By: Michael Lam, MD, MPH

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Many health issues in women may be linked to adrenal fatigue and its symptomsIn 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:

  1. My breasts are swollen and getting bigger.
  2. I can’t put my rings on my fingers.
  3. I am more impatient now than ever.
  4. People tell me I am too bossy.
  5. I am getting cramps again like when I was younger.
  6. I no longer get my period.
  7. I miss my periods regularly.
  8. My periods come irregularly.
  9. I get scared when I see large clots during my period.
  10. I have Pre-Menstrual Syndrome (PMS).
  11. When I get a hug, my breasts hurt.
  12. I have fibroids.
  13. I have endometriosis.
  14. I cannot fit into my shoes.
  15. I have a cyst in my breast.
  16. I feel tired all the time.

Before we look at estrogen dominance in more detail, let us first review the basic menstrual cycle and the key female hormones.

Modern Menstruation

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.

Female Hormones

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.

Estrogen Effect vs. Progesterone Effect

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 Dominance

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.

Estrogen Dominance in Pre-Menopausal Women

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:

  1. 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.
  2. 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.

Estrogen Dominance in Menopausal Women

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.

Causes of Estrogen Dominance

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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. Over production of estrogen. Excessive estrogen can arise from ovarian cysts or tumors.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. Increased sugar, fast food and processed food. Intake of these leads to a depletion of magnesium.
  12. 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.

Estrogen Dominance Continuum

It is clear that estrogen dominance is the underlying common denominator for a variety of illnesses and syndromes that were previously regarded as unrelated entities. They in fact represent different expressions of the same illness in different cell settings. The continuum is a state of excessive estrogen throughout one’s lifetime, with different manifestations at different times.

Conditions and diseases linked to this continuum includes:

  • Allergies, including asthma, hives, rash, sinus congestion
  • Autoimmune disorders such as systemic lupus erythematosus (SLE) and Hashimoto’s thryoiditis
  • Breast cancer
  • Copper excess and zinc deficiency
  • Endometriosis
  • Endometrial cancer
  • Gallbladder disease
  • Syndrome X (Insulin resistance)
  • Infertility
  • Polycystic Ovaries
  • Menopausal symptoms
  • Magnesium deficiency
  • Osteoporosis
  • Pre-menstrual syndrome (PMS)
  • Pre-menopausal syndrome
  • Hypothyroid-like conditions
  • Prostate cancer
  • Uterine fibroids

Common Estrogen Dominance Conditions:

  • Dometriosis
  • Premenstrual Syndrome (PMS)
  • Fibrocystic Breast
  • Pre-menopausal Syndrome
  • Polycystic Ovary Syndrome (PCOS)
  • Fibroids
  • Breast cancer

Let us now look at each of these in more detail.

A. Endometriosis

Endometriosis is a very common condition. Statistics show that approximately ten to fifteen percent of women in their reproductive years from age 25 to 45 are affected. About thirty percent of affected women are infertile. It is a condition where endometrium (the lining of the uterus) is found in locations outside the uterus, such as the ovaries, fallopian tubes, vagina, abdomen, deep inside the uterine muscle, bowel, bladder, utero-sacral ligaments (ligaments that hold the uterus in place), peritoneum (covering lining of the pelvis and abdominal cavity), or other parts of the body. It can grow between organs and cause them to stick together with adhesions.

The causes of endometriosis are not yet fully known. There are quite a few theories, from genetics to toxic environment. Backward bleeding, or retrograde menstruation (when bleeding travels up into the uterus) is thought to be the leading cause. Endometrial cells are estrogen responsive, and estrogen dominance is the norm in developed society. Many researchers believe that estrogens and their close relative xenoestrogens (environmental estrogens) play a significant causative role in this disease. Some have tried to link bleached tampons with pollutant residues as the cause, but these have yet to be proven.

