For fast reading, scan through the topic headings in BOLD BLACK, important conclusions in BOLD BLUE, and "Must Know" in BOLD RED. To jump to specific sections in this article, click on the respective LINKS in the Table of Contents.
Information presented here is for general educational purposes only. Each one of us is biochemically and metabolically different. If you have a specific health concern and wish my personalized nutritional recommendation, write to me by clicking here.
In the past 40 years, we have seen a dramatic rise in female-related illnesses never seen before in history. Today, we see the age of puberty (menarche) dropping precipitously to as low as 10 years of age, endometriosis afflicting 10% of all perimenopausal women; Premenstrual Syndrome (PMS), rising and afflicting close to 30% of perimenopausal women, uterine fibroids affecting close to 25% of women from age 35 to 50, and breast cancer afflicting close to 10% of all women. Being a woman in the 21st century is certainly a high risk profession. Navigating through this hazardous profession is not easy. Imagine having endometriosis, PMS and fibrocystic breasts when you were young, progressing to uterine fibroids, hysterectomy, misguided hormone replacement and ultimately breast cancer as your menopause approaches. The very thought of this journey can send chills up through anyone's spine. Fortunately, scientific evidence is mounting that hormone disruption is the key cause of all these seemingly separate but related diseases.
For too long, we have ignored the importance of hormone balance. For too long, physicians have been misguided on the real truth about hormonal balance. Now, we know that the common thread in many female hormone diseases such as those mentioned above is a little known condition known as estrogen dominance. The underlying problem is a relative excess of estrogen and an absolute deficiency in progesterone. In the west, the prevalence of estrogen dominance syndrome approaches 50% in women over 35 years old.
Here are some typical complaints from patients having estrogen dominance:
Before we look at estrogen dominance in more detail, let us first review the basic menstrual cycle and the key female hormones.
One hundred years ago, the average woman started her menses at age 16. She got pregnant earlier and more frequently. She often spent more time lactating. In total, women back then experienced the menstrual cycle about 100 to 200 times in their lifetime. Today, the average modern women starts puberty at age 12, seldom lactates, has less children, and menstruates about 350 to 400 times during a lifetime. Incessant menstruation has been associated with the increased occurrence of a myriad of pathological conditions including infertility, cancer, fibroids, anemia, migraines, mood shifts, abdominal pain, fluid retention, and endometriosis. What a difference a century makes!
It is apparent that modern woman goes through a lot more than her counterpart just a century ago. Could this have any bearing on the epidemic of female related illness plaguing our society? To answer that question, let us take a closer look at the hormones responsible for regulating the female menstrual cycle.
The two primary female hormones secreted by the ovaries are estrogen and progesterone. The properties of one offsets the other and together they are maintained in optimal balance in our body at all times. Too much of one hormone or the other can lead to significant medical problems.
Estrogen is produced in the ovaries. It regulates the menstrual cycle, promotes cell division and is largely responsible for the development of secondary female characteristics during puberty, including the growth and development of the breast and pubic hair. Estrogen therefore affects all female sexual organs, including the ovaries, cervix, fallopian tubes, vagina, and breast. As a general rule, estrogen promotes cell growth, including signaling the growth of the blood-rich tissue of the uterus during the first part of the menstrual cycle and stimulates the maturation of the egg-containing follicle in the ovary. It softens the cervix and produces the right quality of vaginal secretion to allow the sperm to swim and to lubricate during intercourse. Furthermore, it lifts our mood and gives a feeling of well-being.
In non-pregnant, pre-menopausal women, only 100-200 micrograms (mcg) of estrogen are secreted daily. However, during pregnancy, much more is secreted.
Estrogen in our body actually is not a single hormone but a trio of hormones working together. The three components of estrogen are: estrone (E1), estradiol (E2), and estriol (E3). In addition, there are at least 24 other identified types of estrogen produced in the woman's body, and more will be discovered. In healthy young women, the typical mix approximates 15/15/70 percent respectively. This is the combination worked out by Mother Nature as optimum for human females. Today, we use the word estrogen loosely to include also a family of hormones, including animal estrogens, synthetic estrogens, phytoestrogens (plant estrogens), and xenoestrogens (environmental estrogens, usually from toxins such as pesticides).
