Oestrogen dominance - too much of a good thing?

Today I am going to discuss another hot topic currently circulating the media; the phenomenon known as oestrogen dominance.

Oestrogen dominance was originally coined by Dr John Lee in the 1990s [1], based on his experiences of treating women with natural hormone therapy. His theories have been criticised because they are based on anecdotes rather than scientific evidence [2]. There are still very few published scientific papers on oestrogen dominance and no widely accepted criteria that doctors can use to diagnose the condition.

What is oestrogen dominance theory?

Oestrogen dominance theory refers to when a woman has normal or excessive levels of oestrogen but little to no counterbalancing hormone, progesterone, to mitigate its effects in the body. This hormonal imbalance is thought to occur in peri- and menopausal women where oestrogen levels drop by 40-60% and progesterone levels can drop to nearly zero [3]. Progesterone is the first of the hormones to decline during menopause and is thought to lead to a ratio imbalance which some practitioners think can be attributed to the following symptoms:

• PMS
• Insomnia
• Bloating
• Breast tenderness and swelling
• Irregular/abnormal menstrual periods
• Weight gain
• Fatigue

The change in the oestrogen-progesterone ratio is thought to occur naturally but may also be caused by several external factors including; hormonal replacement therapy, hormonal contraceptives, stress, body weight, diet choices and as discussed in my article - exogenous oestrogens.

As mentioned above, there is no conventional test for oestrogen dominance and it is most likely to be diagnosed by an alternative practitioner.

If you think that a hormone imbalance could be affecting you, or you are experiencing peri-menopausal symptoms, there may be natural steps you can take before considering hormone replacement.

3 natural ways to balance your hormones 

1. Improve diet quality

The relationship between diet and hormones is well-researched with extensive guidelines on which foods positively and negatively affect hormone balance [4]. Even when a hormone imbalance is not currently present, eating a healthy diet provides the body with the energy and nutrients needed for healthy hormone production and so is encouraged for everyone. Following a well-balanced diet focusing on unprocessed produce, lean protein sources, whole grains and plenty of fruit and vegetables improves health and disease prevention [5, 6]. Cruciferous vegetables such as broccoli, cauliflower, kale and collard greens are also thought to be good for balancing the body’s levels of oestrogen due to the abundance of diindolylmethane (DIM), a compound which mops up excess circulating oestrogen [7, 8].

Losing excess body fat is also the standard medical advice if someone is experiencing symptoms associated with a hormonal imbalance. Along with oestrogen being produced in the adrenal glands, brain and ovaries, it is also produced in adipose (fat) tissue [9]. So the higher the body fat, the higher the levels of oestrogen, leading to higher chances of fat storage!

Finally, physical activity and regular exercise will not only help with regulating energy balance and weight control, but also reduce your risk of hypertension, diabetes, and cardiovascular disease and improve your quality of life [10]. Sedentary behaviour is also associated with increased levels of oestrogen [9]. If you have a desk job or are mostly inactive during your day some simple ways of increasing your physical activity could be:

• Schedule regular breaks to move
• Go for a walk during your lunch break
• Take the stairs where possible
• Get involved with a ‘Cycle or Walk to Work’ scheme
• Plan for active days out during the weekend

2. Reduce exogenous oestrogens

Other changes you can make that may aid in balancing your hormones include reducing your exposure to exogenous oestrogens. We are constantly exposed to oestrogen-mimicking environmental toxins that cause hormonal imbalances from sources within food, BPA and other plastics and common household products. My top tips that you can implement straight away that will reduce your exposure to exogenous oestrogens include:

• Reducing your use of plastic food containers
• Switching from plastic water bottles to glass or steel
• Limit the use of extreme heat on plastic products
• Reducing your alcohol intake to within the national guidelines (UK: 14 units a week)

