Why I Don’t Use the Term Estrogen Dominance

Estrogen dominance is not a medical term.Estrogen dominance means high estrogen compared to progesterone. It’s a real condition and, at the same time, a not very helpful term.

There are better ways to discuss estrogen and progesterone balance.

It’s normal to have no progesterone for the first 2-3 weeks of the cycle

You make estrogen almost every day but progesterone for only the final ten to 14 days after you ovulate. If you have a long cycle, then you have at least three weeks with estrogen but no progesterone— and that’s normal!

For example, with a 35-day cycle, you cannot expect to see any progesterone until at least day 21. Read The right way to test progesterone.

“No progesterone” is different from “low progesterone”

It’s all about ovulation. The main reason to even test progesterone is to know if you ovulate or not.

No progesterone. The only meaningful progesterone result is one tested within the ten days before the period. (Wait until your period arrives and then count back to be sure the test was done at the right time.) A progesterone reading within that ten days before the period should be at least 1.8 ng/mL (5.5 nmol/L). If not, then you did not ovulate.

The problem is a lack of ovulation or anovulation, not progesterone deficiency. And the most common reason for anovulation is PCOS.

👉 Tip: A better way to describe the progesterone deficiency of PCOS is “anovulatory cycles” or “unopposed estrogen.”

Low progesterone. A progesterone reading within the ten days before a period that is only a little above 1.8 ng/mL (5.5 nmol/L) is low progesterone.

👉 Tip: Be careful interpreting a progesterone result because a low reading could just mean you were at the low point of progesterone’s 90-minute pulse.

Signs and symptoms of progesterone deficiency include premenstrual spotting, PMS, and heavy bleeding. For treatment strategies, read The road map to progesterone.

If you’re chronically deficient in progesterone, take steps to improve the health of your ovarian follicles and maybe consider taking natural progesterone (also called body-identical or micronized progesterone).

There’s no progesterone in any type of birth control.

Estrogen is a beneficial hormone

Estradiol is good for skin, mood, brain, gut, mitochondria, immune function, and heart health. Estrogen also helps to maintain a healthy weight because of its benefits for muscles and insulin sensitivity.  The loss of estradiol is why women gain abdominal weight with menopause.

👉 Tip: Estrogen does not cause belly fat. In women, estradiol causes bell fat loss and it’s testosterone that causes belly fat gain.

How much estrogen is normal?

It’s normal to have almost no estrogen in the first few days of the cycle. It should then climb to its peak a few days before ovulation (at least 80 pg/mL or 300 pmol/L but not more than 270 pg/mL or 1000 pmol/L). If you need help reducing estrogen, read How to lower estrogen.

👉 Tip: Most symptoms of “estrogen dominance” are probably the result of a histamine or mast cell reaction. Read The curious link between estrogen and mast cells and histamine.

A better way to discuss estrogen and progesterone balance

A more precise way to describe what’s going on is to use the terms anovulation, progesterone deficiency, estrogen excess, or in the case of endometriosis, an inflammatory disease that is affected by estrogen.

Ask me in the comments.

75 thoughts on “Why I Don’t Use the Term Estrogen Dominance”

  1. How do I get tested or acquire a test to check on levels and to determine what problem I have? I’ve been told by many gynecologists that there is no point to testing hormones levels or that they are not accurate and just get the pill pushed on me for my symptoms. Thanks!

  2. Since 11 years old had ovarian cysts .
    At 34 I had a cyst removal surgery, saw an endocrinologist who diagnosed PCOS. I went a year without medications but cysts were returning and my uterine lining was thickening. Started slynd bc estrogen birth control pills cause me migraines, but I’m gaining weight. Also on spironalctone plus an antidepressant bc my mood was also suffering. I’m sure it’s all hormonal. How do I get balanced?

  3. how do perimenopausal women fit into these categories? I’m not low on progesterone because something is wrong but because I’m closing in on the end of my reproductive life. should i be trying to improve the health of my follicles? or should i start taking a hormone? why am i not be considered just a normal aging person with the requisite toppings and spices?

  4. I did a Dutch test and was told my estrogen is low. I’m 44 still have regular periods. I have horrible menstrual migraines since I was 16 years old. Nothing has helped diet magnesium b vitamins even progesterone. Could the low estrogen be the cause?

