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The mysteries of estrogen dominance

By Dr. Sharon Stills, NMD

When women suffer from hormonal imbalance, conventional medicine puts the blame on low estrogen levels, and promotes estrogen (or a combination of estrogen and progesterone) as the best way to feel better. We know it’s just not that simple.

A woman taking notes about symptoms and natural treatments for estrogen dominance

In fact, many symptoms of hormonal imbalance, along with more severe conditions such as endometriosis or uterine fibroids, are associated with relatively high estrogen levels. This is known as estrogen dominance, a common condition that for many women may also be the first stage of perimenopause. But the right solution is not simply reducing estrogen either.

To resolve the underlying cause of your individual hormonal imbalance, estrogen dominance and troubling symptoms you need more than a “one size fits all” or “one hormone” approach.

What is estrogen dominance? 

Estrogen dominance occurs when estrogen levels are high compared to levels of progesterone. It’s especially common in the early stages of the menopause transition, and can occur years before menopause. That’s why when a premenopausal woman suffers from symptoms of hormonal imbalance we always look at the ratio between her estrogen and progesterone.

Normally, these two hormones rise and fall as part of your menstrual cycle. Each month, your estrogen level naturally increases before ovulation, and then falls for the rest of your cycle while progesterone increases. This natural fluctuation pattern is controlled by a complex set of feedback loops which determines how much or little of each hormone is being made at any one time to maintain hormonal balance.

With estrogen dominance, your natural balance is disrupted and you may not even realize it until it leads to troubling symptoms. One disruption occurs when estrogen remains at its regular level, but your progesterone levels begin to drop — so you have “too much” estrogen. Another imbalance can result when extra estrogen is added to your system through diet and lifestyle choices that influence how you metabolize estrogen and regulate energy. For instance, consuming too much sugar can contribute to hormonal imbalance and estrogen dominance.

Normal estrogen levels in women

Life StageEstrone RangeEstradiol Range
Prepubescent FemaleUndetectable – 29 pg/ml Undetectable – 20 pg/ml 
Pubescent Female10-200 pg/ml Undetectable – 350 pg/ml 
Premenopausal Adult Female17-200 pg/ml15-350 pg/ml 
Postmenopausal Female7-40 pg/ml <10 pg/ml
Source: Mayo Medical Laboratories

Even tiny changes in levels can cause symptoms, because estrogen is more powerful in smaller amounts than other steroid hormones.

Signs & symptoms of high estrogen-to-progesterone ratio

  • Unwanted hair growth
  • Irritability
  • Breast tenderness
  • Water retention
  • Weight gain
  • Cyclical (hormonal) headaches
  • Mood swings
  • Skin breakouts
  • Digestive imbalance
  • Fuzzy thinking
  • Irregular periods /anovulatory cycles
  • Breakthrough bleeding, spotting

Conditions associated with relatively high estrogen levels

  • Uterine fibroids
  • Menorrhagia (heavy bleeding)
  • Endometriosis
  • Menstrual headaches
  • PMS
  • Breast/gynecological cancers
  • Lupus

Finding a solution that can balance all of your hormones

Once you understand that estrogen, progesterone, testosterone, and your lifestyle choices all play roles in your symptoms, it’s quite clear why just adding one or two hormones isn’t going to help you feel better. However, many conventional practitioners still push Hormone Replacement Therapy (HRT) as a first step, even though it has a long history of being controversial due to significant health risks.

As always, we recommend you start with the most natural, least invasive form of support to let your body do the work of balancing all of your hormones. With this approach, you increase the amount of support you give your body — through nutrition, supplements, and lifestyle changes — so the support outweighs the demands. We have also found that the use of certain herbs is highly effective for women with symptoms of estrogen dominance.

Ashwagandha and estrogen dominance

Ashwagandha (Withania somnifera) is one of these herbs, A traditional remedy from Ayurvedic medicine, ashwagandha has a growing body of research that backs its use for estrogen dominance. Specifically, ashwagandha has been shown to exert a balancing effect on the endocrine system and to reduce the amount of estrogen in the body by inhibiting the activity of an enzyme called aromatase, which is responsible for converting androgen to estrogen. Ashwagandha also contains compounds called withanolides, which have been shown to have anti-inflammatory and antioxidant effects, helping to diminish symptoms related to estrogen dominance.

Black cohosh and chasteberry

Other beneficial herbs include black cohosh and chasteberry. All three — ashwagandha, black cohosh and chaste berry — make up our landmark phytotherapeutic complex. More than 80% of women who use the natural approach in our Hormonal Health Program, which includes this formula, find relief from their symptoms.

Last Updated: May 17, 2023
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