Estrogen is a pro-growth hormone. Since too much of anything is generally not good, the body has another hormone to offset and counterbalance the effects of estrogen. It is called progesterone.
As its name implies, progesterone is a pro-gestation hormone. In other words, it favors the growth and well-being of the fetus. Without a proper amount of progesterone, there can be no successful pregnancy. It protects us against the "growth effect" of estrogen. When progesterone is secreted, further ovulation is prevented from taking place in the second half of the menstrual cycle, and a thick mucous that is hostile to sperm is produced that prevents its passage into the womb.
Progesterone is made from pregnenolone, which in turn comes from cholesterol. Production occurs at several places. In women, it is primarily made in the ovaries just before ovulation and increasing rapidly after ovulation. It is also made in the adrenal glands in both sexes and in the testes in males. In women, its level is highest during the luteal period (especially from day 19 to 22 of the menstrual cycle). If fertilization does not take place, the secretion of progesterone decreases and menstruation occurs 12 to 14 days later under normal conditions. If fertilization does occur, progesterone is secreted during pregnancy by the placenta and acts to prevent spontaneous abortion. About 20-25 mg of progesterone is produced per day during a woman's monthly cycle. Up to 300-400 mg are produced daily during pregnancy.
As mentioned earlier, progesterone acts as an antagonist to estrogen. For example, estrogen stimulates breast cysts while progesterone protects against breast cysts. Estrogen enhances salt and water retention while progesterone is a natural diuretic. Estrogen has been associated with breast and endometrial cancers, while progesterone has a cancer preventive effect. Studies have shown that pre-menopausal women deficient in progesterone had 5.4 times the risk of breast cancer compared to healthy women.
The following table clearly shows how progesterone and estrogen balance each other. It is very important to note that both hormones are necessary for optimum function. Progesterone will not work without some estrogen in the body to "prime the pump", for example.
|Estrogen Effect||Progesterone Effect|
Causes endometrium to proliferate
Maintains secretory endometrium
Causes breast stimulation that can lead to breast cancer
Protects against fibrocystic breast and prevents breast cancer
Increases body fat
Helps use fat for energy
Increase endometrial cancer risk
Prevents endometrial cancer
Increase gallbladder disease risk
Restrains osteoclast function slightly
Promote osteoblast function, leading to bone growth
Reduces vascular tone
Restores vascular tone
Increase blood clot risk
Normalize blood clot
Estrogen and progesterone work in synchronization with each other as checks and balances to achieve hormonal harmony in both sexes. It is not the absolute deficiency of estrogen or progesterone but rather the relative dominance of estrogen and relative deficiency of progesterone that is the main cause of health problems when they are off balance.
While sex hormones such as estrogen and progesterone decline with age gradually, there is a drastic change in the rate of decline during the perimenopausal and menopausal years for women in these two hormones as mentioned earlier.
From age 35 to 50, there is a 75% reduction in production of progesterone in the body. Estrogen, during the same period, only declines about 35%. By menopause, the total amount of progesterone made is extremely low, while estrogen is still present in the body at about half its pre-menopausal level.
With the gradual drop in estrogen but severe drop in progesterone, there is insufficient progesterone to counteract the amount of estrogen in our body. This state is called estrogen dominance. Many women in their mid-thirties, most women during peri-menopause (mid-forties), and essentially all women during menopause (age 50 and beyond) are overloaded with estrogen and at the same time suffering from progesterone deficiency because of the severe drop in physiological production during this period. The end result - excessive estrogen relative to progesterone, a condition we call estrogen dominance.
According to the late Dr. John Lee, the world's authority on natural hormone therapy, the key to hormonal balance is the modulation of progesterone to estrogen ratio. For optimum health, the progesterone to estrogen ratio should be between 200 and 300 to 1.
What is so bad about estrogen dominance? It is the root cause of a myriad of illnesses. Conditions associated with this include fibrocystic breast disease, PMS, uterine fibroids, breast cancer, endometriosis, infertility problems, endometrial polyps, PCOS, auto-immune disorders, low blood sugar problems, and menstrual pain, among many others.
There are two time periods in a women's life that her progesterone level is low - at puberty and again at peri-menopause (the few years right before menopause). Between puberty and peri-menopause, the production of progesterone can go astray, leading to estrogen dominance as mentioned earlier. Between this time, estrogen dominance can also be the result of excessive external estrogen intake (from diet and environment) or internal estrogen production (from obesity, birth control pills, or ovarian tumors).