  5. I went off birth control in June 2017 and have only had two periods to speak of since then, one of which was due to being prescribed a 10 day pill supply to boost my progesterone levels after my doctor did a blood test. I go back to the doctor in a week, but I’m concerned she’ll have the same suggestion or want me to start on natural progesterone, which makes me nervous. And I’m uncertain how to properly test my hormone levels when I have gone this long without a period/ovulation. I’ve been eating extremely healthy, taking a multivitamin (Garden of Life brand), exercising, and have actually lost 20 pounds and am within a normal BMI for my height now. Still no period. I’ve also tried consistently taking Vitex for 3+ months during this time (I took it 6 months after going off birth control). It only made me spot a very minimal amount for a day here and there (or just a coincidence). I’ve also tried taking Maca powder and did not notice any changes. In the past two or three months, I’ve noticed thinning hair around the crown of my head, some hair on my chin, brittle nails, cracked heals, and my hands and feet get cold easily. I suggested PCOS to my doctor at the first appointment and she simply told me I had no common symptoms such as being overweight or excessive facial hair. I’m just incredibly frustrated and do not know what else to try. My next thought was a DIM supplement or magnesium glycinate…

  6. How do I know when to test hormone levels when I’m in perimenopause and have stopped bleeding?
    My estradiol was tested (51) but that’s arbitrary since I don’t have regular cycles.

    • If you’ve stopped bleeding, the first test is for FSH to determine if you are menopausal, or not. After menopause, I don’t see much reason to test estrogen or progesterone.

  7. what about Ovarian dermoid
    Delete Commentdokan_banat_uaeI am suffereing from ovarian dermoid since I was a baby of 10 months ..
    Delete Commentdokan_banat_uaeI got operated then everything was ok till I was 24 years discovered ovarian dermoid again ..operated when 29 years as it became more than 10 cm long and preserved ovary ..again on age of 36 has same 10 cm same ovary ..as the other ovary might be removed when was a baby ..can not remove that one .. my period is regular 28 days s since pituitary thank God .. eating healthy but not organic ..excercise regularly ..on ashwaganda , Asofoetida , myrrah and started vitex … also have breast fibroscystic fibroadenoma but with 2 newly discovered masses which is not fibroadenoma. . taking maca green smothies ..probiotics ..iodine ..zinc .. gonsing bee pollen probolis …..just started to take di indol methane DIM … I have thining hair since long ..as dermoid cyst made of skin hair tooth nail .. it could take vitamin compete with hair .. ..Any help advice would be appreciated highly ..thanks [email protected]
    Delete [email protected] ..please answer me if you can help ..
    Delete Commentdokan_banat_uaeas you said soy is anti-estrogen .. as I am somehow estrogen dominant as besides ovary 10 cm dermoid .i have 2 cm utrine fivroid and 1.5 breast lump mass not cyst . and my fat in my body doesn’t go down easily after years of excercise and healthy eating .. I started to have estrogen rich herb and soy organic milk and flour for baking mix bread in my fist half of cycle excluding period days .. and vitex as progesterone gesterone in the second half of period cycle 14- 28 ..but I see you advice vitex in the ovulation phase means 25 on and 5 off .. what about soy ? fenugreek , sage ..

  8. Help! I had my hormones tested last week and just got my results. I am 47 years old with Hashimotos thyroiditis, and I had an endometrial ablation 6 years ago, so I have no idea what my cycle is. My progesterone is 7.2 and my Estradiol level is 171.4. Most concerning is that my SHBG is 195!! Yikes. I m not sure what all of this means but it seems very scary to me. My appointment to go over the results is still a week away but I find these results alarming…any thoughts would be SO helpful. Thank you!

