Supplements to Increase Estrogen Levels: Safe and Natural Approaches

Estrogen regulates various aspects of a woman's health throughout her life, from influencing menstrual cycles and bone health to maintaining mood and cognitive function. As a result, many women are increasingly interested in exploring natural ways to support healthy hormone levels.

The good news is that several supplements can boost estrogen naturally, promoting balance and vitality.

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Understanding Estrogen

Estrogen is a steroid hormone derived from cholesterol responsible for the development and functioning of the female reproductive system and secondary sexual characteristics. It significantly influences the menstrual cycle (and reproductive health), bone density, cardiovascular health, cognitive function, and mood regulation. 

There are three main forms of estrogen:

• Estrone (E1) is the predominant form of estrogen during a woman's postmenopausal years. During her reproductive years, estrone is converted to estradiol. 
• Estradiol (E2) is the most potent and active form of estrogen, predominant during the reproductive years.
• Estriol (E3) is the least potent form of estrogen predominant during pregnancy, as the placenta produces it in large amounts. 

Estrogen is also present in men in lower amounts, where it contributes to sexual function, bone density, heart health, and mental health.

Many factors can affect estrogen levels, leading to lower or higher than optimal levels. Some of these factors include: 

• Genetics that govern how estrogens are metabolized and broken down in the body
• Age: estrogen levels peak during the reproductive years and begin to naturally decline during perimenopause (which typically starts in the mid-40s).
• Stress
• Relative energy deficiency in sport (RED-S)
• Environmental exposures to endocrine-disrupting chemicals (EDCs)
• Medical conditions, including polycystic ovary syndrome (PCOS), thyroid disease, primary ovarian insufficiency (POI), and pituitary dysfunction 
• Use of certain medications, such as hormonal contraceptives, hormone replacement therapy (HRT), aromatase inhibitors, gonadotropin-releasing hormone (GnRH) agonists, nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, and steroids

Supplements to Increase Estrogen Levels

Symptoms of low estrogen include those typical of menopause, including:

• Irregular menstrual cycles
• Night sweats
• Hot flashes
• Vaginal atrophy and dryness
• Fatigue
• Insomnia
• Mood swings
• Hair loss
• Poor memory and brain fog
• Weight gain

Those wishing to alleviate these symptoms and naturally support estrogen levels may consider the following supplements: 

Phytoestrogens

Phytoestrogens are naturally occurring plant compounds structurally similar to estrogen, allowing them to mimic its effects in the body. Estrogen exerts its effects by binding to specific receptors, like a key fitting into a lock. Because of their structural similarities, phytoestrogens can "unlock" these same receptors, stimulating them and producing estrogen-like effects.

Dietary and supplemental sources of phytoestrogens include: 

• Soy isoflavones
• Flaxseeds
• Grapes
• Alfalfa sprouts
• Red clover
• Hops

Black Cohosh

Black cohosh (Cimicifuga racemosa or Actaea racemosa) is widely recognized for its potential to alleviate menopausal symptoms. This suggests that it may have estrogenic effects, though the exact mechanisms remain unclear. Early research indicated that formononetin in black cohosh could exert phytoestrogenic effects; however, subsequent studies have failed to isolate formononetin from black cohosh. 

Alternative theories propose that black cohosh's therapeutic effects may involve selectively modulating estrogen receptors (exerting estrogenic effects in some tissues and antiestrogenic effects in others) or influencing serotonergic systems (56).

Traditionally, black cohosh has been used to reduce musculoskeletal pain and support the nervous system because of the herb's ability to bind opioid receptors (attributed to its triterpene glycosides, which are structurally related to steroids) (67).

Regardless of its mechanism(s), research supports the use of black cohosh in alleviating menopausal symptoms, particularly hot flashes and depression. 

Dong Quai

Dong quai (Angelica sinensis) is a mainstay in Traditional Chinese Medicine (TCM), where it is often combined with other herbs to address women's health concerns, such as painful or irregular periods, premenstrual syndrome (PMS), and menopausal symptoms.

Coumarins, a type of phytoestrogen, have been isolated from dong quai. Despite this, research on whether dong quai exhibits estrogenic effects in the human body is very mixed. More research is necessary to determine the extent to which dong quai can regulate hormonal imbalances. 

Therefore, much of the evidence to support dong quai's efficacy in treating hormonal-related symptoms is anecdotal. Based on clinical expertise, TCM providers advocate that dong quai is indicated to treat:

• Menstrual irregularities
• Menopausal symptoms
• PMS
• Infertility
• Pain

Chasteberry

Chasteberry, also known as Vitex agnus-castus, is an herb that has been used for centuries to address various hormonal imbalances. In small doses, chasteberry acts as a pituitary driver and can increase the levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), estrogen, and progesterone. 

Studies have consistently demonstrated the clinical utility of chasteberry in hormone-balancing protocols to treat symptoms of PMS and menopause, such as irritability, breast tenderness, food cravings, menstrual cramps, anxiety, and hot flashes.

