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How to Flush Out Excess Estrogen: A Clinician’s Take

Written by Dr. Michael Ruscio, DC on May 1, 2024

Written by Dr. Michael Ruscio, DC on May 1, 2024 — Reviewed by Dr. Hannah Hamlin

Using diet, lifestyle, and supplementary interventions to achieve hormonal balance

• Identifying the Problem: High Estrogen vs Estrogen Dominance|
• Addressing the Root Cause|
• How to Flush Out Excess Estrogen and Balance Hormones|
• Balance is Key|

Estrogen is notorious for its role in female reproductive health. For decades, much of the buzz around estrogen was in relation to its decrease during menopause and how it can be remediated with hormone replacement therapy. 

More recently, estrogen has become vilified as the culprit behind everything from weight loss resistance to PMS to digestive system upset. But, as you will learn in this article, estrogen isn’t the bad guy and hormonal balance is more complex than estrogen alone.  The main female sex hormones are estrogen and progesterone, and along with testosterone, these need to be in balance with each other in order for a number of functions to happen properly in the body—including, but not limited to, reproductive function.

But the concept of hormonal balance is actually a lot more complicated than simply adding or subtracting sex hormones. Understanding the effects of both endogenous (internal) and exogenous (external) factors on sex hormones and the endocrine system at large (all the hormonal systems of the body) is a big piece of addressing hormone imbalance. 

This is true no matter which hormones you’re addressing, but I’ll focus on how to flush out excess estrogen and balance sex hormones in this post. 

An important note: the functional medicine community, in particular, has often overly vilified estrogen and overstated the risk of estrogen dominance and/or excess estrogen. As a result, I’ve noticed an uptick in the number of women we see in the clinic concerned about doing an estrogen detox to maintain healthy estrogen levels. 

While it’s important to correct imbalances, it’s equally important to make sure you truly do have an estrogen issue before you begin attempting to lower your estrogen levels through herbs or pharmaceuticals. In many cases, women who believe they have excess estrogen actually have low estrogen levels– and decreasing estrogen even further can be problematic. 

Hormonal imbalances can contribute to all sorts of unwanted health issues, which range from inconvenient to incredibly serious— from PMS to ovarian or breast cancer, with a lot in between. By addressing underlying problems that may be causing high estrogen levels and/or estrogen dominance, you can take control of your health and wellness and start feeling better. 

The best approach to doing that involves lifestyle changes like reducing stress, reducing exposure to xenoestrogens, and adding in gentle exercise, dietary changes to regulate blood sugar, and a range of supplements and herbs like black cohosh and dong quai that can assist in balancing your hormone levels.

Key takeaway: It’s essential to be sure that you truly have excess estrogen before trying to reduce levels because lower estrogen levels can be problematic.

Identifying the Problem: High Estrogen vs Estrogen Dominance

Before we dive into the holistic approach for how to flush out excess estrogen, let’s define the difference between “too much estrogen” and “estrogen dominance.” In the case of high estrogen, there’s literally an excess of estrogen, irrespective of how much progesterone is present. In comparison, estrogen dominance can mean that you have normal estrogen levels but low progesterone. This imbalance between the two hormones can result in symptoms.

Abnormally high levels of estrogen levels in women can cause 1:

• Irregular periods
• Dense breast tissue
• Decreased sex drive

and can eventually lead to:

• Breast cancer
• Ovarian cancer
• Endometriosis
• Insulin resistance
• Polycystic ovary syndrome (PCOS)
• Uterine cancer
• Tumors of the ovaries or adrenal glands

Abnormally high levels of estrogen in men can cause 1:

• Infertility
• Erectile dysfunction
• Gynecomastia (enlarged breasts)

The term “estrogen dominance” simply means that the balance between estrogen and progesterone is off. It can mean low progesterone, even if your estrogen levels are normal, for example. It can also mean that both hormones are too high, but estrogen is higher than progesterone. The term “estrogen dominance” isn’t actually an official medical term, but the condition can result in one or some of the following symptoms 2:

• Cyclic breast tenderness or pain, or fibrocystic breasts, especially in the second half of the menstrual cycle
• Uterine fibroids
• Mood swings, irritability, and/or tearfulness with PMS
• Premenstrual headaches or “menstrual migraines”
• Acne, especially in the first half of the menstrual cycle
• Unusually heavy periods
• Abnormal timing of periods
• Weight gain around the hips and butt
• Signs of low progesterone:
  • Difficulty sleeping
  • Short cycles (21-24 days)
  • Spotting
  • PMS
• PCOS diagnosis
• Perimenopause, which typically occurs in your 40s and causes worse PMS, heavier periods, weight gain, hot flashes, and/or night sweats

While the goal in both cases is balanced hormones, it’s not enough to simply add progesterone to make that happen. In fact, progesterone therapy without estrogen can be harmful 3. 