  9. Hi! I’m 20 and usually have a 35 day cycle. But a while ago I started drinking soy milk and in my next cycle I had an extremely light period. I stopped taking soy milk immediately. This time around it’s been the 45th day of my cycle and still no sign of my period (no other factors apart from soy milk). Can you tell me why this is happening and how long will my body take to regulate the monthly cycle?
    Thanks x

  10. My follicular phase is often long (20-26 days) and luteal phase is always short (around 8-10 days). My last blood test taken in mid to late luteal phase showed in-range estradiol (perhaps low at 127 pg/mL) and progesterone (8.4 ng/mL) but that the ratio was a little off. I recently have been spotting 3-5 days before menstruation (sometimes with very big blood clots), have terrible cramping on the first or second day of menstruation, yet a very light period. My doctor thinks I am estrogen dominant (and that other estrogens are too high and not being successfully converted into estradiol) and has me on DIM. I’m now wondering if it’s possible to be estrogen dominant when my periods are so light. Thank you for any input!

    • I should also note that I have PCOS, although my testosterone and other hormones seem ok after years of waiting and paleo eating, and she just had me start a little vitex every day.

  11. You said that if your progesterone is under 1.8 that means you did not ovulate. What about being 5 weeks pregnant with a normal hcg but my progesterone reading was 1.0?

  12. Hi Lara, I really liked your article. Thanks for sharing you knowledge 🙂 I have PCOS and Im on my TTC journey. I have done investigations/bloods/scan etc.. On my 3rd day of the cycle oestradiol was 154pmol/L, FSH 4.9IU/L and LH 11.2 on my day 12 went for a scan that showed that I have ovulated(?) big follicle of 30x21x16mm with free fluid post ov?. The funny part is that on my day 21 I went for progesterone blood test that showed 0.2nmol/L. I dont understand if its possible to get so low values of progesterone if I ovulated. I have been having irregular cycles but last one was 35 days, i may have my period in 5 days if lucky. I hope you can give me your opinion as I much I search, all doesn’t make sense to me as per the scan it shouldn’t be anovulatory cycle. Thanks for your help.

  13. Although my former menstrual issues have improved since my vegan days (40 day +/anovulatory cycles, heavy and painful bleeding), I now always notice a major shift between my follicular and luteal phases. During the first part of my cycle I feel quick-witted, talkative, motivated, and head-over-heels in love with my husband. I also enjoy good digestion with regular morning bowel movements, which are sometimes loose enough that I need to back off my magnesium supplement. As soon as day 16/17 hits (when my estrogen presumably drops and progesterone begins to rise), I get depressed and constipated. I feel cold toward my husband, like he can’t do anything right and doesn’t love me. As the days go on, I feel increasingly dull-witted, unmotivated, bloated, and unenergetic. I experience lots of flatulence, with frequent small bowel movements that always feel incomplete. I can literally feel the loss of tone and “push” in my colon. Directly prior to menses (when my progesterone presumably drops) I am angry, argumentative, and impatient. I also experience night sweats.

    Over the years I have seen a lot of information about estrogen dominance, so I have largely avoided things like unfermented soy and flax. However, it seems as though the “estrogen-dominated” part of my cycle is when I feel at my best and brightest. Any ideas as to how I might go about “evening out” my cycle so that I can feel like the same person from week to week?

  14. Hi Lara,
    Thanks for the great article!
    I have a candida issue (with occasional thrush), and I think it’s starting to affect my hormones. Wondering if you have any thoughts on this?
    My (normally 27 day cycle) period came a week early recently, but I am SURE that I ovulated at the usual time of about day 13.
    Is it possible that a hormonal imbalance (possibly from candida?) can affect the length of the luteal phase?
    Thank you!

  15. Hey Lara
    I have low estrogen I have got a period in 7 years I have pcos and are gaining weight and skin gone bad any ideas what I can do


  16. Hi Lara!

    I’m now fifty and have had never-ending heavy periods with clotting for the past year. My current period has lasted three months and I’m due to have a hysteroscopy, a biopsy and endometrial ablation in a few months’ time. In the meantime, I’ve been taking 5mg of norethisterone 5 times a day. As soon as I stop the norethisterone, the bleeding recommences with a vengeance. Even on the norethisterone, I continue to bleed, but it’s manageable. My GP has never checked my hormone levels and I’m wondering if this should have been done. For example, if I were put on HRT, I imagine that this might solve the problem. Please let me know your thoughts. I used to get pain when ovulating, but stopped some time ago, so I guess I’m not ovulating anymore. Looking forward to hearing from you.