3. Take a break

In the modern world, we are constantly exposed to stress and stressful situations, such as work pressure, school exams, psychosocial stress and physical stress [11]. The reactive hormone changes and prolonged exposure to this stress can lead to an increase in progesterone and cortisol output [12], using pregnenolone to produce both hormones, which has the potential to cause disruptions to the oestrogen progesterone ratio. Finding ways to de-stress daily is key to living a balanced and healthy life. Remember, health is defined as a “state of complete physical, mental and social well-being [13]” so taking time to care for your mental health is just as important as keeping active and eating well. One method I use that helps to mediate stress reactivity is meditation. Meditation has shown to improve anxiety, depression and pain [14], as well as decreased physiological markers of stress including cortisol, blood pressure and heart rate [15]. Everyone will have different methods that help them relax and de-stress, so find a way that works for you and one that fits into your routine.

Whether or not you have a hormonal imbalance, these lifestyle tips will improve your overall health and wellbeing, including the long-term functioning of your hormones.

References 

[1] Lee J. What Your Doctor May Not Tell You about Menopause. New York: Time Warner; 1996.

[2] Watt PJ, Hughes RB, Rettew LB, Adams R (2003). "A holistic programmatic approach to natural hormone replacement". Fam Community Health. 26 (1): 53–63.

[3] Shifren, J. L. & Gass, M. L. S. (2014). The North American Menopause Society Recommendations for Clinical Care of Midlife Women.Menopause: The Journal of The North American Menopause Society, 21(10), 1-25.

[4] Kohlstadt, I. (2009). Food and Nutrients in Disease Management. Boca Raton, FL: Taylor & Francis Group.

[5] Eilat-Adar, S., Sinai, T., Yosefy, C., & Henkin, Y. (2013). Nutritional recommendations for cardiovascular disease prevention. Nutrients, 5(9), 3646-83.

[6] American Heart Association Nutrition Committee. Lichtenstein A.H., Appel L.J., Brands M., Carnethon M., Daniels S., Franch H.A., Franklin B., Kris-Etherton P., Harris W.S., et al. (2006). Diet and lifestyle recommendations revision 2006: A scientific statement from the American Heart Association Nutrition Committee. Circulation, 114(1), 82–96.

[7] Pilátová, M., Chripková. M., & Mojžiš, J. (2011). Cruciferous vegetables in cancer prevention. Acta Facultatis Pharmaceuticae Universitatis Comenianae, 58(1), 62-71.

[8] Aggarwal, B.B. & Ichikawa, H. (2005). Molecular targets and anticancer potential of indole-3-carbinol and its derivatives. Cell Cycle, 4(9), 1201-1215.

[9] Oh, H., Coburn, S. B., Matthews, C. E., Falk, R. T., LeBlanc, E. S., Wactawski-Wende, J., Sampson, J., Pfeiffer, R. M., Brinton, L. A., Wentzensen, N., Anderson, G. L., Manson, J. E., Chen, C., Zaslavsky, O., Xu, X., … Trabert, B. (2017). Anthropometric measures and serum estrogen metabolism in postmenopausal women: the Women's Health Initiative Observational Study. Breast Cancer Research, 19(1), 28.

[10] WHO (2018). Physical Activity - http://www.who.int/news-room/fact-sheets/detail/physical-activity

[11] Ranabir, S., & Reetu, K. (2011). Stress and hormones. Indian journal of endocrinology and metabolism, 15(1), 18-22.

[12] Herrera, A. Y., Nielsen, S. E., & Mather, M. (2016). Stress-induced increases in progesterone and cortisol in naturally cycling women. Neurobuiological Stress, 11(3), 96-104.

[13] Official Records of WHO (1948). Preamble to the Constitution of WHO as adopted by the International Health Conference, no. 2, p. 100.

[14] Goyal, M., et al. (2014). Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Internal Medicine, 174(3), 357-68.

[15] Pascoe, M. C., Thompson, D. R., Jenkins, Z. M., & Ski, C. F. (2017). Mindfulness mediates the physiological markers of stress: Systematic review and meta-analysis. Journal of Psychiatric Research, 95, 156-178