Women’s Hormonal Health: Estrogen Dominance, Part of the Puzzle

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I started my series on women’s hormonal health writing about my own experience. I have been blessed with good health all my life, and my periods have been regular. After sudden complications from an enlarged cyst on my left ovary, I had a singular oophorectomy, which is removal of one ovary. 
cervix, ovaries, fallopian tubes, and uterus

Three months after the surgery, I stopped menstruating, started having hot flashes, severe night sweats, loss of energy, and rapid weight gain. At age 44, it felt like instant menopause without a warning.
The blood tests showed that my ovary was still functioning but the  progesterone levels were very low. My doctor at the time suggested birth control pills to get back to balance, but I did not want to take that road.
I started using natural progesterone cream, and in one month I had my period. The hot flashes, night sweats, and low energy stopped after several weeks. After three months or so my weight  was almost back to normal.
My success so far with natural  progesterone supplementation confirmed that I was estrogen dominant, and balancing with progesterone has helped me so far.
However, this is only one part of a complex puzzle.
Natural hormonal replacement is not a one size fits all approach. It is the opposite of that, because there are many variables in what is causing the imbalance. What is most important is to understand the pieces of the puzzle, so you can work with your doctor to make the best choices for you.
I remember the 1980’s show “Thirty Something”. I was in pharmacy school, and  it quickly became a ritual with friends to watch it every week. It was one of the first, if not the first time on tv, where I saw assertive women openly talk about female issues and taking charge of their health decisions.
One episode in particular has stayed with me where Nancy is talking with her ob/gyn doctor, and he tells her that he is going to play with her estrogen. She lets him know firmly that she is intelligent and informed, and will not be treated with condescendence. After she is finished talking, she looks at him and she says something like “now, let’s talk estrogen”
What is estrogen dominance?
To understand estrogen dominance, let’s first review the menstrual cycle.
Once a month, the ovaries get a signal from the brain to prepare eggs for possible fertilization. Follicle stimulating hormone (FSH) is released from the pituitary gland to signal the ovary to make estrogen and begin egg maturation. The eggs begin to mature inside of sacs in the ovaries. These sacs are called follicles. The uterus lining thickens and fills with blood to be ready to maintain and supply the possible embryo. During this follicular phase estrogen levels are rising.
After 10 to 12 days, the pituitary gland releases leutenizing hormone (LH) which promotes ovulation. One egg (or two for fraternal twins), reaches the ovary surface and the follicle bursts. The egg is released into the fallopian tube for possible fertilization with sperm. This is called ovulation.
Estrogen levels peak at ovulation and then start to drop. Testosterone is also released during ovulation.

The empty follicle in the ovary now becomes the corpus luteum (latin for yellow body appearance), and starts to make progesterone. As the corpus luteum releases progesterone, body temperature rises and the uterus is further prepared for the possible embryo. Progesterone levels continue to rise and dominate the last half of the menstrual cycle. This is called the luteal phase. If pregnancy does not happen, then progesterone and estrogen levels drop quickly, and menstruation begins to shed the uterine lining and blood. 

menstrual cycle’s follicular and luteal phase

Estrogen dominance is a term that Dr. John Lee, a pioneer in women’s hormonal health, used to initially explain how estrogen could dominate the second half of the menstrual cycle if progesterone is not available in sufficient amounts. This does not mean that there has to be an excess of estrogen, and estrogen levels may even be low, but the amount of estrogen that is relatively higher than progesterone makes a difference. The ratio of estrogen to progesterone is what is important, and there are many variations of these ratios among women. If estrogen becomes unopposed by progesterone to a certain extent, hormonal imbalance begins to show up.
Estrogen dominance can start years before menopause, even before perimenopause.
What can cause estrogen dominance?
The secretion and collaboration of estrogen, progesterone, and testosterone   are ordered by the hypothalamus in the brain which signals the pituitary gland (also in the brain) when to release the hormonal messengers FSH and LH. All of this also works with a feedback mechanism from the ovaries and the adrenal glands. What this means is that there are many factors affecting the release and levels of estrogen and progesterone. Estrogen dominance can start with an imbalance in any of these areas.
The possible factors causing estrogen to be dominant are:

  • environmental and industrial xenoestrogen exposure
  • anovulatory cycles
  • stress
  • diet
  • synthetic hormones
  • hysterectomy

In my next post, I will go over each of these factors, and how they contribute to estrogen dominace.

Camille Medina, RPh
Natural Pharmacy C.l.i.n.i.c., llc

The information provided here is not intended to diagnose, treat, cure, or prevent any disease. Suggestions and ideas presented in this document are for information only and should not be interpreted as medical advice, or for diagnosing illness. Seek advice from a health care professional before administering any dietary supplements.

Lee, John, M.D. , with Hopkins, Virginia. What Your Doctor May Not Tell You About Menopause. New York: Wellness Central,  revised  edition 2004

Martin, Raquel, with Gerstung, Judi, D.C. The Estrogen Alternative. Vermont: Healing Arts Press, 2000.

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