of the cycle (the follicular phase), estrogen levels are higher than progesterone, and prior to ovulation, estrogen levels peak. After ovulation, progesterone levels rise higher than estrogen during the cycle's luteal phase. If pregnancy doesn't occur during this menstrual cycle, estrogen and progesterone levels fall, and menstrual bleeding begins the follicular phase of the next cycle. This relationship between estrogen and progesterone is very important for maintaining not only menstrual health but many aspects of health. We refer to this relationship as the estrogen-to-progesterone ratio.

Estrogen dominance occurs when estrogen is elevated in relation to progesterone, and there is an imbalance in the estrogen-to-progesterone ratio. Estrogen dominance can occur when estrogen levels are elevated with normal or low progesterone levels or when estrogen is normal or low with lower progesterone levels. Essentially, estrogen dominance is an increase in the gap between estrogen and progesterone levels.

Estrogen dominance can occur when estrogen levels technically fall within normal ranges. Estrogen excess, on the other hand, occurs when estrogen is elevated outside normal ranges.

Estrogen Excess Symptoms

Symptoms of estrogen excess may include:

• Heavy menstrual bleeding
• Menstrual irregularity
• Irritability and mood swings
• Headaches
• Sleep disturbances
• Fibrocystic breasts (dense breast tissue)
• Fibroids
• Endometriosis
• Gallbladder problems
• Thyroid disorders
• Male infertility
• Gynecomastia (breast enlargement) in males

What Causes Estrogen Excess?

Estrogen levels can become elevated in the body in the following ways:

• Overproduction of estrogen
• Inability to appropriately break down or dispose of estrogen
• Exposure to outside (exogenous) sources of estrogen

Factors associated with increased estrogen production include alcohol consumption, a Western Diet, obesity, and stress.

The inability to metabolize (break down) or excrete estrogen can occur with liver dysfunction and cervicovaginal or gut dysbiosis (an imbalance in the microbes that live in these sites). Low magnesium levels and a diet low in fiber can also prevent proper excretion of estrogen from the body.

Exposure to exogenous sources of estrogen often occurs in the form of hormone medications or xenoestrogens (environmental chemicals that act like estrogen and may increase estrogen levels in the body). Hormone medications include estrogen-containing birth control medications and hormone replacement therapy (HRT). Sources of xenoestrogens, also known as endocrine disruptors, can consist of bisphenol A (BPA), phthalates (found in plastics), pesticides, preservatives, and flame retardants, to name a few.

Functional Medicine Labs to Test for Root Cause of Estrogen Excess

Your Functional Medicine practitioner may order several functional laboratory tests to identify both the presence of estrogen excess and potential contributing factors.

Hormone Testing

Hormone testing is vital to confirm whether there is an excess of estrogen in the body. Hormones can be tested in several ways, including in blood and urine. The DUTCH Complete™ is a urine test that provides a complete picture of hormone health. It assesses the sex hormones, stress hormones, and hormone metabolites.

Micronutrient Testing

A micronutrient test will also determine if nutritional factors, such as magnesium deficiency, play a role in estrogen excess.

Comprehensive Stool Testing

A healthy microbiome in the gut and vagina is important for proper hormone metabolism and disposal. To evaluate for gut dysbiosis, a comprehensive stool analysis, such as the Genova Diagnostics GI Effects® Comprehensive Profile, can provide valuable information about microbiome health. To assess for vaginal dysbiosis, the Doctor's Data Vaginosis Profile is an excellent option for insight as to whether imbalances in the vaginal microbiome are contributing to estrogen excess.

Environmental Toxin Testing

Xenoestrogens can be evaluated with an environmental toxins test. This urine test measures the presence of several xenoestrogens in the body, including BPA, phthalates, and pesticides.

It's essential to evaluate for proper liver function to ensure proper metabolism and excretion of estrogen and xenoestrogens.

Conventional Approaches for Estrogen Excess

Conventional approaches for managing estrogen excess often include medications to manage estrogen production. These include aromatase inhibitors or gonadotropin-releasing hormone (GnRH) agonists.

Functional Medicine Approaches for Estrogen Excess

A functional medicine approach helps practitioners address potential contributing factors of excess estrogen. Here are some of the evidence-based options:

Nutrition for Managing Estrogen Excess

When it comes to estrogen excess, a nutritional approach addresses the improved metabolism and disposal of estrogen, as well as avoiding dietary factors that may increase estrogen production, such as alcohol and a Western diet.

High-fiber foods are an essential consideration to support a healthy microbiome as well as liver health, which may improve metabolism and excretion of estrogen. Other foods that support a healthy microbiome include probiotic-rich foods such as yogurt, kimchi, or pickled veggies.

Adding cruciferous vegetables (broccoli, cauliflower, cabbage, etc.) to the diet may be helpful as they contain a compound called diindolylmethane (DIM). This compound may support the metabolism of estrogen and liver function.

Various foods have been shown to have aromatase-inhibiting effects, making them great additions to the diet. These include white button mushrooms, mangosteen, collards, kale, tea, coffee, and cocoa.

The Mediterranean diet is an excellent option if you're looking for a specific diet to support balanced estrogen levels. Participants in this study that adhered to a Mediterranean diet for six months had reduced total estrogen levels by 40%.

Minimizing exposure to xenoestrogens in the diet is also an important strategy to consider. This can include opting for organic food whenever possible to avoid pesticide exposure, avoiding foods in containers containing BPA, avoiding heating or storing food in plastic containers, and avoiding harsh chemicals in your cleaning and personal care products.

Lifestyle Changes for Estrogen Excess

Exercise can support healthy estrogen metabolism and help manage body fat, which may influence the amount of estrogen the body produces.

Stress management is another crucial lifestyle practice to consider for supporting balanced estrogen levels.

Supplements for Managing Estrogen Excess

Elevated estrogen levels can result in suboptimal magnesium levels; therefore, your Functional Medicine practitioner may suggest a magnesium supplement. Other micronutrient supplements may also be recommended based on the results of your micronutrient test to support hormone health and overall well-being.

When gut dysbiosis is part of the contributing factors of estrogen excess, various herbal antimicrobials, probiotics, prebiotics, and ginger supplements may be recommended to support balance in the microbiome.

In cases of vaginal dysbiosis, oral garlic supplements or oral and vaginal probiotics with the Lactobacillus strain of beneficial bacteria may be used to support balance in the vaginal microbiome.

DIM, the compound found in cruciferous vegetables, can also be supplemented to support metabolism and liver detoxification of estrogen.

Calcium D-glucarate is a supplement that may support estrogen metabolism by modulating liver detoxification and influencing an enzyme called beta-glucuronidase.

Other supplements that may support healthy liver detoxification include curcumin, quercetin, milk thistle, licorice, cinnamon, fish oil, and methylated B vitamins.

Summary

Estrogen excess occurs when estrogen levels rise above normal laboratory reference ranges and may contribute to various health concerns.

Awareness of the symptoms and associated conditions can help indicate whether excess estrogen may be an issue for you to discuss with your functional medicine practitioner. With functional lab testing, your practitioner may identify potential contributing factors for your hormone imbalance and help you develop a plan to support your hormone health and well-being.