Estrogen Dominance – How Can We Avoid It?

🙂 TIME TO LEARN: ESTROGEN DOMINANCE – HOW CAN WE AVOID IT?

👉🏻 FINALLY – this month we will start discussing the most requested topic – HORMONES! Before we get into the THICK of this topic in my newsletter below, I also want to share my favorite book on this topic as I will reference it – WHAT YOUR DOCTOR MAY NOT TELL YOU ABOUT PREMENOPAUSE BY DR JOHN LEE (it’s an oldy but goody!). I have never read a book where I agree with everything the author has to say (like some of his views on estrogen replacement therapy) but concerning estrogen dominance and the use of bioidentical progesterone he is a fabulous source of information. His book helps any woman that is still reproductive understand not only the importance of maintaining female hormone balance but he gives you a handbook for how to do it. I don’t want to gate keep information but for the simplicity of an email format – I will refer to his book in the newsletter – directing you to additional information if you’re interested in expanding your knowledge.

Alright now – let’s dive in… 🏄‍♀️

HORMONES ARE LIKE PERSONAL FINANCE…

😞 …since both can directly affect your well being and success in life you would think you would be educated in school on these important topics but you aren’t. In my opinion, doctors are not even educated adequately about hormonal health. If you’re new here and wonder where I got my expertise you can read more about me at drbrendasmithmd.com (where you can see my background and read MY Back Story).

When I graduated from medical school in the mid 1980’s hormone receptors were still being discovered and mainstream medicine had not yet adopted the use of bioidentical hormones. Back then it was common to ignore women’s hormonal complaints and women were subjected to various treatments that did not address the underlying hormone imbalance – such as birth control pills and antidepressants. Slowly, over the years, things have improved but even in 2025 most medical providers still seem to have a poor understanding and little time for addressing female hormones (insurance allows about 10 minutes for an office visit!). Making things even more confusing is that hormone researchers can’t seem to agree on many facets of female hormone health. What we have ended up with is a mish-mash of hormone recommendations and a lot of hormone confusion. 😫

So let me share with you important hormone concepts and hormone caveats I have learned that will help you avoid common female hormone imbalances. 💪🏻 As always, I will discuss the problems we women commonly encounter but I will also provide HEALTH YOURSELF ACTIONS to help you improve your health.

I am going to start with a “BIG PICTURE VIEW” of the female hormones. A common mistake in managing hormone health is to zero in on a treatment without trying to understand and address the underlying root cause.

Estrogen and progesterone are the primary “female” hormones that dictate your ability to have a normal cycle and conceive. As I will be discussing, they are just one part of an interconnected hormone “web”. To put things in perspective -The female hormones are very important but they are actually “minor” hormones – aka you can live without them. Major hormones in the body such as your thyroid hormones and adrenal hormones – you can’t live without. This is just one of the reasons that when you’re dealing with evaluating hormones – you have to look at many facets of your health.

🚨 THE PROBLEM – WHY ARE SO MANY WOMEN EXPERIENCING FEMALE HORMONE ISSUES SUCH AS EARLY PUBERTY, CYCLE DISTURBANCES, PMS, INFERTILITY AND DIFFICULT MENOPAUSE?

IMPORTANT FEMALE HORMONE FACTS:

Balanced hormonal health depends on proper SIGNALING. Almost every system in the body works by signaling and hormones are no exception.

The primary female hormones – estrogen and progesterone are called sex steroid hormones. Estrogen and progesterone are made in cells from cholesterol – (primarily in the ovary) when the pituitary gland in the brain stimulates their production. ( see diagram on page 25 of Dr Lee’s book). Once produced, the female hormones can actually go into a cell’s nucleus and “SPEAK” to your DNA. Once your DNA is activated by the hormones, instructions are given to the body – such as to grow breasts, begin menstruating or prepare your body for a pregnancy. Since female hormones have receptors in cells throughout your body – they can also affect your brain chemistry, energy and metabolism to name just a few of the important functions they help to orchestrate.

