Estrogen dominance refers to a situation of too much estrogen and not enough progesterone. I know as well as anyone that those problems are real. Many women suffer estrogen excess (see my Estrogen Excess post). Many women suffer progesterone deficiency (see Road Map to Progesterone).
Yet, I think the term ‘estrogen dominance’ is imprecise and has led to a lot of confusion.
Here are five things to understand.
It’s normal to be estrogen dominant in your follicular phase
You have estrogen throughout almost all of your cycle. You have progesterone for only the final 10-14 days, regardless of how long your cycle is.
So if you have a 35 day cycle, then you won’t have any progesterone until at least day 21. Your progesterone will then be highest on day 28, and that would be the best day to test it (7 days before your period).
The only way to gauge the usefulness of a progesterone reading is to wait for your period, and then count back the days. (You could also track your temperatures to know that you tested during your high temperature luteal phase.)
The next time someone tests your estrogen and progesterone (either saliva or blood), ask this very important question:
Was I in my luteal phase at the time of the test? Had I ovulated at least 3 days before? Did my period come within 10 days after?
If the test turns out to have been pre-ovulation,, then don’t worry about low progesterone. It’s fine. It’s normal.
There’s a big difference between no progesterone and low progesterone
As I explain in my book Period Repair Manual, it’s all about ovulation. The main reason to even test progesterone is to know whether or not you ovulated. If you did ovulate, then your serum (blood) progesterone will rise to a mid-luteal reading of at least 5 ng/mL or 15 nmol/L, and your period will come within two weeks.
No progesterone. If your luteal phase reading is below 5 ng/mL (15 nmol/L), then you did not ovulate. Lack of ovulation is your problem—not low progesterone. You need to figure out why you didn’t ovulate. Do you have PCOS? Do you have problem with thyroid? Figure out the underlying reason you don’t ovulate and correct that. You don’t need a “progesterone-boosting” treatment.
⚠️ Tip: Perimenopause is a special situation. If you are over 45 and you never ovulate, then you may not be likely to. You may need bioidentical progesterone.
Low progesterone. If your luteal phase reading is just 5 ng/mL (15 nmol/L), but not much higher, then you may want to boost your progesterone. The best way to do that is to improve the health of your ovarian follicles. That means reducing inflammation and getting enough ovarian nutrients such as zinc, selenium, iodine, and magnesium (see Road Map to Progesterone). The herbal medicine Vitex can also be helpful (see my very popular post the Do’s and Don’ts of Vitex). You can also consider taking bioidentical progesterone (see the last post).
⚠️ Tip: Be careful interpreting your result because progesterone fluctuates widely over a 90 minute cycle. A lowish reading might just mean that you tested it at a low point. Don’t read too much into it unless you also have signs and symptoms of progesterone deficiency (premenstrual spotting, PMS, heavy bleeding).
You want some estrogen
Estrogen is not bad. It is a highly beneficial hormone for both men and women. For example, estradiol (your main estrogen) improves insulin sensitivity and helps to maintain a healthy weight. (Estradiol deficiency is why many women gain weight with menopause.)
Estradiol will be very low early in your follicular phase (that’s normal), and it should then climb to at least 80 pg/mL or 300 pmol/L at its peak a few days before ovulation. It should not go higher than 270 pg/mL or 1000 pmol/L. If it does go higher, then you need estrogen-detoxification strategies. See my Estrogen Excess post.
You probably need to fix your gut
Your gut may be your biggest source of excess estrogen. That’s because all estrogens (including estrogen-like environmental toxins) are detoxified through your liver and gut. If you have a problem with your intestinal bacteria, then you will reabsorb a lot of that estrogen. And that can cause estrogen excess symptoms such as PMS and heavy periods. (You won’t be able to measure those reabsorbed metabolites on blood or saliva tests.)
Trust symptoms rather than tests
By now, you’re probably thinking: “How can I accurately assess my estrogen load?”
I wish I could offer you a simple, foolproof way to test for estrogen excess, but I can’t. Saliva, blood, and urine tests can all give you some idea of your estrogen load, but ultimately you should look at symptoms. The most reliable symptom of estrogen excess is heavy periods.
If you suffer heavy periods, then you have more estrogen than you should. You may also have less progesterone than you should, but those are two separate issues.
What is your experience with estrogen dominance? Please comment below.
Yours in health,