  17. Hi

    Plz I need some advice. I was prescribed Cortisol manager for my high alleviated cortisol at night and I was advised to take three tablets at night. I only took one because of my anxiety and then couldn’t sleep until 2 am. I noticed I get insomnia a day before my period and sometimes after it depends. Is that normal? My symptoms are insomnia,anxiety and tension. My doctor prescribed me bioidentical hormones progesterone 50 mg that I need to take in day 12. I tested low progesterone and high estrogen. Can I have any side effects taking the progesterone? This will be the first time I ever take bioidentical hormones.

  18. Hi Lara,

    Is it possible to have estrogen/progesterone imbalance but not have PCOS? My doctors are quick to jump to the conclusion of PCOS, however, I do think I am ovulating based on discharge etc.

  19. Wow, you make so much more sense than most other articles and information out there.
    So now, you say heavy periods are a sign of excess estrogen. How can you tell if you have excess estrogen if you aren’t having periods? I had a total hysterectomy 2 years ago because of endometriosis , and was left with one ovary. I was doing fine for about a year post surgery, and for this last year I’ve been showing signs of both excess and low estrogen. So how can you tell which is the correct issue if you can’t judge by periods?

  20. Hi our Queen of Hormones

    I am loving your book. There’s so much in here for so many women including me with excess estrogen, friends with PCOS, friends with insulin resistance. I love your work thus your title The Queen of Hormones! Just remember who gave you the title hehehehe 🙂 I wonder if you ever get sick of hearing how appreciative we are of you?

    I’m 42. I have never been on the pill or any other hormonal birth control, don’t drink any alcohol, don’t consume any diary or eat wheat and I have/had excess estrogen (heavy periods for 5 weeks straight, sore boobies, a sense of fear and hopelessness, headaches, really sore shoulders and neck). I believe it started from a very stressful time in my life because the symptoms started 100 days after the stress period.

    I’ve used Iodine & Vitex and it worked (thank you thank you thank you, without you I would never have known about it this impressive herb and probably would have bleed to death lol).

    My first question is, now that I’m having a normal period again (for the first time last month after a year of heavy crazy bleeding/fortnightly spotting), should I take Calcium D-glucarate (to help phase II estrogen detoxification) as recommended on page 171, all month long or just the first half of my cycle where estrogen is at it’s highest? I bought the Thorne Research brand.

    And finally my last question is. I’m curious about my T3 & T4 but my Dr said he would not order a thyroid panel test because my TSH came back in the normal range at 2.4. He also would not agree to a 21 day progesterone test. Do you know of any Dr’s in Sydney who wouldn’t mind doing these tests for me. I almost never see a Dr and now that I need some tests done, he wont help me.

    Thank You.

    • Thanks so much for your warm feedback. ?
      I generally prescribe calcium-d-glucarate daily throughout the cycle.
      And re: thyroid. If I’m suspecting thyroid, then the extra test I usually request is thyroid antibodies. Unfortunately, medicare does not permit bulk-billing of those tests unless TSH is out of range. But you can request them privately from the lab. Thyroid antibodies test is only $47 AUD.

  21. This also makes a ton of sense…my periods have always been terrible (even after thyroid regulation and stabilization) – my mom gave me black cohosh to try and help me and it gave me heart palpitations so I stopped immediately – once I researched what that does, and thought about it in the scheme of estrogen levels it makes a lot more sense. Reading your post I think I need to learn more about estrogen and how it functions within my body because that might be the key to keeping it bearable when i’m stable again!
    Thank you!

  22. Dear Lara,

    I would really appreciate some advise from you 🙂

    First of all:
    About six years ago I was told that I have PCOS; I had a cyst the size of a lemon, and also at that time I used to have terrible, terrible acne. It was a dermatologist who prescribed me Diane. I took it for about 3-4 years; I stopped taking it two years ago once I realized it was not going to solve the problem long-term.

    Since then I started eating healthier (no more milk, cheese, little meat, no bread, no junk food in general) and my skin got SO much better, I don’t really have issues with that anymore. Also, I haven’t had cysts anymore.

    However, I am starting to struggle with more and more hirsutism, and also… my periods are unbearable!! The pain is so bad! And I know it shouldn’t be. Lately I’ve also been struggling with feeling super tired, super cold hands and feet, kind of slow digestion… so I thought, maybe it’s something with my thyroid.

