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Tuesday, August 28, 2012



Estrogen dominance is a common problem today. Both men and women can suffer from this case of hormonal imbalance. As I stated in my previous blogs, this is caused by a combination of a modern fast paced stressed lifestyle, significant environmental issues that need to be dealt with and a genetic predisposition to the problem. Unfortunately, there is so much estrogen and estrogen like products around that it is impossible to fully escape from its effects and impact on the body. We are all surrounded by plastics, car exhaust; soaps, synthetic fibers in clothes; carpet and furniture are just some of the examples.

The diagnosis of estrogen dominance can be difficult especially in the case that some main stream physicians are focusing more on symptoms than cause, yet the signs and symptoms are clear when you ask the right questions. A thorough history and physical together with a keen review of lifestyle, supplements and medications as well as hormonal testing can give insight to this problem.

Today’s blog is intended to review potential recommendations for the treatment of estrogen dominance, yet these are recommendations that you should then review with your physician or caring provider. These are suggestions and as such are not intended for treatment unless you discuss this with your doctor and reviewed your personal history, your complaints and your laboratory results.

Here are my suggestions:


Natural progesterone balances the estrogen effects throughout the body. For this reason, it is at the cornerstone in the treatment of estrogen dominance. Specific dosages need to be addressed individually given the different ways estrogen dominance can present itself. The body normally produces 20 mg of progesterone a day. Replacement of this physiological amount in natural cream form is suggested in most cases. The one caveat to this is that too much of both can also be a problem. For this reason it is important to understand the metabolism of both of these hormones and encourage healthy detoxification practices for the body.


A healthy diet is paramount in the treatment of estrogen dominance. Diets are common place today, yet eating is a subconscious thing… When talking about diet, one needs to consider portions. Calories in and calories out, it is simple math. Exercise needs to be coupled with diet. Cardiovascular training, weights, core, flexibility and balance need to be considered. Statistically, life expectancy increases by two hours for every hour spent doing the proper exercises. Yet it is not all about calories.

Modern ways are usually associated with an acidic diet and an alkaline diet is what is recommended when dealing with hormonal imbalances and estrogen dominance. Understanding the difference between and alkaline diet and acid diet can be challenging, but once you start shifting to an alkaline diet, you will see how good it can be. Under acidic circumstances the body will try to neutralize the acid by withdrawing valuable minerals such as magnesium and calcium from the cells. This leads to mineral depletion that can lead to an array of medical problems.

Studies have shown that the estrogen level fell in women who switched from a typical high-fat, refined-carbohydrate diet to a low-fat, high-fiber, plant-based diet even though they did not adjust their total calorie intake. Plants contain over 5,000 known sterols that have progestogenic effects and therefore, there will be less symptoms of hormonal imbalance. A diet rich in unfermented soy and various cruciferous vegetables such as broccoli, cauliflower, cabbage, kale, bok choy, and Brussels sprouts contain a high level of phyto-estrogen but at the same time have progestogenic and hormone balancing effects. These vegetables are part of an alkaline diet. So on conclusion, a plant-based unprocessed whole-food diet, with at least 15 grams of fiber is recommended. Avoid high-glycemic foods such as refined sugar and refined carbohydrates.

Avoid alcohol or drugs that can damage the liver which will lead to an increase in estrogen due to the lack of estrogen breakdown. Caffeine intake from all sources is linked with higher estrogen levels regardless of age, body mass index (BMI), caloric intake, smoking, and alcohol and cholesterol intake, so Tea or yerbamate can be better in these cases. Coffee is highly acidic. In a recent clinical trial 500 women between the ages of 36 to 45 were studied. Those who consumed at least 500 mg of caffeine daily, the equivalent of four or five cups of coffee had nearly 70% more estrogen in the beginning of their cycle when compared to women who consumed less than 100 mg of caffeine daily. . Excessive chronic coffee intake is associated also with adrenal fatigue and reduced progesterone production.

Maintaining a healthy body weight is important to avoid and treat estrogen dominance. Half of the adults in America are overweight. In the fat cells there is an enzyme called AROMATASE. This enzyme helps produce estrone locally within fat cells. When a person is overweight, aromatase is busy at work producing ESTRONE, the most potent estrogen. This in turn makes the brain think there is plenty of it, and for this reason sends a message to the ovaries to slow production of ALL HORMONES, and tis includes the reduction in the production of progesterone. This causes the estrogen dominance. Obesity is also associated with higher testosterone levels, and higher amounts of free radicals that cause inflammation and increased risk for cancer, and in this case, higher risk for breast cancer.