Common side effects of taking progesterone on its own may include headache, nausea, back pain, dizziness, and an increased risk of blood clot development 4 5. The approaches to addressing each type of imbalance overlap, but understanding the potential symptoms of each will help clarify the best approach for you. Getting at the root cause of the imbalance is critical to long-term and comprehensive treatment.

Key takeaway: High estrogen is different than estrogen dominance. Either way, hormonal imbalance can cause a host of problems ranging from PMS and weight gain to endometriosis and PCOS. 

Estrogen Dominance and Low Estrogen

Importantly, it’s possible to have estrogen dominance while still having lower estrogen levels overall. It’s also possible to mistakenly overcorrect an imbalance by trying to reduce estrogen (or add unopposed progesterone) when it’s not actually the root of your symptoms. 

This is where the problem of the over-vilification of estrogen comes in. Some of the findings from the NIH Women’s Health Initiative study overly blamed estrogen for the hormonal problems they examined in the study, which has placed women experiencing symptoms in a position of being prescribed unnecessary hormonal interventions.

I’ve seen a lot of patients who are put on progesterone, despite the patient having really frank signs of estrogen insufficiency. This can further exacerbate an already existing hormone imbalance. If a patient’s estrogen levels are low—or even normal– we need to use clinical signs and symptoms to inform the recommendation of progesterone. 

It’s also important to keep in mind that stress can impact sex hormones and result in low progesterone. This is especially common among women who are of lower weight. 

Oftentimes, a simple herbal intervention (like black cohosh or dong quai) can be hugely helpful for these women, and the addition of prescription hormone therapy is totally unnecessary.  

Key takeaway: Estrogen is over-vilified. What’s more important is the balance between estrogen and progesterone, which is key for women’s health.

Addressing The Root Cause

Excessive estrogen (whether the excess is a result of high estrogen or estrogen dominance) can result from a number of factors. Some, such as perimenopause (which can cause estrogen dominance), are ultimately unavoidable for women, just as menopause is. But if you can identify certain contributing factors and address what’s addressable, you will be setting yourself on the right path to begin to balance your hormones over time.

Xenoestrogens

The least invasive factor to assess is exposure to synthetic xenoestrogens, which are chemicals that act like estrogen when they get into the body. These can lead to high estrogen levels. Bisphenol A (BPA) and phthalates in plastics and/or components of pesticides, cleaning products, soaps, cosmetics, and shampoos are all areas of exposure that can be eliminated by replacing the offending products 1. Here’s a list of common endocrine disruptors from the Environmental Working Group to use as a reference. 

Body Fat and Stress

Root causes that occur because of the physiology of your body, lifestyle choices, or external stressors will require a somewhat more nuanced approach. For example, excess body fat secretes estrogen, so reducing body fat can help reduce overall estrogen levels 1. Obviously, if losing body fat were simple and easy, everyone would have exactly the correct and healthy amount of body fat. However, taking small steps to gain muscle and lose fat may help balance your estrogen levels.

However, it’s possible that the excess  estrogen can make it harder to lose weight. It’s also possible that excess cortisol (the stress hormone) could be impeding fat loss and making it more difficult for the body to make adequate progesterone, creating further imbalance 1. Stress can dramatically impact sex hormones. Much like weight loss, mitigating stress can feel challenging as well. Finding the right stress management tactics that work for you and your lifestyle is a critical piece of the puzzle.

Alcohol and Poor Liver Function

Drinking too much alcohol can raise estrogen levels and damage your liver, which functions in part to break down and eliminate estrogen 1. Your liver also plays an important part in sugar metabolism (fructose), and a damaged liver can increase the likelihood of insulin resistance from metabolic syndrome.

Metabolic Syndrome and PCOS

Metabolic syndrome is a collection of symptoms that overlap with PCOS. When the body’s sensitivity to insulin goes down,  the activity of the enzyme aromatase (the primary enzyme involved in estrogen biosynthesis) goes up, and converts more testosterone to estrogen 6. Insulin resistance also reduces sex hormone binding globulin (SHBG), which allows more free estrogen to circulate in the body 6.