For the female body to operate correctly there is a lot of COMPLEX “CROSS TALK” that occurs between multiple hormones. Communication occurs between hormones produced in the brain and the peripheral hormones produced in endocrine glands such as the ovaries, thyroid, adrenals and pancreas. Hormone production is also affected by signals from your environment and your general health status. Hormones don’t just decide to become willy-nilly messengers- they become imbalanced due to disturbances in this complicated network. Here are some examples – if the adrenals are producing too much cortisol (the stress hormone), if the thyroid is under or over producing its hormones, if you are missing key nutrients in your diet, if your circadian rhythm (light/dark/seasonal signals) is out of sync – normal sexual development, menstrual cycles and fertility may be affected. The cross talk occurring in the body is basically saying – NOW WOULD NOT BE A GOOD TIME TO REPRODUCE. I know we hear it all the time and intuitively know it’s true – but it’s hard to have normal female hormones if you ignore foundational health practices such as spending time in nature, proper nutrition, exercise, sleep, and stress management. We can dive deeper into these foundational health practices in future newsletters – as each deserves a spotlight. Today I am just going to emphasize how important overall health is to female hormonal health. I know for a busy woman it’s not easy to find the time to take care of yourself. My advice – do what you can -when you can! Obviously, if you’re experiencing hormonal issues that you want to solve – you will need to prioritize healthy habits.

Each hormone in the body has a unique chemical structure or shape. When the shape of a particular hormone fits onto its receptor ( the key in a lock analogy) then that tissue gets a message. Estrogen tends to be a building or stimulating hormone – it can grow your uterine lining, enlarge your breasts and it can stimulate your brain. Progesterone tends to be the counterbalance to estrogen – it can stop the continued growth of your uterine lining and it calms your brain.

The proper timing of female hormone production is also important with estrogen being produced the first half of your cycle. Estrogen reaches a peak midway in your cycle resulting in ovulation. After ovulation progesterone is the dominant hormone that is produced. If you do not conceive that month hormones drop and the cycle starts over. It’s a carefully timed dance between these two hormones (see the diagram on page 59 of Dr Lee’s book). The problem in the modern world is that we are exposed to man made signals and man made chemicals that can mimic or interfere with our natural estrogen and progesterone = HORMONE HAVOC! Man-made chemicals and signals can sometimes get on a hormone receptor and block the natural hormone from landing on and speaking to that receptor. Other hormone disrupters interfere by landing on estrogen or progesterone receptors and overstimulating the production of that hormone. Finally, hormone disruptors can interfere with hormones produced in the brain (the hypothalamus and pituitary). These important brain hormones communicate with the ovary – instructing the ovary when, what and how much hormone to produce. With so many artificial substances in our environment it is easy to see how HORMONE MESSAGES CAN BECOME GARBLED!

❤️ HEALTH YOURSELF ACTIONS:

🌿 Spend time outside in nature to receive important signals from the environment. In a natural environment you get the benefits of fresh air, natural sunlight and contact with the earth. I personally like to try and see the sunrise and get exposure to early morning light while grounding! All of this is important for the health of my mitochondria (tiny powerhouses that run important cellular functions). It turns out that healthy ovaries have more mitochondria than any other tissue. (reference article)

