Estrogen Dominance Part 1: When One Hormone Gets the Upper Hand

Hello, I'm Dr. Pooja
I am a former pharmacist turned licensed dietitian-nutritionist, Institute for Functional Medicine Certified Practitioner, and the founder of Pooja Mahtani Wellness, a virtual functional nutrition practice specializing in
PCOS, Thyroid, and Fertility.
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Perhaps you have noticed more bloating or breast tenderness over the years? How about worsening PMS? It could be due to something called estrogen dominance. The term “estrogen dominance” is becoming increasingly popular. In fact, I see this in my practice all the time. It quite literally means there is too much estrogen, or normal estrogen relative to a really low progesterone level.

I know what you’re thinking: “Well, what is the cut off for estrogen before it reaches a dominant state?” The answer is that it’s all relative. There is no specific value of estrogen that is too much. It has to be compared to your progesterone levels. Estrogen and progesterone balance each other out, so when one hormone gets the upper hand, symptoms arise.

So, what exactly are the symptoms of estrogen dominance?

For some women, estrogen dominance can be as mild as breast tenderness. Unfortunately, for other women, it can be as severe as endometriosis, infertility, or breast cancer. Here is a comprehensive list of symptoms that women can experience when they’re in an estrogen dominant state:

  • Bloating
  • Brain Fog
  • Breast Tenderness
  • Fatigue
  • Fibrocystic Breasts
  • Fibroids
  • Gestational Diabetes
  • Headaches (Especially Premenstrual Women)
  • Infertility
  • Irregular or Lack of Menstruation
  • Ovarian Cysts
  • PMS
  • Mood Disorders (Anxiety, Depression, or Mood Swings)
  • Reduced Sex Drive
  • Sleep Disturbances or Insomnia
  • Slowed Metabolism
  • Thyroid Dysfunction (Especially Cold Hands & Feet)
  • Weight Gain (Particularly Abdomen and Hips)

What is causing this increase in estrogen?

#1: Environmental Factors. Never before in history have we been exposed to so many exogenous chemicals than we are today. Many of the chemicals found in our food, water, the air we breathe, personal care products, and environment are now actually found to be endocrine disruptors. This are also known as xenoestrogens. Here are various examples of xenoestrogens:

Food: One of the greatest sources of excess estrogen is our diet. Conventionally raised meat is injected with growth hormones that will ultimately disrupt our own hormonal balance. Herbicides and pesticides used in conventional produce can also have a major impact on our hormone health.

Water: Unfortunately, chemical residue as a result of farming, pharmaceutical production, use of personal care products, and plastic disposal have all been found in our water supply.

Personal Care Products: Chemicals found in topical personal care products can be especially detrimental as they absorb directly through the skin and into our tissues. More on this here.

Cookware: Nonstick cookware is coated with perfluorooctanoic acid (PFOA). This chemical is used to make products grease and waterproof. It’s now a known endocrine disruptor. Each time the cookware is heated, PFOA can seep into our food.

BPA & Plastics: The chemical bisphenol A has gained notoriety over the last decade. BPA is a known endocrine disruptor commonly found in the lining of cans and thermal receipts. Due to this notoriety, it’s common to now see BPA-free canned goods in the supermarket. Unfortunately, most brands that indicate BPA-free use another substitute such as BPS and BPF. Research has found that these substitutes are just as hormonally active as BPA, and have the same endocrine-disrupting effects. BPA plastics are also much more potent (increasing the estrogenic properties) if put in the microwave or dishwasher. Even acidic contents such as acidic water (i.e. most bottled water) or acidic foods in plastic bottles (i.e. ketchup) can leach plastic into the contents itself.

Heavy Metals: Heavy metal exposure from arsenic, cadmium, lead, and mercury has also been associated with endocrine disruption. These are commonly found in our water and food supply. 

Environment: Simply living near areas were pesticides are used, manufactured, or disposed of can significantly increase exposure through contact and inhalation. This article points out that aerosols and other particulates in the air are significant source of exposure.

This review article and this one go into great depth about the impact of toxins in our environment and their impact on our endocrine system.

#2: Chronic Stress. Our modern lives are increasingly stressful. I’ve seen in practice time and time again that when a client is under stress, her progesterone levels decrease at a rate faster than her estrogen levels. While there are several mechanisms at play here, and some that are still being fully elucidated, what is clear is that cortisol can inhibit estrogen detoxification in the liver. This means that elevated cortisol can increase circulating estrogen in the body. It seems nature designed this system quite brilliantly. Historically, when we went through bouts of famine, drought, or other catastrophic events, there was no opportunity to conceive. Nature knew that it was not the right time to bring a child into the world. In our lives today, while we are not necessarily dealing with the same stressors, we are dealing with chronic stress nonetheless. In turn, many women today are dealing with infertility as a consequence. It’s this excess cortisol through a series of different mechanisms that causes circulating progesterone levels to decline while simultaneously causing estrogen levels to rise.

#3: Gut Microbiome. I would be remiss if I didn’t touch on the gut microbiome. Fascinating research about the gut microbiome and hormone health is reaching center stage. An imbalanced microbiome (also known as gut dysbiosis) is strongly connected to estrogen dominance. In fact, specific bacteria in our gut can actually release an enzyme called beta-glucuronidase that allows estrogen to recirculate in the body, instead of clearing out via elimination. Other issues with intestinal permeability (also known as leaky gut), gut motility, inflammation, and lack of diversity can all impact hormone health. Dysbiosis can also cause further adrenal stress or HPA axis dysfunction. This is described as physiological stress, but our bodies view and act on it the same way as emotional stress.

#4: Liver Impairment. Our liver is one of the hardest working organs in the body. It’s often referred to as the “master detoxifier”. It’s role in the body is to detoxify nearly all chemicals (both endogenous and exogenous) and to help prepare these chemicals for elimination. The estrogen hormone is no exception. In order to eliminate estrogen from the body, it must first go through the liver for processing. Once processed, estrogen can then leave the body through urine and bowel. It is thought that if liver function is compromised then estrogen detoxification is also diminished. Ultimately, this causes excess estrogen to circulate back into the bloodstream.

#5: Medications. Oral contraceptives and hormone replacement therapy can also lead to estrogen dominance. Newer formulations of oral contraceptives appear to have greater overall estrogenicity. That is, there is less progestin in the formulation to counterbalance the estrogen content.


I know this list appears to be daunting, but rest assured that many women have been able to successfully regain balance of their hormones through dietary and lifestyle changes. To find out how to address estrogen dominance, continue on to Part 2.

Hi there

I’m Dr. Pooja!

I am a pharmacist turned functional medicine clinical nutritionist. After years of struggling with PCOS, I finally uncovered the root cause of my hormone symptoms and found a solution that actually works long-term. Now I'm on a fierce mission to help other women achieve hormone healing!

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