Two common causes:
Anovulation (lack of ovulation). Ovulation is the time of the month where an ovarian follicle releases an ovum (egg). Under normal conditions, the released egg makes its way from the ovary to the uterus in preparation for fertilization. This usually happens from day 12 to day 14 of the menstrual cycle. After the egg is released, the empty follicle becomes the corpus luteum. This is the main factory where the production of progesterone takes place.
When the follicles become dysfunctional, no eggs are released. This is called anovulation. If a woman were not ovulating, there would not be a corpus luteum and therefore no increased progesterone production. Laboratory measurement would show both a low estrogen and a low progesterone level. Many still have a seemingly normal menstrual cycle even if there is no ovulation. The lack of progesterone, however, leads to relative estrogen dominance and symptoms like PMS, mood swings, cramps, and tender breasts. Anovulation is commonly caused by exposure of female embryos to environmental estrogen (also called xenobiotics or xenoestrogens) such as pesticides, plastic, and pollution. This is often related to poor diet and stress.
Luteal insufficiency. More frequent than anovulation, the egg is produced but the corpus luteum malfunctions. It just does not make enough progesterone. Laboratory measurements would show high estrogen but low progesterone levels, and typical symptoms of estrogen dominance would arise. Without adequate progesterone, the chance of achieving pregnancy is reduced. Don't forget that progesterone is what keeps the womb going and nourishes the fetus.
The predominant reason why menopausal women develop estrogen dominance is that they are being prescribed unopposed estrogen such as Premarin as part of their hormone replacement therapy (HRT) program. Despite decades of research clearly showing that HRT significantly increases breast cancer, millions of women worldwide are on unopposed estrogen for treatment of menopausal symptoms.
Obesity is another cause. During menopause, the amount of estrogen produced from the ovaries decreases, but not as drastically as another hormone the ovaries produce called androstenedione (a male hormone). Fat cells can convert androstenedione into estrogen. The amount of conversion in some people is enough to maintain a reasonable estrogen level in the body well into the 70s. The result of excessive estrogen and absolute deficiency in progesterone is clear - estrogen dominance.
We mentioned before that our body is essentially soaked in a sea of estrogen. Where does the estrogen come from? Let us take a closer look.
Our body normally functions in perfect homeostasis. With the advent of society and industrial state in the past 70 years, our body has been subjected to unprecedented insults from environmental estrogen-like hormones. In less than one hundred years, we have managed to turn our diet from whole fruits and whole foods to fast and processed food. In the past, cattle were raised on grass and natural organic feed and chickens were allowed to run free. This is in stark contrast to the commercialization of cattle and poultry farms of today where animals are in cages most of the time. Worse yet, feeds laced with pesticides and hormones, both of which have estrogen-like activities, are routinely given to animals, which in turn is passed to humans.
Women in non-industrialized cultures whose diets are whole food based and are untainted with modern processed foods and pesticides seldom suffer a deficiency in progesterone and the signs of estrogen dominance manifested as menopausal symptoms.
12 of the most common reasons:
Commercially raised cattle and poultry. These animals are fed estrogen-like hormones as well as growth hormone that are passed onto humans. It takes 60 pounds of grain, feed, and hay to produce one pound of edible beef. On the other hand, it only takes one pound of feed to produce one pound of edible fish. Deep-sea fish such as halibut, sardine, cod, and mackerel are good to consume. Young ones are often less contaminated than older fish, and smaller fish are better shielded from contamination than larger fish like sharks and swordfish. Avoid all coastal fish and shellfish, which are high in contaminants. Fish are far superior to beef or chicken in terms of hormone load. It is interesting to note that one-half of all antibiotics in the United States are used in livestock - 25 million pounds a year. These antibiotics can contribute to hormone disruptor exposure. The use of antibiotics is especially prevalent in poultry farms. It only takes 6 weeks now to grow a chicken to full size (down from four months in 1940). Up to 80,000 birds may be packed into one warehouse. Feeds used contain a myriad of hormone-disrupting toxins including pesticides, antibiotics, and drugs to combat disease when so many animals are packed closely together.