    Last week I went to a general doctor and they took a blood test and here is what I got:

    -Iron: 27.2 umol/l (apparently a bit higher than normal range? could it be that I’m not absorbing it properly?
    -TSH: 2.0 mIU/l
    -FT3: 5.1 pmol/l
    -FT4: 16.0 pmol/l
    -Thyroid peroxidase antibodies: 8.2 IU/ml
    -Leukocytes: 3.90 Gpt/l (I’m writing this one down too cause apparently it was slightly low?)
    -Estradiol: 0.92 nmol/l (during luteal phase)
    -Testosterone, total: 1.36 nmol/l

    My questions are:

    -Everything with the thyroid seems normal and the doctor didn’t think anything was wrong, but I was wondering, isn’t the ration of T4 to T3 a little off? Could I still have a thyroid issue?
    -Also the testosterone is apparently in the normal range… but why am I turning into a werewolf :-(? Should I ask for other types of tests to look more into androgens?
    -Estrogen also seems to be normal but I’m skeptical about the results, because of my terriiiible period pain, and also I have a bit of skin discoloration/melasma showing up (is it estrogen related?)

    Should I ask doctors to take another blood test and check other things, too?
    I refuse to take birth control pills again, most doctors don’t seem to take it seriously, hmpf.

    Some extra info: I’m 24 and have a normal weight…

    I am so grateful that I found your blog, sorry for this very long post and thank you if you’ve read this far 🙂

    • Estrogen is not the cause of period pain. If your pain is that bad, you could ask your doctor about the possibility of endometriosis. Did you see my article: When Period Pain Isn’t Normal.

      Also, your doctor may want to test for other types of androgens (male hormones)–not just testosterone. The full list includes testosterone, DHEA-S, androstenedione, and 17-OH progesterone. I discuss testing in Chapter 7 of my book.

  23. Need som good advice ! I have normal test of testosteron and estrogen but my levels of shgb is off the Roof ! i been on birthcontrol pills for 20 years but stopped 1,5 years due to swellings face lips and so on. Im better but still have problems When i ovulate and get my period …its like my body is building up of estrogen. How can i balance this ? And help my body lowering my shgb and The access of estrogen? Thank you for Great articals best regards Louise

    • There are many causes of elevated SHBG including: 1) post-Pill (the effect can persist for years), 2) excess estrogen, 3) androgen deficiency (example: DHEA deficiency), and 4) too much thyroid hormone.

      If you were my patient, I might test thyroid and DHEA, and if you show signs of estrogen excess (heavy periods), then I would implement treatment for estrogen excess.

      • Thank you for replating ! Ive been tested many Times for thyrode but all tests are negative ! But thank you im going to look into the rest ?

  24. I just looked at my most recent salivary hormone testing, and my progesterone was 0.2302ng/ml (converted from 230.2pg/ml). The lab says 99.1-332.6pg/ml (0.0991ng/ml-0.3326ng/l) is normal in luteal phase, meaning they don’t think below 5ng/ml is abnormal as these levels are way lower than that! How can this be?! So according to you I’m not ovulating (collected on day 21 of my cycle which was about 25 days at that time and has lately been only 21 days incidentally). I started using a homeopathic progesterone cream after these test results (though I’m not presently it). I got pregnant (and miscarried) two months after this particular test, so I know I’m ovulating. I’m not understanding I guess.

  25. Hi, Dr. Briden!!
    I feel extremely lucky to have found your website with so much useful and informative information. I really need your opinion on my case. I started growing a lot of hair in abnormal places and the male-pattern hair loss became more noticeable, so I finally went to an endocrinologist to get checked out and get blood tests done. I took my saliva sample on day 21 of my cycle as instructed by ZRT Labs. I have slightly irregular periods varying between 25 and 31 days.(I hope that was my luteal phase). Last month it came on the seventh, and this month on the fourth. I got my results back and shockingly my testosterone levels are very normal and my DHEAS level is a little low for my age(17 yrs old).
    Testosterone 24 pg/mL Range 16-55
    DHEAS 5.3 ng/ML Range 2-23 Optimal range for late teens and early 20’s 10-20 ng/mL
    I was even more shocked to find out that my progesterone levels are alarmingly low at 23 pg/mL or 0.023 ng/mL
    My Estradiol levels are at 2.0 pg/mL Range 1.3-3.3 pg/mL
    I don’t know why I have grown abnormal hair. Maybe it’s the estrogen/progesterone imbalance?
    I suspect from your blog and extremely low progesterone levels, that I don’t ovulate. I find it strange, however, that I see a clear stretchy discharge every month about a week before my period.
    What do you recommend for me to do? I need to get an insulin resistance test as well. I have been experiencing fatigue especially after breakfast for 2 years, and more now that I stopped lifting weights regularly.
    I wonder if my body also made too much testosterone while I was lifting weights which caused the hair growth.
    Thank you so so much for helping us distressed women out; It’s very kind of you!

