Estrogen dominance is the condition that “causes” most female hormonal imbalances and resultant symptoms. I use quotation marks around the word “causes” because there is obviously a cause to the estrogen dominance. Estrogen dominance has many causes and a whole book can be written about it.
The symptoms related to estrogen dominance are vast and can vary among individuals. Some symptoms include (but are not limited to): breast tenderness, low libido, depression, mood swings, anxiety, weight gain, fibrocystic breasts, headaches, infertility, irregular menstrual cycles, insomnia, hot flashes, uterine pain (possibly fibroids), digestive disturbances, bloating and water retention, cancer, etc.. Because there can be so many systems affected (e.g.: adrenal, thyroid, digestive, etc.) there can be even more symptoms.
In this article I’m going to explain two ways intestinal dysbiosis (or gastrointestinal microbial imbalances) can contribute to estrogen dominance.
Estrogen is ultimately detoxified in the liver through the phase II detox pathway called glucuronidation. During this process, estrogen molecules are bound to glucuronic acid. This process enables the estrogen to be inactivated and thus not cause an impact on physiology. After this process occurs in the liver, the newly formed complex is transported to the GI tract via bile (the route for many toxins to be disposed of). In an ideal world/body, the complex gets flushed down the toilet per se. However, when intestinal microbial imbalances exist (e.g.: an overgrowth or infestation of harmful bacteria, viruses, protozoa, and/or fungus), an increase in the activity of the enzyme beta-glucuronidase can occur. This enzyme is known to uncouple, or disconnect estrogen from glucuronic acid. The result is that estrogen can now be reabsorbed back into circulation and increase the total estrogen load of the body; and contribute to (or cause) estrogen dominance.
Another reason intestinal imbalances can contribute to estrogen dominance is in the way estrogen gets metabolized. The first phase of estrogen detoxification by the liver is known as hydroxylation. During this process, an “-OH” group is added to one of the carbon atoms on estrogen. When it’s added to the “2-carbon”, the end-product is known as 2-OH (or 2-hydroxy) estrogen. If the -OH group is added to the “4-carbon”, 4-OH estrogen is yielded, and when added to the “16-carbon”, 16-OH estrogen follows.
2-OH estrogen has a weak estrogenic effect. Meaning, 2-OH estrogen won’t contribute much to the harmful, proliferative [or harmful tissue-growing (as in cancer growth) effects] of estrogen. On the other hand, 4-OH and 16-OH estrogen will in fact contribute to the deleterious effects of estrogen. Intestinal microbial imbalances favor the production of (mostly) 16-OH estrogen and 4-OH estrogen, and away from the benign 2-OH estrogen. As a result, the classic symptoms and diseases of excess estrogens can occur.
Take home message: a healthy GI tract is much more important than simply avoiding GI symptoms. Additionally, simply treating symptoms of estrogen dominance and hormone imbalances with bio-identical hormones may not be the way to go!
Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology