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.

First, it’s normal to have no progesterone during the follicular phase, which is the first two to three weeks of the menstrual cycle.

Progesterone is always low in the follicular phase

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 whether you ovulate.

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 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 abdominal fat. In fact, in women, estradiol causes abdominal fat loss, while testosterone causes abdominal 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.

Estrogen and progesterone hormone balance.
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