Risk factors:

  • Family history of endometriosis, especially mother or sister
  • Late childbearing (after age 30)
  • History of long menstrual cycles with a shorter than normal time between cycles
  • Abnormal uterine structure
  • Diet high in hydrogenated fat (trans fats) such as French fries or cookies
  • Stress

Symptoms and Diagnosis

Endometrial tissue responds to the same tissue as the uterus. It grows with estrogen, and may bleed during menstruation just like tissues in the uterus. The most common symptom is pain and cramps that coincide with the menstrual cycle, while scar tissue can form wherever the endometrial tissue is located and interfere with the function of the organs. Other symptoms include heavy menstrual bleeding, pain during intercourse, abdominal pain and or low back pain and diarrhea during menstruation. Sometimes there are no symptoms at all. The degree of severity of symptoms does not necessarily correlate with the degree of involvement, as each person reacts differently. Endometriosis increases risk of uterine fibroids or breast cysts, and may be accompanied by severe fatigue, chronic fatigue syndrome, or fibromyalgia.

The only way to diagnose endometriosis is by laparoscopy, a surgical procedure in which the surgeon places a small scope inside the pelvic cavity looking for endometrial tissues. This is often not successful, and a diagnosis can take years.

Surgical intervention focuses on the removal of endometrial tissues, while drug therapy focuses on balancing the hormonal picture with birth control pills. Both are not very successful. More than 500,000 surgeries are performed each year for endometriosis, and there is an upward of forty percent recurrence rate, continued pain, and disability. This disease often subsides with menopause when the estrogen level is reduced in absolute terms. It also goes away when ovaries are non-functional. This can be surgically induced by the removal of both ovaries, or chemically induced by the use of drugs on a temporary.

B. Premenstrual Syndrome (PMS)

In addition to menopausal symptoms commonly blamed on estrogen deficiency instead of relative estrogen dominance, researchers note that many women suffer a similar set of symptoms associated with estrogen dominance during the menstrual cycle each month. PMS can affect women soon after puberty and all the way to later years.

Here are some typical complaints of patients with PMS:

  • My ring finger is getting swollen (indicative of water retention).
  • My breasts are hot and tender (indicative of breast inflammation).
  • I feel tired all the time (indicative of fatigue).
  • I feel nervous and irritable (indicative of emotional instability).
  • I feel like eating chocolate all the time (indicating an innate magnesium deficiency as chocolate is high in magnesium).

This syndrome was first described in 1931. It is a well-established syndrome consisting of a host of physical and emotional symptoms that develop after ovulation and before the onset of the menstrual cycles. The syndrome can range from a few days to two weeks. The intensity can be mild (relieved by an aspirin) or it can be severe and debilitating. Generally, its symptoms intensify as the period approaches. Interestingly, ninety-five percent of PMS can be vastly improved if steps are taken to balance the body’s hormones.

Dr. Katherine Dalton published the first medical report on PMS in 1953. She observed that the administration of a high dose of progesterone by rectal suppository relieved symptoms of PMS.

It is important to note that not all PMS symptoms are caused by progesterone deficiency and estrogen dominance. Hypothyroidism can produce similar symptoms. Stress leading to adrenal exhaustion and low adrenal reserve commonly seen in working mothers for example, can also cause similar symptoms. A diet low in fiber can cause estrogen to be reabsorbed and recycled. An excessive intake of xenoestrogen-laced beef and poultry also contributes to relative estrogen dominance associated with PMS. Many researchers think that PMS may be linked to xenoestrogen exposure during embryo life, damaging the ovarian follicle. Pollutant damaged ovaries, while they are in the womb, can result in infertility and chronic estrogen dominance.

The key dietary adjustments are elimination of:

  • Empty calories such as potato chips and other junk foods
  • Hydrogenated fats (also called trans fats) found in such foods as cookies and margarine
  • Reduced calcium intake and increased magnesium intake

In addition to regular exercise, elimination of coffee, sugar, alcohol, dairy products, and natural progesterone replacement, these steps frequently succeeded in reducing the symptoms of PMS. A diet high in phytoestrogens or supplementation of isoflavone extract or DIM, as well as nutritional supplementation with nutrients high in fatty acids such as evening primrose oil or fish oil to reduce the inflammatory response also helps. Last and most importantly, the use of natural progesterone cream should be considered.

C. Fibrocystic Breast

One of the most common reasons why women visit the gynecologist is the discovery of a breast lump. Fortunately, not all lumps are cancerous.