The goal here is to try to improve the clearance and the metabolism of estrogen. The body gets rid of excess estrogen via the liver detoxification pathway. This pathway has two components: Phase 1 and Phase 2.

The Phase 1 Detoxification Pathway

In the liver, Phase 1 detoxification uses enzymes to help convert toxins into metabolites through a series of chemical reactions (such as oxidation, reduction and hydrolysis). One pathway involves the Cytochrome P-450 enzyme. This phase makes substances such as pesticides, alcohol and several medications become water soluble. Once water soluble the body can excrete them more efficiently via the gastrointestinal system, sweat and urine after going through the Phase 2 detoxification pathway. In order to enhance Phase 1 detoxification pathway and prevent free radical overload, a wide variety of anti-oxidants including ascorbic acid, lipoic acid, grape seed extract, quercetin, and N-acetyl-cysteine is needed by the body.

The Phase 2 Detoxification Pathway

In the liver, Phase two detoxification is about a process called conjugation. The liver adds another substance such as cysteine, glutathione, glucuronide, sulphur or a glycine molecule to estrogen, the toxic drug or chemical which is being eliminated. Once conjugated, the metabolite compound, whether it is toxic or not, is neutralized. This renders it less harmful to the body. In Phase 2, drugs, toxins, and hormones are converted into execretable substances that are in turn removed from the body via watery fluids such as bile or urine. Studies have shown that calcium d-glucurate, a natural ingredient found in certain vegetables and fruits can increase the elimination of toxins from the liver. In addition, methionine, folic acid, Taurine, and N-acetyl-cysteine are very useful synergistic nutrients that will help this pathway.


Estradiol (E2) is the principal and most active estrogen circulating inside our body, and its breakdown, like many other steroidal hormones, occurs in the liver. In normal circumstances, estradiol (E2) has a half-life of about 3 hours. There are multiple pathways that convert E2 to metabolites that have widely different biological activities. Estrone (E1) is the second most potent estrogen in circulation. It is easily converted back and forth from estradiol through enzymatic reactions. Both estrone and estradiol are metabolized by a process called hydroxylation. Estriol (E3) is a weaker estrogen and a consequence of hydroxylation of both estrone and estradiol at the liver. It is them conjugated and excreted in the urine.

All of the three major estrogens and their metabolites possess estrogenic properties in varying degrees, and are all part of the estrogen family. The degree of production of estrogen is tightly related to the degree of clearance and removal of estrogen in the body. While the production of estrogen is going on, a similar amount of estrogens should be removed from the body. This ongoing production and destruction process results in a constant balance of estradiol in our body.

By products of the breakdown of estrogen are also called metabolites. Some metabolites have good effects and are potent antioxidants while some are toxic to the body, and generate free radicals which can in turn promote mutations and cancer cells to develop.

Examples of good metabolites include 2-(OH)-estrone and 2-(OH)-estradiol. These are considered good estrogen metabolites. These metabolites are usually low in women who are overweight and have a high animal fat, acid diet. The goal is to increase these. They are powerful anti-oxidants and can protect the heart and lower bad cholesterol (LDL) while at the same time elevates the good cholesterol (HDL).

Examples of toxic metabolites of estrogen are 16 alpha-(OH) estrone and 4-(OH)-estrone. These are "bad" estrogen metabolites and are toxic. Sixteen alpha estrone has been shown to be more potent than estradiol. It can have a powerful long lasting effect on the estrogen receptor and it causes for cell changes and mutations. For this reason it is thought that it increases the risk of breast cancer significantly. Four-(OH)-estrone is a free radical generator and has been implicated in some of the bad effects of estrogen in clotting as well as in breast cancer. This is a field of active clinical investigation right now.

The ideal ratio of 2-(OH)-estrone to 16-alpha-(OH)-estrone as measured in the urine is 2.0 or more. Studies have shown that 73% of breast cancer patients have a ratio below 2.0. In other words, their 16-alpha- (OH) estrone level is high compared to the 2-(OH)-estrone. Women with such low ratios have been shown to have a 30% greater chance of developing breast cancer compared to those with higher ratios. Fortunately both levels can be measured in the urine.