🍎 Consume a varied whole food diet that maintains your normal weight. Adequate nutrients found in real foods are needed to make hormones and to properly metabolize hormones so they don’t build up in the body. You also want to avoid the chemicals and hormones found in many industrialized foods. I personally try to avoid packaged/ processed/restaurant food whenever I can since it is not nutrient dense, often contains hormone disrupters and is high in calories.
🏃🏽‍♀️‍➡️ Exercise in moderation. Excessive exercise is a stress for the body. What your body will tolerate is different for everyone but if you have hormonal issues it may be a sign that the intensity of your exercise is not correct for you.
😴 Get adequate sleep – which for most people is at least 8 hours (use your body as a guide). Important hormone signaling occurs at night when we sleep. I’m great at this now but as an Ob/Gyn and when I was a mom of young children, my sleep suffered (as did my health). Again – Just do the best you can – but if your hormones are off – do try to make it a priority.
🧘🏻‍♀️ De-stress each day. I get it – I get it! This can seem very hard to do in today’s fast paced world. Your body does however need to strike a balance between the sympathetic ( fright or flight) and parasympathetic (rest and digest) nervous system. The great news is it doesn’t have to be equal time. Quick moments of gratitude, time in nature, slow breathing are all examples that can help. When I was a busy mother my favorite place to de-stress was when I didn’t have kids in my car. No news, no scrolling – just quiet time. Look for those little windows of time during the day -AND RESIST THE URGE TO MULTITASK. When you can schedule extended time for yourself – DO IT! Finally, I want to remind you that – NO. CAN BE A COMPLETE SENTENCE and it will help you maintain the important nervous system balance that is needed for female hormone health.
- PRO TIP: Because I know how difficult it is to eat perfectly in this modern world, busy world… taking a quality multivitamin is a great “insurance policy”. If you are TTC, pregnant, or in postpartum – I recently had the opportunity through Mal to connect with the Needed team and review their products. While there are other great options on the market, of course, Needed meets my standards and has offered you a discount using code MAL20.
🙌 I preach about reducing your exposure to toxins for MANY reasons – but let’s add female hormone balance to the list! This table lists many of the hormone disrupters in your environment that we should aim to avoid.

Xenoestrogens (substances that can act like estrogen) are common ones women encounter. Xenoestrogens upset the delicate estrogen – progesterone balance.

✨ Pro TIP- start with “BIG IMPACT” changes like purifying your air and water and choosing to buy food and cosmetics that contain fewer chemicals.Here are a few of my recos…

REMEMBER – It’s a process over time. Do the best you can and don’t get neurotic.

👉🏻 THE PROBLEM – WHEN ATTENTION TO DIET AND LIFESTYLE DO NOT BALANCE YOUR HORMONES – WHAT SHOULD YOU DO?

If I were to guess what a woman’s hormone imbalance was – the most common ones I see are elevated adrenal stress hormones, low thyroid hormones, elevated insulin and an estrogen that is not balanced with sufficient progesterone. That’s obviously a lot of hormones to consider – so I find it’s best to test and not guess. I will cover more in depth the mechanism behind these hormone disturbances in future newsletters . What I want to touch on today is that HORMONE LABS help to make an accurate diagnosis.

❤️ HEALTH YOURSELF ACTIONS: ASK YOUR PROVIDER FOR THE FOLLOWING HORMONE LABS

Adrenal – Cortisol and DHEA-S
Thyroid – TSH, Free T3, Free T4, Thyroglobulin Antibodies, Thyroid Peroxidase Antibodies
Pituitary – FSH, LH and Prolactin
Ovarian – Estradiol, Estrone, Progesterone, and Testosterone
Pancreatic – Insulin

These labs should be done fasting – in the morning between 7-9 am (this is important when looking at the level of your stress hormone cortisol) and if you are having regular cycles on day 19-21 of a 28 day cycle to see if you’re ovulating (day 1 of your cycle is the first day of your menstrual cycle). If you are not having regular cycles your doctor will advise you on which day to test. FYI – if you’re testing for infertility they may also recommend testing FSH, LH and Estradiol on day 2-4 of your cycle. Also these hormonal labs do not include some of the autoimmune labs needed when investigating infertility or specialty labs to investigate diseases that could impact your hormones. This list of hormone labs is just a great place to start. Advanced infertility lab testing will need to be done with a specialist.

✨ PRO TIP: If you are on a common B vitamin called Biotin – it can interfere with the way many lab tests are run. The advice is to stop the Biotin at least 2-3 days before your lab is drawn. (See this article).

✨ PRO TIP: If you don’t feel like you are making progress with your OB/GYN – advocate for yourself and ask for a specialist referral.

‼️ I have not included the normal values for each lab – the ranges vary depending on which lab is used. An astute provider will even want your values to be in an optimal range – not just a normal range. Obviously any lab values that are not in that lab’s normal range are cause for concern.

Hopefully your provider is open to ordering these labs – especially if you ask nicely! Unfortunately, due to pressure from insurance companies – providers often only want to do MINIMAL lab testing such as just checking your estradiol and progesterone. That may be enough if you’re having minimal problems or just can’t afford to pay out of pocket for more comprehensive lab testing. You can always start with abbreviated hormone testing. Oftentimes providers are willing to do additional testing if the first lab shows abnormalities. PRO TIP – If you’re shopping for a new doctor you can always inquire beforehand to see if they are willing to do more comprehensive hormone labs.

In the modern world – where there is a will – there is a way! I teach women to be advocates for their own health. If your doctor won’t order the tests you want (or you never reach your high deductible) you can go to self pay labs and order your own tests. Questhealth is one such lab. It’s the same Quest laboratory that you often use through your insurance company but it’s self pay/self order. Self pay labs are discounted compared to the “list” price. You can even use HSA/FSA money to pay for this lab.

QuestHealth has a WOMEN’S HORMONE TEST PANEL – EXPANDED (often on sale like right now!) which includes everything but the cortisol, thyroglobulin antibodies, and the insulin so it does include a lot for $289. If you wanted to add the additional tests- you can order a CORTISOL STRESS HORMONE TEST FOR $89, and a HEMOGLOBIN A1C TEST for $39 (since they don’t have the fasting insulin this is another way to see if pancreatic dysfunction is contributing to your hormone imbalance). There are other self pay lab companies available that you can investigate online. When you do self pay labs – any abnormalities you should bring to the attention of your provider. I SINCERELY hope your provider will order the labs for you but I wanted to give you an alternative option as insurance “road blocks” can make it difficult to obtain proper testing. In the specialty hormone clinic I used to run it was common to see women who had suffered for years trying to get a proper hormone diagnosis.

Of course the lab studies can uncover a multitude of issues that can impact hormone balance. Since it’s not practical to cover them all. I want to discuss the most common one found in premenopausal women – ESTROGEN DOMINANCE.

🚨 THE PROBLEM – ONE OF THE MOST COMMON HORMONE IMBALANCES FOUND ON LAB IS ESTROGEN DOMINANCE. THE LAB SHOWS A LEVEL OF ESTROGEN THAT IS NOT ADEQUATELY BALANCED BY PROGESTERONE. THIS IMBALANCE IS A COMMON CAUSE OF IRREGULAR CYCLES, PMS, INFERTILITY AND PCOS (polycystic ovarian syndrome).

If you have estrogen dominance it could be that your estrogen is too high or it could be that your progesterone is too low. BOTTOM LINE – The delicate balance of these two hormones is disrupted. Poor diet, being overweight, exposure to xenoestrogens in the environment, poor detoxification of estrogen, too much stress and failure to ovulate are all things that can cause estrogen dominance (see pages 45-48 of Dr Lee’s book for more information on estrogen dominance). Your laboratory testing and your health history will be used by your provider to help determine what has upset the balance. I obviously can’t delve into all the individual factors that contribute to estrogen dominance in a general newsletter. What I can do is discuss one of the MOST COMMON REASONS for estrogen dominance – which is inadequate progesterone production due to inadequate or infrequent ovulation. In this condition, laboratory studies reveal that your progesterone level on day 19, 20 or 21 of your cycle is low. Diet and lifestyle adjustments of course can help but treatment with progesterone is often needed so I want to explain that treatment. TWO TYPES OF PROGESTERONE are available- bioidentical progesterone and non-bioidentical progesterone.