    • Did your endocrinologist order a saliva test? That would surprise me very much. Salivary testosterone results are not accurate. What are the results of your blood test?

      • My doctor approved me getting a saliva test. I have read some sources that say that saliva tests are accurate and some say they’re not very accurate. I got the saliva test because the blood hormone tests were out of my price range since my family doesn’t have health insurance. Based on my symptoms and results what’s your opinion? My doctor won’t order and insulin resistance test. She’s stubborn and will only let me get my insulin taken once during the day. Maybe I should go to another doctor.
        I’m working on cutting back in refined sugars but how much fruit is too much per day, and should I avoid wheat or the gluten in the wheat?
        I really really appreciate your guidance… thank you!

      • i’m going to get my hormone test done again but this time in blood. Can you please clear up for me how many servings of fruit per day is too much for women with PCOS and can I eat wheat as long as the gluten has been extracted? I usually feel almost normal pertaining to fatigue by 6 p.m. Do you think I could have low cortisol?

        • There is no such thing as wheat with the gluten removed.
          I generally do not restrict fruit with any patient, although I do think dried fruit can be a problem especially if there is insulin resistance.

  26. Hi my problem is that on my 4 th day of period is my progestone high 0.94 and 2.5 on 12th day of period. Plz could u help me vitex can beneficial for me in this situstion.plz help me

  27. Hi Lara,

    Firstly a huge thanks for such an informative blog, it has been a wealth of information for me. I’m wondering what you think of the idea of anovulatory periods?? I assumed this was happening to me frequently but then another practitioner told me that if you have a regular, healthy period then it 100% means you have ovulated – i.e. that a true period is always the result of ovulation.

    I have very regular periods and cycles that range from 29-32 days in length. I recently had my progesterone tested on day 24 of a 32 day cycle (i.e. 8 days before my period) and the result was 10.4 nmol/l. From what I read here this would suggest I didn’t ovulate, however I feel that I do get other signs of ovulation. I was diagnosed with PCOS at 18 (I am now 30) and continue to have some symptoms such as acne breakouts, however my periods are very regular with very healthy looking blood. Do you think I could be consistently not ovulating despite regular periods? I am concerned as I would like to try to conceive soon.


    • Anovulatory cycles are actually quite common, and can occur in women with fairly regular cycles. In fact, there was just a new research study about this “Ovulation Prevalence in Women with Spontaneous Normal-Length Menstrual Cycles” by Canadian endocrinologist Dr Jerilynn Prior. She found that anovulatory cycles occurred in over a third of clinically normal menstrual cycles.

      But the real question for you is: “Is every cycle anovulatory?” The best way to figure it out is to start tracking your basal body temperatures. That’s easier than having a blood test every month.

      I discuss PCOS anovulatory cycles in my book.

  28. Hi Lara, I’m 39 and have severe endometriosis. I had surgery for it several years ago but decided against the pill to “control” it after my surgery. I’ve since had two children and I believe that I am having perimenopause symptoms. Do you have any resources that I can read or do you recommend any? I do not have insurance so I’m cash pay and have not gone to see my doctor because of money. After reading a few of these articles I don’t think it’s estrogen related as someone told me.
    I’ve been having hot flashes for as far back as I can remember. My cycle used to be between 25-28 days and is stretching out each month but is around 34 days at this point. I’ve been having difficulty sleeping, or sleeping well. I do have a 3 and 6 yo so sometimes the issue is that they wake me but I can’t seem to get back to sleep.
    I’m unsure what to do at this point and I do have a family history on my maternal side of breast cancer. I do want to be sure I know what I’m looking at and what is normal for this time in my life as well as any precautions I should be taking. Thank you for your time!

