Understanding relative oestrogen excess
Relative oestrogen excess is not having ‘too much oestrogen’, but refers to the ‘relative’ excess of oestrogen in a woman’s body in relation to other hormones. When discussing relative oestrogen excess, we examine factors that increase a woman’s exposure to oestrogen throughout her life, and her propensity to have more oestrogen floating around more often for varying reasons. This state is referred to as ‘relative’ because it is describing oestrogen levels that are unusually high relative to other hormones. It may not mean that oestrogen is high.
There is no one test that can determine whether a woman has relative oestrogen excess, but we can look at a range of factors to try to figure it out. It may not need treatment as such, but too much oestrogen is never a good thing.
Factors that can increase exposure to oestrogen throughout our lives
- What age we get our first period (menarche)
- What age we hit menopause
- Obesity (but not being overweight – fat cells facilitate the conversion of androgens (like testosterone) to oestrogen
- Hormone therapies
- Environmental oestrogens (called xenoestrogens, found in plastic water bottles, takeaway containers, water supply
- Unknown reasons
Causes of relative oestrogen excess
The more menstrual cycles you have (periods, if you like), the more oestrogen you are exposed to across each cycle. Factors that reduce your total lifetime periods include how many times you are pregnant (long periods without periods), if you breastfeed your babies (breastfeeding suppresses your normal menstrual cycle due to high levels of prolactin, required to produce milk, preventing ovulation), when you got your first period ever, and when you get your last period ever.
Women now, particularly in the western world, have vastly different lifetime exposure to oestrogen than our foremothers. This is because we have fewer pregnancies, decreased rates of breastfeeding, earlier onset of puberty and periods, and later menopause, all resulting in more menstrual cycles and thus more overall oestrogen exposure.
This increase in overall exposure means we are seeing the same proportional increase in oestrogen-dependent conditions like endometriosis, fibroids, adenomyosis, endometrial and breast cancers, and fibrocystic breast disease.
Oestrogens in hormone therapies
Hormone replacement therapy (HRT) may bump up overall oestrogen exposure when given to women over age 55. Early menopause may be managed with hormone therapy to help protect bone density up to age 55, which is not believed to adversely affect health. This age cut-off is around what would normally occur over a normal life, where fertile years end with natural menopause at about age 50.
Unopposed oestrogens as a cause of relative oestrogen excess
If progesterone levels are low or absent, oestrogen has no opposite force to keep it in check, which results in unopposed oestrogen floating around your system. Free roaming unopposed oestrogen – which comes with a lack of the oppressor, progesterone – occurs when ovulation has stopped for some reason or is irregular (including when nearing menopause). Once menopause occurs, the ovaries stop producing oestrogen, so there is no longer unopposed oestrogen, or much else hormonally.
Progesterone is thought to moderate the forceful effect of oestrogen on tissues. There are a few key things observed in women who are not regularly ovulating, and therefore have low or absent progesterone, including the proliferation of oestrogen-responsive tissues in the breasts and endometrium. Healthy progesterone levels appears to reduce the risk of endometriosis and fibroids.
In a fertile-aged woman who has a regular, healthy menstrual cycle, the endometrium is shed every period – all those excess endometrial cells that were produced under the influence of oestrogen disappear down the toilet. When there is no ovulation, there is no period, so the endometrial lining stays put. These cells can overgrow and facilitate cancers. This is why a healthy menstrual cycle and HRT (for menopausal women who still have a uterus) containing both oestrogen and progesterone protects us against these types of oestrogen-fed proliferation cancers. Oestrogen given alone to menopausal women increases rates of endometrial cancer.
Benign breast conditions can be worsened by relative oestrogen excess, while premenstrual syndrome (PMS) can also be aggravated. In PMS, hormone levels may not appear unusual, however, despite signs and symptoms.
How obesity affects oestrogen levels
Ovulation can be disrupted by obesity due to increased levels of a specific type of oestrogen, particularly oestrone (E1), which is produced via fat cells. The more fat you have, the more E1 is produced through the activation of an enzyme present in fat cells, aromatase, that converts androgens to E1. This is not cyclic, thus constantly exposing an obese woman to a greater source of oestrogen over a longer time. Polycystic ovarian syndrome can also result in a lack of ovulation, and the same types of endometrial issues.
