Up until perimenopause starts to make itself known, many of my younger female patients don’t think about estrogen all that much. But, interest about estrogentends to go way up when patients find themselves struggling with significant PMS issues or later on, start to notice their levels starting to drop precipitously during and after menopause. The skin becomes more prone to wrinkles, bones more vulnerable to thinning (think, osteoporosis) and the risk of heart disease increases.

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But wait – if lower levels of estrogen present challenges for older women, how can it be a bad thing to have too much of it in the younger, pre-menopausal and peri-menopausal years? Well, it’s a big enough deal to have spawned a new-ish term that’s entered the medical lexicon to describe it– ‘estrogen dominance’. So what’s it all about? Here’s an overview on this common yet not often discussed condition:

What are the symptoms of estrogen dominance?

The symptoms range from annoying to serious: extra-strength PMS; heavy periods; weight gain; an increased risk for everything from depression and anxiety to uterine fibroids. The reason the laundry list of potential problems is so long (and I’ve only scratched the surface here) is because cells throughout the body, including your brain cells, come equipped with estrogen receptors. That allows this one hormone to be involved in hundreds of different processes. Yes, estrogen plays a crucial role in puberty, but it’s a “sex hormone” whose influence extends way beyond sex and reproduction.

Why does estrogen dominance matter?

The reason why these estrogen-related problems are so common is because the hormones in your body all have to act in concert. When estrogen is out of balance with the other hormones, it’s like an out-of-tune instrument in a symphony orchestra. The sour notes throw off the whole performance. Let’s say, you’re feeling stressed and your body is producing high levels of your primary stress hormone, cortisol. More cortisol means your body is producing less of the other major female sex hormone, progesterone, which acts as a check on estrogen. So even though your levels of estrogen may be normal, the hormone has a disproportionate, and destabilizing, impact on the whole system. In other words, estrogen dominance.

Estrogen dominance interferes optimal hormonal harmony.

Sleep is another arena where all these interconnected hormones play out. High estrogen levels tamp down the production of your body’s sleep hormone, melatonin. That likely results in less and lower-quality sleep. And that can give your estrogen an unhealthy double-boost. Feeling tired and wrung-out increases your cortisol levels (lowering progesterone, upping the estrogenic effect). And the lack of restorative, deep sleep means the body is less efficient at breaking down (or “metabolizing”) the used-up estrogen allowing you to excrete it, making way for the new supplies of hormone your ovaries (and to a lesser extent, your adrenal glands and your fat tissues) are producing.

Handle your hormones, and treat them right.

Some women run high estrogen levels for genetic reasons or because of some underlying medical condition that should be investigated with their doctor. Basic blood and urine tests can give provide a useful hormonal read-out. But for most of my patients, following some basic healthful rules of the road can go a long way towards keeping estrogen in its proper place and keep the rest of you healthy as well.Bottom line: Know that anything to you do to keep your body on the low-inflammation track will help your body detoxify estrogen and stay in hormonal balance. To do that, here’s my list of musts-to-avoid and must-dos:

TOP 6 MUSTS-TO-AVOID

1. Ditch sugar and the processed foods – Don’t stop me if you heard this one before -- hormonal balance is one more good reason to heed this all-purpose advice. Not only does the bad stuff push the body into a pro-inflammatory state, it encourages weight gain – and extra body fat pumps out its share of unneeded and unwanted estrogen.

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2. Quit conventionally grown produce – Conventionally grown produce will likely be sprayed with loads of pesticides that contain endocrine-disrupting chemicals. We don’t know for sure what the effect is on the human hormonal systems but safe to assume none of it’s good, and there’s plenty of animal research that is certainly cause for concern. Opt for organic or farmers’ market products instead, and use The EWG’s 'Clean 15 /Dirty Dozen' lists as your buying guide.

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3. Redline factory-farmed meats and dairy products-- Factory-farmed animals are pumped up with hormones to encourage fast growth which may have an estrogenic effect in humans – so the less of it you take in the better.Here too, opt for organic or farmers’ market products instead.

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4. Do a purge of conventional cleaning, cosmetic and personal care products. –Take a close look at the stuff you put on your body and the items you use to clean your home. Read the labels and opt for the cleanest, most natural, least-chemical-laden products you can find. The fewerendocrine-disrupting products you’re exposed to the better. The EWG’s consumer guides to safer cosmetics, personal care and cleaning products are essential reading.

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5. Cool it on the alcohol. – Let’s be real, alcohol is a toxin and an inflammatory one at that. Moderate your intake, no more than a couple of drinks a week or, better yet, just drop it altogether. What’s more, alcohol also interferes with the body’s breakdown of estrogen.

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6. Re-evaluate birth control pills – Contraception is a highly personal issue but you might review other ways to achieve it with your doc, rather than re-wiring your sex hormones. Among the risks: The contraceptive pills may push women with naturally high estrogen levels into estrogen dominance.  

TOP 6 MUST-DOS

1. High-quality sleep – of at least 7 hours a night: You need it to keep your stress hormones in check and your sex hormones in balance.

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2. Manage stress – with whatever works for you: Whether it’s sitting meditation practice or yoga or, even just a warm bath before bedtime, find a practice, or several on them, to vent off agita during the day and settle yourself down at night. One big payoff – normal cortisol levels that won’t unbalance your estrogen.

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3. High fiber vegetables – they’ll never steer you wrong! They’re packed with nutrients, although it’s the fiber that’s the real star here, as they are prebiotics feeding the "good" bacteria. The fiber also binds with the estrogen that’s past its shelf life and sends it exiting out the digestive system. An added bonus: cruciferous vegetables like broccoli and arugula chemically assist the detoxification of the “old” estrogen.

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4. Optimize gut health – as there are bacteria in the gut which are capable of metabolizing and modulating the body’s circulating estrogen. Research is showing that the microbiome plays a big role in estrogen regulation, so optimizing and protecting the health of your microbiome is essential in preventing estrogen levels becoming imbalanced.

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5. Strategic supplementation – instead of hitting the prescription pad, first try the more natural route, using supplements that support healthy hormone balance. A few great ones to consider adding:

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• DIM – or diindolylmethane, supports phase 1 liver detoxification and healthy estrogen metabolism, maintaining a healthy ratio of the "good" to "bad" estrogen ratio.
• Sulphorophane – supports phase 2 liver detoxification and healthy estrogen metabolism, raising the protective form of estrogen. It is also anti-inflammatory, neutralizes free radicals, is anti-aging and cancer protective, so it’s great to have in your corner.
• Calcium D Glucarate– helps with liver detoxification and aids with the removal of excess estrogen and other toxins.
• Omega 3 fish oils– their anti-inflammatory properties make them especially helpful in keeping hormones balanced.
• Progesterone cream – though not a supplement per se, as a last resort, if none of the above is working,  consider a low dose of progesterone cream, prescribed by your practitioner and produced by an accredited compounding pharmacy.

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6. Movement – and plenty of it. Build as much movement as you can into your everyday life. Besides being handy for weight control, moving the body helps with the conversion of estrogen into forms that are easier for the body to break down and get rid of.