Estrogen Dominance: Why, How and What to do About it.

Estrogen Dominance: Why, How and What to do About it.
Scott Resnick MD 2020

One of the common themes that I have seen in social media is the association of estrogen dominance with adrenal fatigue. Now, I don’t like the term adrenal fatigue because it’s not medically accurate, but I’ll use it here for convenience.

The important thing is to understand how this relates to the adrenal glands, because really, all of the stuff is connected.

To do this, we have to first look at a woman’s physiology from a “birds-eye” perspective.

A human’s basic task: Survival and Reproduction

Consider this. For all living organisms on the planet, the ultimate end goal in terms of survival is to survive and reproduce. No reproduction, and your species is dead in the water.

The production and balance of our hormones reflect this need. When our hormones are balanced and healthy, we tend to feel and behave in a more sexual manner. I mean we tend to feel more lush, full and vibrant –- and not just in the carnal sense.

How does this relate to adrenal fatigue, and what can we do about it?

Start to look at systems, not symptoms

When I evaluate a human body, and this is based on nearly 30 years of practice as a physician and 10 as a functional medicine doctor, I look at the body as a series of related systems.

The systems are all related, and ultimately create a body that is fit to meet its ultimate goal– to reproduce. Reproduction requires both the emotional desire to reproduce in addition to the hormonal relationships that produce either a fertile egg or viable sperm.

Why stress plays a huge part in estrogen dominance

The entire human physiology is geared to react to stressors. As we all know, stressors can either be minor or significant, but over time their affect is cumulative.

But here’s what I find really interesting. The human, unlike other animals, can generate a verifiable stress response using nothing but his or her mind. Even an imagined stressor promotes all of the downstream effects of the stress response.

Now picture this: You and your caveman husband are hunkered down in a cave. It’s cold, the crops didn’t come in last season, the groundhog saw its shadow and last night a squirrel stole your remaining nuts. You are cold hungry and may not have stored enough energy to survive into the spring, when the nuts and berries will reappear.

Survival step 1: Turn down the heat

So what does a well-intended and clever human body do? It hunkers down.

We first take on a hypothyroid state. This all makes sense. It benefits us to be able to lower our metabolism if we have a fininte number of calories stored in our body.

If you are running out of gas in your car, you don’t want to rev the engine and drive at high speeds. The body does the same thing.

So you can see how I am never surprised when a woman struggling with low adrenal function also has low thyroid function, and a state of estrogen dominance. But why the estrogen dominance?

Survival Step 2: Estrogen dominance?

In short, the definition of a successful ovulation is the production of a viable egg. With this comes a rise in progesterone, peaking in the second half of the woman’s cycle. A woman’s estrogen is maintained through the entirety of the month. There are some peaks and valleys, but it is always there.

Normal progesterone is almost immeasurable in the first half of the month; it only rises in the second two weeks of the cycle.

But when a woman is under significant stress—think starving in a cave, starving on a diet, or simply stressing out—your body knows that this is not a good time to reproduce. I mean it all makes sense.

Survival step 3: Don’t get pregnant!

With significant stressors, it is not the best time to subject a body to the additional stressors of pregnancy and childbirth. Our bodies are pretty smart; the first priority is to keep us alive.

Recall that the estrogen is present throughout the entire month. The progesterone, following a healthy ovulation, peaks only in the second half of the month. When a woman is under big stress it makes sense not to ovulate. It’s hard enough to survive as it is, a pregnancy would probably seal the deal.

When a woman doesn’t ovulate, she doesn’t make progesterone. The hormone is now low in both the first and second halves of the cycle. This creates relative estrogen dominance in the second half of the cycle.

Estrogen dominance: Common symptoms

In my experience, women with a sustained estrogen dominance experience weight gain, mood changes, skin and hair changes, and headaches. Menstrual cycles change, and insomnia is common.

And this doesn’t include the additional symptoms from the “protective” energy-conserving hypothyroidism.

I have worked with so many women suffering from the triad of adrenal symptoms, hypothyroidism, and estrogen dominance. It all stems from the body moving to a state of self-preservation.

Know your numbers to reverse estrogen dominance!

Could this be you? The trick is to correctly measure your cortisol, thyroid, and sex hormones. Do that first. For women in the reproductive ages, I recommend doing a blood spot test of estrogen, progesterone and testosterone in day 18 to 20 of the cycle. A good lab like ZRT shows you the normal relationships with your results.

Hundreds of my patients benefitted with the addition of bio identical progesterone in the second half of the cycle. When correctly applied, this itreatment is safe and effective.

Of course, the biggest challenge is uncovering and fixing the stresses that precipitated all these problems in the first place.

That merits another post.




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