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Estrogen Dominance and Fertility: Symptoms & Diet

Oct 19, 2022
A woman lies down on a bed holding her stomach while struggling with estrogen dominance and fertility issues

Have you been told you have symptoms of estrogen dominance or too much estrogen? If you’re struggling with estrogen dominance and fertility challenges, then you probably have a lot of questions.

You might be wondering if heavy periods, cramping, difficulty getting pregnant, and/or weight that just won’t shed could be explained by a hormone imbalance? You might also be wondering how these symptoms might also signal an issue with fertility.

As women, so much of our hormonal health feels like Pandora’s box – it’s a complex, confusing  and an overwhelming can of worms. 

It doesn’t have to be this way. You don’t have to dread your period each month. Hormones don’t have to stand between you and your baby.

You can claim control of your hormones – and you can do it with the six simple, commonsense nutrition and estrogen dominance diet strategies that we’ll cover below (plus a few bonus steps).

This post will help you get crystal clear about whether estrogen dominance is to blame for your symptoms and if so, what diet changes and natural treatments you can get started on right away to get your hormones in balance and give your fertility a boost. Let’s dive right in. 

What is estrogen dominance?

Although not an official diagnosis, estrogen dominance describes a condition in which estrogen levels are too high and progesterone levels too low.

Note that “estrogen dominance” is technically a misnomer that many conventional doctors don’t recognize. The controversy comes from a history of dubious medical claims made by a couple of bad actors selling synthetic progesterone based on unfounded science. 

What's more, estrogen “dominance” is not quite accurate because estrogen is supposed to dominate in the initial, follicular phase, of your menstrual cycle. Your ovaries do not produce progesterone until after ovulation, so estrogen is inevitably dominant pre-ovulation.

All of that said, excess estrogen throughout your cycle, regardless of progesterone levels, is a real thing that’s linked to debilitating menstrual cramps, heavy periods, fibroids, infertility, endometriosis, and more. So it’s not surprising to learn that estrogen dominance and fertility also have a complicated relationship.

What happens when estrogen levels are too high? 

Why should you care about high estrogen?

Before diving into the concerns, let’s clear the air that estrogen is not “bad”. Far from it – you need estrogen – particularly the estradiol (E2) form – for everything from fertility, to bone density, to heart health, to motivation, drive and labido. 

The catch with estrogen is that there can be too much of a good thing, if it’s not adequately metabolized by the liver, if there’s too much of the more damaging form (estrone or E3 produced by fat cells), and/or if it’s not balanced out by healthy progesterone levels.

Potential health risks associated with excess estrogen include:

  • Risk of breast and uterine cancer;
  • Low thyroid hormone, slowing down your metabolism;
  • Irregular ovulation making it harder to get pregnant;
  • Overly-thick uterine lining, causing heavier, more painful periods; 
  • Increased risk of developing fibroids or worsening endometriosis;
  • Anxiety, depression and poor sleep.

So can estrogen dominance cause infertility? Taking a look at the list of health risks above, it’s clear that too much estrogen could have a negative impact on your ability to get pregnant, especially if you’re experiencing irregular ovulation. But let’s keep digging into this issue a little more.

What causes estrogen dominance?

So what causes this excess of estrogen? 

Your body is constantly making and eliminating estrogen. Excess amounts build up when you produce more estrogen than you can break down and eliminate. 

Where does estrogen come from?

There are three main sources of estrogen: 

  1. The follicles in your ovaries are the primary producers of estrogen. In the follicular phase of your cycle, your brain sends follicle stimulating hormone (FSH) to the ovaries. Follicles in the ovaries respond to FSH by growing and producing estrogen. 

It is rare for the follicles to produce too much estrogen – this typically only occurs during perimenopause or with polycystic ovarian syndrome (PCOS). 

  1. Fat cells are the next largest producers of estrogen, which is one reason why excess body fat is associated with infertility.
  2. Xenoestrogens can also contribute to excess estrogen. These are estrogen-mimicking compounds – also called endocrine disrupting chemicals (EDCs) – that act as estrogen in your body. They come from toxins all around us -in pollution, pesticides, perfumes, plastics and more. (I cover exposure in full detail in my post, Improving Egg Quality.)

How do you get rid of estrogen?