Oestradiol (E2), by contrast, is produced by the ovaries in varying amounts across a normal menstrual cycle. Levels drop off just before a period, and increase in the ramp-up to and after ovulation.
It is important to note that being overweight does not cause these oestrogen-related risk factors to increase; this only occurs in severely overweight women.
How your body shape affects oestrogen levels
Interestingly (and somewhat mysteriously), the distribution of fat on your body determines how much sex hormone-binding globulin (SHBG) you have snatching up oestrogen, and thus more free-floating oestrogen. Women who gain their weight on the top half (both visceral and abdominal) fall into this category.
How your digestive system affects oestrogen levels
Your liver, kidneys and bowel are responsible for taking oestrogen from your bloodstream, where it can fit into receptors and cause oestrogenic effects, and out of your body. Not only do you need these organs in proper working order to clear oestrogen effectively, you need a set of nutrients to make this complex chain of events occur in the order and speed in which it is designed.
Chronic constipation, for example, can result in oestrogen not being cleared out of the bowel fast enough and being recirculated, while a meat/fat-heavy diet can increase certain bacteria that ultimately cause oestrogen to be recycled. Our diet plays an enormous role in the daily theatre of our digestive tract, with some foods known to increase and others to decrease oestrogen levels in the blood.
Low fibre, high carbohydrate, and high saturated fat diets all come with a caveat: higher risk of oestrogen-dependent problems. Conversely, plant oestrogens can reduce circulating oestrogen effects by plugging up oestrogen receptors with a low-fi, low-risk imposter – phytoestrogens, which are about 300 times weaker than normal oestrogens. Diet plays an incredibly interesting role in oestrogen levels.
How our environment contributes to relative oestrogen excess
Our hormonal systems are affected by our environment in a few ways, with one important contributor to relative oestrogen excess being environmental oestrogens (xenoestrogens). These oestrogens appear from what we might think of as unlikely sources, for example a water system that pumps ‘sanitised’ water cleaned of bugs and crap, but not the oestrogen peed out by women on the pill every day. The Thames River in London, England, for example, has some interesting specimens appearing as a result of environmental oestrogens.
Closer to our skin are items like sunscreen, plastics, make-up, and a thousand other common, everyday items. We are exposed to these ingredients everyday from before we are born until death.
Oestrogen metabolism – the pathway to salvation
Oestrogens are metabolised into one of two things using one of two pathways. One pathway leads to a carcinogenic, DNA-damaging, strongly oestrogenic metabolite (the C-16 pathway), while the other pathway results in a comparatively insipid metabolite (the C-2 pathway).
How or why each of us produces more or less of either metabolite is unknown, but we do know that cruciferous vegetables, coffee (but not if you are on the pill), and linseed are favourites to end up down the path of least resistance, the C-2 pathway.
What to do about relative oestrogen excess
Figuring out what’s going on is the first and most important step, since it will dictate what treatments or management strategies are appropriate. There are a handful of approaches taken by practitioners, however what you are presented with will be deeply impacted by who you see – every practitioner will deal with this in a different way using their various toolkits. It’s wise to have a variety of options, do your homework, and evaluate the risks and benefits of every treatment on offer.
It’s important to understand that unopposed oestrogen over long periods of time, for example if you stop getting periods and ovulating, can be risky business. An integrative approach is a useful place to start, since many practitioners can care for you with complementary strategies provided by multiple practitioners as required.
What your doctor will do about relative oestrogen excess
After investigations for an underlying problem, you may be offered progestogens, which is a synthetic form of progesterone that acts the same in terms of opposing oestrogen and flicking the switches of receptors. Oral contraceptives may be suggested; if obesity is a factor, weight loss strategies need to be considered; and even menopause may be induced if symptoms are severe. The specific causes will be individually treated.
What your naturopath will do about relative oestrogen excess
The first thing that will be evaluated will be diet and lifestyle choices, to clear out the low-hanging fruit of a diet and digestive tract that likes to cling on to oestrogen and throw it back in the ring for round two. Focussing on oestrogen clearance is an important part of managing relative oestrogen excess, with some herbal formulas prescribed to stimulate the liver.
If you are not ovulating, understanding why will provide other treatment strategies to overcome this. Ovulating is a necessary and natural element in managing relative oestrogen excess.
With food, digestion, lifestyle and ovulation taken care of, a huge step forward in reducing unfavourable oestrogens will have occurred. These changes often take some time to implement.