Got Estrogen Dominance? How to Tell and What You Can Do Now

August 26th, 2023

by Dr. Ginger Garner PT, DPT, ATC-Ret

What is estrogen dominance? Estrogen dominance sounds like a strange term, especially to those of you who may be peri- meno- or postmenopausal. How can you have too much estrogen if a lab and your symptoms indicate you are estrogen deficient? Well, here’s how…

Being estrogen dominant doesn’t necessarily mean you have excessive estrogen levels. It can often mean your body isn’t doing a good job at metabolizing the estrogen it is producing, specifically the bad estrogen which can be a contributor to pelvic pain, headaches, endometriosis, PMS, and pain flares, interstitial cystitis, painful intercourse, weight gain problems, osteoarthritis or joint inflammation, and peri-menopausal or menopausal symptoms.

Estrogen dominance can also be created by the environment. You can get estrogen disruptors in your diet through the food you eat, the chemicals in your food or the hormones fed to animals you eat, and/or you are putting estrogen disruptors on your skin via self-care products you use.

The intent of this blog is to help you identify and get rid of estrogen disruptors that can cause a range of issues, starting with the ones listed above.

The most common scenarios causing estrogen dominance include the following (source):

High estrogen, normal progesterone
High estrogen, low progesterone
Normal estrogen, low progesterone
Low estrogen, lower progesterone (so that estrogen is still the dominant sex hormone)

What are the signs of estrogen dominance in females?

Weight gain, especially around the middle
Heavy or light periods
PMS
Fatigue
Uterine fibroids
Fibrocystic breast lumps
Loss of libido
Anxiety
Bloating
Headaches
Disrupted sleep
Hair loss

The signs of estrogen dominance in males include:

Infertility due to reduced sperm concentration
Reduced libido
Erectile dysfunction
Breast fatty tissue growth
Slowed growth in young boys – short stature or delayed puberty
Epiphyseal closure – which causes the plates in the bones to close prematurely, leading to short stature
Fatigue
Hair loss
Shrinking muscle mass
Reduced growth of penis and testicles in boys
Osteoporosis/bone density loss
Hot flashes
Trouble focusing
Also read this blog on Low testosterone

What are the risk factors for it?

Heart disease
Gall bladder has been removed (cholecystectomy)
Worsening endometriosis
Interstitial Cystitis
Uterine fibroids
Breast Cancer
Heavy periods/bleeding
Histamine intolerance
Fibrocystic breast change and breast tenderness
New dietary (food) sensitivities
Poor sleep
Hot flashes
Mood swings

How do you know you have estrogen dominance?

Other than paying close attention to the symptoms above – labs are your second stop on the path to identifying estrogen dominance.

The DUTCH test is probably the most comprehensive hormonal and cortisol panel on the market today (not an endorsement and I have no financial interest or connection to DUTCH), plus it measures other biomarkers that can you give you critical information about improving sleep, sexual function, hormone balance, musculoskeletal strength and endurance, including bone health, metabolism, weight management, and PMDD, peri-menopausal or menopausal symptoms. For men, it’s also a critical window into improving testosterone levels, improving stress management, and overall musculoskeletal and sexual function.

However there are many other options. The key to narrowing down which option is best for you is to discuss it with your practitioner – and also know that comprehensive hormone testing does not just look at a single measure (serum or saliva) of estrogen (for example, in the morning). Rather, comprehensive hormone testing looks at all 3 types of estrogen PLUS their metabolites (how estrogen is being metabolized by the liver) over a 24-hour period. In addition, it’s also necessary to include progesterone and testosterone.

Urine testing can provide the most insight into estrogen, testosterone, and progesterone metabolism, as well as a 24-hour level, instead if a single fixed point in time as the other methods test. ZRT Labs has an Essential Hormonal Panel urine test that is less comprehensive, but still helpful toward determining if you are in estrogen dominance.

What can you do to manage estrogen dominance?

Do you have estrogen dominance, why it matters and what you can do

Your pelvic health practitioner may make a referral –

Your practitioner will look carefully at the DUTCH or a similar lab to determine if a referral to a functional medicine or other related practitioner, like a functional endocrinologist, is necessary. Those practitioners would look at bioidentical hormone therapies or other supplementation. It is helpful to advocate to have the lab information in order to improve pelvic physical therapy outcomes, for all genders. It is also a foundational guide to help your pelvic physical therapist direct physical therapy care and make the right referrals.

Your pelvic health practitioner will use Integrative & Lifestyle Medicine to help –

There is also a great deal that your integrative pelvic health therapist can do naturally, through integrative and lifestyle medicine, without drugs. Managing estrogen dominance really comes down to helping the body produce and process hormones naturally. You would be surprised at how many functional and integrative physical therapy strategies are available to help balance hormones naturally and without expensive medications.

How to Get Started

The first step is improving all three phrases of estrogen metabolism. In functional and integrative physical therapy, we work backwards to improve metabolism, starting with phase III.

Phase III Estrogen Metabolism – This is the excretion phase – or pulling the plug in the proverbial bathtub to let the tub drain.

Interventions your therapist could include but isn’t limited to addressing:

Gut dysbiosis
Overall digestive health
Constipation
Pelvic organ prolapse – posterior wall
Pelvic floor dysfunction, chiefly tightness
Vaginal microbiome health

Phase II Estrogen Metabolism – This is what is often identified as the phase where the tub is full, but it’s not yet emptying. So in phase II, we help estrogen prepare itself to exit the body the phase III – hence tackling things like constipation first.

Some interventions can include things like:

Improving cortisol regulation – think…
Stress management techniques
Correcting poor sleep and sleep habits (also called sleep hygiene)
Supporting healthy pathways responsible for DNA preservation and maintenance (like methionine and methylation pathways) and maintaining levels of vitamins and minerals that support them (think magnesium, D3, zinc, and B vitamins, for example)
Optimizing the ATP cycle (energy production)
Vaginal and oral microbiome health, which can include orofacial and myofunctional treatments (since a tight neck and face can often mean a tight pelvic floor).

Phase I Metabolism – Finally, in phase I estrogen metabolism we like to focus on making lifestyle changes for things you often associate with physical therapy.

These interventions include things like:

Designing a physical activity plan that fits your specific pelvic health and core fitness needs
Look more closely at dietary choices to make sure they are supporting optimal bowel and bladder (and hence pelvic health) function.
Identifying and eliminating any dietary sensitivities that could trigger an inflammatory response.
Pelvic physical therapy to optimize sexual health, bowel and bladder function, and overall musculoskeletal, metabolic, and neuromuscular quality of life.

That’s not all we do in integrative pelvic physical therapy, but this is a super short summary of how we can use Functional, Integrative, and Lifestyle Medicine (FILM) to support healthy estrogen metabolism for all genders.