Metabolic syndrome and PCOS share symptoms like weight gain, high blood sugar, and insulin resistance. When it comes to high estrogen levels, insulin resistance is an overlooked root cause. As your body’s cells become more resistant to insulin and the pancreas pumps out more and more insulin to compensate for the resistance, an enzyme called aromatase increases. Aromatase is one of the enzymes needed to create sex hormones and it is stimulated by insulin. When aromatase is kicked into high gear, estrogen levels increase, and hormones become imbalanced.   

Gut Imbalance

Poor gut health can also contribute to estrogen dominance. Estrogen dominance and its symptoms, including irregular menstruation, mood swings, painful or heavy periods, bloating, and conditions including PCOS, may actually be caused by imbalances in the gut microbiome, which have been shown to disrupt estrogen levels 7 8.

Key takeaway: The root causes of estrogen imbalance include exposure to BPA and phthalates, excess body fat, unmanaged stress, alcohol consumption, insulin resistance, and gut dysbiosis.

How to Flush Out Excess Estrogen and Balance Your Hormones

After understanding some of the root causes of excess estrogen, you can probably guess what some of the recommendations will be in this section. Let’s start with the biggest and most important change: your diet.

What to Eat to Flush Out Excess Estrogen

One of the first steps to flush out excess estrogen is to do a proper elimination diet. The purpose of this detox diet is to reset the gut and discover which symptoms clear up just by removing the most irritating and inflammatory foods. This usually includes foods like sugar and alcohol (which we’ve already covered), processed foods, and fried foods, as well as foods that may be problematic for some (but not all) people, like dairy, grains, and/or eggs. 

Interestingly, foods that contain phytoestrogens may actually help your body get back into balance without adding even more estrogen into the mix. While you should consult your doctor before eating too much soy, flaxseeds have been shown to help balance female sex hormones, reduce symptoms of menopause like hot flashes and bone loss, and also slightly lower the risk of breast cancer 9. Flaxseeds and chia seeds are also rich in anti-inflammatory omega-3 fatty acids, so grind those up and add them to your fruit and veggie smoothie, or find an awesome chia seed pudding recipe like this.

Supporting liver detoxification and gut health through your diet is also a super important step in flushing out excess estrogen. If you tend toward constipation, it’s important to know that regular bowel movements are needed to avoid reabsorbing estrogen through your waste. Eating fiber-rich* foods like fruits, vegetables, and legumes is a great place to start. Fiber not only encourages healthy bowel movements, but it also feeds the healthy bacteria in your gut. 

*Take care not to overdo fiber, especially if you have SIBO or other gut challenges that are coinciding with your hormonal symptoms. Excessive fiber, especially those that fall into the high FODMAP categories, can exacerbate gut problems, which you want to avoid. 

You may also want to take a magnesium supplement, especially if you’re constipated. (See below for a list of recommended supplements.)

Foods that support your liver, especially cruciferous vegetables like broccoli, cauliflower, kale, and Brussels sprouts should be in the regular rotation (these are also high in fiber). These foods also contain a compound called indole-3-carbinol, which encourages certain metabolic pathways that protect against cancer. Flaxseed contains indole-3-carbinol too 6.

In addition to increasing your intake of healthy plant foods, eating healthy fats is also crucial. That’s because healthy fats are required to make cholesterol, and cholesterol is required to make adequate sex hormones 10. 

You need the proper ingredients to make the hormones if you plan to balance them out, so don’t be afraid of fat, even if you have a fat loss goal. By changing your diet in the ways I’ve outlined, you will likely begin to lose body fat naturally. Healthy fats include coconut oil, extra virgin olive oil, all sources of omega-3 fatty acids (fatty fish, fish oil, flax oil, walnut oil), avocados, and avocado oil.

Additional Tips to Flush Excess Estrogen: Lifestyle and Supplements

Even though diet is the most important place to start, a holistic approach to balancing your hormones will also include additional lifestyle changes. I’ve already mentioned reducing your exposure to xenoestrogens. Now that we’ve covered diet, let’s dive into some lifestyle tweaks and supplement options to help reduce your symptoms of estrogen dominance.

Lifestyle Changes

In addition to reducing your exposure to xenoestrogens, exercise, stress management, and proper sleep are all critical to hormonal balance.

Exercising often results in sweating—one of your body’s natural detoxification mechanisms. It can also aid in fat loss, improve your overall sense of well-being, improve insulin resistance, reduce your risk of developing metabolic syndrome, and it’s been shown to reduce estrogen levels 11.

