• Rohini Pathmanathan

Managing Oestrogen Dominance

Updated: Jul 17, 2018


Though Susie was adrift in a raging hormonal sea, she was determined to show her menstrual cycle who was boss.

In a perfect world, a woman’s periods would run like clockwork and her pre-menstrual symptoms would be minimal at best. While this may have been true for our grandmothers and mothers, millennial women are exposed to a host of environmental, nutritional and chemical nasties that disrupt hormonal balance and are responsible for higher rates of reproductive cancers, early-onset menopause, and hormone-driven diseases such as endometriosis, polycystic ovarian syndrome, adrenal fatigue and thyroid dysfunction.


While both oestrogen and progesterone are required for female hormonal health and to ensure reproductive function, exposure to chronic stress, foods high in fat and sugar, and endocrine-disrupting chemicals skew this balance in favour of oestrogen, thereby creating a condition within the body where excess oestrogen impairs the counter-balancing effect of progesterone. Though this may imply that oestrogen is the hormonal equivalent of Ultimate Evil and progesterone is Glenda the Good Witch, the truth remains that in an ideal world, oestrogen and progesterone are best buddies who work in tandem with each other to support a common goal: a regular, fuss-free menstrual cycle.



Oestrogen Dominance and the Menstrual Cycle

Though cycle length may differ among women, a typical menstrual cycle spans 28 to 30 days, with active menstruation (shedding of the uterine lining through the vagina) occurring over a course of three to five days (Trickey, 2011). During the first 14 days of a woman’s cycle, oestrogen assumes a starring role and supports the maturation of ovarian follicles in preparation for ovulation. This is called the follicular phase.


Ovulation typically occurs between days 14 and 15, and signals the start of the luteal phase. In this second half of the cycle which lasts from ovulation until the start of menstruation, progesterone assumes a more dominant role and supports the development of blood vessels and glandular structures within the uterine lining to aid possible fertilisation and to prepare the uterus for a developing foetus (Trickey & Mikosza, 2011). If fertilisation does not occur, both oestrogen and progesterone begin a gradual decline until menstruation commences a fortnight from ovulation onset.


In cases of oestrogen dominance, progesterone is insufficient or unavailable during the luteal phase due to irregular, impaired or absent ovulation. Other notable causes of impaired ovulation include certain types of medication, stress (Barsom et. al, 2004), sleep deprivation, poor liver function, and unhealthy dietary habits (Trickey & Mikosza, 2011). The good news is that addressing any of these possible imbalances has a beneficial influence on oestrogen-progesterone ratio, whether it's incorporating more liver-supportive foods in your diet, getting better-quality sleep, boosting physical activity levels or improving the way you manage stress in your life.



Pre-Menstrual Syndrome (PMS): A Hallmark of Oestrogen Dominance

One of the core signs of oestrogen dominance in women of childbearing age is PMS onset at the tail-end of the follicular phase (day 14) due to a lack of progesterone’s moderating influence (Khajehei, 2015). Higher levels of oestrogen relative to progesterone stimulate PMS-characteristic symptoms such as breast tenderness, water retention, mood swings, migraines, food cravings and weight-gain (Hechtman, 2012).


Oestrogen dominance is also associated with increased risk of asthma, food intolerances and various types of allergy due to oestrogen's hyper-stimulating effect on immunoregulatory cells (Bonds & Midoro-Horiuti, 2013). In support, research suggests that between 30 to 40 percent of women with high oestrogen are prone to experiencing asthma, rhinitis or other respiratory complications during the luteal phase of their menstrual cycle (Bonds & Midoro-Horiuti, 2013).


Oestrogen’s function as an anabolic hormone also causes excess reproductive tissue growth, such as abnormal endometrial tissue outside the uterine cavity in endometriosis, as well as malignant cell growth which may develop into breast, cervical and/ or uterine cancers. Furthermore, impaired ovulation and inflammation perpetuated by abnormal oestrogen-fuelled tissue growth has been associated with higher rates of infertility and spontaneous abortion in reproductive-aged women (Hechtman, 2012).



