What are estrogen and progesterone?

After sexual development, the menstrual cycle in women is regulated by the activity of two major hormones; estrogen and progesterone.

Reference: https://microbenotes.com/menstrual-cycle/

Estrogen is produced by the ovary and rises in the first half of the cycle before the egg is released. It is released in response to the brain sending the hormones Luteinizing Hormone (LH) and Follicular Stimulating Hormone  (FSH) to the ovary to begin the cycle.

Progesterone is released in the second half of the cycle;it is released by the matured egg or ovum. If there is no egg release, because of the cycle not starting, then there is no progesterone (see PolyCystic Ovarian Syndrome)

What do these hormones do?

These hormones have a wide variety of effects on the body including,

but not limited to…

• Bone health
• Heart and brain health
• Regulating how breast duct tissues grow
• The menstrual cycle
• Ovulation, the release of an egg
• Mood
• Blood vessels

What factors influence estrogen?

Estrogen is made in the ovary. The brain sends a signal for the ovary to release estrogen at the beginning of the cycle. This peaks at day 14 when the egg is released, after which progesterone is dominant.

Estrogen levels depend on much more than just the ovary producing it. There are multiple potential impacts on estrogen:

• Fat cells create more estrogen; extra fat will lead to more estrogen. More estrogen makes it harder to lose weight and leads to more fat!
• Environmental hormone disruptors: chemicals in the environment encourage estrogen or act like estrogen
• Xenoestrogen (fake estrogen) are chemicals in the environment that behave like estrogen
• Heavy metals, makeup, herbicides, chemicals can impede estrogen breakdown in the liver resulting in higher estrogen
• Mould will increase aromatase activity, an enzyme which converts testosterone to estrogen, and can lead to more estrogen
• Soy protein isolates; GMO soy isoflavones are estrogen-like
• Oral contraceptive pill contains a small amount of synthetic estrogen Liver toxicity of any cause will slow down the excretion of estrogen
• Genetic variations such as ‘COMT’ gene defects may exist and impair a person’s ability to deactivate the estrogen

Bacteria in our gut influence how the liver breaks down estrogens; if there is a relative imbalance of bacteria, estrogen will not be excreted as well and will build up

Remember that progesterone is released by the matured egg itself in the second part of the menstrual cycle.

If there is no ovulation, progesterone will not be released

There are many circumstances under which the egg will not be released.

This occurs in…

• PolyCystic Ovarian Syndrome (a hormone disorder that involves high testosterone and insulin which delays a cycle happening),
• Early menopause (when the body stops undertaking a cycle) and
• When the brain decides not to send the FSH/LH chemical signal to the ovary to kickstart the new cycle. This may be due to high estrogen, high testosterone, a medical illness or taking the oral contraceptive pill

Sometimes, an egg is being released but the progesterone is not as high as it should be. This might be because there is too much estrogen relative to the progesterone. This can be due to a slow liver, too much weight or other nutritional factors. Sometimes there is something called insulin resistance; too much insulin in the body that is not functioning well. This is a complex condition that we will discuss in another article. This can lead to not enough progesterone being made.

What can go wrong with the balance of estrogen and progesterone?

Estrogen and progesterone should be thought about in terms of healthy ranges and a healthy balance between the two in the second half of the cycle

Hormone imbalances can either be from:

• Too much estrogen in the body
• Not enough progesterone
• A lack of both estrogen and progesterone, such as after menopause or when the cycle stops completely

Too much estrogen in the body is quite common and we have seen before many of the causes of that. Sometimes this will be enough to tell the brain not to start the new cycle; without a new cycle, an egg is not matured until later on and there is simply too much estrogen compared with progesterone.

This is the most common scenario causing delayed and irregular periods with horrible period symptoms. PCOS goes a step further and involves additional hormones which can really delay the period leading to a potentially high estrogen or low estrogen state in the long term.

One of the common endpoints of these imbalances is a relative lack of progesterone compared with estrogen; this is called estrogen dominance.

What is Estrogen Dominance?

Estrogen Dominance is a relative progesterone deficiency syndrome. It is caused by any of the estrogen promoting factors listed above.

What are some of the symptoms of estrogen dominance?

Estrogen dominance describes a setting of higher estrogen, unopposed by adequate progesterone levels. This may be associated with:

• Adenomyosis
• Uterine fibroids
• Fibrocystic breast disease
• Endometriosis
• Endometrial hyperplasia (heavy periods)
• Puffy face
• Hot flushes
• Constant abdominal pain before period,
• breast pain and cysts,
• PCOS (lots of testosterone and estrogen and not progesterone), bile stones and gall bladder inflammation

Most importantly, estrogen dominance leads to weight gain and delayed or absent periods. Prolonged exposure to higher estrogen with lower progesterone is linked to breast cancer.

Reference: https://www.fitnutrition.com.au/blogs/blog/estrogen-dominance-and-how-to-combat-it

How is Estrogen Dominance treated?

The approach to dealing with estrogen dominance is generally to improve estrogen excretion and minimise environmental estrogen exposure.

Measures may include…:

• Reduce toxins such as smoking, alcohol
• Clear the home of any mould
• Go through the kitchen and bathroom cupboards; remove products with unsafe chemicals (see toxicity)
• Support liver by eating vegetables
• Support gut using probiotics, prebiotics
• Weight loss
• Replace progesterone to protect the uterus and breasts

Sometimes it is necessary to treat any gut conditions and encourage bile flow and estrogen metabolism. Supplements to help with this include…

• Saccharomyces Boulardii
• DIM, a broccoli powder extract
• Calcium D glucarate
• Zinc replacement if necessary
• Vitamin D replacement if necessary

Finally, it may be necessary to give progesterone to a woman from days 14-24 of the cycle; this will counteract some of the estrogen and lead to a more regular and comfortable period.

You can read about relevant health topics by clicking the articles below:

• PCOS
• Insulin resistance
• Gut dysbiosis

References

Cheskis BJ, Greger JG, Nagpal S, Freedman LP. Signaling by estrogens. J Cell Physiol. 2007;213(3):610-617. doi:10.1002/jcp.21253

Davidson MH, Maki KC, Marx P, et al. Effects of continuous estrogen and estrogen-progestin replacement regimens on cardiovascular risk markers in postmenopausal women. Arch Intern Med. 2000;160(21):3315-3325. doi:10.1001/archinte.160.21.3315

Manson JE, Hsia J, Johnson KC, et al. Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med. 2003;349(6):523-534. doi:10.1056/NEJMoa030808

Patel S, Homaei A, Raju AB, Meher BR. Estrogen: The necessary evil for human health, and ways to tame it. Biomed Pharmacother. 2018;102:403-411. doi:10.1016/j.biopha.2018.03.078

Santen RJ, Allred DC, Ardoin SP, et al. Postmenopausal hormone therapy: an Endocrine Society scientific statement. J Clin Endocrinol Metab . 2010;95(7 Suppl 1):s1-s66. doi:10.1210/jc.2009-2509