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How to Increase Estrogen Naturally (or Should You Do Hormone Therapy?)

Written by Dr. Michael Ruscio, DC on March 17, 2022

Written by Dr. Michael Ruscio, DC on March 17, 2022 — Reviewed by Dr. Hannah Hamlin

Your Guide to Balancing Estrogen Levels and Improving Hormonal Health

• Role of Estrogen|
• 6 Ways to Increase Estrogen|
• Acupuncture for Low Estrogen|
• Hormones and Your Gut|
• Does HRT Have a Place?|
• Low Levels of Estrogen Can Be Tweaked|

Mention “female hormones” and estrogen is the one that usually springs to mind for most of us.

Estrogen is produced in varying amounts throughout a woman’s fertile years, but levels start to flag as menopause approaches. Sometimes symptoms that mimic estrogen deficiency can occur even when estrogen is within normal limits, because of hormone imbalances (when estrogen is out of balance with other sex hormones like progesterone and testosterone).

How to increase estrogen is a question many women in their 40s and 50s ask when they start to get symptoms such as hot flashes and vaginal dryness.

In this article I’ll walk you through how to increase or balance estrogen levels with the help of diet, supplements, and other natural methods, and when to consider hormone therapy.

The Role of Estrogen in a Woman’s Health

Estrogen is one of the sex hormones made in the body from cholesterol, which is one reasons it’s not a good idea to eat a very low-fat diet if you’re concerned about low estrogen. It’s responsible for the development of breasts and reproductive function during puberty 1. Estrogen’s roles include 2 3 4:

• Maintaining vaginal blood flow and lubrication
• Causing the regrowth of the womb’s interior wall sloughed off during menstruation (progesterone then takes over, turning it into a cozy place for an egg to implant and grow)
• Keeping the vaginal lining elastic
• Helping preserve bone strength
• Decreasing stress by impacting cortisol levels
• Regulating cholesterol and triglyceride metabolism, which protects women from heart disease

Estrogen / Progesterone Balance

Estrogen levels fluctuate throughout each menstrual cycle during a woman’s fertile years. They peak and fall dramatically just before ovulation (when an egg is released mid-cycle) and have a steadier increase and decrease in the second half of the menstrual cycle (the luteal phase).

Meanwhile progesterone, an opposing hormone, stays lower than estrogen during the first half of the menstrual cycle (the follicular phase), but is higher than estrogen during the luteal phase. Progesterone’s role is to get the uterus ready to accept and maintain a fertilized egg. If pregnancy doesn’t happen, the womb lining sheds (a menstrual period) and progesterone levels fall.

How to Increase Estrogen: 6 Helpful Supplements and Foods

When you’re wondering how to increase estrogen levels or ease estrogen deficiency symptoms, consuming the right diet and supplements can make a big difference.

Some research has suggested that a Mediterranean-style diet helps improve ovarian function, which can result in a more finely tuned balance of estrogen and progesterone 5. Fresh, unprocessed foods that dampen down inflammation are partly what makes the Mediterranean diet so healthy, and are also at the heart of a balanced Paleo diet. Many of our female patients find Paleo eating particularly helpful for promoting good hormonal balance.

Paleo has the added benefit of being good at controlling blood sugar and insulin levels 6, which is a key strategy in dealing with unbalanced hormone conditions such as polycystic ovary syndrome (PCOS).

Once you have a good diet in place, you can take extra steps to raise low estrogen levels and balance female hormone levels by introducing some key supplements. There are many that are touted as useful, but these six have the best research backing them:

1. Dehydroepiandrosterone (DHEA)

DHEA is a hormone produced by the body’s adrenal glands, which can also be taken as a supplement. Research has shown that a form of estrogen called estradiol increased in women over 60 who took DHEA at a dosage of 50mg per day for at least six months 7. Generally, DHEA supplements have been safely used in studies for up to two years without severe side effects 8 9. However, DHEA can have potent effects, so it’s very important to discuss usage with a clinician well-versed in using this supplement before getting started.

2. Ashwagandha 

This herb, used in Ayurverdic medicine, has been associated with a statistically significant increase in serum estradiol in menopausal women 10. Those taking the herb also had a statistically significant reduction in menopausal symptoms that interfered with their quality of life.

3. Fenugreek 

Taken as a supplement, fenugreek seed extract can boost estrogen levels in younger women age 20-49, according to a study to investigate herbs that may affect sexual desire. In this group of healthy menstruating women who reported a low sex drive, taking fenugreek extract was associated with both higher estradiol and testosterone levels, as well as improved sexual desire and arousal compared with a placebo group 11.

4. Phytoestrogen/Isoflavones

Phytoestrogens are natural chemicals in plant foods that have a mild estrogen-boosting effect. Isoflavones are the major class of phytoestrogens, found in soybeans and soy products, nuts and seeds (such as sesame seeds and flax seeds), and chickpeas and other legumes. Eating these foods regularly may help to top up flagging estrogen levels, but isoflavone supplements are a more reliable way to mitigate low-estrogen symptoms 12 13 14 15. It’s best to consult with a practitioner before taking these supplements.

5. Herbal Combinations 

Combination therapy using a blend of herbal ingredients may be more effective for raising or balancing estrogen levels than individual herbs 16. This certainly matches our clinical experience at the Ruscio Institute for Functional Medicine.

