Understanding Oestrogen Detox: Why It Matters (Part 1)

As women transition into perimenopause, the hormonal landscape can become a complex terrain to navigate. For example, a key characteristic of perimenopause is high (particularly in the earlier stages) and fluctuating oestrogen levels.

This can lead to a variety of physical and emotional symptoms. Understanding how to support your body to effectively detoxify (clear) your used oestrogen is essential for promoting well-being and health during this pivotal time.

In this blog (part 1), we’ll explore the importance of oestrogen detoxification, the first two phases of oestrogen detox, the factors that influence it, and how to support it.

In part 2 of this blog, we will look at the third phase, which occurs further down the chain in the gallbladder, gut microbiome, and intestines.

So, let’s delve into this essential topic, empowering you to embrace this transitional phase with confidence and knowledge.

What exactly is ‘oestrogen detoxification’?

Where oestrogen is concerned, you need to use it and swiftly lose it! This is a biological process known as estrogen metabolism, oestrogen clearance, or detoxification.

Efficiently clearing your used oestrogen from the body is ESSENTIAL for hormone health and your experience of perimenopause. That’s because inefficient clearance leads to a build up of oestrogen in the body, which causes many unwanted symptoms and intensifies a situation known as unopposed oestrogen.

Symptoms associated with oestrogen detoxification issues (leading to excess levels or a worsening of oestrogen dominance) include:

• Premenstrual Syndrome (PMS)
• Heavy periods and/or lots of clotting
• Breast pain, swelling or tenderness (in the second half of the cycle and before your period)
• Mood swings including low mood, anger, rage, and irritability
• Weight gain
• Water retention (‘puffy’ ankles and fingers)
• Headaches
• Histamine symptoms such as itchiness, headaches, bloating, or a stuffy nose
• Acne breakouts
• Fibroids or uterine cysts/polyps

These symptoms can be caused by high oestrogen levels and or low progesterone levels. 

It may sound counterintuitive, but oestrogen detoxification is also essential during the low oestrogen phases of life. Such as late perimenopause AND in menopause.

It also (and especially) applies to anyone using oestrogen replacement therapy. Basically, whatever stage of life you are in, efficient clearance of any oestrogen you do have, is essential for health.

How the liver supports oestrogen clearance

In the liver, there are 2 main phases of oestrogen breakdown, known simply as phase 1 and phase 2. This process is occurring 24/7, it never takes a break. Let’s take look at each of these phases in turn. Inefficient detoxification can lead to hormonal imbalance, affecting menstrual cycles, pregnancy, and menopause.

Phase 1 Oestrogen Detoxification

Once estrogen levels have circulated throughout the body – doing all the “jobs” they need to do, from keeping your hair shiny, your mood balanced, and your menstrual cycles healthy, to keeping your bones strong and supporting your metabolic health – they end up in the liver.

The liver breaks it down into oestrogen “metabolites” (break-down products). Then, the liver packages up the metabolites and delivers them to the intestines, for permanent removal from the body.

This breakdown (metabolism) and inactivation of your used oestrogen occurs in phase 1 of the liver detoxification process. A specific group of enzymes, called the CYP450 enzymes, help this phase to do it’s important work. 

In this phase, used oestrogen goes through a chemical process called Hydroxylation. Hydroxylation converts your oestrogens into 3 different metabolites; 2-Hydroxy-Oestrogen (2OH), 4-Hydroxy-Oestrogen (4OH), and 16-Hydroxy-Oestrogen (16OH).

You can think of 2OH as the well behaved, safe and preferred metabolite for used oestrogens to convert into. 4OH as the unruly, less preferred metabolite, and 16OH as somewhere in-between. Your liver will always break down oestrogen into all three metabolites (2OH, 4OH and 16OH). The ideal scenario is that the majority of it converts into the 2OH metabolite.

It’s a Delicate Hormone Balance

Some women have genetic polymorphisms (the presence of two or more variations on a specific DNA sequence), which can impact the enzymes responsible for the breakdown of oestrogen down into the various metabolites.

In this case, the body requires additional support to convert their oestrogen into the preferred (safest) metabolite (2OH). In the diagram below (taken from the DUTCH test), the piechart on the right shows an example of this person’s percentage split of the three metabolites versus the expected (healthy) split.

If too much oestrogen converts into the 4OH metabolite, it is harmful for health and increases the risk of oestrogen-driven cancers, including breast cancer.

If too much oestrogen converts into the 16OH metabolite, it may increase symptoms such as breast pain, heavy periods and fibroids. I use the Dutch Complete Hormones Urine Test on myself and my clients to check hormone metabolism.

