Oestrogen Dominance In Perimenopause: What You Need to Know

Perimenopause is the natural phase in a woman’s life that starts the body’s slow and gradual transition towards eventually reaching menopause. 

One common yet frequently misunderstood aspect of perimenopause is a situation known as “oestrogen dominance” or “estrogen dominance”. 

Also called “unopposed oestrogen”, this situation can cause many unwanted symptoms or worsening of some previously experienced ones. 

In this blog, we’ll explore what oestrogen dominance is, why it’s more likely in perimenopause, and how you can address it. 

Whether you’re just starting to notice changes or are deep into perimenopause, this blog will provide you with essential information and practical tips to navigate this challenging yet natural phase of life.

Your Hormones In Perimenopause 

Many people still assume that oestrogen starts to decline as soon as they move into perimenopause, but actually, estrogen levels rise and fluctuate erratically during this phase, which can be as early as mid to late 30s. 

Perimenopause starts with high (and erratically fluctuating) oestrogen and ends with low levels (menopause). In other words, oestrogen gets higher (sometimes even 3 times higher than ever before) before it starts to decline. 

Oestrogen usually only starts to decline in the later phase of perimenopause, approximately mid to late forties.

Progesterone however, unlike oestrogen, DOES start to decline from early perimenopause. The decline in progesterone coupled with higher and erratically fluctuating oestrogen sets the stage for oestrogen dominance. 

These fluctuations can lead to a hormonal imbalance, contributing to various symptoms experienced during perimenopause.

As mentioned already, the terms “oestrogen dominance” and “unopposed oestrogen” mean the same thing and are often used interchangeably. However, for consistency in this blog, I will use the term “oestrogen dominance”.

What Exactly Is Oestrogen Dominance?

Oestrogen and progesterone work together throughout the menstrual (hormone) cycle. Maintaining a proper hormone balance between estrogen and progesterone is crucial for a healthy menstrual cycle. 

In a healthy menstrual cycle, oestrogen dominates in the first half of the cycle (the follicular phase) while progesterone levels dominate in the second half (the luteal phase). 

See the diagram below and for more detail about the menstrual cycle you can read my blog here.

How Does Oestrogen Dominance Occur?

The situation of oestrogen dominance occurs when the body doesn’t make any or enough progesterone in the second half of the cycle, resulting in oestrogen being the dominant hormone in both halves of the cycle. 

Another way to describe it is that progesterone does not oppose oestrogen, hence the term ‘unopposed oestrogen.’

Hopefully you can understand that, contrary to popular belief, oestrogen doesn’t have to be in excess in order for a person to be oestrogen dominant / have oestrogen dominance. 

When oestrogen levels are high, the symptoms associated with oestrogen dominance are felt more intensely.

Excess estrogen in the body can exacerbate the symptoms of oestrogen dominance.

Why is Unopposed Oestrogen More Common in Perimenopause?

A menstrual cycle is, by definition, an ovulatory cycle in which ovulation is the main event and progesterone is made. 

Oestrogen dominance is more likely in perimenopause due to hormonal imbalances that occur as ovulation becomes less frequent. 

Ovulatory cycles are the only way to make progesterone, therefore the less ovulatory cycles a woman achieves, the less progesterone she makes. 

Menstrual cycles where ovulation does not occur are called anovulatory cycles.

This leaves oestrogen unopposed by progesterone and therefore the dominant hormone across that cycle, leading to symptoms of elevated estrogen levels. 

Further, when ovulation does occur, the body may not always make the robust levels of progesterone of previous years. This can be due to various factors, such as an unhealthy corpus luteum formation, the small temporary gland formed during ovulation that releases progesterone into the system. 

For more on how progesterone is made and how to optimise it, read my blog here.

Symptoms Of Oestrogen Dominance

Typical symptoms 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
• 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
• Weight gain, particularly around the midsection and hips.

These are some of the common symptoms of high estrogen levels in the body.

Other Reasons For Oestrogen Dominance Symptoms Aside From Low Progesterone

High Oestrogen Levels

Oestrogen excess makes oestrogen dominance worse and or more likely. This is when there is excess oestrogen in the body. 

A few of common reasons for this are: 

1) Poor oestrogen clearance / oestrogen detox issues

When it comes to oestrogen, you need to use it and efficiently lose it to maintain healthy estrogen levels. 

This is a process known as oestrogen detoxification or oestrogen metabolism. It refers to a two-step process, primarily occurring in the liver, known as Phase 1 and Phase 2 oestrogen detox. These 2 steps/phases are where your body breaks down oestrogen to get rid of it safely once you’ve used it. 

This process happens 24/7, 365 days a year. Unfortunately, this intricate biological liver process can go awry and start to go in the wrong direction, leading to inefficient detox processes and used oestrogen remaining in the body. Proper oestrogen clearance is essential for maintaining hormone balance.

Furthermore, after the two phases of oestrogen breakdown have taken place in the liver, the third phase of the oestrogen detoxification process moves down to the gallbladder, gut microbiome, the intestines, and the kidneys. 

Therefore, if you are not passing healthy stools at least once per day, peeing, sweating and staying hydrated, you may have oestrogen back-up issues.

Foods such as cruciferous vegetables, broccoli sprouts, onions, garlic, and oily fish can support the detox pathways in the liver. Nutrients such as magnesium, methylfolate, methylB12, choline, methionine, zinc, vitamin B2, vitamin B3, and molybdenum are also important.

To support the third phase of clearance, you want to support a healthy gallbladder, gut microbiome, and intestines. 

Helpful tips include:

• Proper hydration with water and quality electrolytes
• Chew your food (really, really properly chew your food) and take your time over your meals
• Consider bile support such as supplementing with bile acids (such as TUDCA or ox bile), and increasing bitter greens and herbs in your diet
• Taking quality probiotics and prebiotics

I go into more detail on oestrogen detoxification in my blog post here.

2) Hormone-disrupting Chemicals

Certain chemicals, found in our everyday environment and certain products we use, disrupt the endocrine system, leading to hormone imbalance and wreaking havoc on the production, communication, and action of hormones. 

Also known as “xenoestrogens”, they mimic real oestrogen and once inside the body, they can enter the cell, increasing your body’s total load of oestrogen.

Plastics, pesticides, commercial skin and hair care products, fragrances, sprays, makeup, and household cleaning products and detergents contain hormone-disrupting chemicals.

What can you do?

• Filter your water (e.g., Brita jug filter or Berkey)
• Use glass, ceramic, or stainless steel for cooking, heating, storing, and drinking
• Switch to cleaner skincare brands like Green People, Antipodes, Sukin, Jason, Ren, Neal’s Yard, Tropic, and others
• Choose cleaner household cleaning and detergent brands such as Bio-D, Method, and Attitude.

3) Alcohol

Alcohol must be detoxified as soon as it reaches your liver and this will always take precedence over the detoxification of other toxins and used hormones. 

Studies show that consuming alcohol acutely increases high estrogen levels in the body. The less alcohol you can drink in your 40s the better. 

Find any small ways you can reduce your consumption, and over time, it makes a difference!

Wrapping Up

One of the most important things you can do to prevent or minimise oestrogen dominance in perimenopause is support your body to ovulate as many months as possible, so that you make progesterone as many months as possible. Ovulation is about so much more than fertility. 

Ovulation is the definition of a healthy menstrual (hormone) cycle and MUCH smoother perimenopause experience. Check out my blog here, where I explain how to support ovulation and track whether it has occurred.