Estrogen dominance is one of the most common hormonal patterns we see at FUTURE WOMAN, yet it’s often oversimplified. Many women assume it means “too much estrogen” and try to fix it by cutting out foods, adding supplements, or detoxing more. In reality, estrogen dominance is much more complex with multiple possible drivers.
How your body clears used estrogen, and processes hormones through the liver and gut all matter just as much as how much estrogen you make. And progesterone production is vitally important too. Understanding which estrogen dominance pattern is affecting you is what allows you to stop guessing and start making targeted, effective changes.
What is estrogen dominance?
Estrogen dominance refers to a hormonal picture where estrogen’s effects are not sufficiently balanced by progesterone. Common symptoms include heavy or painful periods, intense PMS, breast tenderness, bloating, headaches, and conditions such as fibroids or endometriosis.
Importantly, estrogen does not need to be high or out of range for estrogen dominance to occur. In clinical practice, the term actually covers several distinct underlying issues, including low progesterone production and problems with estrogen metabolism and clearance.
At FUTURE WOMAN, we identify six different estrogen dominance types through our comprehensive hormone testing. Each one has different drivers and requires a different approach. We outline all six in this article, along with their most common causes and how we address them.
Why estrogen needs to be opposed by progesterone
Estrogen is a vital hormone involved in bone health, cardiovascular function, and brain health, but it must be balanced by progesterone. During the second half of the menstrual cycle, progesterone should be roughly 100 times higher than estrogen. When this ratio is disrupted, symptoms can begin to appear.
The most well-known example of this balance is in the uterus. Estrogen builds the uterine lining, while progesterone stabilises and thins it, helping to prevent heavy or painful periods. But this balancing act happens throughout the body.
Progesterone has a calming effect on the nervous system, counteracting estrogen’s stimulating influence on the brain. It also acts as a natural antihistamine, helping to offset estrogen’s tendency to increase histamine release. These are just two examples of how progesterone protects the body from estrogen’s overstimulating effects.
Crucially, estrogen dominance can occur even when estrogen levels are low or normal. Progesterone may be too low due to poor or absent ovulation, or used estrogen may not be cleared efficiently through the liver and gut. Often, more than one of these factors is involved.
At FUTURE WOMAN, we use the Advanced Hormone Test to identify the real drivers behind an estrogen dominance picture, then address them with a personalised 12-week plan.
Who is affected by estrogen dominance?
Estrogen dominance is extremely common and can be experienced by cycling women of all ages. It’s particularly common in early perimenopause where estrogen levels can surge as progesterone levels start to fall away.
You can also experience estrogen dominance if you’re using hormone therapy and your estrogen dose is not sufficiently opposed by a body or bio identical progesterone. That’s because progestins, the synthetic form of progesterone, only opposes estrogen’s effects in the uterus.
The six estrogen dominance types
So let’s go through the six distinct estrogen dominance types we see at FUTURE WOMAN with our Advanced Hormone Test and how we address them in your 12 week plan.
1. High Overall Estrogen (The Over-Producer)
The first estrogen dominance type occurs when the body is simply producing too much estrogen in one or more of its three forms.
The causes: This can be driven by excess body fat, as fat tissue can secrete its own estrogen. It can also be caused by an over-expression of the aromatase enzyme, which converts androgens into estrogen, or by exposure to xenostrogens: environmental toxins found in plastics and fragranced products that mimic estrogen in the body.
What to do about it: In your 12 week plan, our practitioners will recommend specific nutritional strategies to lower overall production. This often includes cutting alcohol to support the liver and targeted supplements to help clear excess hormones from circulation. We also guide you on how to reduce your toxic load.
2. Low Progesterone (The Ovulation Struggle)
This is a very common scenario where estrogen dominates because there is not enough progesterone to keep it in check. We look for a serum equivalent luteal phase reading of progesterone of more than 10ng/mL to feel the full body benefits of progesterone.
The causes: Progesterone is only made after you ovulate. If ovulation is sporadic or missing, which can happen due to chronic stress, perimenopause, or conditions like PCOS, your progesterone levels will be low. Dysregulated cortisol can also impact progesterone levels because the body prioritises survival over reproduction, downregulating sex hormone production.