The Rise of Xenoestrogens

From shampoos to face creams, xenoestrogens are sneaky, hormone-disrupting nasties found in a wide range of personal-care and household products.

Xenoestrogens are synthetic environmental oestrogens that are absorbed into the bloodstream following contact or exposure, and bind to oestrogen receptors within the body to mimic its effects. The World Health Organization officially acknowledges xenoestrogens as endocrine disruptors in both humans and animals, and is a causal factor of reproductive diseases and infertility in men and women alike (Bergman et. al, 2012). Up to 800 compounds have been identified as potential hormone disruptors, as xenoestrogens are found in a wide range of household products, skincare products, cosmetics, shampoos, cleaning agents and air pollutants (Fucic et. al, 2012).


This list includes:

  • Polycyclic aromatic hydrocarbons

  • Pesticides and fungicides

  • Bisphenol A

  • Dioxins

  • Parabens

  • Phthalates

  • Polychlorinated biphenyl (PCB)

  • Dichlorodiphenyl-trichlorethane (DDT)

  • Polystyrene


Phytoestrogens: Yay or Nay?

Pumpkin seeds, sunflower seeds, flaxseeds and chia seeds are all sources of naturally-occurring plant phytoestrogens.

Phytoestrogens are plant-based oestrogens found in foods such as soy, red wine, flaxseeds, a wide variety of nuts, seeds and legumes, as well as in herbs such as shatavari and ashwaghanda. The verdict on these naturally occurring oestrogens is mixed: while some sources suggest an oestrogenic effect, others report that phytoestrogens may counter oestrogen dominance by exerting anti-oestrogenic benefits (Trickey & Mikozsa, 2011). This anti-oestrogenic effect is courtesy of ‘competitive inhibition’, a process by which phytoestrogens compete for oestrogen-receptor binding with the body’s own supply of oestrogen (endogenous oestrogen), thereby preventing endogenous oestrogen from exerting its influence (Trickey & Mikozsa, 2011).


However, it is difficult to gauge whether increasing phytoestrogen intake as a counterpoint to oestrogen dominance is truly effective, as multiple factors such as genetics, digestive physiology and metabolic phenotypes dictate whether phytoestrogens will have a beneficial anti-oestrogenic influence or conversely, cause a worsening of oestrogen dominance symptoms (Patisaul & Jefferson, 2010). Research also suggests that phytoestrogens may be more beneficial for menopausal and post-menopausal women than pre-menopausal women as oestrogen dominance largely affects women of child-bearing age and decreases after menopause due to a natural decline in oestrogen production (Hechtman, 2012).



Managing Oestrogen Dominance with Nutrition

Cruciferous vegetables such as cabbage, cauliflower, brocolli and bok choy are rich in sulphurous compounds which aid Phase 2 liver detoxification processes.

Nutritional intervention for oestrogen dominance involves enhancing liver function to ensure proper metabolism and excretion of circulating oestrogen in the body. The liver metabolises oestrogen through two detoxification pathways which play very different but ultimately synergistic roles in excreting excess oestrogen.


Phase 1 involves the hydroxylation of oestrogen by cytochrome P450 enzymes, which are a group of enzymes tasked with oxidising and reducing a range of toxins and hormones in the body (Tsuchiya et. al, 2005). In Phase 2, oestrogen is conjugated via processes such as sulphation, glucuronidation and methylation to make it more water-soluble so it can be excreted in bile and urine. Phase 2 detoxification is critical because conjugated oestrogen can no longer bind to oestrogen receptors in the body, and therefore loses its damaging hyper-oestrogenic activity (Trickey & Mikozsa, 2011).


Research recommends the following foods and dietary measures for increasing oestrogen clearance via phase 1 and phase 2 liver detoxification mechanisms:


(1) Make fibre your friend

The average daily fibre intake is 35 grams for adult men and 25 grams for adult women. Ensuring you achieve your daily fibre quota is important to keep your bowels and hormones...um, moving in the right direction.