Once oestrogen has gone through phase 1, it has to move quickly into phase 2. Because the metabolites it converts into during phase 1 can be toxic to your body and so they must move swiftly onto the next phase of processing, which makes them safe molecules, ready for permanent excretion.

Support For Phase 1

What’s great is that certain foods, botanicals, and nutrients can encourage phase 1 (hydroxylation) to work efficiently.

Maintaining hormone balance during this phase is crucial for alleviating symptoms associated with hormonal imbalances, such as PMS, weight gain, and mood swings.

The following foods are helpful and should ideally form part of your daily diet.

Things That Hinder Phase 1

Inflammatory foods can impede proper oestrogen processing, leading to excess oestrogen. They can prevent it from breaking down into 2OH metabolites and achieving the ideal percentage balance of all 3 metabolites.

This includes foods such as:

• Processed omega 6 oils, typically found in vegetable, rapeseed and sunflower cooking oils and sprays, margarines, processed foods, takeaways, deep-fried foods, confectionery and long-life baked goods. 
• High consumption of sugar and processed/refined carbohydrates
• Burned/charred/blackened meats
• Alcohol
• Pesticides

PHASE 2 OESTROGEN DETOXIFICATION

Then, in the second phase of oestrogen clearance, your liver takes your 2OH and 4OH (not 16OH) metabolites through a process called ‘methylation’, where it converts them into a further metabolite called 2-methoxy-oestrogen.

This occurs with the help of an enzyme called COMT (catechol-o-methyltransferase).

This methylation process neutralises the 2OH and 4OH metabolites, making them water-soluble molecules that can now safely be excreted from the body – via bile, stool, and urine.

Poor COMT enzyme activity can block methylation from occurring and lead to a build-up of the “intermediary molecules” from phase 1.

This becomes harmful to the body and hormone health.

To support this second phase, you need to support the COMT enzyme to work well. Some people can have genetic variations on this enzyme that can slow it down, causing it to be sluggish and work less efficiently. 

Support For Phase 2 

The good news is that certain ‘cofactor’ nutrients can support the COMT enzyme to work better, such as;

• Magnesium
• B Vitamins, particularly B12, B6 and folate (B9)
• Choline
• N-Acetyl-Cysteine (NAC) which comes from the amino acid (found in protein) L-cysteine
• Trimethylglycine or TMG (also referred to as betaine)

Chronic stress and inflammation can impair the COMT enzyme.

Where things can go wrong

Anything that impacts your liver’s ability to efficiently process and clear out used oestrogen is going to be a factor in symptoms and conditions associated with hormone imbalance.

Especially heavy and or painful periods, clotting, breast pain, headaches, mood swings and increased risk of fibroids, cysts and oestrogen-driven cancers.

An Over-burdened Liver

If other toxins are high, your liver will be overburdened, leading to hormonal imbalances and therefore not able to efficiently keep up with oestrogen detox.

The detoxification of alcohol, also a toxin, is prioritised over oestrogen detox, so if alcohol use is high and or frequent, this impacts oestrogen detox.

Factors That Increase The Liver’s Burden:

Environmental toxins and chemicals

Certain chemicals (also known as xenoestrogens), such as those found in plastics, pesticides, skin and hair care products, fragrances, sprays, makeup and household cleaning products and detergents, can mimic real oestrogen once they get inside the body.

This means they can enter into the cell, as if it were the real thing, and increase the body’s total load of oestrogen. This increases the detoxification burden on your liver. Additionally, environmental toxins can impact reproductive hormones, such as testosterone and progesterone, disrupting the delicate balance required for hormonal homeostasis.

Alcohol

Alcohol must be detoxified as soon as it reaches your liver. The clearance of alcohol takes absolute precedence over the detoxification of other toxins and used hormones. 

Acute consumption of alcohol has been shown to increase oestrogen levels in the body.

Can you test for the different phases? 

Yes.

Phases 1 and 2 can be tested through a urine test called the DUTCH test, I use with my clients via Regenerus Labs. Testing during different phases of the menstrual cycle is important to understand hormonal fluctuations and their impact on health.

Phase 3 can be evaluated through a comprehensive stool test, I use the GI Effects test from Genova Diagnostics.

These tests are what’s known as “functional testing”, which means they are not available on the NHS or via a conventional medicine doctor.

Your standard acute care doctor is unlikely to know about these tests. If you are interested in having either or both of these tests done, you would need to be working with a functional medicine doctor or a Nutritional Therapy practitioner such as myself.

In Part 2 of this blog, you will learn about the third (final) phase of used oestrogen clearance, which occurs primarily via the gallbladder, gut, and intestines. See you in part 2!