Commercially grown fruits and vegetables containing pesticides. If you eat in any developed country, you are taking in pesticides from fruits and vegetables, many of which are known hormone disruptors. Approximately 5 billion pounds of pesticides, herbicides, fungicides, and other biocides are being added to the world each year. In the past 100 years, several hundred billion pounds of pesticides have been released into the environment. Pesticides that are banned in the US, such as DDT, are being used in some other countries freely. Illegal pesticides are being used on crops that we eat everyday. It is estimated that a person eats illegal pesticides 75 times a year just by following USDA's recommendation of five servings of fruits and vegetables a day if these are purchased in regular supermarkets. Vegetables grown in developing foreign countries such as South America and Africa find their way back to our dinner table in this global community. Pesticide residues have chemical structures that are similar to estrogen. These are eventually passed onto humans. Produce with the most pesticides reported in A Shopper's Guide to Pesticides in Produce include strawberries (contain vinclozolin, a known endocrine disruptor), bell peppers, peaches, apples, apricots, and spinach. Foods with the least amount of pesticides include avocados, corn, onions, sweet potatoes, bananas, green onions, broccoli, and cauliflower. If you are eating non-organic fruits and vegetables, peel and wash them well with diluted vinegar. This will help to reduce pesticides on the surface. However, this will not help to eliminate the pesticides on the inside of the produce. Discard the outer leaves of leafy vegetables, and trim fat from meat and skin from poultry and fish that tend to collect residues.
Exposure to xenoestrogen. When a female embryo develops in the womb, 500,000 to 800,000 follicles are created in the embryo, each enclosing an immature ovum. These fragile ovarian follicles are extremely sensitive to the toxicity of environmental pollutants. When the mother is exposed to toxic chemicals that resemble estrogen in its molecular structure, she may experience no apparent damage outwardly. However, the baby is more vulnerable to the toxins that may damage its ovarian follicles and render them dysfunctional. This will not be apparent until the baby reaches puberty some 10 to 15 years later, when symptoms of incomplete ovulation or insufficient progesterone production can be noted.
Petrochemical compounds found in general consumer products such as creams, lotions, soaps, shampoos, perfumes, hair sprays and room deodorizers. Such compounds often have chemical structures similar to estrogen and indeed act like estrogen. Other sources of xenoestrogens include car exhaust, petrochemically derived pesticides, herbicides, and fungicides; solvents and adhesives such as those found in nail polish, paint removers, and glues; dry-cleaning chemicals; practically all plastics, industrial waste such as PCBs and dioxins, synthetic estrogens from urine of women taking HRT and birth control pills that are flushed down the toilet and eventually find their way into the food chain and back into the body. They are fat soluble and non-biodegradable.
Industrial solvents. A common source of industrial xenoestrogens often overlooked is a family of chemicals called solvents. These chemicals enter the body through the skin, and accumulate quickly in the lipid-rich tissues such as myelin (nerve sheath) and adipose (fat). Some common organic solvents include alcohol like methanol, aldehydes like acetaldehyde, glycol like ethylene glycol, and ketones like acetone. They are commonly found in cosmetics, fingernail polish and fingernail polish remover, glues, paints, varnishes, and other types of finishes, cleaning products, carpet, fiberboard, and other processed woods. Pesticides and herbicides such as lawn and garden sprays, indoor insect sprays are also sources of minute amounts of xenoestrogens. While the amount may be small in each, the additive effect from years of chronic exposure can lead to estrogen dominance.
Hormone Replacement Therapy (HRT). HRT with estrogen alone without sufficient opposing progesterone such as the drug Premarin should be banned. This increases the level of estrogen in the body. Premarin, an estrogen-only drug commonly used in the past 40 years, is the mainstay of estrogen replacement therapy (ERT). It is a patented, chemicalized hormonal substitute that is different than the natural estrogen in your body. It contains 48% estrone and only a small amount of progesterone, which is insufficient to have an opposing effect. The indiscriminate and over-prescription of Premarin to many who may not need it is the problem. Symptoms include water retention, breast swelling, and fibrocysts in the breast, depression, headache, gallbladder problems, and heavy periods. The excessive estrogen from ERT also lead to increased chances of DNA damage, setting a stage for endometrial and breast cancer.
Over production of estrogen. Excessive estrogen can arise from ovarian cysts or tumors.
