Short temper? Killer PMS symptoms? Heavy periods? Anxiety ? Contrary to what you’ve probably been told, these symptoms (and a whole lot more) don’t just “come with the territory” of being a woman.
In fact, these symptoms could mean that certain hormones in your body are seriously out of whack, and that you may have a condition commonly referred to as estrogen dominance.
Keep reading to learn more about estrogen dominance, what causes it, the most common symptoms, and how Parsley Health's medical providers approach treatment.
Estrogen dominance is a hormonal imbalance characterized by estrogen levels that are elevated in comparison to your other sex hormones. This means that there may be an overproduction of estrogen, or that other sex hormones such as progesterone are too low, which would result in an elevated estrogen-progesterone ratio.
In turn, these relatively high levels of estrogen can lead to a cascade of negative effects throughout your entire body that range from headaches and mood swings to heavy periods and fertility problems .
The range of symptoms resulting from estrogen dominance (which we’ll dive into below) are due, in part, to the interconnected nature of hormones: they all affect each other, and when one is out of whack, others often follow.
“Our sex hormones, including estrogen, progesterone, testosterone, DHEA, and cortisol , come from our ovaries and adrenals—and they all talk to each other as well as interact with other important hormones like thyroid hormone, insulin, and melatonin,” says Parsley's Dawn Johnson, DO , an expert in hormonal health.
Additionally, all organs, including your brain, muscles, bones, heart, blood vessels, lungs, and gut, have a special place designated just for estrogen called an estrogen receptor, explains Dr. Johnson. “So, when we have too much estrogen and our hormones get out of balance, it can affect all of these areas,” she says.
While estrogen dominance is not an official diagnosis (and thus doesn’t have any official statistics on how many women are affected), Dr. Johnson says that in her professional experience it’s an incredibly common hormonal imbalance and can occur at any age and any stage of life, but that it’s particularly common among certain groups of women, including pre- and perimenopausal women who are more likely to experience periodic surges and lulls in estrogen production, and people who carry extra weight or body fat, since estrogen is made in our fat cells.
“Estrogen drives over 400 crucial processes in our body, just by itself, and then it acts upon and in conjunction with other hormones to affect a bunch of other processes,” says Dr. Johnson. Needless to say, estrogen dominance can trigger a range of far-reaching effects.
Here are some important signs of estrogen dominance to keep in mind.
Any unpleasant symptoms that you typically associate with PMS can be exacerbated by estrogen dominance. These may include heavy periods, weight gain, bloating , breast tenderness, and mood swings. “These organs—the vagina, the uterus, the breasts—have more estrogen receptors than some of your other organs, which is why these symptoms tend to be more common than others,” says Dr. Johnson.
Neurotransmitters such as dopamine and serotonin are chemicals produced in the brain and gut that regulate mood, and estrogen helps control their formation. “You need some estrogen for an overall balanced mood, but having too much can drive an imbalance in neurotransmitters that contributes to anxiety and depression,” says Dr. Johnson.
Too much estrogen can dampen the body’s ability to make melatonin, a hormone that prompts you to get sleepy at night in response to decreased light exposure, says Dr. Johnson. Without enough melatonin, you may have a hard time falling asleep and staying asleep, which contributes to fatigue and general crankiness.
Estrogen and thyroid hormone work together nicely when things are in balance, but too much estrogen binds thyroid hormone, says Dr. Johnson. This can potentially lead to symptoms of hypothyroidism , which may include things like chronic fatigue, weight gain, constipation, dry skin, and hair loss .
The uterus has loads of receptors for estrogen. And because estrogen is stimulatory in nature, too much estrogen in the uterus can lead to (non-cancerous) growths of tissue called uterine fibroids . They can cause intense pain and even impair fertility by affecting whether the sperm and egg meet, whether an embryo can implant, positioning of the fetus, and more.
It’s not necessarily too much estrogen that causes fertility problems, but often, it’s low progesterone levels, which creates a higher than normal estrogen-to-progesterone ratio, says Dr. Johnson. Low progesterone, in turn, has been associated with an increased risk of miscarriage .
As mentioned, estrogen is stimulatory—it keeps skin wrinkle-free and keeps bones strong. But it’s not helpful when we have too much stimulation. According to Dr. Johnson, that can increase our risk of cancers, especially in the breast, uterus, cervix, and ovaries; and it can also stimulate certain autoimmune disorders, such as lupus .