After a needle biopsy and workup, many of these patients are told that they suffer from benign cystic breast disease. The patient is reassured that the lumps are not cancerous for now. However, it is most important to alert these patients that such lumps are the body’s cry for more progesterone. Estrogen promotes the growth and proliferation of breast cells. Breast fibrocysts are an overgrowth of these normal breast tissues. The primary causative factor is excessive estrogen. It is an early warning sign of progesterone deficiency and impending estrogen dominance.

Progesterone cream is a good remedy. Apply 20 mg of progesterone cream from ovulation (day 12 to 14) until the day or two before your period starts. Normal breast tissue will return within three to four months. In addition to reducing estrogen, supplementing with natural vitamin E (d-alpha tocopherol) and borage or evening primrose oil (omega-6) will help reduce the inflammatory response. Borage oil is preferred over evening primrose oil as it is more potent.

D. Pre-Menopausal Sydrome

Scientists have also identified a chronic condition similar to PMS, which they call pre-menopause syndrome. The symptoms are similar to those of menopause, but they often occur from the mid-thirties to early forties and years ahead of menopause. This may be due to primary ovulation failure and the resultant lack of progesterone output from the ovaries. More often than not, it is due to luteal failure (failure to produce enough progesterone) in pre-menopausal women. In addition, there may also be stress induced adrenal gland exhaustion leading to a reduction of progesterone output from the adrenal glands. The overall reduction in progesterone level leads to a relative excess of estrogen or estrogen dominance. Pre-menopausal syndrome may include PMS, fibrocystic breast, uterine fibroids, irregular periods, and endometriosis.

E. Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is a condition where multiple cysts are found on the ovaries together with other symptoms like anovulation (lack of ovulation), menstrual abnormalities, hirsutism (facial hair), male pattern baldness, acne, and often obesity. It is estimated that ten to twenty percent of women today have PCOS, and among young women, this figure could be even higher, thus qualifying PCOS as an epidemic.

PCOS takes place when the normal ovulation cycle of a woman is disrupted or stopped. This upsets the normal balance between the glands of the pituitary, hypothalamus, and ovarian axis. Under normal conditions, the hypothalamus regulates the hormone output of the ovaries and synchronizes the menstrual cycle.

PCOS happens when this cycle is disrupted due to unsuccessful ovulation. This could take place for a myriad of reasons, for example, the follicle migrates to the outside of the ovary, but does not pop the egg to release it. This follicle thus becomes a cyst and there will be no progesterone production. If for some reason these follicles are also unable to produce a mature egg that can secrete the progesterone, the menstrual cycle is dominated by increased estrogen and androgen production without progesterone. This hormonal imbalance is the main reason behind PCOS.

These women may concurrently have different degrees of insulin resistance (Syndrome X) and therefore higher incidence of Type II diabetes, unfavorable lipid patterns (usually high triglycerides, high LDL and low HDL cholesterol), and a low bone density. Laboratory tests often show higher than normal circulating androgens, especially testosterone.

Since standard tests usually indicate that a woman with PCOS has plenty of estrogen, and since she is still having periods, there is a danger that the doctor assumes she is still ovulating and producing plenty of progesterone.

F. Uterine Fibroids

Uterine fibroids (uterine leiomyomata) are non-cancerous tumors consisting of fibers or fibrous tissue that arise in the uterus. It is the most common tumor within the female genital tract. These growths are highly sensitive to estrogen. They develop following the onset of menstruation; enlarge during pregnancy, and decrease, often disappearing after menopause when the estrogen level decreases by half. They can be as small as a hen’s egg, or commonly grow to the size of an orange or grapefruit. The largest fibroid on record weighed over 100 pounds. It afflicts many women, especially from ages 35 to 50. One in four women in the U.S. have at least some evidence of fibroids. Discovery is usually accidental, and coincidental with heavier periods, irregular bleeding, and/or irregular bleeding, or work up for endometriosis or PMS.

In cases where the tumor’s size compromises other bodily functions such as compression of the bladder or excessive bleeding, surgery may be indicated. The most common surgery is hysterectomy where the uterus is removed. Many hysterectomies, however, are performed way before the patient reaches this stage. In fact, over 500,000 hysterectomies are performed every year in the US alone as mentioned earlier.

Fibrous tissues are sensitive to estrogen. The higher the estrogen, the faster the fibroid grows. While a fibroid in itself does not usually lead to cancer or become cancerous, it clearly signals a serious underlying imbalance in a woman’s reproductive and hormonal system. Specifically there is an estrogen dominance and progesterone deficiency. Such imbalance does not only affect the uterus, but affects other hormone-sensitive tissues such as breast, cervix, ovaries and the vagina as well. If not taken care of, the consequences can be devastating.

The fibroid is clearly one part of a continuum of disease associated with estrogen dominance.

G. Breast Cancer

Breast cancer is a rampant epidemic, striking one in nine women in the U.S. Up from 1 in 30 women in 1960, before estrogen replacement therapy was popularized. The greatest surge of breast cancer diagnoses is in the western hemisphere and now spreading globally to all industrialized countries. Among women between the ages of 18 to 54, it is the most common cause of death. It is also the top cancer killer among women aged 45 to 50.

There are many forms of breast cancer. Some grow slowly, while others are much more aggressive. Ninety percent of breast cancers start in the milk glands or milk ducts, and ten percent in the fatty or connective tissue. The size of the tumor alone is not an accurate marker for virulence. About fifteen percent of all breast cancer are called in situ carcinoma. This cancer is contained entirely within a milk duct with no invasion into surrounding tissue. Ninety-two percent of breast cancer stricken women aged 30 to 39 and forty-three percent of all breast cancer in women aged 40 to 49 has what is called ductal carcinoma in situ (DCIS). This is considered a precursor to invasive cancer. It is localized, but can be invasive. The diagnosis of DCIS has risen dramatically with the advent of mammogram, since it often presents as small calcifications on this test. Lobular carcinoma in situ (LCIS) occurs mostly in pre-menopausal women and does not form palpable mass. Its detection is therefore more difficult. About twenty-five percent of women with LCIS develop invasive breast cancer, often up to 40 years after finding the LCIS. Because of its low virulence, many oncologists think of LCIS as atypical hyperplasia (abnormal changes are found in the cells but not necessarily cancerous) with higher propensity of breast cancer. Lastly, invasive ductal and lobular breast cancers have the worst prognosis because cancer cells can spread relatively quickly. Breast cancers are usually discovered when a women feels a painless lump during a self-breast examination. Other symptoms include an area of dimpled, creased skin on the breast, vague discomfort in the breast; and indentation of the nipple.

FDA-approved estrogen drugs have been documented to cause cancer. Published studies have shown that women taking estrogen and a synthetic progesterone drug had a thirty-two to forty-six percent increase in their risk of breast cancer. This was based upon a large pool of data from the famous Nurses’ Health Study conducted at Harvard Medical School. This study showed that the carcinogenic risk of estrogen-progestin replacement therapy became most pronounced when it was used for 10 or more years. However, recent data from the Breast Cancer Detection Demonstration Project suggest that relative risk is increased by twenty percent even after four years of use compared to no hormone treatment, and that surprisingly there was a forty percent increased risk of breast cancer using both estrogen and synthetic progesterone (called progestin) combined, compared to only twenty percent increase for estrogen alone. Clearly, the progestin (such as Provera) that is supposed to counter-balance the estrogen is not what the body recognizes as good.

The body needs natural progesterone to counter the estrogen effect. Synthetic progesterone’s are far from the natural form. While some studies in fact show that estrogen does not cause cancer in the short-term, but in women taking estrogen and/or a synthetic progestin for more than 10 years, there appears to be a significantly elevated risk of breast, ovarian, and uterine cancers.

In addition to breast cancer risk, long-term estrogen replacement therapy increased the risk of fatal ovarian cancer. A large seven-year study included 240,073 pre- and post-menopausal women focuses on this. After adjusting for other risk factors, women who used estrogen for six to eight years had a forty percent higher risk of deadly ovarian tumors, while women who used estrogen drugs for 11 or more years had a startling seventy percent higher risk of dying from cancer of the ovaries.