Stress. Stress causes adrenal gland exhaustion as well as reduced progesterone output. This tilts the estrogen to progesterone ratios in favor of estrogen. Excessive estrogen in turn causes insomnia and anxiety, which further taxes the adrenal glands. This leads to a further reduction in progesterone output and even more estrogen dominance. After a few years in this type of vicious cycle, the adrenal glands become exhausted. This dysfunction leads to blood sugar imbalance, hormonal imbalances, and chronic fatigue.
Obesity. Fat has an enzyme that converts adrenal steroids to estrogen. The higher the fat intake, the higher the conversion of fat to estrogen. Overeating is the norm in developed countries. A population from such countries, especially in the Western hemisphere where a large part of the dietary calorie is derived from fat, has a much higher incidence of menopausal symptoms. Studies have shown that estrogen and progesterone levels fell in women who switched from a typical high-fat, refined-carbohydrate diet to a low-fat, high-fiber and plant-based diet even though they did not adjust their total calorie intake. Plants contain over 5,000 known sterols that have progestogenic effects. People who eat more wholesome foods have a far lower incidence of menopausal symptoms because their pre- and post-menopause levels of estrogen do not drop as significantly.
Liver diseases. Liver diseases such as cirrhosis from excessive alcohol intake reduce the breakdown of estrogen. Taking drugs that can impair liver function may also contribute to a higher level of estrogen.
Deficiency of Vitamin B6 and Magnesium. Both of these are necessary for the neutralization of estrogen in the liver. Too much estrogen also tends to create deficiencies of zinc, magnesium and B vitamins. These are all important constituents of hormonal balance.
Increased sugar, fast food and processed food. Intake of these leads to a depletion of magnesium.
Increase in coffee consumption. Caffeine intake from all sources is linked with higher estrogen levels regardless of age, body mass index (BMI), caloric intake, smoking, alcohol, and cholesterol intake. Studies have shown that women who consumed at least 500 milligrams of caffeine daily, the equivalent of four or five cups of coffee, had nearly 70% more estrogen during the early follicular phase than women who consume no more than 100 mg of caffeine daily, or less than one cup of coffee. Tea is not much better as it contains about half the amount of caffeine compared to coffee. The exception is herbal tea like chamomile, which contains no caffeine.
In absolute terms, those who live in the developed world are bathed in a continuous sea of estrogen and do not know it. Yes, we all have hormonal imbalances, and specifically - estrogen dominance.
Message from Dr. Lam
I hope you have enjoyed reading this article. If you have areas you don't understand,
or if you have a specific health concern, feel free to write to me by clicking here.
About The Author
Michael Lam, M.D., M.P.H., A.B.A.A.M., is a western trained physician specializing in nutritional and anti-aging medicine. Dr. Lam received his Bachelor of Science degree from Oregon State University, and his Doctor of Medicine degree from the Loma Linda University School of Medicine in California. He also holds a Master’s degree in Public Health. He is board certified by the American Board of Anti-Aging Medicine where he has also served as a board examiner. Dr. Lam is a pioneer in using nontoxic, natural compounds to promote the healing of many age-related degenerative conditions. He utilizes optimum blends of nutritional supplementation that manipulate food, vitamins, natural hormones, herbs, enzymes, and minerals into specific protocols to rejuvenate cellular function.
Dr. Lam was first to coin the term, ovarian-adrenal-thyroid (OAT) hormone axis, and to describe its imbalances. He was first to scientifically tie in Adrenal Fatigue Syndrome (AFS) as part of the overall neuroendocrine stress response continuum of the body. He systematized the clinical significance and coined the various phases of Adrenal Exhaustion. He has written five books: Adrenal Fatigue Syndrome - Reclaim Your Energy and Vitality with Clinically Proven Natural Programs, The Five Proven Secrets to Longevity, Beating Cancer with Natural Medicine (Free PDF version), How to Stay Young and Live Longer, and Estrogen Dominance. In 2001, Dr. Lam established www.DrLam.com as a free, educational website on evidence-based alternative medicine for the public and for health professionals. It featured the world’s most comprehensive library on AFS. Provided free as a public service, he has answered countless questions through the website on alternative health and AFS. His personal, telephone-based nutritional coaching services have enabled many around the world to regain control of their health using natural therapies.
For More Information
© 2004 Michael Lam, M.D. All Rights Reserved.