In summary it is important to consider both the production and source of estrogen as well as how the body breaks it down. The liver needs to be cared for, and substances that will promote healthy liver detoxification and especially healthy pathways of estrogen clearance towards the healthier versions are necessary when considering estrogen dominance.


Reducing the external estrogen load is a key component that everyone should follow. Start with your home with the following:

1. Be aware of pesticides, herbicides, and fungicides and consider alternative organic ones

2. Consider organic cosmetics, and reduce or throw away cosmetics that have toxic ingredients

3. Be aware of the chemicals in nail polishes and nail polish removers

4. Try to use organic soaps and toothpaste

5. Avoid synthetic soaps and fabric softeners as they puts petrochemicals right on your skin

6. Consider naturally based perfumes

7. Have a good water filter for your source of water

8. Avoid too much plastic goods and be aware of their influence on your body try not to microwave food in plastic containers, and especially avoid the use of plastic wrap in the microwave

9. Try to use certified organic based whole foods and wash your food well to rid the pesticides

10. If there is a new carpet, allow for plenty of ventilation in your home

11. Avoid excess alcohol

12. Quit smoking


Excess stress makes the adrenal gland constantly work producing adrenaline, cortisone and cortisol. Chronic stress can lead to a condition that has been called adrenal fatigue. This is not always recognized by the traditional medical community, yet I consider it a good name when there is excess stress and the body is pushed to the limit. This is common in today’s fast paced world. Adrenal stress or adrenal fatigue can cause progesterone depletion and thus estrogen dominance. Managing physical and psychological stress is key in treating and avoiding estrogen dominance. I have written some blogs in stress and will discuss adrenal fatigue in more detail in the future.


It is no surprise that thyroid disease is more common in women who have excess estrogen and in women when they are having at hormonal changes such as in puberty, child bearing age, imbalanced hormones, PCOS, pregnancy, delivery and menopause.

Geographic differences in the rates of breast, endometrial, and ovarian cancer show that these cancers are more frequent in areas where iodine intake is low. Low iodine intake and low circulating iodine may stimulate the brain to send more messages to the ovaries to work. This in turn may cause estrogen to be secreted at high levels, particularly estrone. This may be an explanation for the higher rate of estrogen dependent cancers. Increasing dietary iodine intake may reduce the risk of these cancers. On another note, estrogen receptors become more sensitive when iodine is low. On the other hand, excess estrogen inhibits iodine absorption. Low Iodine can cause a relative state of hypothyroidism that causes thyroid gland to enlarge and in some cases, the labs can still be normal. For these reasons iodine supplementation is very important in women’s health. It may balance estrogen production and metabolism, and in turn aid the thyroid to function better. The recommended dose varies based on the patient, yet it is on average 150-300 mg iodine per day.


Nutritional supplements are essential to ensure your body has the micro and macro nutrients it needs to make and balance hormones appropriately. Many of these nutrients will help balance estrogen. I have chose these, but I am sure there are many more that could be used at any given time depending on the patient, her complaints, and the desired outcome. Here are some nutritional supplements that I recommend when considering estrogen dominance.
1. Fish Oil

2. Vitamins
     a. Vitamin A
     b. Vitamin C
     c. Vitamin E
     d. Vitamin B12
     e. Vitamin B6
     f. Vitamin B1- Thiamine

3. Minerals
    a. Magnesium
    b. Iodine
    c. Zinc

4. Aminoacids
    a. Methionine
    b. SAMe
    c. Taurine
    d. N-acetyl-cysteine (NAC)

5. Herbs
    a. Milk Thistle
    b. DIM: Diindolylmethane
    c. Quercetin
    d. Grape Seed Extract

6. Other
    a. Calcium-d-glucarate
    b. Alpha- Lipoic Acid

In our next blog we will go over these supplements in full detail. We did this to avoid the blog from getting too long… Stay tuned….

Margarita Ochoa-Maya, MD

1 comment:

  1. Nutritional supplements are essential to ensure your body has the micro and macro nutrients it needs to make and balance hormones appropriately.