The Interaction of Estrogen and Calcium

By: Michael Lam, MD, MPH; Carrie Lam, MD

Estrogen and Calcium: Facts about women's healthHere is a good clinical case to illustrate estrogen and calcium, and the interrelationship between these three important factors for healthy aging. Here is some background: A 65 year old patient in good health with family history of hypertension. She has had a complete hysterectomy 6 years ago and is on hormone replacement of synthetic estrogen (Premarin) 0.625 mg once a day. A major question is: How do estrogen and calcium interact in a low magnesium condition?

The patient wishes to take calcium and magnesium but is not sure how much.

Here are My Thoughts on Estrogen and Calcium:

  1. She should not be on unopposed estrogen especially Premarin, (synthetic estrogen). That is a sure prescription for worsening hormonal imbalance (estrogen dominance). Though this is not your main question, you need to be careful. Consider progesterone (natural) cream to counter the effect and taper of estrogen.
  2. Too high a calcium level leads to increased coagulation and increased risk of vascular accident. Too low a magnesium (and 80% of modern day diet is low in magnesium) will raise the ca/mg ratio, causing similar problem as too much calcium.
  3. Most adults are walking around with estrogen dominance due to our diet and exposure to environmental estrogen. Excessive estrogen reduces circulating Magnesium, leading to a relative excess of calcium. So any excessive calcium will only increase even more the already high ca/mg ratio in the presence of high estrogen. The lesions of arteries and heart caused by experimental Mg deficiency have been well documented and may contribute to human cardiovascular disease. Estrogen’s enhancement of Mg utilization and uptake by soft tissues and bone may explain resistance of young women to heart disease and osteoporosis, as well as increased prevalence of these diseases when estrogen secretion ceases.
  4. In summary
    1. Most of us are in an estrogen dominant environment, resulting in lowered Magnesium.
    2. Most of us can easily get into a calcium dominant environment. Reason: Too little magnesium.
    3. Most of us are in a magnesium deficient state.

As a Result, We All End Up with Too Much Calcium

When discussing estrogen and calcium in the body, we need to understand how stress works. Under stress, the body’s hypothalamic-pituitary-adrenal (HPA) axis is activated, essentially speeding up the body to fight stress. This action includes speeding up the heart rate. The adrenal glands secrete cortisol to fight the stress. Ideally, the effects of stress are handled adequately, and the body slows down again. But if stress continues, the adrenals may become unable to keep up with the demand for cortisol, eventually reaching a state of complete fatigue, not allowing a slow down.

Adequate addressing of stress and its detrimental effects requires physicians to adopt the NeuroEndoMetabolic model of stress response. This model considers all the interacting systems of the body and the effects of stress on them. The cardionomic system is disrupted under continued stress and may lead to significant heart involvement. High blood pressure, palpitations, arrhythmias, and even atrial fibrillation may result. This constant activation of the cardionomic system doesn’t allow for rest and repair needed by our bodies.

As shown in conditions of low magnesium and high calcium that can occur in the presence of a high estrogen environment, heart involvement will be present. Previously, the conventional wisdom was estrogen protected women against heart disease. And at menopause, estrogen needed to be replaced to continue this protection. However, research has more recently linked hormone replacement therapy (the use of synthetic estrogen) to higher risk of heart attack.

In addition, low magnesium levels have also been linked to heart disease. In fact, some researchers believe low magnesium levels to be the best predictor of heart disease, rather than high fat levels in the diet and high cholesterol.
So, elevated levels of calcium and low levels of magnesium raise the likelihood of heart disease. This, estrogen dominance, too much calcium, and not enough magnesium set the stage for heart-related health problems to develop too easily.

Estrogen and Calcium supplementation as important as magnesiumWhat do you do? Simply reduce calcium intake and increase magnesium. The ideal ratio is Ca/Mg ratio of 1 to 2 for adults. The same rule does not apply to growing children, and does not apply to those who are on whole food.

a. Obtain intracellular calcium and magnesium blood level if you want to be scientific about it.
b. Reduce calcium to 300-500 mg a day.
c. Increase magnesium to 500-1000 a day, or as tolerated (excessive amount can cause diarrhea).

Estrogen and Calcium supplementation as important as magnesium
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I just wanted to thank you for your info on lone a-fib. I have had 4 episodes in 12 years, the last happening in January of this year. I’ve added Hawthorn Berry and Magnesium to my diet, along with Armour Thyroid for my hypothyroidism. I play golf 3 times a week and walked every hole. Thanks Dr. Lam!


  • T. says:

    Thank you for the feedback.

  • T. says:

    Thank you for addressing calcium magnesium effects. How might this is apply to women newly in menopause that have low estrogen and low progesterone? Is there another article that may better address my needs when seeking the right balance of calcium magnesium?

    • Dr.Lam says:

      Women’s need for magnesium is greater than calcium overall. If you can tolerate it without diarrhea, a 2:1 magnesium to calcium ratio is optimum

      Dr Lam

  • Sharona Ramrajkar says:

    I am 46 years old and suffering from severe urine infections. Applying esgrogen cream is helping me to reduce these infections. I used to get uringe infection every month in my monthly periods. Now I get them about every 4 months because of the help of estrogen cream but extra estogen is also causing in me the magnesium deficiancy. How should I tackle this problem.

    • Dr.Lam says:

      The way to detect mangesium deficiency is by what is called a RBC magnesium level. Serum low in magnesium is not reflective. Having said that , most people are megnesium deficient and the easiest way is to supplement with magnesium orally. So I am not very sure when you say you are “deficient” in magnesium, what you really mean to being with. So that is the first thing you need to make sure. Estrogen usually does not help with UTI unless they are triggered by hormonal issues and you need to see a doctor to make sure you track it to the root and see what is really going on, especially if you are nearing menopause. these are just some ideas. your question may appear simply but the physiology is actually quite complex.

      Dr Lam

  • Jennifer says:

    How would we change our diet to reflect more balance within Calcium and Magnesium?

    • Dr. Lam says:

      The balance of calcium and magnesium rest largely on pH balance of the body. When you alkalize the body , such as by taking more vegetables relative to meat, the body balance is shifted towards magnesium bias. So that can be a first step without taking supplements.

      Dr Lam