The main function of phase 2 liver detoxification is rendering toxins and hormones water-soluble so they can be dissolved in bile and excreted as faeces. However, inadequate intake of dietary fibre is associated with increased risk of constipation and reduced oestrogen clearance from the digestive tract, as increased colonic transit time increases oestrogen’s likelihood of being reabsorbed from the gut back into the bloodstream (Trickey & Mikozsa, 2011). Whole-grains, fruits and vegetables are packed full of dietary fibre and valuable micronutrients to boost liver health while keeping you regular.


Dietary fibre is also crucial for optimising healthy gut bacteria, as certain strains of bacteria are capable of producing enzymes that deconjugate oestrogen and may therefore exacerbate oestrogen dominance. Enzymes such as beta-glucuronidase impair phase 2 glucuronidation processes and contribute to the deconjugation and reabsorption of oestrogen, which is why ensuring adequate fibre intake may alter gut pH to support reduced beta-glucuronidase activity (Kwa et. al, 2016). These findings may also explain why vegetarian women on the whole have a lowered risk of oestrogen-dependent diseases due to increased faecal elimination of oestrogen (Trickey & Mikozsa, 2011).


(2) Chow down on cruciferous vegetables

The cruciferous family includes broccoli, cauliflower, cabbage, Brussel sprouts, kale, bok choy and mustard greens. These oestrogen-detoxifying powerhouses contain indole-3-carbinol, which is a compound that activates liver-based enzymes tasked with metabolising oestrogen. Research associates regular consumption of cruciferous vegetables with reduced risk of reproductive cancers as well as hormone-driven diseases such as fibroids and endometriosis due to improved efficacy of phase 1 and phase 2 detoxification pathways (Evans, 2008).


(3) Eat more high-quality protein

Eggs are abundant in choline, a nutrient that aids liver metabolism and DNA methylation for enhanced detoxification benefits.

Ensuring adequate protein intake is vital for oestrogen metabolism within liver cells, and requires a combination of lean animal protein as well as vegetable protein in the form of beans, pulses and legumes (Trickey & Mikozsa, 2011). Free-range beef, chicken, lamb, pork and eggs are excellent sources, and are best purchased organic and ethically farmed to ensure they are free from synthetic hormones and endocrine-disrupting growth factors. Protein is also an important consideration in weight management as it promotes increased muscle relative to fat, and is useful for counteracting weight gain and bloating common to oestrogen dominance.


(4) Consider a B-vitamin supplement

Found in whole-grains, legumes, pulses and fortified cereals, B vitamins are essential for energy production and liver health. Specific B vitamins such as folate, B6 and B12 support phase 1 liver detoxification by serving as co-factors for cytochrome P450 enzymes. In phase 2, the methylation process is dependent on adequate folate and B12 to conjugate oestrogens and enhance bile release (Trickey & Mikozsa, 2011). These three superhero B vitamins also function as coenzymes that support DNA integrity, and may therefore help minimise the risk of oestrogen-driven cancers (Wu et. al, 2013).


(5) Consume phytoestrogens…in moderation

Even though research on the benefits of phytoestrogens for oestrogen clearance is mixed, sources argue that due to phytoestrogens’ weak oestrogenic activity and their ability to minimise endogenous oestrogen binding via competitive inhibition, moderate intake of high-quality phytoestrogenic foods may be helpful (Trickey & Mikozsa, 2011). As per general nutrition guidelines, aim for two to three serves of high-quality phytoestrogens such as miso, tempeh and flaxseeds per week for overall health and hormonal support.

Treating oestrogen dominance requires a careful, multi-pronged approach that targets lifestyle factors as well as nutritional influences over a period of several months. Beneficial therapeutic modalities include acupuncture for hormonal rebalancing and short-term symptom relief, as well as supplemental aids and functional foods for more long-term hormone recalibration and enhanced liver health. Book a consultation with me to discuss the best approach for you inclusive of lifestyle modification guidance and a personalised nutrition plan, or visit www.applesandunicorns.com for more information.


