There are a lot of myths surrounding estrogen these days. Here are some basics of this important steroid hormone. There are three types of estrogen: Estrone (E1), Estradiol (E2 – most active during reproductive years), and Estriol (E3 – highest during pregnancy). 

Estrogen is necessary! Beyond regulating female reproduction, estrogens also control cell growth, gene regulation, bone density, cholesterol production, cardiovascular function, mood and emotions, memory, body temperature, immune function and aging. Therefore, imbalance in estrogen hormones and metabolites can have profound impacts on the body as a whole. 

Balancing estrogen with progesterone is essential. Too much estrogen can lead to PMS, tender breasts, bloating, weight gain, headaches, low libido, brain fog, heavy periods, and depression. Estrogen dominance may not simply be an issue of over-production, but more likely under-elimination of it (due to constipation, poor digestion, & poor methylation) and too little progesterone.  Estrogen can climb due to a poor diet, impaired liver clearance, obesity (fat cells create estrogen), poor bile production, low fiber, and xenoestrogens (foreign chemicals). 

Estrogen balance is not just for women, but men too. Men can also experience the benefits or consequences of estrogen imbalance. 

Estrogen Metabolism

We have three phases of liver detoxification. During Phase 1, used hormones are sent to the liver and go through several phases before finally eliminated. First, they are transformed by enzymes to make the compounds more water soluble. Compounds also become more reactive here and potentially more harmful. In Phase 2, they go through conjugation and are bound with certain minerals. Specific enzymes come into play to break down substances for excretion via bile.  During Phase 3, there are six pathways all requiring specific enzymes and nutrients to expel toxins. Some of those are B2, B3, B5, B6, B12, magnesium, choline, folate, amino acids from animal protein and glutathione. This is why a well-rounded diet is essential. 

E1, 2 and 3 are eliminated from the body via specific pathways in the liver. The 2-OH pathway is our “goody-two-shoes” pathway and we want most of our estrogen to be eliminated via this way. Detoxification is promoted by using DIM, cruciferous veggies, omega 3-fatty acids, fresh ground flax seed and I3C. Cruciferous vegetables and broccoli sprouts can also promote this pathway. The 4-OH pathway is carcinogenic and inflammatory. This pathway is promoted by environmental toxins and poor receptors. (Think: standard cleaning products, parabens, fragrance, dryer sheets, plastics, and chemical-laden personal care products.) We want to down-regulate this pathway with grapefruit, resveratrol, flax seeds and citrus peel.  If you find yours is high, avoid charbroiled meats or very high temperature cooking, like frying, which can induce this enzyme to activate 4-OH metabolites. 

Then, we have the 16-OH metabolite which is very potent. It’s almost as active as E2 and promotes cell growth, which is helpful for proper bone density, but not for cancer. Too much contributes to estrogen dominance and too little may impact bone health. This pathway is promoted by inflammation and decreased by I3C, DIM, grapefruit, quercetin, and flax seed. 

Dysbiosis in the gut can contribute to estrogen imbalance by recycling metabolites back into the bloodstream. That’s why it’s so important that you have a daily bowel movement (if not 2!). Support digestion with adequate hydration, moving your body, gallbladder support (healthy fats, beets, dandelion, lemon juice, apple cider vinegar), and microbiome health with a nutrient-dense whole foods diet that includes cruciferous vegetables and psyllium husks. Testing your levels of beta-glucuronidase is important to make sure they are not too high. High levels means you are recycling dirty, used estrogen back into the bloodstream. Using Calcium d-glucarate (a supplement) can help eliminate this, but you need to work with a practitioner to assess and work on dosing. 

The most accurate way to test your estrogen metabolites is via the DUTCH test. It stands for Dried Urine Testing for Comprehensive Hormones. It’s a simple urine test that tests your estrogen, progesterone, testosterone, DHEA, melatonin, cortisol levels and several organic acids. I run one on myself annually because I use Bio-identical hormone replacement therapy (BHRT). If you are a peri-menopausal or newly menopausal woman, it’s essential to test these hormones and even more important if you’re taking hormones. We want to make sure you are not sending too much estrogen down the 4-OH pathway. 

This test is one of my favorites that I use on my clients. If you’re interested in running a DUTCH test, please reach out.  You can find more information at

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