For example, gamma oryzanol, black cohosh, dong quai, licorice, and trans-resveratrol is a blend we recommend to women to boost estrogen levels. Other benefits associated with the ingredients in this blend are 17 18 19 20 21 22:

• Reduced hot flashes and night sweats (gamma oryzanol, dong quai, licorice, black cohosh)
• Improved sleep in women with sleep disturbances (black cohosh)
• Heart-protecting benefits (resveratrol)
• Improved mood and cognition (gamma oryzanol and resveratrol)

Licorice, white peony, and chasteberry can also help correct the symptoms of low estrogen 16, but clinical experience suggests this combination is more relevant in cases where there’s hormone imbalance, contributing to problems like PCOS and premenstrual syndrome (PMS).

6. Prunes 

Prunes (dried plums) may seem like a surprise addition to your healthy-hormone dietary toolkit, but these dried fruits can benefit bone health in postmenopausal women who have a higher risk of osteoporosis due to low estrogen levels. A daily dose of five to six prunes was effective in reducing body bone loss in one randomized controlled trial, perhaps as a result of the phenols in the fruit limiting bone breakdown 23.

Acupuncture for Low Estrogen Levels

Acupuncture is another therapy that might be of use for low estrogen levels.

A 2020 systematic review and meta-analysis looked at acupuncture for effectiveness at treating premature ovarian failure (early menopause), which is commonly treated with hormone replacement therapy (HRT). The review concluded that 24:

• Standard acupuncture was as effective as HRT at improving menopausal symptoms.
• Acupuncture and acupoint embedding were the best at improving estrogen (estradiol) levels.

Acupuncture can also help manage stress and ease the sleep difficulties that plague so many menopausal women 25 26.

Your Gut Health Influences Your Hormones

When considering how to increase estrogen, the health of your gut is something to bear in mind. In particular, the quality of your gut microbiota can have an impact on the balance of female hormones 27 28 29.

Some signs of hormonal imbalances, such as PCOS and painful periods, have been associated with low microbial diversity 30 31 and a leaky gut 31 32 33. A healthy gut may contribute to stable hormone levels 28, and stable hormones may improve gut health 33 34.

Plus, if you’re taking phytoestrogens, healthy gut microbes play a large role in metabolizing them and transforming them into their bioactive forms, ideally helping to relieve menopause symptoms 35.

Though there’s no direct evidence that taking probiotics can increase low estrogen levels, probiotics can help to correct gut bacteria imbalance (dysbiosis), which means your gut is in a better place to support a healthy hormonal balance overall.

What Causes Low Estrogen Symptoms?

Low estrogen levels occur when the ovaries become less active and produce less of the hormone. This happens naturally over a period of months or years running up to menopause 36 37.

Estrogen and progesterone can also become unbalanced in younger women. More commonly this results in there being a relative excess of estrogen — so-called estrogen dominance 38. However, hormones can become unbalanced in a way that causes a relative deficiency of estrogen, too 39.

Menopause is the biggest reason for low estrogen levels. Other causes include 36:

• Eating disorders that can deprive the body of nutrients required to make estrogen 
• Genetic conditions, including Turner syndrome and Fragile X syndrome
• Autoimmune disorders that attack the ovaries and inhibit their ability to produce estrogen
• Medical treatments, including chemo and radiation therapy for cancer
• Disorders of the pituitary gland
• Extreme over-exercising

Below is a table showing the symptoms of low estrogen versus high estrogen. It’s worth noting there’s some overlap. 

When considering if or how to increase estrogen levels, you might want to talk to your practitioner about blood tests that can help determine snapshot levels of various forms of estrogen in your body 36. Other types of testing, such as DUTCH or ZRT Labs menstrual mapping (using dried urine), may provide a more comprehensive picture of hormone levels throughout an extended period of time, such as a whole menstrual cycle 40.

All these tests have their limitations however, and it can be more informative to listen to what your body is telling you in terms of signs and symptoms.

Does HRT Have a Place?

While doing things naturally is a good goal, hormone replacement therapy can be safe and effective if more natural treatments don’t work

The bottom line is that HRT comes with a complex set of potential benefits and downsides that each require careful consideration for patients who haven’t benefited from more natural approaches 43.

Beyond the alleviation of menopausal symptoms (through increasing estrogen), HRT has these benefits:

• Decreased risks of bone fracture, diabetes, and esophageal, gastric, and colorectal cancers 44 45 46 47 48
• Possibly reduced risk of cardiovascular disease and all-cause mortality in women under 60 or within 10 years of menopause (though more research is needed to validate this) 48

The downsides include a slightly increased risk of blood clots and hormone-dependent breast cancers 48 49 50 51.

Overall, the negative side effects of HRT may have been overhyped and the treatment appears not to appreciably raise health risks if used for no more than five to 10 years 52.

How to increase estrogen in the safest way with HRT involves using topical estrogen (applied to the skin), rather than an oral form, which can increase the risk of clots. Bioidentical progesterone should be taken alongside to protect the wall of the womb from estrogen-related thickening 52.

Low Levels of Estrogen Can Be Improved

With the right diet and supplement, figuring out how to increase estrogen becomes an easier puzzle to solve. You should be able to restore your level to one that’s appropriate for your stage of life, whether that’s the fertile years or beyond. A combination of herbs can be particularly useful for gently shoring up estrogen levels at menopause or for balancing out an estrogen deficiency at any time of life.

Acupuncture is something else to consider, or if more help is needed, hormone replacement therapy is worthy of consideration — under the right circumstances it can be safe and very effective.

For more individualized support around hormonal health, you can request a consultation with me or a colleague at the Ruscio Institute for Functional Medicine.

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, including the hormone-balancers Estro-Harmony and Progest-Harmony, please click on the relevant links. Note that there are many other options available, and we encourage you to research which products may be right for you.