More often than not, excess estrogen is caused by a backup in the estrogen metabolism and excretion process. This process has broadly two steps: 

  1. It starts in the liver, where the estrogens get broken down. To perform this job optimally, the liver needs sufficient nutrients – including folate, vitamins B6 & B12, selenium, magnesium and zinc. 
  2. The liver then secretes the broken down estrogen into the intestine, where your gut bugs (microbiome) shuttle it out of the body. (In simpler terms, you poop out the excess estrogen). 

This process can go awry and excess estrogen can build up if: 

  • The liver does not have all of the nutrients it needs to function optimally and break down all of the estrogen coming in;
  • The liver is overly taxed with other chemicals to detoxify – think too much alcohol, environmental toxins, or certain medication use (including hormonal birth control);
  • If your digestion is out of whack – think constipation or imbalance of bacteria in your GI tract.

If you’re not pooping on the daily and eliminating the excess estrogen, then it gets reabsorbed from your intestine back into your bloodstream. 

Signs & symptoms of estrogen dominance 

How do you know if you have excess estrogen? Here are the hallmark signs & symptoms: 

  • Severe period pain* – typically so severe that its not relieved by NSAIDs like Ibuprofen or Tylenol
  • Heavy periods* (if you soak through a pad or tampon every two hours or less, or if you bleed for more than 7 days, that’s heavy)
  • Intense PMS* including, mood swings, irritability, headaches, acne and/or cramping
  • Tender, swollen breasts
  • Uterine fibroids 
  • Short cycles (less than 21 days)
  • Spotting between periods

If you have excess estrogen, you could have one or all of the above symptoms. 

*These symptoms can also indicate a condition called endometriosis. Be sure to discuss with your provider. 

Additional symptoms of estrogen dominance include: 

  • Bloating and water retention
  • Difficulty sleeping
  • Depression and anxiety 
  • Low labido 

Does estrogen dominance cause weight gain? 

Excess body fat and excess estrogen often go hand in hand, but it’s a chicken and egg scenario, meaning that it’s hard to tease apart which causes which. Excess estrogen can contribute to weight gain and visa-versa. 

On the one hand, excess estrogen stifles thyroid hormone production. Low thyroid dials down your metabolism, encouraging your body to hold onto fat stores. 

On the other hand, fat cells produce hormones – including estrone (the E3 form of estrogen). Losing body fat, can therefore, help rid the body of excess estrogen. 

In a study of overweight and obese women [based on their body mass index (BMI)], an average weight loss of 16 pounds resulted in an 13.4% average reduction in circulating estrogen levels. 

Excess body fat is also linked to insulin-resistance, which in turn, decreases sex hormone binding globulin (SHBG). Just like it sounds, SHBG binds to estrogen, decreasing circulating estrogen levels. So, more body fat means more insulin resistance, which results in less SHBG, and ultimately, more estrogen. 

Can excess estrogen cause infertility?

We don’t have the research to say if your estrogen climbs to this (fill in the blank) level, then you can’t get pregnant. However, we do know that when your estrogen is too high, your fertility suffers. Here’s how: 

  1. Low thyroid: As described above, excess estrogen can stifle thyroid hormone production, and low thyroid is a major cause of infertility
  2. Anovulation: Excess estrogen can interfere with the signals from your brain to your ovaries, preventing ovulation, thus making it harder to get pregnant. 

How do I know if I have estrogen dominance? 

While some providers will use symptoms alone to identify and treat excess estrogen, I prefer testing so we can take a tailored, data-driven approach to inform your treatment plan and to track your progress. 

How to test for estrogen dominance

OB/GYNs will typically test your estradiol (the E2 form of estrogen) levels around day 2 or 3 of your cycle (while you’re on your period), when estrogen levels are at their lowest. 

Your estrogen is considered high if your day 3 estradiol levels come back >115 pg/mL*. 

*If your estrogen levels are elevated, be sure to talk with your doctor to rule out serious causes such as tumors or hyperpituitarism.  

In my practice, I do a deeper analysis of estrogen levels; I use the DUTCH test for: 

  1. Evaluating estrogen in relation to progesterone (this test is run after ovulation rather than before); and 
  2. Going beyond if hormone levels are out of balance, into why they’re off, and where in the estrogen metabolism process the bottleneck is occurring. 

