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Estrogen Dominance

Estrogen Dominance
Estrogen Dominance (ED) affects about half the women in the United States. It is caused by an imbalance between the stimulating hormone estrogen and the calming hormone progesterone and is the cause of many metabolic dysfunction symptoms. To get a brief understanding of Rinds approach to identifying and correcting metabolic energy problems read his overview on Metabolic Therapy.

Start with the Estrogen Dominance Questionnaire
Take the Estrogen Dominance Questionnaire (pdf) for a brief explanation and a quick test.

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The Estrogen Dominance / Adrenal Fatigue Connection
Adrenal fatigue and ED are very similar in their symptom presentation and share a lot in common. Most women who have one tend to have the other to some degree. They have the following relationship:

* Progesterone goes on to become cortisol as well as other hormones.
* Most ED is due to insufficient progesterone and therefore there is a low cortisol production.
* Most adrenal fatigue involves an inability to keep up with cortisol production.
* When the adrenals are stressed, the increased need for cortisol depletes the progesterone levels used in making cortisol. As more progesterone is shunted or sequestered to make cortisol, less is available to balance off the estrogen. Another common reason for low progesterone levels is an anovulatory cycle (a menstrual cycle in which there is no ovulation). Without the ovulation there is no corpus luteum to make additional progesterone for the cycle. The lowered progesterone level leaves us with an excessive estrogenic effect due to deficiency of progesterone.
* In summary, fixing adrenal function and estrogen dominance go hand-in-hand and it is therefore difficult to fix one while ignoring the other.

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Estrogen Dominance from Excessive Estrogenic Stimulation
ED can also be caused by excessive estrogenic stimulation. Typical sources of estrogenic effect are:

* Excessive fatty tissue: Fat cells make estrogen and estrogen causes fatty tissue growth. This is a vicious cycle wed like to avoid.
* Hormone replacement with non-bio-identical hormones such as:

Estrogens from horses or chemically modified estrogens. These have very potent estrogenic effects. This is especially problematic if there is no (calming) progesterone being given at the same time to balance off the (excitatory) estrogen. Unopposed estrogen is a powerful cause of ED. Synthetic or non-bio-identical estrogens would more appropriately called estrogenoids (substances that have an effect similar to estrogen) as they are not truly the estrogen our body makes.

Progestins are chemical substances whose effects are similar to progesterone but act differently from progesterone because they are chemically different. Our bodies can not convert the progestins into cortisol to help the adrenals or convert them into any other hormonal compounds as we could with bio-identical progesterone.
* Exposure to chemicals that mimic estrogen such as many plastics (e.g., microwaving food in plastic dishes or using plastic wraps and containers) or from eating non-organic food. The livestock is typically given potent estrogenic substances (super-estrogens) to make them more productive. Our produce is often laced with these substances.

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Fixing Estrogen Dominance
Direct help to the adrenals indirectly helps improve the ED (estrogen-progesterone balance) by allowing more progesterone to be available to offset the estrogen. Direct help to the estrogen-progesterone balance indirectly supports the adrenals by making more progesterone available for cortisol production. In addition, progesterone itself has a toning down, calming and sleep supporting effect which further helps stressed adrenals.

If we want a very gentle support for progesterone production we can try Chaste Tree (1-2 tablets early each morning upon waking). This is typically helpful for menstruating women with estrogen dominance. Herbalists often use this to help produce more regular ovulation and subsequently improve progesterone production as there is a healthier corpus luteum. It is often helpful in relieving menopausal symptoms (hot flashes) when taken in combination with Black Cohosh. Otherwise, we can use progesterone.

I find that the easiest way to restore balance to estrogen dominance is with progesterone. Ive developed a progesterone protocol for doing this which helps most of my patients. There are always some that might respond poorly for which corrections need to be made. That is why it is always advisable to work with a physician who is familiar with the use of natural hormones while trying to restore a physiological hormonal balance.

It is important to note that there are different ways to take progesterone and these affect us differently. Dosage is also an important factor. As with any hormone, optimal dosage is the key. Too much or too little will either not produce the desired result or actually produce an undesirable result. There is an important consideration when post menopausal women use progesterone for the first time. The progesterone will temporarily increase the bodys sensitivity to estrogen (estrogen receptors temporarily become more sensitive to estrogen) thus producing a temporary increase in estrogenic effects. This can produce a temporary worsening of symptoms. To minimize this effect, progesterone needs to be started at a very small dose that is increased slowly to full dose over 2-4 weeks. See progesterone protocol.

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Which Form of Progesterone should I Take?
There has been some controversy regarding which form to take the progesterone. Proponents of saliva testing claim that creams cause an excessive elevation of progesterone. In my experience, I find this to be true only in the saliva testing and not in the serum testing. I therefore consider this to be an artifact and not a true elevation of progesterone. I list below some ways to take progesterone and their pros and cons. The capsules and troches are typically obtained from compounding pharmacies, especially when a specific dose is needed.
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