Stress management will look different from person to person. I recognize that sometimes reading a recommendation like “stress management” in and of itself can be stressful. You may not always have time to do a yoga class. You can’t control the stressors coming at you, and life might feel relentless. But there are small things that even the busiest of us can manage. Taking deep breaths while doing the dishes, listening to relaxing music in the car, using part of your exercise time for quiet, gentle stretching, or starting the day with a simple 5-minute meditation are all simple relaxation techniques. You might be surprised at what spaces open up in your life when you begin to make yourself a priority.

Sleep is another critical piece for supporting detoxification and hormonal reset. It’s also linked to a healthy gut microbiome. If you need to take melatonin or herbal sleep aids to get quality sleep, start there. Proper sleep hygiene (including staying away from alcohol) will also help get you closer to a good night’s sleep. Sometimes hormonal imbalances can actually cause sleep disturbance, so be patient with yourself on this one.

Supplements

Supplements to support gut health, detoxification, and reduce inflammation are all foundational pieces of not only flushing excess estrogen but also your overall health and wellness. There are also certain supplements that can address your production of estrogen in its various types (estradiol and estrone).

Probiotics can improve the biodiversity of your gut, which can lead to a major cascade of health benefits, including reducing insulin resistance, reducing gut inflammation, and improving estrogen metabolism 8 12 13 14 15 16 17 18. Research shows that gut dysbiosis can disturb estrogen levels 8. PCOS, obesity, endometriosis, cardiovascular disease, and breast cancer) are associated with low bacterial diversity in the digestive tract 19.

Vitamins and minerals are rich in antioxidants, which are also anti-inflammatory and have been shown to improve hormonal balance and reduce the adverse symptoms of conditions like PCOS and PMS. Although diet is the preferred way to obtain vitamins, if you find that dietary changes aren’t enough, taking a daily multivitamin (or individual vitamins as needed) can help. The following nutrients have specifically been shown to aid in reducing symptoms of estrogen dominance:

• Vitamin B1 20 21 22
• Boron 20
• Vitamin B2 21 22
• Vitamin B6 21 22
• Vitamin D 20 23
• Vitamin E 20
• Vitamin K 20
• Magnesium 20 24 25
• Zinc 20 25 26 27
• Selenium 28 29 30
• Calcium 20 31 32 33
• Iron (only recommended when ferritin levels are lower than 57 ng/mL and no insulin resistance is present) 34

Herbal Supplements like fenugreek, dong quai, cohosh, resveratrol licorice, white peony, and chaste tree berry can all balance out your hormones, depending on what your condition and symptoms are. In the case of estrogen dominance (where you don’t necessarily need to lower your overall estrogen levels but may need a progesterone boost) fenugreek, licorice, white peony root, and chaste berry will serve to bolster your natural progesterone levels 35 36 37. In the case where you need to balance your estrogen levels, cohosh, dong quai, licorice, and resveratrol may be helpful 38 39 40 41 42 43 44 45 46 47. 

Other Considerations

If you haven’t had your thyroid checked, it might be time to do that, as a number of symptoms overlap with a thyroid imbalance. Your thyroid regulates body temperature, energy production, digestive function, body weight, nervous system function, and even fertility 48. So knowing your numbers and how well your thyroid is functioning is actually a pretty important part of hormonal balance. Furthermore, women are more likely to be thyroid patients than men, so it’s possible that your thyroid could be to blame for a number of issues 49 50.

The final consideration is hormonal birth control. Some doctors actually use hormonal birth control to help balance estrogen production. However, these hormones are synthetic and are not without side effects. They can affect your gut health, create nutrient deficiencies, and ultimately create additional hormonal problems down the line. This isn’t to say that no one should ever take hormonal birth control, but be wary of using it as a quick fix.

Key takeaway: Diet is the cornerstone when it comes to flushing out excess estrogen, but exercise, sleep, stress management, and even thyroid health are equally important. Supplements like probiotics, vitamins, and herbs can help you get back into balance. 

Balance is Key

As in pretty much all of life, balance is key. Whether you have too much estrogen or estrogen dominance, the approach to balance involves improving your diet, exercising, sleeping, and generally taking care of your mental health and well-being. 

Supplements to support gut health and hormonal balance are also a big piece of the puzzle, especially as you reach perimenopause and menopause. Taking progesterone on its own or putting a bandaid on the problem with hormonal birth control will not serve to solve the root cause of your imbalance, and it could make things worse.

If you’re struggling with your hormonal health, we’d love to help. Reach out to our clinic to set up an appointment.The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.