Sometimes total estrogen levels can be within the normal range, but you still struggle with symptoms of estrogen dominance – heavy, painful periods, etc. This can occur if your liver is not metabolizing the estrogen as it should. 

I’m a big fan of the DUTCH test because it shows us HOW the estrogen is getting metabolized in the liver, helping to explain your symptoms, whether your overall estrogen comes back low, normal or high. 

Contact me so I can help you evaluate your estrogen and hormone levels. 

How to reduce estrogen dominance naturally

Now to the good stuff – all that you can do to reduce excess estrogen and get your hormones in check for better periods and better fertility. 

As a registered dietitian, it’s particularly exciting to me that food can have such a HUGE impact on hormone health. And it’s all relatively simple, commonsense nutrition advice. Here’s what you do: 

Diet for estrogen dominance - 6 simple steps

1. Eat more greens 

You don’t need me to tell you that vegetables are good for you. But, if you’re like me, and could use a little nudge to eat more of them, here’s your motivation to do so. 

Cruciferous vegetables – broccoli, kale, cauliflower, Brussels sprouts, cabbage, bok choy and collards – are your first line of defense against excess estrogen. 

These veggies release indole-3-carbinol (I-3-C) molecules that then form DIM. If you’ve gone off in the Google-Sphere researching estrogen dominance, you’ve likely read recommendations for I-3-C and DIM supplements. These compounds support the liver’s metabolism of estrogen.

While these supplements may be helpful for some, definitely start with food – eat cruciferous veggies every day! Research shows this simple step of eating more cruciferous vegetables can significantly reduce excess estrogen. 

Last but not least, these veggies are rich in fiber… keep reading for a deep dive into fiber’s role in healing your hormones. 

2. Eat tons of fiber

The health benefits of fiber are basically common knowledge these days. And for good reason – especially for hormone balance. If you’re facing estrogen dominance and fertility issues, fiber will be a key part of your healing diet.

Research shows that women who eat a high fiber diet, compared to a low fiber diet, excrete three times as much estrogen in their stool and have 15-20% lower circulating estrogen levels. 

Why is fiber so beneficial? Because: 

  1. Fiber draws water into your GI tract, bulking up your stool to make you go more regularly. As explained above, regular bowel movements are essential to eliminating excess estrogen; and 
  2. Fiber is the fuel for your gut microbiome – keeping your gut bugs well fed and healthy means they are better able to do their job of shuttling toxins (including excess estrogen) out of the body. 

What is high fiber? If you’re a numbers gal, shoot for 25-30g of fiber per day. 

To achieve this goal, you need to eat high fiber foods at every meal and snack. The highest fiber foods come from plants, including: beans, whole grains, nuts, seeds, fruits and vegetables. 

Here are the 23 of some of the highest fiber foods: 

  1. Edamame (1 cup cooked & shelled): 18 g fiber
  2. Rolled oats (1 cup cooked; not instant): 16.5 g fiber
  3. Split peas (1 cup cooked): 16 g fiber
  4. Lentils(1 cup cooked): 15.5 g fiber
  5. Chickpeas (1 cup cooked):: 12.5 g fiber
  6. Beans (1 cup cooked):: 12-15 g fiber
  7. Avocado (1 cup fresh): 10 g fiber
  8. Chia seeds (1 ounce, raw): 10 g fiber
  9. Green peas(1 cup cooked): 9 g fiber
  10. Raspberries (1 cup fresh): 8 g fiber
  11. Flaxseeds (1 ounce, whole): 7.7 g fiber
  12. Artichoke (1 cup fresh): 6.9 g fiber
  13. Quinoa (1 cup cooked): 5.2 g fiber
  14. Broccoli(1 cup cooked): 5 g fiber
  15. Apples & Pears (1 medium, fresh): 4.4 – 5.5 g fiber
  16. Brussels sprouts (1 cup cooked): 4 g fiber
  17. Almonds (1 ounce, raw): 4 g fiber
  18. Brown rice (1 cup cooked): 3.5 g fiber
  19. Strawberries (1 cup fresh): 3 g fiber
  20. Banana (1 medium, fresh): 3 g fiber
  21. Orange (1 medium, fresh): 3 g fiber
  22. Sunflower seeds (1 ounce, raw): 3 g fiber
  23. Pistachios (1 ounce, raw): 3 g fiber

3. Eat flaxseeds

Not only are flaxseeds a mega source of fiber (see above), but they also provide lignans. Lignans are phytochemicals found in plants that increase levels of SHBG – discussed above for its role in binding estrogen to reduce circulating levels. 

