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Estrogen Dominance

Estrogen Dominance (ED) affects about half the women in the United States. It is caused by an imbalance between ‘the stimulating hormone’ estrogen and ‘the calming hormone’ progesterone and is the cause of many metabolic dysfunction symptoms. To get a brief understanding of Rind’s approach to identifying and correcting metabolic energy problems read his overview on Metabolic Therapy™.

Start with the Estrogen Dominance Questionnaire

Take the Estrogen Dominance Questionnaire (pdf) for a brief explanation and a quick test.

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The Estrogen Dominance / Adrenal Fatigue Connection

Adrenal fatigue and ED are very similar in their symptom presentation and share a lot in common. Most women who have one tend to have the other to some degree. They have the following relationship:

* Progesterone goes on to become cortisol as well as other hormones.
* Most ED is due to insufficient progesterone and therefore there is a low cortisol production.
* Most adrenal fatigue involves an inability to keep up with cortisol production.
* When the adrenals are stressed, the increased need for cortisol depletes the progesterone levels used in making cortisol. As more progesterone is shunted or sequestered to make cortisol, less is available to balance off the estrogen. Another common reason for low progesterone levels is an anovulatory cycle (a menstrual cycle in which there is no ovulation). Without the ovulation there is no corpus luteum to make additional progesterone for the cycle. The lowered progesterone level leaves us with an excessive estrogenic effect due to deficiency of progesterone.
* In summary, fixing adrenal function and estrogen dominance go hand-in-hand and it is therefore difficult to fix one while ignoring the other.

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Estrogen Dominance from Excessive Estrogenic Stimulation

ED can also be caused by excessive estrogenic stimulation. Typical sources of estrogenic effect are:

* Excessive fatty tissue: Fat cells make estrogen and estrogen causes fatty tissue growth. This is a vicious cycle we’d like to avoid.
* Hormone replacement with non-bio-identical hormones such as:

Estrogens from horses or chemically modified estrogens. These have very potent estrogenic effects. This is especially problematic if there is no (calming) progesterone being given at the same time to balance off the (excitatory) estrogen. Unopposed estrogen is a powerful cause of ED. Synthetic or non-bio-identical estrogens would more appropriately called estrogenoids (substances that have an effect similar to estrogen) as they are not truly the estrogen our body makes.

 Progestins are chemical substances whose effects are similar to progesterone but act differently from progesterone because they are chemically different. Our bodies can not convert the progestins into cortisol to help the adrenals or convert them into any other hormonal compounds as we could with bio-identical progesterone.

* Exposure to chemicals that mimic estrogen such as many plastics (e.g., microwaving food in plastic dishes or using plastic wraps and containers) or from eating non-organic food. The livestock is typically given potent estrogenic substances (‘super-estrogens’) to make them more productive. Our produce is often laced with these substances.

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Fixing Estrogen Dominance

Direct help to the adrenals indirectly helps improve the ED (estrogen-progesterone balance) by allowing more progesterone to be available to offset the estrogen. Direct help to the estrogen-progesterone balance indirectly supports the adrenals by making more progesterone available for cortisol production. In addition, progesterone itself has a toning down, calming and sleep supporting effect which further helps stressed adrenals.

If we want a very gentle support for progesterone production we can try Chaste Tree (1-2 tablets early each morning upon waking). This is typically helpful for menstruating women with estrogen dominance. Herbalists often use this to help produce more regular ovulation and subsequently improve progesterone production as there is a healthier corpus luteum. It is often helpful in relieving menopausal symptoms (hot flashes) when taken in combination with Black Cohosh. Otherwise, we can use progesterone.

I find that the easiest way to restore balance to estrogen dominance is with progesterone. I’ve developed a progesterone protocol for doing this which helps most of my patients. There are always some that might respond poorly for which corrections need to be made. That is why it is always advisable to work with a physician who is familiar with the use of natural hormones while trying to restore a physiological hormonal balance.

It is important to note that there are different ways to take progesterone and these affect us differently. Dosage is also an important factor. As with any hormone, optimal dosage is the key. Too much or too little will either not produce the desired result or actually produce an undesirable result. There is an important consideration when post menopausal women use progesterone for the first time. The progesterone will temporarily increase the body’s sensitivity to estrogen (estrogen receptors temporarily become more sensitive to estrogen) thus producing a temporary increase in estrogenic effects. This can produce a temporary worsening of symptoms. To minimize this effect, progesterone needs to be started at a very small dose that is increased slowly to full dose over 2-4 weeks. See progesterone protocol.

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Which Form of Progesterone should I Take?

