Dr. Michael Ruscio, DC is a clinician, Naturopathic Practitioner, clinical researcher, author, and adjunct professor at the University of Bridgeport. His work has been published in peer-reviewed medical journals and he speaks at conferences around the globe.
Is Estrogen a True Villain or Simply Misunderstood?
High estrogen symptoms include irregular menstrual cycles, dense breast tissue, mood swings/irritability, weight gain, acne, and many others.
High estrogen symptoms can result from a true excess of estrogen levels, or you might have estrogen dominance (relatively high estrogen in relation to low progesterone).
While excess estrogen and estrogen dominance symptoms are similar, these are two different conditions that can require different treatments.
It’s important to address hormone imbalances from the perspective of balancing all hormones, not necessarily targeting one or the other.
Treating high estrogen involves identifying the source of the high estrogen and reducing it, as well as helping the body detoxify excess estrogen.
Gut health is heavily tied to hormone balance and detoxification and should be addressed as part of treatment.
Hormone-balancing herbs are greatly useful as a starting treatment, alongside diet and lifestyle modifications as needed. If you are still experiencing symptoms, hormone replacement therapy (HRT) may be a next step.
Dealing with high estrogen symptoms can throw you into the confusing and ever-changing world of estrogen dominance. While excess estrogen can certainly be the culprit of heavy menstrual bleeding, migraines, and acne, what many don’t know is that low progesterone (or even low estrogen) can be behind your symptoms.
If your symptoms have you feeling like you don’t know which way is up or where to turn for help, don’t worry. This article will break down the differences between high estrogen symptoms, estrogen dominance, and low estrogen symptoms. We’ll also dispel some myths around estrogen itself and its recent role as a scapegoat for a majority of hormonal issues.
What is Estrogen?
Estrogen is a sex hormone that is present in both women and men, but it’s present at much higher levels and is more commonly associated with women and the female reproductive system.
There are three types of estrogen — estriol, estrone, and estradiol — with the most common being estradiol. But for simplicity’s sake, we’ll just call it estrogen. Estrogen is essential to the menstrual cycle, stimulating the regrowth of the endometrium (the uterine interior wall that is sloughed off during menstruation) during the follicular and luteal phases .
Like progesterone, estrogen levels naturally fluctuate throughout the menstrual cycle. Estrogen is normally highest in the follicular phase, during the first half of the menstrual cycle. It is also associated with higher energy levels and sex drive, bone health, heart health, and cholesterol and triglyceride metabolism .
In general, estrogen is associated with growth in all cells and tissues, while progesterone is associated with inhibition and cell differentiation . This associates too high estrogen levels with conditions like breast and ovarian cancer, endometriosis, and polycystic ovarian syndrome or PCOS, diseases of cell overgrowth and overproliferation.
However, these conditions can also be caused by an imbalance of progesterone to estrogen where progesterone is too low, causing estrogen to become “dominant.” We’ll discuss this further in the upcoming section.
Team E&P: The Estrogen/Progesterone Relationship
Estrogen and progesterone should work together in a tightly controlled relationship, one preventing imbalance in the other. In the first half of the menstrual cycle, the peak of estrogen just before ovulation triggers the release of luteinizing hormone, which signals ovulation (the release of a mature egg from the ovary, without which pregnancy can not occur).
When ovulation occurs, progesterone begins to rise and peak during the luteal phase as estrogen steadily decreases. If pregnancy does not occur, both sex hormones steadily fall until menstruation begins, and the cycle starts over again.
Despite this close relationship, estrogen is often still thought of as the dominant hormone in women, especially in a conventional medicine context where estrogen-based birth control is prescribed for many hormone-related conditions. However, we should always keep the estrogen-progesterone relationship in mind when considering treatment for conditions like PCOS, hormonal migraines, and even PMS symptoms.
An imbalance in the estrogen-progesterone relationship can look like :
High levels of estrogen and low or normal progesterone, causing high estrogen symptoms
Normal levels of estrogen and low progesterone (which may still exhibit as symptoms of “high” estrogen levels)
Low estrogen and low progesterone, but where estrogen is still dominant to progesterone, causing symptoms
High estrogen and high progesterone, which is less common and occurs with granulosa cell tumors that excrete lots of both hormones  and sometimes breast cancer
There is a time where low estrogen and low progesterone are normal, and that’s during menopause. But aside from during her menses, a woman in her 20s or 30s should not be experiencing low levels of these sex hormones as a regular and “normal” part of life.
Symptoms of High Estrogen Levels (vs. Estrogen Dominance)
When you have genuinely too-high estrogen levels that are outside the lab reference range, aka a medically recognized condition called estrogen excess (not necessarily high estrogen in relationship to progesterone, aka estrogen dominance), the following may occur :
Irregular timing of menstrual cycles
Irregular bleeding during the period
Dense breast tissue
Mood issues, especially irritability, anger, or having a “short fuse”
Increased risk for blood clots, stroke, and estrogen-related cancers
Excess estrogen can also lead to a lot of the following symptoms that are seen in estrogen dominance. Estrogen dominance, where estrogen is “high” in relation to low progesterone, even if estrogen levels are physiologically normal (or even low), may cause:
Cyclic breast tenderness or pain, or fibrocystic breasts, especially in the second half of the menstrual cycle
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
Short cycles (21-24 days)
A PCOS diagnosis
Perimenopause, which typically occurs in your 40s and causes worse PMS, heavier periods, weight gain, hot flashes, and/or night sweats
It’s important to distinguish between these two issues by consulting with a knowledgeable practitioner. Whether you have truly high estrogen levels or not will affect your treatment options. If you have abnormally high estrogen levels, you will have to work on detoxing the excess estrogen from your body and figure out where that excess estrogen is coming from (birth control medication, xenoestrogen exposure in cosmetics and plastics, stress, excess body fat, etc.).