What to do about it: Your personalised plan will focus on supporting healthy ovulation for as long as possible. Our practitioners might recommend targeted supplements to support the adrenal glands or the communication pathway between the brain and the ovaries. We may also help you to prioritise sending improved safety signals to the body with strategies to improve nutrient intake, sleep hygiene and blood sugar.
3. The 16-OH Preference (The Proliferative Pathway)
Once estrogen is used, it moves to the liver for Phase 1 detoxification. There are three possible pathways your estrogen can move down: the 2-OH, 4-OH or 16-OH. This estrogen dominance type occurs when your body sends more estrogen down the 16-OH pathway, relative to the other pathways.
This pathway is highly proliferative, meaning it acts as a loud amplifier for estrogen’s message. If more than 30% of your estrogen takes this route, it can accelerate tissue growth, leading to cramps, heavy bleeding, and tender breasts.
The causes: Genetics, inflammation, environmental toxins and stress can all play a role in 16-OH preference.
What to do about it: If your results show this preference, your 12 week plan will likely include anti-inflammatory and antioxidant support. Supplements like DIM which work to lower estrogen, can make this preference worse, which is why knowing your estrogen dominance type is so important.
4. The 4-OH Preference (The Inflammatory Risk)
Another Phase 1 pathway is the 4-OH pathway. This is the least favored of the Phase 1 pathways because it is the most unstable. High levels of the 4-OH metabolite are linked to increased inflammation and the formation of quinones, which can cause DNA damage.
The causes: This preference can be influenced by genetics, but it is also exacerbated by poor liver health and high toxin exposure.
What to do about it: To address this risk, we focus on supplements to nudge your body back toward the safer 2-OH pathway. Your practitioner might also recommend strategies to reduce toxin exposure and support liver health.
5. Slow Methylation (The Phase 2 Traffic Jam)
In Phase 2 detoxification, your liver must make estrogen water soluble so it can be safely excreted. This involves a process called methylation. If methylation is slow, used estrogen metabolites cannot be neutralised and they may recirculate in the body.
The causes: This is often caused by genetic variants on the COMT gene or deficiencies in key nutrients like B12, B6, and folate, as well as chronic stress.
What to do about it: Our testing specifically looks at the ratio of your metabolites to see how quickly or slowly you methylate. If methylation is slow, our practitioners might recommend supplements to support the COMT enzyme. We also work on foundational stress reduction to prevent cortisol from further slowing down this vital process. If you have an issue with Phase 1 and Phase 2, then addressing Phase 2 is the priority.
6. Poor Phase 3 and Bad Gut Health (The Reabsorption Loop)
Phase 3 estrogen detoxification is the final stage of hormone clearance, taking place primarily in the gut, where estrogen is intended to be permanently removed from the body via urine and stool. The estrobolome is a specific group of microbes within your gut microbiome dedicated to this process.
If you have gut dysbiosis (an imbalance of bacteria), certain microbes can release an enzyme called beta-glucuronidase. This enzyme acts like a pair of scissors that unpackages the estrogen you were about to eliminate, allowing it to be reabsorbed back into your bloodstream.
The causes: Gut dysbiosis is the main driver of this estrogen dominance type – we test for Indican, a specific marker of gut dysbiosis, in our Advanced Hormone Test to see if this is happening to you. Constipation also fuels this cycle by giving estrogen more time to sit in the colon and be recycled.
What to do about it: Your 12 week plan will focus on gut healing, which may include increasing fiber intake, addressing food sensitivities, and using targeted probiotics or other supplements to repair the gut lining. If you have issues with Phase 1 or Phase 2 as well as Phase 3, then our practitioners will prioritise Phase 3 support.
How to discover your estrogen dominance type
If you recognise yourself in one or more of these patterns, the most important thing to know is that symptoms alone cannot tell you which estrogen dominance type is driving them. Two women with identical symptoms can have completely different underlying issues, and therefore need very different solutions. That’s why at FUTURE WOMAN we test over 30 markers, including estrogen and progesterone, detoxification pathways, stress hormones, and gut health, to build a personalised plan that targets the real root cause. Identifying your estrogen dominance type is the crucial first step toward finally feeling balanced again.
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