There has been some controversy regarding which form to take the progesterone. Proponents of saliva testing claim that creams cause an excessive elevation of progesterone. In my experience, I find this to be true only in the saliva testing and not in the serum testing. I therefore consider this to be an artifact and not a true elevation of progesterone. I list below some ways to take progesterone and their pros and cons. The capsules and troches are typically obtained from compounding pharmacies, especially when a specific dose is needed.

Form Pros Cons
Capsule
  • Convenient
  • Since around 80% is broken down by the liver, to get a 20mg blood level dose, you need to take a 100mg capsule. This places a further burden on the liver which, if one is estrogen dominant, is already stressed.
  • Blood level tends to be short lasting and may require splitting the dose into 2 doses daily to get a more even or stable blood level throughout the day/night.
Troche (soft tablets you dissolve under your tongue)
  • Less convenient than a capsule but less messy than a cream.
  • To get the 20mg, you need a 20mg troche.
  • Some people don’t like sucking on a tablet for the 1-2 minutes it takes to dissolve.
  • Blood level tends to be short lasting and may require splitting the dose into 2 doses daily to get a more even or stable blood level throughout the day/night.
Cream
  • To get a 20mg blood level, you apply 20mg.
  • You can control the rate of release into the blood stream by choosing a location with a thick fatty layer (slow release) or a thin fatty layer (fast release). This gives you more control in using the cream. For example, to help sleep, apply a small amount on the thin skin of the wrist and use the wrist to rub the cream on the stomach or thigh. The wrist gets immediate (sedative) action while the stomach or thigh gives a slow release throughout the night. See progesterone protocol for more details.
  • Creams can be messy
  • Need to alternate the site of application (alternate days) to allow the skin to refresh itself. Otherwise the skin may become a little resistant to the hormone as it becomes saturated with the hormone. This resistance can happen when applying other hormones as well.
  • May make a saliva test for progesterone unreliable.
  • Tends to release slowly over hours, days, or weeks from fatty tissue deposits. Some doctors consider this a problem but I consider this an asset. If used correctly, we can obtain a steadier blood level of progesterone than by any other practical method.

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Progesterone Protocol

Cycling Women:

* Take Progesterone cream in the following manner [if you use the ProgX pump from Xymogen, the pump will give about a 1" strip of cream per pump. 1 pump = 4mg progesterone.]
o During the period, 4mg daily
o Then 8mg daily x 8 days
o Then 16-20mg daily until the period when you return to 4 mg daily etc.
o Take more if estrogenic symptoms (e.g. PMS) and less if progesterone symptoms (lethargy, sleepiness, yeast infections, constipation, weight gain)
o Apply to fatty areas for slow release (eg, abdomen) and non fatty areas for fast release (wrist).
o Progesterone helps sleep if you take at night. You can split between day dose and the night dose.

Menopausal or post menopausal women:

* Take Progesterone cream in the following manner [if you use the ProgX pump from Xymogen, the pump will give about a 1" strip of cream per pump. 1 pump = 4mg progesterone.]
* If you have not taken progesterone before (tables or other forms) then your body is not yet used to progesterone. There is a paradoxical effect that occurs and you need to be familiar with it. Progesterone has two effects. It gives a progesterone effect (calming effects) long term but for the short term (several days to a couple of weeks) it also gives estrogenic (excitatory) effects. The estrogenic effects fizzle out over the first week or two while the progesterone effects remain.

General rules for ‘how to apply’ progesterone: You can control the rate of uptake and release rate of the Progesterone by where you apply it.

* Try not to apply at the same location 2 days in a row in order to allow that area of skin to refresh itself. Otherwise it may become a little resistant to absorbing the hormone.
* Use thin skin low fat areas (like the wrist) for rapid uptake and rapid release of the hormone (e.g., to ‘go to sleep now’)
* Use areas where the fat layer is thicker like thighs or hips or stomach for slower uptake and release (to last more hours through the night or day).
* You can mix and match thin and thick areas to have a little of both effects.
* take more if there are estrogenic symptoms (PMS type etc)
* take less if there are symptoms of excessive progesterone (sluggishness, excessive sleep, constipation, yeast infection, weight gain)

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Estrogen Dominance – A Very Important Metabolic Therapy Consideration for Woman

Correcting Estrogen Dominance involves more than just correcting the estrogen-progesterone balance and supporting the adrenals. It is important to eliminate the causative factors as much as possible. Excessive exercise, insufficient sleep, toxic exposure, poor nutrition (high carbohydrates, low fat / protein intake, low nutrient value), and stress are some common causes.

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