Estrogen Dominance—Signs, Symptoms, Tests and Treatment

Posted by Medical Board on July 23, 2021 in Uncategorized Last updated on July 23, 2021

Following the reproductive years in a woman’s life estrogen and progesterone levels change in response to the body’s need for hormone production. 

Why Estrogen is Needed

In females estrogen is the primary hormone associated with sexual development and health.  During puberty physical characteristics such as breasts and pubic hair are developed.  In the reproductive years both estrogen and progesterone work together to regulate ovulation and the menstrual cycle.  Estrogen is also necessary for cognitive and bone health, as well as optimal cardiovascular function.   

Estrogen dominance affects many women throughout life in both the reproductive years and in menopause.  This common hormonal imbalance can be detected through saliva testing.

Healthy levels of estrogen and progesterone are necessary for both physical and emotional well-being.  Sometimes, however, the body produces too much estrogen or too little progesterone causing the ratio between sex steroid hormones to change.  This is known as estrogen dominance.

Symptoms of Estrogen Dominance include:

  • Brain fog
  • Fatigue
  • Anxiety
  • Depression
  • Nausea
  • Bloating
  • Breast sensitivity
  • Menstrual discomfort
  • Weight gain 
  • Tender breasts
  • Uterine fibroids
  • Excessively heavy menstrual flow
  • Irritability
  • Thyroid issues
  • Mood swings
  • Cold hands/feet
  • Sleepiness
  • Memory difficulties
  • Hair loss
  • Insomnia
  • Low libido
  • Increased PMS symptoms
  • Headaches
  • Vasomotor symptoms (hot flashes, night sweats)

Excessive estrogen levels can put women at risk for other serious medical conditions including: blood clots, stroke, thyroid dysfunction, breast cancer, ovarian cancer, and according to the American Cancer Society, endometrial cancer.

Natural Estrogen Imbalance

Premenopause: This marks the period of less ovulatory activity and progesterone production.

Perimenopause: (40s-mid-50s): Fluctuating progesterone levels and erratic ovulation cycles cause fluctuating estrogen levels at this time.    

Postmenopause: The estrogen to progesterone ratio becomes imbalanced as ovarian production of estrogen significantly declines (by as mush as 60%) and progesterone levels drop to nearly zero.  At this time ovulation has ceased completely.

Additional Causes of Estrogen Dominance

Estrogen dominance can occur as the result of exposure to synthetic estrogen or the body’s inability to metabolize estrogens properly.  Some hormone-based medications for use in hormone replacement therapy can cause or contribute to excessive estrogen in the system as well.

Balancing Estrogen, Testing is Key

The Estrogen Dominance Test measures:

  • Progesterone (Pg)
  • Estradiol (E2)
  • Estrogen to progesterone ratio

Normal Estrogen Levels


Prepubescent female: Undetectable–29 pg/mL/Undetectable–20 pg/ml

Pubescent female: 10–200 pg/mL/Undetectable–350 pg/ml

Premenopausal adult female: 17–200 pg/mL/15–350 pg/ml

Postmenopausal adult female: 7–40 pg/mL/<10 pg/ml

How Estrogen Dominance is Treated

Medication—Doctors may treat estrogen dominance in women with a number of medications depending on the primary cause of the hormone imbalance.  Changes to hormone replacement therapy regimens are common.  Some cancers are also sensitive to high levels of estrogen and may become worse if estrogen levels are not reduced.  Medications such as Tamoxifen may be prescribed to block the binding of cancer cells to estrogen.  Other medications known as aromatase inhibitors stop the enzyme aromatase in its conversion process from androgens to estrogen.  Other pharmaceuticals can inhibit estrogen production from ovaries as well.

Surgery—In some cases radiation or a surgical procedure is necessary to render ovaries inactive.  An oophorectomy, also referred to as surgical menopause, removes ovaries altogether.   

Diet—Depending on the severity of estrogen dominance a physician may prescribe a diet lower in fat and higher in fiber.  Weight loss may also help reduce estrogen production from excess fat cells.

Balanced hormones are important at any age and life stage of a woman.  Testing at home, or through a healthcare practitioner is the necessary first step to long-term hormone health and wellness.

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