On the other hand, if you have normal or low estrogen alongside relatively lower progesterone, treatment may look completely different. Your practitioner may recommend bioidentical progesterone to raise your progesterone levels as well as bioidentical estrogen if necessary, but hormone replacement therapy (HRT) doesn’t fix the underlying cause of the imbalance in most cases (unless the cause is menopause).
If you are a premenopausal woman and you don’t want to jump straight to hormone replacement therapy, there are many herbal preparations that can help regulate and balance hormone levels. The best part about these herbs is that they often act as adaptogens, meaning they work to bring hormone levels back into balance whether they are high or low.
They promote homeostasis (balance) within the body, which is incredibly important when restoring the tight-knit relationship that your hormones have with one another. Diet and exercise also work to naturally balance all of your hormones (adrenal, thyroid, sex hormones, etc.), if HRT doesn’t feel right for you as a first step.
Causes of High Estrogen
If you find that you do have truly high estrogen levels, you need to figure out the root cause. Some potential causes could include :
Prescription birth control
Hormone replacement therapy that is not yet balanced and has too much estrogen
Excess body fat, which secretes estrogen
Stress and the cortisol response may impact the body’s ability to make progesterone, which functions in part to keep estrogen at the right level
Drinking too much alcohol, which can raise estrogen and inhibit the body’s natural methods of estrogen metabolism
A poorly functioning liver, which functions in part to break down and eliminate estrogen
Synthetic xenoestrogens (chemicals such as bisphenol A (BPA) and phthalates in plastics or components of pesticides, cleaning products, soaps, and shampoos) that act like estrogen when they get into the body
Granulosa cell tumors that secrete lots of estrogen and progesterone 
When you reach the point of having high estrogen symptoms, it’s likely that you’ll find more than one root cause of the problem, but you may only need to make significant changes in one or two areas to relieve your symptoms. Still, it never hurts to address stress, alcohol consumption, and liver support as part of your treatment plan.
In addition to reducing your estrogen exposure, you’ll also want to look at how your body is breaking down and eliminating estrogen from your body.
Estrogen Metabolism and Your Gut Health
Your gut health plays a huge role in controlling estrogen levels in the body.
Research has actually shown that 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 [6, 7].
Certain gut bacteria also determine whether estrogen will be excreted from the body or absorbed and recirculated. If you’re not having regular bowel movements, odds are good that you’re reabsorbing some estrogen that should have been taken out with the trash.
Make sure that addressing your gut health — whether you need a comprehensive protocol that includes diet, probiotics, and potentially other gut-healing supplements, or simple tweaks that support better gut motility and digestion — is a central part of your hormone healing journey. Supporting gut health is a foundational step to rebalancing estrogen and progesterone and normalizing your monthly cycle.
Is Estrogen a True Villain, or Simply Misunderstood?
While most conventional doctors are quick to prescribe estrogen or dismiss it as a root cause of hormone issues, many integrative and holistic practitioners can be too quick to demonize estrogen and promote progesterone as a miracle solution.
But we see many younger women at the Ruscio Institute for Functional Medicine come in with low progesterone andlow estrogen, and these patients respond best when we address both hormones (often using herbal adaptogens alongside the foundations of diet, stress management, and gut health).
Despite the bad press it’s gotten over the last several years, estrogen isn’t simply a necessary evil we have to put up with for the body to remain healthy. Estrogen has many positive benefits for both men’s and women’s health when it stays within a normal range. We should always make sure to look at the estrogen-to-progesterone ratio when evaluating hormone imbalances, not simply supplement one hormone or the other.
Work With an Unbiased Professional to Achieve Hormone Balance
If you walk away with one thing from this conversation on high estrogen, estrogen dominance, and other hormone imbalances, look for a trusted health professional who can help you navigate your symptoms and address the estrogen to progesterone relationship from an unbiased perspective.
Your symptoms may appear to be textbook estrogen dominance, for example, but the underlying issue may actually be low progesterone instead of high estrogen. Or you may have low estrogen and low progesterone together. From there, you want to figure out the root cause of the imbalance, support your detoxification pathways, and promote homeostasis in the body through diet and lifestyle foundations.
At the Ruscio Institute for Functional Medicine, we work with many patients on identifying and treating hormone imbalances, including high estrogen, but just as often, low estrogen. We never assume you have one or the other and always evaluate you individually to determine the right treatment plan. If you’re interested in working with us, reach out and schedule a free consultation call.
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.
Campbell M, Jialal I. Physiology, Endocrine Hormones. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. PMID: 30860733.
Hariri L, Rehman A. Estradiol. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. PMID: 31747204.
Prior JC. Women’s reproductive system as balanced estradiol and progesterone actions—A revolutionary, paradigm-shifting concept in women’s health. Drug Discovery Today: Disease Models. 2020;32:31–40. DOI: 10.1016/j.ddmod.2020.11.005.
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