The highest incidence of breast cancer occurs when women are in their mid-thirties to mid-forties. The peak time is about five years before menopause. During this time, levels of estrogen are still high in the body, but progesterone levels have already started, a precipitous drop. Studies have shown that by the time a lump is discovered in the breast, the tumor has been there already for about seven years. Clearly, non-genetically linked cancer is one that starts in a woman in her early thirties and is not a cancer of estrogen deficiency. This is the time when many women in industrialized nations have anovulatory cycles. As explained earlier, anovulation can be due to a variety of causes, the most important being stress and excessive xenoestrogen exposure during prenatal life. Women suffering from anovulation have reduced progesterone in their body and resulting unopposed estrogen and estrogen dominance.

Furthermore, xenoestrogens contribute to increased breast cancer risk by:

  • Direct and persistent stimulation of the breast ductal cells unaccompanied by progesterone
  • Damaging the ovaries, resulting in increased estrogen and decreased progesterone secretion
  • Suppression of the immune system

Clinicians have often reported seeing patients return with breast lumps six to twelve months after starting on HRT. This classic history reflects the effect of HRT on breast cells. Researchers have shown that estradiol increases breast cell proliferation rates by two hundred and thirty percent, while progesterone decrease it by more than four hundred percent. When estradiol is combined with progesterone, the normal proliferation rate is maintained. It is clear that unopposed estrogen (especially estradiol) is an important causative factor of breast cancer. This is well documented by numerous scientific studies. In addition, studies also show that estrogen stimulates breast cell (and breast cancer cell) hyperplasia and dysplasia whereas progesterone inhibits it. Pathologically, estradiol has been shown to stimulate and up-regulate the oncogene, Bcl-2, leading to cancer cell proliferation. Progesterone, on the other hand, up-regulates the p53 gene that increases apoptosis and blocks the Bcl-2 carcinogenic effect. It is clear that estrogen stimulates breast cancer while progesterone has the opposing effect.

Study after study has repeatedly shown that the majority of breast cancers in adult women are non-genetically linked, and upwards of eighty percent of breast cancer, is caused by estrogen dominance. Therefore, breast cancer can be cured and reversed if the body’s estrogen level is bought under control. It is not a coincidence that after menopause (and reduced rate of estrogen production), the rate of increase in the risk for breast cancer drops dramatically.

We shall not dwell in depth on breast cancer here. Suffice to say that reducing estrogen aggressively forms the key foundation to prevention and treatment of breast cancer.

© Copyright 2012 Michael Lam, M.D. All Rights Reserved.

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Zachary Benson

Is the ration of estrogen and progesterone at pre-menopause levels the reason why most women cannot have children at that age ? What does it say about a women’s body when the ration does not come in to play till age 50 or so ?

Dr. Lam

There are multiple reasons for conception diruptions, from structural to hormonal imbalances. overall, estrogen dominance is one of the common hormonal imbalances, and can often lead to hot flashes during menopause. In severe cases, estrogen dominance is related infertility as well.

Dr Lam.


oral natural progesterone is called Prometrium and identical to natural progesterone cream except you take it by mouth. Most conventional docs use the oral form because it is a prescription. The problem for many is that oral form is metabolized by the liver up to 85%, so if you have congested liver and or weak body, such as people in adrenal or chronic fatigue, oral form can make matters worse. The cream form is slower in delivery because the progesterone stays in the adipose tissue longer and thus is a more gentle form of delivery. It is also a lot less expansive. I dont find the need to use oral form except in people that cannot tolerate topical delivery. As far as other hormones, it is a complicated topic and through the years, there are many alternative pathways that can do the job if your doctor knows what they are doing. Conventional synthetic hormones are not usually encouraged due the many possible side effects. If you have PCOS and estrogen dominance, you have to be extra careful. if you are small frame, you also have to be very careful.

Dr Lam


I appreciate all of your articles you share! They are so helpful! My question for you is in regards to PCOS and estrogen dominance. My doctor wants to treat it using birth control but I am apprehensive about putting more hormones into my body. She is willing to explore other options but we are unsure what direction to take. Would it be better to take oral progesterone or to use the cream?