These symptoms may seem weird to lump together, but they have one big thing in common: blood vessels. Remember how there are estrogen receptors on all of our blood vessels? Having enough estrogen is important for dilating or opening up blood vessels, but too much estrogen—or having fluctuations in estrogen levels—can alter blood flow in a way that contributes to poor circulation and even migraines .
There are many contributing factors to the root cause of estrogen dominance, says Dr. Johnson. For some women, there may be a genetic component at play, but often, the factors below work together to push you into an estrogen-dominant state.
“Estrogen dominance is an inflammatory state,” says Dr. Johnson. “When you experience inflammation , the body has to use all of its resources to dampen that inflammation , and when it does that, it runs out of resources to detoxify and break down hormones properly.” So, anything that’s going to increase overall inflammation—too much sugar or processed foods, stress, obesity, an underlying medical condition—can potentially increase risk for estrogen dominance.
Our adrenal glands and ovaries are intimately connected, so when stress affects the adrenals, prompting them to pump out stress hormones like cortisol, our ovaries naturally want to help—and this leads to an overproduction of estrogen as “an attempt to balance things out,” says Dr. Johnson. (Here’s a toolkit to combat stress .)
Inflammatory foods such as added sugars, refined carbohydrates, and high-fat processed foods can get in the way of our body’s ability to properly process and eliminate estrogen. And, according to Dr. Johnson, even moderate consumption of alcohol can interfere with our body’s ability to detox estrogen. Additionally, conventional meat and dairy may contain hormones. “Hormones, including estrogen, are given to animals to promote quick growth, but when we consume animal foods, we also ingest them,” she says. “They can have a stimulatory effect on our whole body, as they do in animals, which can make overall hormonal balance very difficult.”
There are many chemicals in conventional cosmetics and cleaning supplies, and even sprayed onto foods as pesticides that look and act like estrogen in our body—these are often referred to as endocrine disruptors or xenoestrogens. These man-made chemicals mimic estrogen, contributing to your overall estrogen load, which can lead to estrogen dominance.
Your body processes a lot of hormones and toxins when you sleep —it’s essentially “clean up” time. So if you’re not getting enough restorative sleep , you may not be able to eliminate excess estrogen efficiently, explains Dr. Johnson. And, as previously mentioned, too much estrogen can impair melatonin production—so you have an even harder time getting quality sleep, causing a vicious cycle.
Birth control options often contain estrogen—and although many women tolerate them, they can create an imbalance in others. “If you already have a high baseline estrogen level, then these medications can actually push you over into estrogen dominance,” says Dr. Johnson.
Your body breaks down estrogen and then removes it via your bowels. But if you’re chronically constipated, say, from a poor, low-fiber diet (here’s what to eat to combat that ) or an underlying medical condition, then the estrogen basically just sits there, allowing it to be reabsorbed and recirculated, explains Dr. Johnson.
There’s no perfect test to diagnose estrogen dominance—it takes more of a multipronged approach, and often depends on how well versed a provider is in looking for symptoms. At Parsley Health , the first step involves getting the patient’s story, including their sleep, their diet, their movement habits, as well as their symptoms, according to Dr. Johnson. This will inform your provider as to what type of testing may be most appropriate.
Testing will vary depending on the person but often involves a simple blood test to determine your levels of estrogen (this includes all three types of estrogen: estradiol, estriol, estrone), progesterone, DHEA-s, and cortisol. Additionally, a urine test may be performed to determine if your body’s various estrogen-eliminating mechanisms are functioning appropriately. Looking at all of this data, together, will help your doctor determine if you have estrogen dominance and what type of estrogen dominance treatment is best.
Because the things that contribute to estrogen dominance are often a result of lifestyle factors that are within your control, Parsley Health medical providers advise on how to make simple, sustainable changes to rebalance your hormones. These changes may include:
According to Dr. Johnson, if a patient is diligent with these and other recommendations, they often experience some benefit within three months. Occasionally, medication is needed alongside these lifestyle changes—but that’s always determined on a case-by-case basis.
While the symptoms of estrogen dominance can be overwhelming, the medical providers at Parsley Health can help you get back on track with targeted testing, strategic lifestyle changes, and ongoing, year-round support.
Stephanie Eckelkamp is a writer and certified health coach based in Allentown, PA. She received her B.S. in journalism from Syracuse University with a minor in nutrition. Her work has appeared in Martha Stewart Living, mindbodygreen, Greatist, Women's Health, Men's Health, Prevention, and Good Housekeeping. When she's not writing or nerding out on the latest health news, she's most likely on a walk with her pup Lucy Goose or trying to convince her boyfriend to eat more broccoli.