One study found that women who ate flax seeds everyday for 12 weeks significantly lowered their estrogen levels. 

4. Drink more water

Like green vegetables and fiber, you likely don’t need me to tell you that hydration is important. What you might not realize is just how critical it is for restoring healthy hormone levels. 

First and foremost, hydration is your first step to combat constipation. (Yes, we’re talking a lot about poop! – if you don’t poop regularly, you can’t eliminate that excess estrogen!)

In general, drinking plenty of fluids helps your body eliminate toxins, including excess estrogen, but also other toxins that may be taxing your liver. 

5. Drink less alcohol 

I love my wine as much as you do – so I know this is not what you want to hear. That said, ‘less’ doesn’t mean ‘no’ alcohol. 

Cutting back to 4 drinks per week or less will do worlds of good for your liver health, so it can work most efficiently at eliminating toxins and restoring healthy estrogen levels. If the relationship between estrogen dominance and fertility is your main concern, then it probably makes sense to avoid drinking while trying to conceive anyway.

6. Avoid dairy

I do not typically recommend eliminating entire food groups unless you have an allergy or intolerance to that food. However, we know that cow milk is laden with estrogen and consumption of dairy products can increase your estrogen levels. 

With many of my clients, I recommend full fat grass fed and organic dairy – like yogurt and cottage cheese. The organic and grass-fed qualifiers do help reduce the amount of toxins in the milk products, but they don’t necessarily mean less estrogen. 

It doesn’t have to be forever, but while you’re healing your hormones and reducing estrogen levels, it’s best to avoid all dairy. 

More lifestyle strategies to reverse estrogen dominance naturally

Exercise daily 

If you need yet another reason to get moving, here it is: exercise helps you poop. We’ve talked a lot about how constipation can contribute to excess estrogen, since the hormones can get reabsorbed from your GI tract into your bloodstream. 

Exercise gets blood flowing and promotes the natural muscular contractions in your GI tract to promote regularity. 

Further, exercise promotes a healthy body weight, and as you now know, excess body fat is a leading contributor to excess estrogen. 

Detox your environment 

Remember from above, how your liver can get overly taxed if it’s burdened with too many toxins? To help your liver best break down estrogens, it needs to be free of toxin overload especially from hormone-mimicking chemicals (called xenoestrogens).

The most important steps to take right away are to: 

  1. Make sure your personal care and household products are free from fragrances and phthalates
  2. Make sure your food and drinks come in BPA- free containers (ideally glass); and
  3. Never heat your food or drinks in plastic. 

(See my previous post on Improving Egg Quality to get a simple 4-step process to get these environmental toxins out of your life). 

And another shout out to fiber, which helps you eliminate toxins, sparing your liver from overload. Do what you can to reduce hormone-disrupting chemicals in your day to day life, then pack the fiber on your plate to help eliminate the exposures you can’t avoid.

Moving forward with estrogen dominance and fertility

To sum it all up, when your estrogen exposure surpasses your ability to break down and eliminate that estrogen, excess levels can build up. 

This excess estrogen can show up as physical symptoms, including painful, heavy periods, irregular cycles or tender breasts, and/ or mental and emotional symptoms including anxiety, depression, low labido or poor sleep.

Painful, dreaded periods are not the norm and you don’t have to just suffer through it. 

Don’t let month of after month of negative pregnancy tests be your fate.

With the 6 simple diet steps outlined above, plus a few healthy lifestyle choices, you can restore healthy estrogen and hormone levels. Within 2-3 cycles you can see noticeable improvements to how you feel and your fertility. 

Make your hormones work for you, rather than against you so you can get pregnant more quickly and easily. 

I offer fertility nutrition coaching to give you custom solutions, designed for your unique physiology, to get you pregnant more quickly and easily – click below to get started!

Making a baby is natural, but that doesn’t mean it’s easy. I can help.

Here for you,

Anna

I can help you conceive easily and enjoy a healthy pregnancy.

Fertility is not one-size-fits-all.

As a registered dietitian, I use strategic testing to understand your unique physiology, and a data-driven approach to balance your hormones, improve egg quality and get you pregnant. Let's make a baby!

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