Maca Root

Maca root is an adaptogenic herb with a history dating back thousands of years to treat fatigue and hormonal-related health conditions due to its ability to modulate various hormonal signaling pathways (namely, those controlling the release of cortisol and sex hormones). Maca acts at the level of the hypothalamus and pituitary gland to modulate levels of cortisol, LH, FSH, estrogen, and progesterone. (5, 15) 

In one small study of postmenopausal women, two months of supplementing with a patented formula called Maca-GO® resulted in measurable elevations in serum estradiol, improvements in menopausal symptoms (especially hot flashes, sweating, disrupted sleep, and nervousness), and increased bone density. 

Vitamins and Minerals

Vitamins and minerals act as cofactors for the biochemical pathways responsible for synthesizing and metabolizing hormones. Nutrient deficiencies can disrupt these pathways and contribute to hormonal imbalances. 

To support estrogen levels, consider focusing on getting enough of the following nutrients:

• Boron
• Calcium
• Choline
• Magnesium
• Vitamin A
• B vitamins
• Vitamin C
• Vitamin D
• Vitamin E
• Zinc (23, 49) 

Safety and Considerations

Using supplements to boost estrogen levels requires careful consideration of dosing, safety, potential side effects, and contraindications. Just because a supplement is natural does not guarantee that it is safe for everyone. Anyone interested in a new dietary supplement should seek professional guidance before starting to ensure safety and efficacy. Your doctor can make personalized recommendations tailored to your health goals and profiles. 

Lab Tests and Biomarkers to Monitor

The following labs are available for assessing hormonal levels and monitoring the effectiveness of estrogen-balancing therapies:

Hormone Levels

Sex hormones and cortisol levels can be measured through blood, salivary, and urine tests, each with its own advantages and disadvantages. 

Blood tests, such as the Female Hormone Panel by Precision Point, are widely used for their accuracy and ability to measure both free and bound hormone levels. However, they can be invasive, may not reflect diurnal variations in hormone levels, and accurate interpretation relies upon knowing where a patient is in their menstrual cycle. (29) 

Salivary tests, such as the Saliva Female Hormones test by Ayumetrix, are non-invasive, easy to administer, and effective for assessing the bioavailable, or active, fraction of hormones, making them suitable for monitoring diurnal fluctuations. (29) 

Urine tests, such as the Sex Hormones Profile by Doctor's Data, are as accurate as serum testing for estradiol and progesterone and offer the additional benefit of being able to measure hormone metabolites, which provide insights into how the body is breaking down hormones – an often overlooked contributor to hormonal imbalance. (29) 

Thyroid Function Tests

When a patient presents with symptoms suggestive of hormonal imbalance, a doctor should consider measuring thyroid hormones due to the thyroid gland's role in regulating metabolism. Symptoms of thyroid disease can mimic those of low estrogen (e.g., fatigue, weight gain, menstrual irregularities). Additionally, thyroid hormones interact with various aspects of the signaling network responsible for the gonadal secretion of sex hormones. Thyroid dysfunction has been linked to reproductive dysfunction due to its downstream impacts on estrogen metabolism and transport and the health of the reproductive tract. (7) 

To thoroughly assess thyroid health and function, consider ordering a panel with at least TSH, free T3, and free T4. The Comprehensive Thyroid Panel w/ Antibodies by Precision Point is one example of a comprehensive thyroid panel.

Liver Function Tests

One of the liver's many jobs is metabolizing hormones into water-soluble compounds that can be eliminated from the body. In Phase I liver metabolism, liver enzymes convert estradiol into intermediate metabolites, including 2-hydroxyestrone (2-OHE), 16-hydroxyestrone (16-OHE), and 4-hydroxyestrone (4-OHE). These metabolites have varying levels of biological activity, and certain imbalances, such as a low ratio of 2:16-OHE, have been associated with an increased risk of breast cancer. 

Therefore, evaluating liver function by measuring liver enzymes should be included in any hormone-balancing protocol. Implementing liver-supportive therapies as necessary ensures that the liver can efficiently convert estrogen into beneficial metabolites, promoting balanced hormonal activity and reducing the risk of estrogen-related health issues. 

Bone Density Tests

Research indicates that up to 20% of bone loss can occur during menopause. Approximately 10% of women over 60 have osteoporosis. (47) 

Estrogen prevents bone loss by suppressing osteoclasts, the cells responsible for breaking down bone tissue. Increased bone resorption can result from estrogen deficiency due to the absence of estrogen's inhibitory effects on osteoclasts. This imbalance in bone turnover significantly contributes to the development of osteoporosis in menopausal women. (19) 

A DEXA scan uses x-rays to measure bone density. The U.S. Preventive Services Task Force (USPSTF) recommends screening for osteoporosis to prevent osteoporotic fractures in women 65 years and older and any postmenopausal women younger than 65 with an increased risk of osteoporosis. 

Overall Health Markers

Consider adding the following tests to a comprehensive health screening to evaluate general health and nutritional status:

• Comprehensive metabolic panel (CMP)
• Complete blood count (CBC)
• Micronutrient panel

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Key Takeaways

• There are many effective supplements that can help increase estrogen levels and alleviate symptoms of estrogen deficiency. 
• It is always important to approach supplementation cautiously and seek professional guidance to ensure safety and efficacy, as individual needs and responses can vary widely. 
• Maintaining a balanced lifestyle is essential for overall hormone health. Patients looking to optimize hormonal health should always prioritize an anti-inflammatory lifestyle, encompassing a nutritious diet, regular physical activity, stress management, good sleep, and avoiding toxic exposures.