    • It does sound like might have lowish estrogen. The best way to tell is the quantity and duration of your menstrual flow. More estrogen = more flow.

      If you have lowish estrogen, then the best strategy is not to take estrogen (at least not when you’re still having periods), but rather to support your HPA (adrenal) function. If you have enough cortisol and enough DHEA, than it’s easier to make enough estrogen.

      As for endometriosis, it is worsened by estrogen excess but not caused by estrogen (see my Estrogen Excess post). Endometriosis is primarily an inflammatory condition — probably autoimmune. See my post: Endometriosis Is An Autoimmune Disease.

  29. Hello! What’s your opinion on saw palmetto for pcos with associated severe hair loss? I started taking it two weeks ago and I’m shedding less. Should I stop? Thank you.

    • I’m neutral about saw palmetto. I don’t often prescribe it, but it can work as a natural androgen-blocker. However, the herb is not why you’re seeing an improvement now. Even with the absolute perfect treatment, you cannot expect to see improvement for at least 2-4 months (because of the lag-time with hormonal hair loss).

  30. Hi Dr. Briden,
    I tracked my cycles for several months (recorded start of period, severity of cramps and the amount/color of nearly constant spotting in between each cycle). Sadly, I did not know to track BBT during this time. My cycles ranged from 40 to 19 days and I had two cycles this last month. I am trying to figure out when my luteal phase actually begins because I suspect my periods are anovulatory bleeds? I spot before and after periods which I have learned from reading your book is most likely caused from my PCOS (recently received dx) and possibly other factors. You advise to use the PC the last 7-10 days of the luteal phase for PCOS, but I am not certain how to know when this is for me? I do not want to worsen issues or possibly suppress ovulation if there is a small chance it occurs. You say that to get an accurate progesterone reading to count back from your period to the day of testing. I did a saliva text from ZRT on day 20 of that cycle, but then I started my period 19 days later. So, this may not have been done in the right window? My progesterone came back at 46 (saliva ZRT lab). I do have PMS, heavy bleeding for the first 2-3 days with several (less than dime sized) clots, spotting etc. Could using the progesterone be a way to help symptoms while I am still trying to find the underlying reason for my PCOS and irregular cycles? When do you suggest using the cream? Could it possibly begin to help the extreme hair loss? I have read (and re-read) your book and nearly every article on this blog. I wish I would have found your resources when my health began to decline. Perhaps, I would not be as far down health wise as I currently am. You devote so much time, kindness and generous resources to women who truly need this! I sincerely thank you for your reply in advance! Do you offer email/phone consults by chance?

    • Hi Chelsea,
      Thanks for your warm feedback. 🙂
      You might be ovulating with some of those cycles, and BBT would be a good way to figure that out. I wish now I’d provided a bit more detail about BBT tracking in my book. You need an ovulation thermometer or basal body temperature thermometer. Look for the temperature rise that I describe in the Fertility Awareness Method section of Chapter 3. Your day 20 ZRT test was not a luteal phase test, so that low progesterone is “normal”.

      I might be able to help you further. Please send me a private message.

    • Hi Dell, that’s something I truly cannot answer here, sorry. Just to clarify: a breast cancer being positive for estrogen receptors (ER) does not directly relate to the concept of “estrogen dominance” discussed in this article.

  31. I’ve been all over the united states for my hormonal troubles. I’ve even been to the n.I.h. Your blog is very informative. Thank you. Hopefully I can get some answers about my androgen issues

  32. Thank you! This is such an overused term used by the typical holistic health coach. Great article and will definitely share it! I help balance hormones with Chinese medicine and find women coming to me who claim they have this and it is not the case at all.

  33. Hi Dr. Briden, I am 39 and since I started my period at 15 I’ve only had it 3-4 times a year at the most. The last few years I’ve been lucky if I’ve had 2-3 a year and this year I’ve only had one period in March. I had my thyroid tested (the full set of tests) and they came back normal. I had my hormones tested and I am on the very low side of normal for estrogen, my progesterone is extremely low and my testosterone is extremely high. I was diagnosed with PCOS and after reading your blog on magnesium I’ve started taking that everyday along with progesterone creme and Metformin as prescribed by my doctor. I’ve also been tracking my basal temp and cervical mucus everyday. My question is, is there something else I be looking for and based on my temp and mucus how do I know if I’m ovulating? I’m totally new to all of this and rather overwhelmed. Thanks so much for your help.