Let’s start with BIOIDENTICAL PROGESTERONE. Bioidentical means that the progesterone you take is shaped just like the progesterone your body produces. That way when it lands on your progesterone receptor your body gets the same message that natural progesterone would deliver (see page 64-65 of Dr Lee’s book for a list of the actions of progesterone). In my opinion this gives better relief of symptoms with fewer side effects. Bioidentical progesterone is made by starting with a molecule from nature (usually soy or yams) that has a chemical structure that closely resembles natural progesterone. In a lab they rearrange the molecule so that it ends up being a replica of your natural progesterone. As an aside- You could collect bioidentical progesterone from women’s blood or urine and use that as a truly bioidentical hormone but that is not logistically feasible and has a “yuk” factor! So creating bioidentical progesterone in the lab is preferred. Examples of bioidentical progesterone that require a prescription are the brand name Prometrium (generics are also available) which is an oral capsule. The good news is this can be obtained at your pharmacy and is usually covered by insurance. Since Prometrium is not a good fit for all women other options are available such as progesterone creams or capsules obtained with a prescription from a compounding pharmacy (these may or may not be covered by insurance). Finally, you can also find over the counter topical progesterone such as PRO Progesterone at WholeScripts (one can create an account and order through me). I always recommend using progesterone under the guidance of a provider but bioidentical progesterone is over the counter because it is safe to use even when trying for a pregnancy – in fact bioidentical progesterone is often used to help a woman conceive or to reduce miscarriage. It varies depending upon your circumstances but the bioidentical progesterone is usually given the 2nd half of your menstrual cycle – when your body is naturally supposed to produce progesterone. The downside to bioidentical progesterone is that it does not provide pregnancy protection so women who are desiring to balance their hormones BUT do not want a pregnancy will need to use a non-hormonal contraceptive – such as permanent sterilization, natural family planning, a non-hormonal copper IUD, condoms or diaphragm.
NON-BIOIDENTICAL PROGESTERONE’s are close matches but not exact. These are produced by various drug companies under a patent (they own the unique shape of the molecule that they have made that RESEMBLES progesterone). These non- bioidentical progesterones are called PROGESTIN’S. They can be oral or placed in implants and IUD’s. In my experience, progestins have more side effects and some have been associated with an increased cancer risk. They are not preferred but are needed if a woman wants to treat a hormone imbalance AND wants to use the more convenient hormonal contraception methods. If you need contraception, discuss with your provider the best progestin for you (it can be in a product by itself or combined with ethinyl estradiol in birth control pills). Just realize since the progestins all have a unique shape – some progestins are associated with more side effects such as weight gain, moods or acne. Women tend to respond differently to progestins so work with your provider to find the best fit for you.

❤️ HEALTH YOURSELF ACTIONS

Armed with your laboratory studies, your health history and a list of your symptoms – work with a provider well versed in hormones. As I have said, even in 2025 it can be difficult to find a provider interested in investigating hormone imbalances and who is well versed in hormone treatments. It may be your OB/GYN, an endocrinologist or even a primary care doctor. Again, there is nothing wrong with calling an office and asking questions to determine if they have hormone expertise. ✨ PRO TIP – You can even call local compounding pharmacies that dispense hormone treatments and inquire what doctors in your area have an expertise in hormones. Since they work with these doctors they may be able to direct you to a provider.
Advocate for follow up labs if a BIOIDENTICAL progesterone has been prescribed for you. If you’re on an ORAL bioidentical progesterone (from regular or compounding pharmacies) this can be done with bloodwork. Follow up bloodwork tends to be limited -such as just retesting your estrogen and progesterone levels to see if they are now balanced. If you’re on TOPICAL bioidentical hormones (OTC or compounded) saliva testing is more accurate than bloodwork. If you want to dive into the weeds and really learn about saliva hormone testing – (see this article I wrote – just scroll down to where I discuss hormone testing). Of course it will also be important to monitor your symptoms to see if they are now improved. PRO-TIP – Labwork is not helpful when you’re on a non-bioidentical progestin. Non- bioidentical hormones can help with symptoms but these hormones that are foreign to the body do not “register” in bloodwork or saliva.

Thats a wrap ++ what to expect next month!

🤠 WHEW! That’s enough for today’s newsletter. It’s a lot to digest and think about. You may be needing this information now or it may be a newsletter you need to hang onto and refer back to later (you can also find my newsletters on my website drbrendasmithmd.com). If you’re currently experiencing hormonal imbalance I also recommend using the book I have referenced to become a well informed advocate for your health. Since time is so limited at most doctor visits – I think women get the best results when they work with their doctor as a team.

Looking forward to our next newsletter in March which will cover pregnancy and postpartum.

Until next month ❤️

Your Women’s Health Expert and Advocate

Dr. Brenda Smith M.D.

Dr. Brenda Smith, M.D. newsletter provides general health information for educational purposes only. The information in this newsletter is not to be used as a substitute for medical advice, can not diagnose or treat any health condition, and does not substitute for care from your own in person physician. Any questions regarding your own health should be addressed to your own primary care physician or other healthcare provider .

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