References

Barsom, S. H., Mansfield, P. K., Koch, P. B., Gierach, G. & West, S. G. (2004). Association between psychological stress and menstrual cycle characteristics in perimenopausal women. Women’s Health Issues, 14, 235-241. doi:10.1016/j.whi.2004.07.006


Bergman, A., Heindel, J. J., Jobling, S., Kidd, K. A. & Zoeller, R. T. (2012). State of the science of endocrine disrupting chemicals. United Nations Environment Programme and the World Health Organization: Geneva, Switzerland.


Bonds, R. S., & Midoro-Horiuti, T. (2013). Estrogen effects in allergy and asthma. Current Opinion in Allergy and Clinical Immunology, 13(1), 92-99. doi:10.1097/ACI.0b013e32835a6ddb


Evans, J. M. (2008). An integrative approach to fibroids, endometriosis and breast cancer prevention. Integrative Medicine, 7(5), 28-32. Retrieved from http://www.imjournal.com/resources/web_pdfs/popular/1008_evans.pdf


Fucic, A., Gamulin, M., Ferencic, Z., Katic, J., Von Krauss, M. K., Bartonova, A. & Merlo, D. F. (2012). Environmental exposure to xenoestrogens and oestrogen related cancers: Reproductive system, breast, lung, kidney, pancreas, and brain. Environmental Health, 11 (Supplement 1), 1-9. Retrieved from www.ehjournal.net/content/11/51/58


Hechtman, L. (2012). The female reproductive system. In L. Hechtman (Ed.), Clinical naturopathic medicine, pp. 734-871. Chatswood, NSW: Mosby Elsevier.


Khajehei, M. (2015). Aetiology, diagnosis and management of premenstrual syndrome. Journal of Pain & Relief, 4(4), 1-4. doi:10.4172/2167-0846.1000193


Kwa, M., Plottel, C. S., Blaser, M. J. & Adams, S. (2016). The intestinal microbiome and estrogen receptor-positive female breast cancer. Journal of the National Cancer Institute, 108(8), 1-10. doi:10.1093/jnci/dwj029


Mehedint, M. G. & Zeisel, S. H. (2013). Choline's role in maintaining liver function: New evidence for epigenetic mechanisms. Current Opinion in Clinical Nutrition and Metabolic Care, 16(3), 339-345. doi:10.1097/MCO.0b013e3283600d46


Patisaul, H. B. & Jefferson, W. (2010). The pros and cons of phytoestrogens. Frontiers in Neuroendocrinology, 31(4), 400-419. doi:10.1016/j.yfrne.2010.03.003


Trickey, R. (2011). Menstruation and the menstrual cycle. In R. Trickey (Ed.), Women, hormones and the menstrual cycle (3rd ed.), pp. 29-37. Victoria, Australia: Melbourne Holistic Health Group.


Trickey, R. & Mikosza, S. (2011). Hormones. In R. Trickey (Ed.), Women, hormones and the menstrual cycle (3rd ed.), pp. 37-53. Victoria, Australia: Melbourne Holistic Health Group.


Trickey, R. & Mikosza, S. (2011). Hormonal imbalance. In R. Trickey (Ed.), Women, hormones and the menstrual cycle (3rd ed.), pp. 54-74. Victoria, Australia: Melbourne Holistic Health Group.


Tsuchiya, Y., Nakajima, M. & Yokoi, T. (2005). Cytochrome P450-mediated metabolism of estrogens and its regulation in humans. Cancer Letters, 227(2), 115-124. doi:10.1016/j.canlet.2004.10.007


Wu, W., Kang, S. & Zhang, D. (2013). Association of vitamin B6, vitamin B12 and methionine with risk of breast cancer: A dose-response meta-analysis. British Journal of Cancer, 109, 1926-1944. doi:10.1038/bjc.2013.438

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