    • With only 2-3 periods per year, you’re almost certainly not ovulating. Probably no point in tracking mucus or temperatures until you start to see more regular cycles.

      If your testosterone is that high, then you’re probably insulin resistant. (Which is probably why the doctor prescribed Metformin.) Do you know anything about your insulin reading? Knowing how insulin resistant you are will tell you how much you need to change your diet. As I explain in my Insulin Resistance post and my book, the #1 treatment for insulin resistance is to quit sugar (to stop all high-fructose foods).

  34. Dr. Briden, What does a short luteal phase mean? What is causing it? And can bioidentical progesterone help lengthen it? I know I ovulate but my LP in a good cycle might be 11 days but can often fall under 10 days. I am concerned about trying to get pregnant/sustaining a pregnancy. Recently started taking B6 Bcomplex hearing that could help, and magnesium supplement. But what about the role of progesterone and what else I can do?

    • Good levels of progesterone are a consequence of a healthy luteal phase. To lengthen your luteal phase, you need to improve the health of your ovarian follicles, and that means correcting any underlying problems such as stress, thyroid, insulin, inflammation, or nutrient deficiencies.

      Like I say in my book, “Our periods are our monthly report card”. The luteal phase is the most important part of that report card.

  35. I’ve seen several other highly acclaimed naturopathic blogs so far and you’re the best one so far that goes in-depth with hormone imbalances while others are focused towards diet/nutrition and healthy living. Thanks for being straight forward, detailed, and touching on specific hormones instead of addressing them collectively with each post.

  36. Is it safe to use progesterone cream even though I don´t have a menstrual cycle? Haven´t had my period for over two years which I think is because of combination of adrenal fatigue and being on the pill (I suffered from adrenal fatigue at the time I came off birth control and didn´t get my period after that). Still recovering from adrenal fatigue and hormonal imbalance. The gynecologist/endocrinologist I was seeing about six months ago didn´t believe it was due to stress and thought me just gaining weight would fix the problem, which I have ( about 7-8 kg) and I was normal weight before that (I was underweight during a period of high stress/adrenal exhaustion but gained weight during recovery) Still no period or ovulation. The doctor said nothing´s wrong with my ovaries and that the problem basically is my pituitary gland is “asleep”. I have been taking progesterone cream to ease my symptoms from the hormonal imbalance and try to follow a pattern as if I would be ovulating in the middle of the month (around full moon). I have been concerned though that I might be messing it up by using the progesterone cream when I don´t know exactly when I naturally would be ovulating.Could that stop me from actually start ovulating? Also taking vitex (Femaprin) and the herb Shatavari.

    • If you’ve been having no ovulations, and therefore no hormones, then progesterone can be very helpful and soothing. However, Yes, too much progesterone could stop you from ovulating. I see this very often with my own patients, but usually only if they’re taking a high dose (more than 20 mg) and taking it every day. You’re taking breaks so you might be okay.

      Now that you’ve gained some weight, you should ovulate soon (as long as everything else is okay with your thyroid, prolactin, zinc and iodine status). Watch for ovulation signs such as fertile mucus, and you might want to cut back the progesterone a bit more.

  37. I was diagnosed with PCOS in my early 20s, and have fibroids. I am in my late 40s now, and still have regular periods. I am on bioidentical compounded progesterone 50mg orally every day, non stop…or else I am a mess premenstrually. I have really low saliva cortisol, high inflammation (due to autoimmune arthritis) and my weight WILL NOT BUDGE no matter what I do. Is it safe to assume that I have estrogen excess?

    • Do you know if you ovulate with any of your cycles? Since you’re in your late 40s you may not.
      The lack of progesterone during perimenopause makes it a time of ‘estrogen dominance’ almost by definition.

      It’s the one time when fairly constant dosing of natural progesterone can be justified. That said, I still think it’s important to have some kind of break from progesterone–even 5-7 days from the start of your bleed.


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